human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Five hundred and twenty-six patients suffering from chronic bronchitis were r and omized to receive either N-acetylcysteine ( NAC ) or placebo during a 6-month period . The aim was to compare the number of acute exacerbations in the two groups . General practitioners were asked to enter patients with a diagnosis of chronic bronchitis , based on the MRC criteria . We failed to find any statistically significant difference in the number of exacerbations between the two treatment groups although there was a slight trend towards improvement in the NAC group during the first 3 months of the trial . The tolerability was similar for both treatments . Patients taking NAC showed a reduction in number of days on which they were incapacitated and this result was statistically significant Seventy-four pulmonologists and one allergist were recruited to assess the efficacy and safety of iodinated glycerol ( Organidin ) , 60 mg qid , vs placebo in patients with stable chronic obstructive bronchitis in a r and omized , double-blind , placebo-controlled , parallel design . A total of 361 patients ( 180 to iodinated glycerol and 181 to placebo ) who complained of cough and difficulty bringing up sputum entered the eight-week study . Evaluations were based upon eight primary symptom efficacy parameters ( cough frequency , cough severity , chest discomfort , dyspnea , ease in bringing up sputum , patient and physician global assessment s , and a derived patients ' global assessment ) , and six secondary parameters ( frequency of aerosol bronchodilator use , incidence and duration of acute exacerbations , frequency of concomitant medication use , incidences of adverse experiences and dropouts ) . Cough frequency , cough severity , chest discomfort , patients ' ease in bringing up sputum , patients ' overall condition , and a derived subject global assessment were significantly ( p less than 0.05 ) improved by iodinated glycerol as compared with placebo within eight weeks of treatment . Dyspnea showed a trend toward improvement and the physicians ' global evaluation showed no significant difference between groups . Similar findings were noted in a subgroup analysis of moderately-to-severely affected patients . The mean duration ( days ) of acute exacerbations and number of dropouts attributable to adverse experiences were significantly less ( p less than 0.05 ) in the iodinated glycerol group . ( ABSTRACT TRUNCATED AT 250 WORDS STUDY OBJECTIVE It has been reported that therapy with iodinated glycerol ( IG ) can improve the quality of life for patients with chronic bronchitis . The purpose of this study was to determine the effects of IG therapy on the quality of life , pulmonary function , and on the properties of sputum collected from adults with stable chronic bronchitis . DESIGN Thirty-two week , double-blind , r and omized , placebo-controlled cross-over study . SETTING A university outpatient pulmonary clinic . PARTICIPANTS Twenty-six adults with stable chronic bronchitis completed the study ; 28 completed the first treatment arm . INTERVENTIONS Sixteen weeks each of placebo or IG 60 mg qid . MEASUREMENTS First , pulmonary function by spirometry and plethysmography . Second , symptom score measured using a question naire . Third , sputum bulk and surface rheology , spinnability , mucociliary transportability and cough transportability . RESULTS There were no significant changes in pulmonary function , clinical scores , or sputum properties related to therapy with IG . There was a significant improvement in the Global Petty score after both IG ( p = 0.01 ) and placebo ( p < 0.01 ) when compared with baseline , but there was no difference between treatment periods . There was a positive correlation between changes in the Global score during therapy and changes in sputum spinnability ( p < 0.01 , r = 0.38 ) . CONCLUSIONS This study clearly demonstrates that in chronic bronchitis , 16 weeks of therapy with IG does not produce any appreciable effect on pulmonary function , well being , or on sputum viscoelasticity or clearability The PARI-IS Study is a double-blind placebo-controlled r and omized clinical trial to study the effect of an immunostimulating agent to prevent acute respiratory exacerbation in patients with COPD . Three hundred eighty-one ambulatory patients ( 190 placebo and 191 immunostimulant )  were followed at home for 6 mo by experienced research nurses . The risk of having at least one episode of acute exacerbation ( primary outcome ) was similar in the two groups ( p = 0.872 ) . In contrast , the total number of days of hospitalization for a respiratory problem was 55 % less in the group treated with OM-85 BV ( 287 d ) than in the group treated with placebo ( 642 d ) . Patients treated with OM-85 BV spent an average of 1.5 d in hospital compared with 3.4 d for patients treated with placebo ( p = 0.037 ) . The risk of being hospitalized for a respiratory problem was 30 % lower in the treated group ( 16.2 % ) than in the placebo group ( 23.2 % ) ; p = 0.089 . Eight deaths were observed : two in patients treated with OM-85 BV and six in patients treated with placebo ( p = 0.153 ) . During the course of the study dyspnea improved slightly in patients treated with OM-85 BV , whereas it deteriorated slightly in patients receiving placebo ( p = 0.028 ) . These results suggest that this immunostimulating agent may be beneficial for patients with COPD by reducing the likelihood of severe respiratory events leading to hospitalization The clinical effect of N-acetylcysteine ( NAC ) controlled-release tablets , 300 mg b.i.d . , and placebo , in chronic bronchitis was investigated . The study was performed as a double-blind six month comparison between active drug and placebo in two parallel groups , with statistical evaluation after four and six months . The patients were chosen from nine centres . One hundred and sixteen out- patients were included and ninety one of them completed the six month study . The acetylcysteine-treated group had a significantly reduced number of sick-leave days caused by exacerbations of chronic bronchitis after the four winter months December-March compared with the control group ( NAC 173 , placebo 456 ) . The number of exacerbation days was also very much reduced , however , not significantly ( NAC 204 , placebo 399 ) . At the end of the six month trial , including also two spring months , the absolute numbers of sick-leave days and exacerbation days were still fewer in the acetylcysteine-treated group , ( NAC 260 , placebo 739 ) and ( NAC 378 , placebo 557 ) respectively . This study demonstrates a significant reduction in sick-leave days after four months of NAC-treatment . A constant tendency to reduction in the number of exacerbations and exacerbation days was also registered after four and six months . The differences in these parameters were , however , not statistically significant . This was probably due to the small number of patients participating BACKGROUND Pulmonary rehabilitation seems to be an effective intervention in patients with chronic obstructive pulmonary disease . We undertook a r and omised controlled trial to assess the effect of outpatient pulmonary rehabilitation on use of health care and patients ' wellbeing over 1 year . METHODS 200 patients with disabling chronic lung disease ( the majority with chronic obstructive pulmonary disease ) were r and omly assigned a 6-week multidisciplinary rehabilitation programme ( 18 visits ) or st and ard medical management . Use of health services was assessed from hospital and general- practice records . Analysis was by intention to treat . FINDINGS There was no difference between the rehabilitation ( n=99 ) and control ( n=101 ) groups in the number of patients admitted to hospital ( 40 vs 41 ) but the number of days these patients spent in hospital differed significantly ( mean 10.4 [ SD 9.7 ] vs 21.0 [ 20.7 ] , p=0.022 ) . The rehabilitation group had more primary -care consultations at the general-practitioner 's premises than did the control group ( 8.6 [ 6.8 ] vs 7.3 [ 8.3 ] , p=0.033 ) but fewer primary -care home visits ( 1.5 [ 2.8 ] vs 2.8 [ 4.6 ] , p=0.037 ) . Compared with control , the rehabilitation group also showed greater improvements in walking ability and in general and disease-specific health status . INTERPRETATION For patients chronically disabled by obstructive pulmonary disease , an intensive , multidisciplinary , outpatient programme of rehabilitation is an effective intervention , in the short term and the long term , that decreases use of health services This multicentre trial was undertaken to confirm previous results indicating that long-term treatment with oral acetylcysteine reduces the exacerbation rate in patients with chronic bronchitis . Two hundred and eighty-five patients , smokers or ex-smokers , with chronic bronchitis started a pre-trial placebo-period of 1 month . After this run-in period 259 patients were included in the trial and r and omized into two parallel groups . The patients were treated in a double-blind way either with acetylcysteine 200 mg b.i.d . or placebo b.i.d . for 6 months . The trial was completed by 98 patients in the acetylcysteine group and by 105 patients in the placebo group . Initially , there were no significant differences between the groups . Twice weekly , the patients filled in a diary card concerning symptoms . The number of exacerbations was assessed from these cards and at visits 2 , 4 and 6 months after institution of therapy . The exacerbation rate was significantly lower in the acetylcysteine group in which 40 % of the patients remained free from exacerbations compared to 19 % in the placebo group . Sick-leave due to acute exacerbation was significantly less common in the acetylcysteine group . The drug was well tolerated Summary In 69 out- patients with chronic bronchitis in 6 centres the effects of acetylcysteine 600 mg daily , 3 days a week for 6 months , and a placebo have been compared in a double-blind controlled trial . Thirty-five patients were treated with the mucolytic and 34 with the dummy preparation .  In the former the clinical course of the chronic bronchitis improved to a greater extent and a significantly lower number of exacerbations was observed . The advantages of long-term oral treatment with the mucolytic in chronic bronchitis suggest that it may be useful as an alternative to long-term antibiotic prophylaxis , or to complement brief courses of antibiotics , in addition to the usual physiotherapy Oral N-acetylcysteine ( NAC ) exerts a beneficial action in chronic bronchitis by reducing the number of exacerbations . There have been few studies of the effect of NAC ( or of any other drug ) on general well-being in chronic bronchitis . We used an established psychiatric instrument ( General Health Question naire ; GHQ ) and a visual analogue scale ( VAS ) to measure well-being in a 22-week , placebo-controlled , double-blind , parallel-group study of NAC administered as sustained release tablets 600 mg b.i.d . , including during the winter months , to patients with mild chronic bronchitis . One hundred and fifty-three patients were accepted for r and omized treatment , 129 finished the study ( 59 NAC , 70 placebo ) , and well-being was measured in 105 ( 46 NAC , 59 placebo ) . The number of observed exacerbations was unexpectedly low in both groups . The number was lowest in the NAC group , however , the difference did not reach statistical significance in the present study ( P = 0.08 ) . There were no statistically significant differences between NAC and placebo in subjective symptom scores , FEV1 or FVC . The distribution of GHQ score at baseline was uneven , but NAC was significantly superior to placebo in terms of a favourable effect on GHQ score . GHQ score correlated with the number of exacerbations , and VAS correlated with GHQ score . This study therefore demonstrates the validity of measuring general well-being in patients with mild chronic bronchitis . Future studies of the treatment of chronic bronchitis should use a battery of more specifically adapted instruments which are now becoming available to measure well-being This multicentre , double-blind , placebo controlled , between-patient study in general practice in the United Kingdom examined the effect of oral N-acetylcysteine ( Fabrol ® ) on the symptomatology of patients with chronic bronchitis over a 3-month period . Although improvement in subjective symptoms ( sputum viscosity and character , difficulty in expectoration and cough severity ) occurred in both treatment groups over the trial period , improvements in difficulty in expectoration and cough severity were greater in patients receiving N-acetylcysteine compared to matching placebo . Trial medication was well tolerated , with a greater number of side-effects attributed to therapy occurring in patients receiving placebo The clinical results and changes in sputum found in both a short-term inpatient trial and a subsequent long-term outpatient investigation ( three-month double-blind controlled study ) of 82 patients with chronic bronchitis treated with a new mucolytic agent , S-carboxymethylcysteine ( Mucodyne )  , are reported . Fluidification of sputum with reduction in certain measurements of the viscosity of morning sputum aliquots , associated with improvement in the ability to cough up bronch 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Five hundred and twenty-six patients suffering from chronic bronchitis were r and omized to receive either N-acetylcysteine ( NAC ) or placebo during a 6-month period . The aim was to compare the number of acute exacerbations in the two groups . General practitioners were asked to enter patients with a diagnosis of chronic bronchitis , based on the MRC criteria . We failed to find any statistically significant difference in the number of exacerbations between the two treatment groups although there was a slight trend towards improvement in the NAC group during the first 3 months of the trial . The tolerability was similar for both treatments . Patients taking NAC showed a reduction in number of days on which they were incapacitated and this result was statistically significant Seventy-four pulmonologists and one allergist were recruited to assess the efficacy and safety of iodinated glycerol ( Organidin ) , 60 mg qid , vs placebo in patients with stable chronic obstructive bronchitis in a r and omized , double-blind , placebo-controlled , parallel design . A total of 361 patients ( 180 to iodinated glycerol and 181 to placebo ) who complained of cough and difficulty bringing up sputum entered the eight-week study . Evaluations were based upon eight primary symptom efficacy parameters ( cough frequency , cough severity , chest discomfort , dyspnea , ease in bringing up sputum , patient and physician global assessment s , and a derived patients ' global assessment ) , and six secondary parameters ( frequency of aerosol bronchodilator use , incidence and duration of acute exacerbations , frequency of concomitant medication use , incidences of adverse experiences and dropouts ) . Cough frequency , cough severity , chest discomfort , patients ' ease in bringing up sputum , patients ' overall condition , and a derived subject global assessment were significantly ( p less than 0.05 ) improved by iodinated glycerol as compared with placebo within eight weeks of treatment . Dyspnea showed a trend toward improvement and the physicians ' global evaluation showed no significant difference between groups . Similar findings were noted in a subgroup analysis of moderately-to-severely affected patients . The mean duration ( days ) of acute exacerbations and number of dropouts attributable to adverse experiences were significantly less ( p less than 0.05 ) in the iodinated glycerol group . ( ABSTRACT TRUNCATED AT 250 WORDS STUDY OBJECTIVE It has been reported that therapy with iodinated glycerol ( IG ) can improve the quality of life for patients with chronic bronchitis . The purpose of this study was to determine the effects of IG therapy on the quality of life , pulmonary function , and on the properties of sputum collected from adults with stable chronic bronchitis . DESIGN Thirty-two week , double-blind , r and omized , placebo-controlled cross-over study . SETTING A university outpatient pulmonary clinic . PARTICIPANTS Twenty-six adults with stable chronic bronchitis completed the study ; 28 completed the first treatment arm . INTERVENTIONS Sixteen weeks each of placebo or IG 60 mg qid . MEASUREMENTS First , pulmonary function by spirometry and plethysmography . Second , symptom score measured using a question naire . Third , sputum bulk and surface rheology , spinnability , mucociliary transportability and cough transportability . RESULTS There were no significant changes in pulmonary function , clinical scores , or sputum properties related to therapy with IG . There was a significant improvement in the Global Petty score after both IG ( p = 0.01 ) and placebo ( p < 0.01 ) when compared with baseline , but there was no difference between treatment periods . There was a positive correlation between changes in the Global score during therapy and changes in sputum spinnability ( p < 0.01 , r = 0.38 ) . CONCLUSIONS This study clearly demonstrates that in chronic bronchitis , 16 weeks of therapy with IG does not produce any appreciable effect on pulmonary function , well being , or on sputum viscoelasticity or clearability The PARI-IS Study is a double-blind placebo-controlled r and omized clinical trial to study the effect of an immunostimulating agent to prevent acute respiratory exacerbation in patients with COPD . Three hundred eighty-one ambulatory patients ( 190 placebo and 191 immunostimulant )  were followed at home for 6 mo by experienced research nurses . The risk of having at least one episode of acute exacerbation ( primary outcome ) was similar in the two groups ( p = 0.872 ) . In contrast , the total number of days of hospitalization for a respiratory problem was 55 % less in the group treated with OM-85 BV ( 287 d ) than in the group treated with placebo ( 642 d ) . Patients treated with OM-85 BV spent an average of 1.5 d in hospital compared with 3.4 d for patients treated with placebo ( p = 0.037 ) . The risk of being hospitalized for a respiratory problem was 30 % lower in the treated group ( 16.2 % ) than in the placebo group ( 23.2 % ) ; p = 0.089 . Eight deaths were observed : two in patients treated with OM-85 BV and six in patients treated with placebo ( p = 0.153 ) . During the course of the study dyspnea improved slightly in patients treated with OM-85 BV , whereas it deteriorated slightly in patients receiving placebo ( p = 0.028 ) . These results suggest that this immunostimulating agent may be beneficial for patients with COPD by reducing the likelihood of severe respiratory events leading to hospitalization The clinical effect of N-acetylcysteine ( NAC ) controlled-release tablets , 300 mg b.i.d . , and placebo , in chronic bronchitis was investigated . The study was performed as a double-blind six month comparison between active drug and placebo in two parallel groups , with statistical evaluation after four and six months . The patients were chosen from nine centres . One hundred and sixteen out- patients were included and ninety one of them completed the six month study . The acetylcysteine-treated group had a significantly reduced number of sick-leave days caused by exacerbations of chronic bronchitis after the four winter months December-March compared with the control group ( NAC 173 , placebo 456 ) . The number of exacerbation days was also very much reduced , however , not significantly ( NAC 204 , placebo 399 ) . At the end of the six month trial , including also two spring months , the absolute numbers of sick-leave days and exacerbation days were still fewer in the acetylcysteine-treated group , ( NAC 260 , placebo 739 ) and ( NAC 378 , placebo 557 ) respectively . This study demonstrates a significant reduction in sick-leave days after four months of NAC-treatment . A constant tendency to reduction in the number of exacerbations and exacerbation days was also registered after four and six months . The differences in these parameters were , however , not statistically significant . This was probably due to the small number of patients participating BACKGROUND Pulmonary rehabilitation seems to be an effective intervention in patients with chronic obstructive pulmonary disease . We undertook a r and omised controlled trial to assess the effect of outpatient pulmonary rehabilitation on use of health care and patients ' wellbeing over 1 year . METHODS 200 patients with disabling chronic lung disease ( the majority with chronic obstructive pulmonary disease ) were r and omly assigned a 6-week multidisciplinary rehabilitation programme ( 18 visits ) or st and ard medical management . Use of health services was assessed from hospital and general- practice records . Analysis was by intention to treat . FINDINGS There was no difference between the rehabilitation ( n=99 ) and control ( n=101 ) groups in the number of patients admitted to hospital ( 40 vs 41 ) but the number of days these patients spent in hospital differed significantly ( mean 10.4 [ SD 9.7 ] vs 21.0 [ 20.7 ] , p=0.022 ) . The rehabilitation group had more primary -care consultations at the general-practitioner 's premises than did the control group ( 8.6 [ 6.8 ] vs 7.3 [ 8.3 ] , p=0.033 ) but fewer primary -care home visits ( 1.5 [ 2.8 ] vs 2.8 [ 4.6 ] , p=0.037 ) . Compared with control , the rehabilitation group also showed greater improvements in walking ability and in general and disease-specific health status . INTERPRETATION For patients chronically disabled by obstructive pulmonary disease , an intensive , multidisciplinary , outpatient programme of rehabilitation is an effective intervention , in the short term and the long term , that decreases use of health services This multicentre trial was undertaken to confirm previous results indicating that long-term treatment with oral acetylcysteine reduces the exacerbation rate in patients with chronic bronchitis . Two hundred and eighty-five patients , smokers or ex-smokers , with chronic bronchitis started a pre-trial placebo-period of 1 month . After this run-in period 259 patients were included in the trial and r and omized into two parallel groups . The patients were treated in a double-blind way either with acetylcysteine 200 mg b.i.d . or placebo b.i.d . for 6 months . The trial was completed by 98 patients in the acetylcysteine group and by 105 patients in the placebo group . Initially , there were no significant differences between the groups . Twice weekly , the patients filled in a diary card concerning symptoms . The number of exacerbations was assessed from these cards and at visits 2 , 4 and 6 months after institution of therapy . The exacerbation rate was significantly lower in the acetylcysteine group in which 40 % of the patients remained free from exacerbations compared to 19 % in the placebo group . Sick-leave due to acute exacerbation was significantly less common in the acetylcysteine group . The drug was well tolerated Summary In 69 out- patients with chronic bronchitis in 6 centres the effects of acetylcysteine 600 mg daily , 3 days a week for 6 months , and a placebo have been compared in a double-blind controlled trial . Thirty-five patients were treated with the mucolytic and 34 with the dummy preparation .  In the former the clinical course of the chronic bronchitis improved to a greater extent and a significantly lower number of exacerbations was observed . The advantages of long-term oral treatment with the mucolytic in chronic bronchitis suggest that it may be useful as an alternative to long-term antibiotic prophylaxis , or to complement brief courses of antibiotics , in addition to the usual physiotherapy Oral N-acetylcysteine ( NAC ) exerts a beneficial action in chronic bronchitis by reducing the number of exacerbations . There have been few studies of the effect of NAC ( or of any other drug ) on general well-being in chronic bronchitis . We used an established psychiatric instrument ( General Health Question naire ; GHQ ) and a visual analogue scale ( VAS ) to measure well-being in a 22-week , placebo-controlled , double-blind , parallel-group study of NAC administered as sustained release tablets 600 mg b.i.d . , including during the winter months , to patients with mild chronic bronchitis . One hundred and fifty-three patients were accepted for r and omized treatment , 129 finished the study ( 59 NAC , 70 placebo ) , and well-being was measured in 105 ( 46 NAC , 59 placebo ) . The number of observed exacerbations was unexpectedly low in both groups . The number was lowest in the NAC group , however , the difference did not reach statistical significance in the present study ( P = 0.08 ) . There were no statistically significant differences between NAC and placebo in subjective symptom scores , FEV1 or FVC . The distribution of GHQ score at baseline was uneven , but NAC was significantly superior to placebo in terms of a favourable effect on GHQ score . GHQ score correlated with the number of exacerbations , and VAS correlated with GHQ score . This study therefore demonstrates the validity of measuring general well-being in patients with mild chronic bronchitis . Future studies of the treatment of chronic bronchitis should use a battery of more specifically adapted instruments which are now becoming available to measure well-being This multicentre , double-blind , placebo controlled , between-patient study in general practice in the United Kingdom examined the effect of oral N-acetylcysteine ( Fabrol ® ) on the symptomatology of patients with chronic bronchitis over a 3-month period . Although improvement in subjective symptoms ( sputum viscosity and character , difficulty in expectoration and cough severity ) occurred in both treatment groups over the trial period , improvements in difficulty in expectoration and cough severity were greater in patients receiving N-acetylcysteine compared to matching placebo . Trial medication was well tolerated , with a greater number of side-effects attributed to therapy occurring in patients receiving placebo The clinical results and changes in sputum found in both a short-term inpatient trial and a subsequent long-term outpatient investigation ( three-month double-blind controlled study ) of 82 patients with chronic bronchitis treated with a new mucolytic agent , S-carboxymethylcysteine ( Mucodyne )  , are reported . Fluidification of sputum with reduction in certain measurements of the viscosity of morning sputum aliquots , associated with improvement in the ability to cough up bronch 
    Output:
    