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: The aim of the present r and omized , double-blind study was to evaluate the effect of inhaled budesonide on daily symptoms , ventilatory capacity , and airway responsiveness in smokers with chronic bronchitis . Twenty-five subjects with a provocative concentration producing a 20 % fall in forced expiratory volume in one second PC20(FEV1 ) less than 2.0 mg.ml-1 , by bronchial histamine challenge , were included . Eighteen subjects accomplished the entire 12 week study , eight receiving inhaled budesonide 400 micrograms b.i.d . and ten receiving placebo .  Cough decreased significantly in the actively treated group during the treatment period , but no change could be demonstrated in expectoration , dyspnoea , or sleep disturbances . No changes in any of these symptoms were found in the placebo group , and no differences in symptoms scores were found between the groups . No significant differences in ventilatory capacity or bronchial responsiveness could be demonstrated . In conclusion , a moderately high dose of inhaled steroid in eight subjects with chronic bronchitis did not improve the symptom scores , ventilatory capacity , or airway responsiveness to any clinical ly relevant degree BACKGROUND Many patients with asthma or chronic obstructive pulmonary disease use their medication inhalers incorrectly . General practitioners , pharmacists and other health care providers do not always have the opportunity to instruct patients in correct inhaler technique . OBJECTIVE To find out whether the inhaler technique and respiratory symptoms of patients can be improved after instruction by practice assistants . METHODS Single blind , r and omized intervention study in which 48 patients who had been using a dry powder inhaler for at least one month took part . Their inhaler technique was videotaped on two visits with a two-week interval between visits . The inhaler technique on the videos was subsequently scored by two experts on nine criteria . At both visits the patients completed a question naire about their respiratory symptoms . After the first video , 25 patients were r and omly chosen to receive instruction from one of six practice assistants who had followed a one evening course about inhaler instruction , and who had been issued an instruction-set . RESULTS The patients who received instruction had a significantly greater reduction in number of mistakes at the second visit than the patients who did not ( P = 0.01 ) . The instructed patients also reported less dyspnoea at the second visit ( P = 0.03 ) . No effect of instruction was found on wheezing , cough and sputum production . CONCLUSION The inhaler technique of patients can be improved significantly by the instruction of patients by trained practice assistants , possibly result ing in less dyspnoea A r and omized , controlled trial was conducted to assess the effectiveness of Blue Angel for Asthma Kids , an Internet-based interactive asthma educational and monitoring program , used in the management of asthmatic children . One hundred sixty-four ( n = 164 ) pediatric patients with persistent asthma were enrolled and r and omized into two study groups for a 12-week controlled trial . The intervention group had 88  participants who were taught to monitor their peak expiratory flows ( PEF ) and asthma symptoms daily on the Internet . They also received an interactive response consisting of a self-management plan from the Blue Angel monitoring program . The control group had 76 participants who received a traditional asthma care plan consisting of a written asthma diary supplemented with instructions for self-management . Disease control was assessed by weekly averaged PEF values , symptom scores , and asthma control tests . Adherence measures were assessed by therapeutic and diagnostic monitoring . Outcome was assessed by examining quality of life and retention of asthma knowledge . The data were analyzed by comparing results before and after the trial . At the end of trial , the intervention group decreased nighttime ( -0.08 + /- 0.33 vs. 0.00 + /- 0.20 , p = 0.028 ) and daytime symptoms ( -0.08 + /- 0.33 vs. 0.01 + /- 0.18 , p = 0.009 ) ; improved morning ( 241.9 + /- 81.4 vs. 223.1 + /- 55.5 , p = 0.017 ) and night PEF ( 255.6 + /- 86.7 vs. 232.5 + /- 55.3 , p = 0.010 ) ; increased adherence rates ( p < 0.05 ) ; improved well-controlled rates ( 70.4 % vs. 55.3 % , p < 0.05 ) ; improved knowledge regarding self-management ( 93.2 % vs. 70.3 % , p < 0.05 ) ; and improved quality of life ( 6.5 + /- 0.5 vs. 4.3 + /- 1.2 on a 7-point scale , p < 0.05 ) when compared with conventional management . The Internet-based asthma telemonitoring program increases selfmanagement skills , improves asthma outcomes , and appears to be an effective and well-accepted technology for the care of children with asthma and their caregivers We compare the efficacy including spirometry , peak expiratory flow ( PEFR ) and quality of life and safety of an 8-week treatment with inhaled oxitropium , theophylline or their combination in patients with mild-to-severe chronic obstructive pulmonary disease ( COPD ) . We conducted a multicentre , double-blind , double-dummy r and omized , parallel-group study at 29 Italian out patients clinics . A group of 236 patients with mild-to-severe COPD ( baseline FEV1 < or = 70 % of predicted value ) were recruited . Treatments were as follows : Inhaled oxitropium bromide 200 microg ( N=75 ) , sustained-release oral theophylline 300 mg ( N=81 ) or their combination ( N=80 ) , taken twice daily .  Spirometry ( FEV1 and FVC ) was evaluated every 4 weeks , and morning and evening PEFR ( before and 2 - 4 h after drug intake ) was measured daily . Symptoms , cough and dysponea , were recorded daily . Health status was evaluated at baseline and week 8 using the disease specific St George ' Respiratory Question naire ( SGRQ ) . Any adverse event occurring during the treatment period was recorded on a diary card . FEV1 and FVC improved in all the groups at 4 and 8 weeks , but the difference between treatment groups did not reach statistically significant levels . Differences between groups in pre-dosing morning and evening PEFR were not significant . Post-dosing morning and evening PEFR were increased and the largest increase was seen in patients treated with both drugs . However , differences between groups was significant only for evening values ( P=0.008 ) . The proportion of patients who experienced a decrease in symptoms was high in all groups but no differences among groups were observed . SGRQ total scores decreased in all treatment groups after 8 weeks , particularly in the oxitropium and combination groups . Clinical ly significant change ( > or = 4 units ) was only observed in patients treated with oxitropium bromide whether with or without theophylline .  Adverse events related to treatments were higher in the group treated with theophylline alone ( P < 0.02 ) . We conclude that inhaled oxitropium bromide alone was associated with an improvement in FEV1 , PEFR and symptoms in patients with COPD that was not statistically different from that of oral theophylline alone or of the combination of both drugs . Oxitropium bromide in combination with theophylline provided a greater improvement in evening post-dosing PEFR . Oxitropium bromide alone or in combination with theophylline improved the quality of life better than theophylline alone Objective : Recent studies suggest an association between chronic cough and gastroesophageal reflux . Our study aims were 1 ) to define the prevalence of acid reflux induced cough in the general community , 2 ) to examine the ability of esophageal testing to identify gastroesophageal reflux related cough , and 3 ) to assess the utility of omeprazole in a chronic cough algorithm . Methods : Patients with chronic cough of unknown etiology , who were mostly from the community , were evaluated . Subjects underwent a chest x-ray , methacholine challenge test , and empiric trial of postnasal drip therapy , and completed daily cough symptom diaries subjectively evaluating cough frequency and severity on a grade d scale of 0–4 ( combined maximum 8) . After excluding other causes of cough , the remaining patients underwent esophageal and pH testing . Those testing positive were r and omized to omeprazole 40 mg b.i.d . or placebo for 12 weeks . Follow-up was 1 yr . Results : A total of 71 patients were screened ; 48 were excluded . Twenty-three patients were evaluated for gastroesophageal reflux disease ; six ( 26 % ) were eventually determined to have an acid-related cough . Of these patients , 17 had a positive pH test , six ( 35 % ) of whom showed a striking improvement or resolution of their cough during omeprazole treatment which was sustained for up to 1 yr . Six had a negative pH test , none of whom responded to omeprazole therapy . No significant differences were seen between responders ( n = 6 ) and nonresponders ( n = 11 ) for demographic factors , baseline symptom frequency and duration , or physiological parameters ( motility/pH ) . Conclusions : Acid-related chronic cough was present in 26 % ( six of 23 ) of patients evaluated for gastroesophageal reflux disease . Esophageal testing does not reliably identify patients with acid induced chronic cough responsive to proton pump inhibitor therapy . We suggest that the best diagnostic and therapeutic approach , after excluding asthma and postnasal drip syndrome , is empiric treatment for 2 wk with a high dose proton pump inhibitor Abstract Objective : To investigate the efficacy and tolerability of high-dose N-acetylcysteine ( NAC ) in the treatment of patients with exacerbations of chronic obstructive pulmonary disease ( COPD ) . Design and patients : R and omised , double-blind , double-dummy , placebo-controlled study in 123 patients experiencing an acute exacerbation of COPD . Interventions : NAC 1200 mg/day , 600 mg/day or placebo administered once daily for 10 days . Main outcome measures : The primary objective was to assess the proportion of patients with normalised C-reactive protein ( CRP ) levels . Also assessed were effects on interleukin (IL)-8 levels , lung function and symptoms . Results : Both NAC 600 and 1200 mg/day were associated with a significantly higher proportion of patients achieving normalised CRP levels compared with placebo ( 52 % and 90 % vs 19 % of patients ; p ≤ 0.01 ) ; however , NAC 1200 mg/day was superior to NAC 600 mg/day ( p = 0.002 ) . Furthermore , treatment with NAC 1200 mg/day was more efficacious than NAC 600 mg/day in reducing IL-8 levels and difficulty of expectoration , while the two active regimens had similar beneficial effects on lung function and other clinical outcomes ( cough intensity and frequency , and lung auscultation ) . Treatments were well tolerated with one adverse event reported in NAC 1200 mg/day recipients and two reported in placebo recipients . Conclusion : Treatment with NAC 1200 mg/day improved biological markers and clinical outcomes in patients with COPD exacerbations . It is speculated that the effect of NAC on inflammatory markers may be due to both mucolytic and antioxidant properties RATIONALE Cough is the most common complaint for which medical attention is sought , and chronic cough can be both physically and mentally debilitating . There is currently no evidence supporting the use of antitussives in chronic treatment-resistant cough . OBJECTIVES We tested the hypothesis that morphine sulfate in the dose of 5 mg twice daily would bring about a reduction in cough frequency and severity in patients failing to respond to specific measures . METHODS Patients recruited from the Hull Cough Clinic were enrolled into a r and omized double-blind placebo-controlled study using 4 weeks of slow-release morphine sulfate and a corresponding period of matched placebo . An open-labeled extension of the core study allowed dose escalation to 10 mg twice daily . Cough was assessed using the Leicester Cough Question naire , daily symptom diary , and citric acid cough challenge . RESULTS Twenty-seven patients completed the core study . A significant improvement of 3.2 points over baseline was noted on the Leicester Cough Question naire ( p < 0.01 ) . A rapid and highly significant reduction by 40 % in daily cough scores was noted among patients on slow-release morphine sulfate ( p < 0.01 ) . Objective testing of the cough reflex using citric acid cough challenge tests did not show any significant changes . Eighteen patients continued into the extension study . Two-thirds of these patients opted to increase the morphine to 10 mg twice daily . At the end of 3 months , there was a similar improvement in cough between the 5- and 10-mg groups . CONCLUSION Morphine sulfate is an effective antitussive in intractable chronic cough at the doses of 5 to 10 mg twice daily Background : This study aim ed to assess and compare the effectiveness of lidocaine and bronchodilator inhalation treatments for rapid cough suppression in patients with chronic obstructive pulmonary disease ( COPD ) . Methods : Prospect i ve comparison study carried out in a tertiary emergency department . Consecutive 
    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: The aim of the present r and omized , double-blind study was to evaluate the effect of inhaled budesonide on daily symptoms , ventilatory capacity , and airway responsiveness in smokers with chronic bronchitis . Twenty-five subjects with a provocative concentration producing a 20 % fall in forced expiratory volume in one second PC20(FEV1 ) less than 2.0 mg.ml-1 , by bronchial histamine challenge , were included . Eighteen subjects accomplished the entire 12 week study , eight receiving inhaled budesonide 400 micrograms b.i.d . and ten receiving placebo .  Cough decreased significantly in the actively treated group during the treatment period , but no change could be demonstrated in expectoration , dyspnoea , or sleep disturbances . No changes in any of these symptoms were found in the placebo group , and no differences in symptoms scores were found between the groups . No significant differences in ventilatory capacity or bronchial responsiveness could be demonstrated . In conclusion , a moderately high dose of inhaled steroid in eight subjects with chronic bronchitis did not improve the symptom scores , ventilatory capacity , or airway responsiveness to any clinical ly relevant degree BACKGROUND Many patients with asthma or chronic obstructive pulmonary disease use their medication inhalers incorrectly . General practitioners , pharmacists and other health care providers do not always have the opportunity to instruct patients in correct inhaler technique . OBJECTIVE To find out whether the inhaler technique and respiratory symptoms of patients can be improved after instruction by practice assistants . METHODS Single blind , r and omized intervention study in which 48 patients who had been using a dry powder inhaler for at least one month took part . Their inhaler technique was videotaped on two visits with a two-week interval between visits . The inhaler technique on the videos was subsequently scored by two experts on nine criteria . At both visits the patients completed a question naire about their respiratory symptoms . After the first video , 25 patients were r and omly chosen to receive instruction from one of six practice assistants who had followed a one evening course about inhaler instruction , and who had been issued an instruction-set . RESULTS The patients who received instruction had a significantly greater reduction in number of mistakes at the second visit than the patients who did not ( P = 0.01 ) . The instructed patients also reported less dyspnoea at the second visit ( P = 0.03 ) . No effect of instruction was found on wheezing , cough and sputum production . CONCLUSION The inhaler technique of patients can be improved significantly by the instruction of patients by trained practice assistants , possibly result ing in less dyspnoea A r and omized , controlled trial was conducted to assess the effectiveness of Blue Angel for Asthma Kids , an Internet-based interactive asthma educational and monitoring program , used in the management of asthmatic children . One hundred sixty-four ( n = 164 ) pediatric patients with persistent asthma were enrolled and r and omized into two study groups for a 12-week controlled trial . The intervention group had 88  participants who were taught to monitor their peak expiratory flows ( PEF ) and asthma symptoms daily on the Internet . They also received an interactive response consisting of a self-management plan from the Blue Angel monitoring program . The control group had 76 participants who received a traditional asthma care plan consisting of a written asthma diary supplemented with instructions for self-management . Disease control was assessed by weekly averaged PEF values , symptom scores , and asthma control tests . Adherence measures were assessed by therapeutic and diagnostic monitoring . Outcome was assessed by examining quality of life and retention of asthma knowledge . The data were analyzed by comparing results before and after the trial . At the end of trial , the intervention group decreased nighttime ( -0.08 + /- 0.33 vs. 0.00 + /- 0.20 , p = 0.028 ) and daytime symptoms ( -0.08 + /- 0.33 vs. 0.01 + /- 0.18 , p = 0.009 ) ; improved morning ( 241.9 + /- 81.4 vs. 223.1 + /- 55.5 , p = 0.017 ) and night PEF ( 255.6 + /- 86.7 vs. 232.5 + /- 55.3 , p = 0.010 ) ; increased adherence rates ( p < 0.05 ) ; improved well-controlled rates ( 70.4 % vs. 55.3 % , p < 0.05 ) ; improved knowledge regarding self-management ( 93.2 % vs. 70.3 % , p < 0.05 ) ; and improved quality of life ( 6.5 + /- 0.5 vs. 4.3 + /- 1.2 on a 7-point scale , p < 0.05 ) when compared with conventional management . The Internet-based asthma telemonitoring program increases selfmanagement skills , improves asthma outcomes , and appears to be an effective and well-accepted technology for the care of children with asthma and their caregivers We compare the efficacy including spirometry , peak expiratory flow ( PEFR ) and quality of life and safety of an 8-week treatment with inhaled oxitropium , theophylline or their combination in patients with mild-to-severe chronic obstructive pulmonary disease ( COPD ) . We conducted a multicentre , double-blind , double-dummy r and omized , parallel-group study at 29 Italian out patients clinics . A group of 236 patients with mild-to-severe COPD ( baseline FEV1 < or = 70 % of predicted value ) were recruited . Treatments were as follows : Inhaled oxitropium bromide 200 microg ( N=75 ) , sustained-release oral theophylline 300 mg ( N=81 ) or their combination ( N=80 ) , taken twice daily .  Spirometry ( FEV1 and FVC ) was evaluated every 4 weeks , and morning and evening PEFR ( before and 2 - 4 h after drug intake ) was measured daily . Symptoms , cough and dysponea , were recorded daily . Health status was evaluated at baseline and week 8 using the disease specific St George ' Respiratory Question naire ( SGRQ ) . Any adverse event occurring during the treatment period was recorded on a diary card . FEV1 and FVC improved in all the groups at 4 and 8 weeks , but the difference between treatment groups did not reach statistically significant levels . Differences between groups in pre-dosing morning and evening PEFR were not significant . Post-dosing morning and evening PEFR were increased and the largest increase was seen in patients treated with both drugs . However , differences between groups was significant only for evening values ( P=0.008 ) . The proportion of patients who experienced a decrease in symptoms was high in all groups but no differences among groups were observed . SGRQ total scores decreased in all treatment groups after 8 weeks , particularly in the oxitropium and combination groups . Clinical ly significant change ( > or = 4 units ) was only observed in patients treated with oxitropium bromide whether with or without theophylline .  Adverse events related to treatments were higher in the group treated with theophylline alone ( P < 0.02 ) . We conclude that inhaled oxitropium bromide alone was associated with an improvement in FEV1 , PEFR and symptoms in patients with COPD that was not statistically different from that of oral theophylline alone or of the combination of both drugs . Oxitropium bromide in combination with theophylline provided a greater improvement in evening post-dosing PEFR . Oxitropium bromide alone or in combination with theophylline improved the quality of life better than theophylline alone Objective : Recent studies suggest an association between chronic cough and gastroesophageal reflux . Our study aims were 1 ) to define the prevalence of acid reflux induced cough in the general community , 2 ) to examine the ability of esophageal testing to identify gastroesophageal reflux related cough , and 3 ) to assess the utility of omeprazole in a chronic cough algorithm . Methods : Patients with chronic cough of unknown etiology , who were mostly from the community , were evaluated . Subjects underwent a chest x-ray , methacholine challenge test , and empiric trial of postnasal drip therapy , and completed daily cough symptom diaries subjectively evaluating cough frequency and severity on a grade d scale of 0–4 ( combined maximum 8) . After excluding other causes of cough , the remaining patients underwent esophageal and pH testing . Those testing positive were r and omized to omeprazole 40 mg b.i.d . or placebo for 12 weeks . Follow-up was 1 yr . Results : A total of 71 patients were screened ; 48 were excluded . Twenty-three patients were evaluated for gastroesophageal reflux disease ; six ( 26 % ) were eventually determined to have an acid-related cough . Of these patients , 17 had a positive pH test , six ( 35 % ) of whom showed a striking improvement or resolution of their cough during omeprazole treatment which was sustained for up to 1 yr . Six had a negative pH test , none of whom responded to omeprazole therapy . No significant differences were seen between responders ( n = 6 ) and nonresponders ( n = 11 ) for demographic factors , baseline symptom frequency and duration , or physiological parameters ( motility/pH ) . Conclusions : Acid-related chronic cough was present in 26 % ( six of 23 ) of patients evaluated for gastroesophageal reflux disease . Esophageal testing does not reliably identify patients with acid induced chronic cough responsive to proton pump inhibitor therapy . We suggest that the best diagnostic and therapeutic approach , after excluding asthma and postnasal drip syndrome , is empiric treatment for 2 wk with a high dose proton pump inhibitor Abstract Objective : To investigate the efficacy and tolerability of high-dose N-acetylcysteine ( NAC ) in the treatment of patients with exacerbations of chronic obstructive pulmonary disease ( COPD ) . Design and patients : R and omised , double-blind , double-dummy , placebo-controlled study in 123 patients experiencing an acute exacerbation of COPD . Interventions : NAC 1200 mg/day , 600 mg/day or placebo administered once daily for 10 days . Main outcome measures : The primary objective was to assess the proportion of patients with normalised C-reactive protein ( CRP ) levels . Also assessed were effects on interleukin (IL)-8 levels , lung function and symptoms . Results : Both NAC 600 and 1200 mg/day were associated with a significantly higher proportion of patients achieving normalised CRP levels compared with placebo ( 52 % and 90 % vs 19 % of patients ; p ≤ 0.01 ) ; however , NAC 1200 mg/day was superior to NAC 600 mg/day ( p = 0.002 ) . Furthermore , treatment with NAC 1200 mg/day was more efficacious than NAC 600 mg/day in reducing IL-8 levels and difficulty of expectoration , while the two active regimens had similar beneficial effects on lung function and other clinical outcomes ( cough intensity and frequency , and lung auscultation ) . Treatments were well tolerated with one adverse event reported in NAC 1200 mg/day recipients and two reported in placebo recipients . Conclusion : Treatment with NAC 1200 mg/day improved biological markers and clinical outcomes in patients with COPD exacerbations . It is speculated that the effect of NAC on inflammatory markers may be due to both mucolytic and antioxidant properties RATIONALE Cough is the most common complaint for which medical attention is sought , and chronic cough can be both physically and mentally debilitating . There is currently no evidence supporting the use of antitussives in chronic treatment-resistant cough . OBJECTIVES We tested the hypothesis that morphine sulfate in the dose of 5 mg twice daily would bring about a reduction in cough frequency and severity in patients failing to respond to specific measures . METHODS Patients recruited from the Hull Cough Clinic were enrolled into a r and omized double-blind placebo-controlled study using 4 weeks of slow-release morphine sulfate and a corresponding period of matched placebo . An open-labeled extension of the core study allowed dose escalation to 10 mg twice daily . Cough was assessed using the Leicester Cough Question naire , daily symptom diary , and citric acid cough challenge . RESULTS Twenty-seven patients completed the core study . A significant improvement of 3.2 points over baseline was noted on the Leicester Cough Question naire ( p < 0.01 ) . A rapid and highly significant reduction by 40 % in daily cough scores was noted among patients on slow-release morphine sulfate ( p < 0.01 ) . Objective testing of the cough reflex using citric acid cough challenge tests did not show any significant changes . Eighteen patients continued into the extension study . Two-thirds of these patients opted to increase the morphine to 10 mg twice daily . At the end of 3 months , there was a similar improvement in cough between the 5- and 10-mg groups . CONCLUSION Morphine sulfate is an effective antitussive in intractable chronic cough at the doses of 5 to 10 mg twice daily Background : This study aim ed to assess and compare the effectiveness of lidocaine and bronchodilator inhalation treatments for rapid cough suppression in patients with chronic obstructive pulmonary disease ( COPD ) . Methods : Prospect i ve comparison study carried out in a tertiary emergency department . Consecutive 
    Output:
    