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: OBJECTIVE To determine the ability of budesonide via an inhaler ( Pulmicort Turbuhaler ; Astra Draco AB ) to replace oral glucocorticosteroids ( GCSs ) in adult subjects with moderate-to-severe asthma . DESIGN Double-blind , r and omized , and placebo-controlled study , with parallel groups . SETTING Multicenter study in outpatient setting . PARTICIPANTS Eighty men and 79 women , aged 20 to 69 years , with moderate-to-severe asthma and a mean FEV1 of 58.3 % predicted normal . All subjects were receiving oral GCS treatment and 79 % of subjects were also receiving inhaled beclomethasone dipropionate ( BDP ) . The mean daily doses of prednisone at baseline , including converted dose of BDP , for the placebo , budesonide 400 microg , and budesonide 800 microg , respectively , were 19.7 mg , 19.5 mg , and 18.7 mg . MEASUREMENTS AND INTERVENTIONS After a 2-week baseline period , subjects entered a 20-week treatment period , during which the oral dose of prednisone was reduced by forced down-titration at 2-weekly intervals . RESULTS Subjects receiving 400 microg or 800 microg bid of budesonide achieved a significantly greater reduction ( 82.9 % and 79.0 % respectively ) in oral GCS dose compared with placebo-treated subjects ( 27 % ; p<0.001 ) . Two thirds of the subjects receiving budesonide were able to achieve sustained oral corticosteroid cessation , compared with 8 % in the placebo group . Additionally , both doses of budesonide result ed in significant improvement in results of pulmonary function tests and asthma symptoms scores , and a significant decrease in the use of bronchodilator therapy . The mean plasma cortisol levels before and after adrenocorticotropic hormone stimulation increased most toward the normal range in the budesonide-treated groups compared with placebo-treated subjects . CONCLUSION Budesonide administered via Turbuhaler has a significant oral GCS-sparing capacity with maintained or improved asthma control in adult subjects with moderate-to-severe asthma Two hundred and forty-one children with perennial asthma had their normal dose of budesonide ( administered via Nebuhaler ) reduced by 50 % . Asthma control deteriorated in 126 patients to such an extent that budesonide had to be increased to the normal dose . During a subsequent two week run-in these 126 patients were treated with their normal dose of budesonide via Nebuhaler . Thereafter 64 were r and omized to treatment with their normal budesonide therapy and 62 to treatment with half their normal budesonide dose via Turbuhaler for nine weeks . Asthma symptoms , peak-flow measurements , and beta 2-agonist use were recorded . Pulmonary function tests , exercise tests and 24 hour urine sample collection s were performed . There were no differences between the groups in any of the parameters studied during run-in or during the study period , except for use of beta 2-agonist , which was significantly lower in the Turbuhaler-treated group . We conclude that Turbuhaler is more effective than Nebuhaler in the treatment of asthma . Therefore the dose of budesonide should be reduced when patients are switched from Nebuhaler to Turbuhaler treatment BACKGROUND Optimal management of chronic , mild-to-moderate asthma with inhaled  steroids may include use of the lowest possible doses , as recommended in guidelines , and a reduction in the frequency of daily administration for greater convenience . Lower doses and once daily treatment with inhaled steroids must be rigorously evaluated in controlled clinical trials . OBJECTIVES The objective of this study was to assess the efficacy and safety of once daily treatment with budesonide in subjects with stable asthma . METHODS Once daily budesonide was assessed in 309 adult subjects , including those who were and were not using an inhaled steroid at baseline . The subjects were stratified by inhaled steroid use and r and omly assigned to one of 3 treatments : 200 microgram budesonide , 400 microgram budesonide , or placebo administered by means of Turbuhaler once daily in the morning for 6 weeks . Beyond this point , treatment was continued unchanged for another 12 weeks ( maintenance ) in those receiving 200 microgram budesonide once daily and placebo . In those who received 400 microgram budesonide once daily , the dose was reduced to 200 microgram once daily at week 6 and held constant for the remaining 12 weeks ( 400/200 microgram group ) . Primary efficacy endpoints were mean change from baseline in FEV1 and morning peak expiratory flow . RESULTS Once daily budesonide was well tolerated and result ed in significant improvements in all efficacy endpoints , even though baselines were well stabilized . Baseline lung function was elevated with little room for improvement ; however , mean increases in FEV1 during the maintenance period were 0.10 L and 0.11 L in the 200 microgram and 400/200 microgram groups , respectively , versus a decrease of -0.09 L in the placebo arm ( P < .001 ) . Results for peak expiratory flow were similar . Significant improvements in secondary endpoints , including symptoms , beta-agonist use , and quality of life , also developed with budesonide 200 and 400 microgram once daily . CONCLUSION Inhaled budesonide , in doses as low as 200 microgram , may be an appropriate introductory or maintenance dose in subjects with stable , mild-to-moderate asthma Two hundred and forty one children with chronic perennial asthma , who had been treated with budesonide via a metered dose inhaler with a spacer device ( Nebuhaler )  , had their normal dose of budesonide reduced by 50 % to determine if they had been overtreated . Within three weeks , asthma control deteriorated in 126 patients to such an extent that budesonide had to be increased to the normal dose . After stabilising their asthma , these children were enrolled in a r and omised , double blind , double dummy , parallel study , performed to compare the effect of budesonide via Nebuhaler with that of half the dose of budesonide via Turbuhaler . The study started with a two week run-in during which patients were treated with their normal dose of budesonide via Nebuhaler . After run-in , 64 children were r and omised to treatment with their normal budesonide treatment and the remaining 62 children to treatment with half their normal dose via Turbuhaler for nine weeks . Throughout the study , patients recorded asthma symptoms , peak flow measurements , and beta 2 agonist use in a diary . Pulmonary function tests , exercise tests , and 24 hour urine sample collection s were performed at hospital visits during run-in and the study period . Apart from beta 2 agonist use , which was significantly lower for patients on Turbuhaler treatment than on Nebuhaler treatment , there were no differences between the groups in any of the parameters studied during run-in or during the study period . Furthermore , there was no trend of deterioration in asthma control when the dose of budesonide was reduced by 50 % when Turbuhaler was the inhalation device . It is concluded that budesonide via Turbuhaler is more effective than via Nebuhaler in the treatment of asthma . Based on this finding , attempts should be made to reduce the dose of budesonide when patients are switched from Nebuhaler to Turbuhaler treatment The budesonide dose delivered to the patient from three different spacer devices ( Nebuhaler = 750 ml , Aerochamber = 140 ml , and Babyspacer = 260 ml ) was assessed by measuring the budesonide dose deposited on a filter inserted between the spacer outlet and the mouth of the patient . Twenty children aged 10 - 25 months were given a single dose of 200 micrograms budesonide from each spacer device in a r and omised crossover study . All spacers had a facemask attached and a one way valve system . The children breathed through the inhalation system for 30 seconds . Furthermore , the minute ventilation of the children through a tightly fitting facemask was measured . The filter dose of budesonide  was significantly lower after Aerochamber treatment ( 39.4 micrograms , range 19 - 67 micrograms ) than after Nebuhaler ( 53.5 micrograms , range 34 - 88 micrograms ) and Babyspacer ( 55.5 micrograms , range 39 - 76 micrograms ) treatment . The minute ventilation of the children varied from 1.4 l/min to 7.0 l/min ( mean 5.0 l/min ) . This was sufficient to empty all spacers within the 30 seconds of inhalation . It is concluded that spacer volume does not seem to be so important for children aged 10 - 25 months as long as spacers with a volume lower than 750 ml are used BACKGROUND It is desirable to prescribe the minimal effective dose of inhaled steroids to control asthma . To ensure that inflammation is suppressed whilst using the lowest possible dose , a sensitive and specific method for assessing airway inflammation is needed . METHODS The usefulness of exhaled nitric oxide ( NO ) , sputum eosinophils , and methacholine airway responsiveness ( PC20 ) for monitoring airway inflammatory changes following four weeks of treatment with an inhaled corticosteroid ( budesonide via Turbohaler ) were compared . Mild stable steroid naive asthmatic subjects were r and omised into two double blind , placebo controlled studies . The first was a parallel group study involving three groups receiving either 100 μg/day budesonide ( n = 8) , 400 μg/day budesonide ( n = 7 ) , or a matched placebo ( n = 6 ) . The second was a crossover study involving 10 subjects r and omised to receive 1600 μg budesonide or placebo . The groups were matched with respect to age , PC20 , baseline FEV1 ( % predicted ) , exhaled NO , and sputum eosinophilia . RESULTS There were significant improvements in FEV1 following 400 μg and 1600 μg budesonide ( 11.3 % and 6.5 % , respectively , p<0.05 ) . This was accompanied by significant reductions in eosinophil numbers in induced sputum ( 0.7 and 0.9 fold , p<0.05 ) . However , levels of exhaled NO were reduced following each budesonide dose while PC20was improved only with 1600 μg budesonide . These results suggest that exhaled NO and PC20 may not reflect the control of airway inflammation as accurately as the number of eosinophils in sputum . There were dose dependent changes in exhaled NO , sputum eosinophils , and PC20 to inhaled budesonide but a plateau response of exhaled NO was found at a dose of 400 μg daily . CONCLUSION Monitoring the number of eosinophils in induced sputum may be the most accurate guide to establish the minimum dose of inhaled steroids needed to control inflammation . This , however , requires further studies involving a larger number of patients The aim of the present study was to examine the efficacy of low-dose inhaled budesonide ( BUD ) administered via Turbuhaler once or twice daily on symptoms , lung function and bronchial hyperreactivity in children with mild asthma . One hundred and sixty-three children ( mean age 9.9 yrs , 56 females/107 males ) with mild asthma ( forced expiratory volume in one second ( FEV1 ) 103 % of predicted , morning peak expiratory flow ( PEF ) 87 % pred , reversibility in FEV1 3 % , fall in FEV1 after exercise 10.4 % from pre-exercise value ) and not previously treated with inhaled steroids , were included in a double-blind , r and omized , parallel-group study . After a two-week run-in period , the children received inhaled BUD 100 microg or 200 microg once daily in the morning , 100 microg twice daily or placebo for 12 weeks . Exercise and methacholine challenges were performed before and at the end of treatment . After 12 weeks of therapy , the fall in FEV1 after an exercise test was significantly less in all three BUD groups ( 43 - 5.1 % ) than in the placebo group ( 8.6 % ) . Bronchial hyperreactivity to methacholine with the provocative dose causing a 20 % fall in FEV1 decreased significantly in the BUD 100 microg twice-daily group compared with placebo ( ratio at the end of treatment 156 % ) . Changes in baseline lung function ( FEV1 and PEF ) were less marked than changes in bronchial responsiveness . In conclusion , low doses of inhaled budesonide , given once or twice daily , provided protection against exercise-induced bronchoconstriction in children with mild asthma and near normal lung function New British guidelines on the treatment of asthma ( 9 ) advocate starting with a higher dose of inhaled corticosteroids in newly detected asthma patients . We investigated whether initiating inhaled steroid treatment with a higher dose is clinical ly more effective than a lower dose in steroid naive patients with asthma . The study had a 13-wk r and omized , double-blind , parallel design : 1-mo 
    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: OBJECTIVE To determine the ability of budesonide via an inhaler ( Pulmicort Turbuhaler ; Astra Draco AB ) to replace oral glucocorticosteroids ( GCSs ) in adult subjects with moderate-to-severe asthma . DESIGN Double-blind , r and omized , and placebo-controlled study , with parallel groups . SETTING Multicenter study in outpatient setting . PARTICIPANTS Eighty men and 79 women , aged 20 to 69 years , with moderate-to-severe asthma and a mean FEV1 of 58.3 % predicted normal . All subjects were receiving oral GCS treatment and 79 % of subjects were also receiving inhaled beclomethasone dipropionate ( BDP ) . The mean daily doses of prednisone at baseline , including converted dose of BDP , for the placebo , budesonide 400 microg , and budesonide 800 microg , respectively , were 19.7 mg , 19.5 mg , and 18.7 mg . MEASUREMENTS AND INTERVENTIONS After a 2-week baseline period , subjects entered a 20-week treatment period , during which the oral dose of prednisone was reduced by forced down-titration at 2-weekly intervals . RESULTS Subjects receiving 400 microg or 800 microg bid of budesonide achieved a significantly greater reduction ( 82.9 % and 79.0 % respectively ) in oral GCS dose compared with placebo-treated subjects ( 27 % ; p<0.001 ) . Two thirds of the subjects receiving budesonide were able to achieve sustained oral corticosteroid cessation , compared with 8 % in the placebo group . Additionally , both doses of budesonide result ed in significant improvement in results of pulmonary function tests and asthma symptoms scores , and a significant decrease in the use of bronchodilator therapy . The mean plasma cortisol levels before and after adrenocorticotropic hormone stimulation increased most toward the normal range in the budesonide-treated groups compared with placebo-treated subjects . CONCLUSION Budesonide administered via Turbuhaler has a significant oral GCS-sparing capacity with maintained or improved asthma control in adult subjects with moderate-to-severe asthma Two hundred and forty-one children with perennial asthma had their normal dose of budesonide ( administered via Nebuhaler ) reduced by 50 % . Asthma control deteriorated in 126 patients to such an extent that budesonide had to be increased to the normal dose . During a subsequent two week run-in these 126 patients were treated with their normal dose of budesonide via Nebuhaler . Thereafter 64 were r and omized to treatment with their normal budesonide therapy and 62 to treatment with half their normal budesonide dose via Turbuhaler for nine weeks . Asthma symptoms , peak-flow measurements , and beta 2-agonist use were recorded . Pulmonary function tests , exercise tests and 24 hour urine sample collection s were performed . There were no differences between the groups in any of the parameters studied during run-in or during the study period , except for use of beta 2-agonist , which was significantly lower in the Turbuhaler-treated group . We conclude that Turbuhaler is more effective than Nebuhaler in the treatment of asthma . Therefore the dose of budesonide should be reduced when patients are switched from Nebuhaler to Turbuhaler treatment BACKGROUND Optimal management of chronic , mild-to-moderate asthma with inhaled  steroids may include use of the lowest possible doses , as recommended in guidelines , and a reduction in the frequency of daily administration for greater convenience . Lower doses and once daily treatment with inhaled steroids must be rigorously evaluated in controlled clinical trials . OBJECTIVES The objective of this study was to assess the efficacy and safety of once daily treatment with budesonide in subjects with stable asthma . METHODS Once daily budesonide was assessed in 309 adult subjects , including those who were and were not using an inhaled steroid at baseline . The subjects were stratified by inhaled steroid use and r and omly assigned to one of 3 treatments : 200 microgram budesonide , 400 microgram budesonide , or placebo administered by means of Turbuhaler once daily in the morning for 6 weeks . Beyond this point , treatment was continued unchanged for another 12 weeks ( maintenance ) in those receiving 200 microgram budesonide once daily and placebo . In those who received 400 microgram budesonide once daily , the dose was reduced to 200 microgram once daily at week 6 and held constant for the remaining 12 weeks ( 400/200 microgram group ) . Primary efficacy endpoints were mean change from baseline in FEV1 and morning peak expiratory flow . RESULTS Once daily budesonide was well tolerated and result ed in significant improvements in all efficacy endpoints , even though baselines were well stabilized . Baseline lung function was elevated with little room for improvement ; however , mean increases in FEV1 during the maintenance period were 0.10 L and 0.11 L in the 200 microgram and 400/200 microgram groups , respectively , versus a decrease of -0.09 L in the placebo arm ( P < .001 ) . Results for peak expiratory flow were similar . Significant improvements in secondary endpoints , including symptoms , beta-agonist use , and quality of life , also developed with budesonide 200 and 400 microgram once daily . CONCLUSION Inhaled budesonide , in doses as low as 200 microgram , may be an appropriate introductory or maintenance dose in subjects with stable , mild-to-moderate asthma Two hundred and forty one children with chronic perennial asthma , who had been treated with budesonide via a metered dose inhaler with a spacer device ( Nebuhaler )  , had their normal dose of budesonide reduced by 50 % to determine if they had been overtreated . Within three weeks , asthma control deteriorated in 126 patients to such an extent that budesonide had to be increased to the normal dose . After stabilising their asthma , these children were enrolled in a r and omised , double blind , double dummy , parallel study , performed to compare the effect of budesonide via Nebuhaler with that of half the dose of budesonide via Turbuhaler . The study started with a two week run-in during which patients were treated with their normal dose of budesonide via Nebuhaler . After run-in , 64 children were r and omised to treatment with their normal budesonide treatment and the remaining 62 children to treatment with half their normal dose via Turbuhaler for nine weeks . Throughout the study , patients recorded asthma symptoms , peak flow measurements , and beta 2 agonist use in a diary . Pulmonary function tests , exercise tests , and 24 hour urine sample collection s were performed at hospital visits during run-in and the study period . Apart from beta 2 agonist use , which was significantly lower for patients on Turbuhaler treatment than on Nebuhaler treatment , there were no differences between the groups in any of the parameters studied during run-in or during the study period . Furthermore , there was no trend of deterioration in asthma control when the dose of budesonide was reduced by 50 % when Turbuhaler was the inhalation device . It is concluded that budesonide via Turbuhaler is more effective than via Nebuhaler in the treatment of asthma . Based on this finding , attempts should be made to reduce the dose of budesonide when patients are switched from Nebuhaler to Turbuhaler treatment The budesonide dose delivered to the patient from three different spacer devices ( Nebuhaler = 750 ml , Aerochamber = 140 ml , and Babyspacer = 260 ml ) was assessed by measuring the budesonide dose deposited on a filter inserted between the spacer outlet and the mouth of the patient . Twenty children aged 10 - 25 months were given a single dose of 200 micrograms budesonide from each spacer device in a r and omised crossover study . All spacers had a facemask attached and a one way valve system . The children breathed through the inhalation system for 30 seconds . Furthermore , the minute ventilation of the children through a tightly fitting facemask was measured . The filter dose of budesonide  was significantly lower after Aerochamber treatment ( 39.4 micrograms , range 19 - 67 micrograms ) than after Nebuhaler ( 53.5 micrograms , range 34 - 88 micrograms ) and Babyspacer ( 55.5 micrograms , range 39 - 76 micrograms ) treatment . The minute ventilation of the children varied from 1.4 l/min to 7.0 l/min ( mean 5.0 l/min ) . This was sufficient to empty all spacers within the 30 seconds of inhalation . It is concluded that spacer volume does not seem to be so important for children aged 10 - 25 months as long as spacers with a volume lower than 750 ml are used BACKGROUND It is desirable to prescribe the minimal effective dose of inhaled steroids to control asthma . To ensure that inflammation is suppressed whilst using the lowest possible dose , a sensitive and specific method for assessing airway inflammation is needed . METHODS The usefulness of exhaled nitric oxide ( NO ) , sputum eosinophils , and methacholine airway responsiveness ( PC20 ) for monitoring airway inflammatory changes following four weeks of treatment with an inhaled corticosteroid ( budesonide via Turbohaler ) were compared . Mild stable steroid naive asthmatic subjects were r and omised into two double blind , placebo controlled studies . The first was a parallel group study involving three groups receiving either 100 μg/day budesonide ( n = 8) , 400 μg/day budesonide ( n = 7 ) , or a matched placebo ( n = 6 ) . The second was a crossover study involving 10 subjects r and omised to receive 1600 μg budesonide or placebo . The groups were matched with respect to age , PC20 , baseline FEV1 ( % predicted ) , exhaled NO , and sputum eosinophilia . RESULTS There were significant improvements in FEV1 following 400 μg and 1600 μg budesonide ( 11.3 % and 6.5 % , respectively , p<0.05 ) . This was accompanied by significant reductions in eosinophil numbers in induced sputum ( 0.7 and 0.9 fold , p<0.05 ) . However , levels of exhaled NO were reduced following each budesonide dose while PC20was improved only with 1600 μg budesonide . These results suggest that exhaled NO and PC20 may not reflect the control of airway inflammation as accurately as the number of eosinophils in sputum . There were dose dependent changes in exhaled NO , sputum eosinophils , and PC20 to inhaled budesonide but a plateau response of exhaled NO was found at a dose of 400 μg daily . CONCLUSION Monitoring the number of eosinophils in induced sputum may be the most accurate guide to establish the minimum dose of inhaled steroids needed to control inflammation . This , however , requires further studies involving a larger number of patients The aim of the present study was to examine the efficacy of low-dose inhaled budesonide ( BUD ) administered via Turbuhaler once or twice daily on symptoms , lung function and bronchial hyperreactivity in children with mild asthma . One hundred and sixty-three children ( mean age 9.9 yrs , 56 females/107 males ) with mild asthma ( forced expiratory volume in one second ( FEV1 ) 103 % of predicted , morning peak expiratory flow ( PEF ) 87 % pred , reversibility in FEV1 3 % , fall in FEV1 after exercise 10.4 % from pre-exercise value ) and not previously treated with inhaled steroids , were included in a double-blind , r and omized , parallel-group study . After a two-week run-in period , the children received inhaled BUD 100 microg or 200 microg once daily in the morning , 100 microg twice daily or placebo for 12 weeks . Exercise and methacholine challenges were performed before and at the end of treatment . After 12 weeks of therapy , the fall in FEV1 after an exercise test was significantly less in all three BUD groups ( 43 - 5.1 % ) than in the placebo group ( 8.6 % ) . Bronchial hyperreactivity to methacholine with the provocative dose causing a 20 % fall in FEV1 decreased significantly in the BUD 100 microg twice-daily group compared with placebo ( ratio at the end of treatment 156 % ) . Changes in baseline lung function ( FEV1 and PEF ) were less marked than changes in bronchial responsiveness . In conclusion , low doses of inhaled budesonide , given once or twice daily , provided protection against exercise-induced bronchoconstriction in children with mild asthma and near normal lung function New British guidelines on the treatment of asthma ( 9 ) advocate starting with a higher dose of inhaled corticosteroids in newly detected asthma patients . We investigated whether initiating inhaled steroid treatment with a higher dose is clinical ly more effective than a lower dose in steroid naive patients with asthma . The study had a 13-wk r and omized , double-blind , parallel design : 1-mo 
    Output:
    