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: BACKGROUND The value of azithromycin for treatment of acute bronchitis is unknown , even though this drug is commonly prescribed . We have investigated this question in a r and omised , double-blind , controlled trial . METHODS Adults diagnosed with acute bronchitis , without evidence of underlying lung disease , were r and omly assigned  azithromycin ( n=112 ) or vitamin C  ( n=108 ) for 5 days ( total dose for each 1.5 g ) . All individuals were also given liquid dextromethorphan and albuterol inhaler with a spacer . The primary outcome was improvement in health-related quality of life at 7 days ; an important difference was defined as 0.5 or greater . Analysis was by intention to treat . FINDINGS The study was stopped by the data -monitoring and safety committee when 220 patients had been recruited . On day 7 , the adjusted difference in health-related quality of life was small and not significant ( difference 0.03 [ 95 % CI -0.20 to 0.26 ] , p=0.8 ) . 86 ( 89 % ) of 97 patients in the azithromycin group and 82 ( 89 % ) of 92 in the vitamin C group had returned to their usual activities by day 7 ( difference 0.5 % [ -10 % to 9 % ] , p>0.9 ) . There were no differences in the frequency of adverse effects ; three patients in the vitamin C group discontinued the study medicine because of perceived adverse effects , compared with none in the azithromycin group . Most patients ( 81 % ) reported benefit from the albuterol inhaler . INTERPRETATION Azithromycin is no better than low-dose vitamin C for acute bronchitis . Further studies are needed to identify the best treatment for this disorder BACKGROUND The role of oral corticosteroids in treating patients with exacerbations of chronic obstructive pulmonary disease ( COPD ) remains contentious . We assessed in a prospect i ve , r and omised , double-blind , placebo-controlled trial the effects of oral corticosteroid therapy in patients with exacerbations of COPD requiring hospital admission . METHODS We recruited patients with non-acidotic exacerbations of COPD who were r and omly assigned oral prednisolone 30  mg once daily  ( n=29 ) or identical placebo ( n=27 ) for 14 days , in addition to st and ard treatment with nebulised bronchodilators , antibiotics , and oxygen . We did spirometry and recorded symptom scores daily in in patients . Time to discharge and withdrawals were noted in each group . We recalled patients at 6 weeks to repeat spirometry and collect data on subsequent exacerbations and treatment . Hospital stay was analysed by intention to treat and forced expiratory volume in 1 s ( FEV1 ) according to protocol . FINDINGS FEV1 after bronchodilation increased more rapidly and to a greater extent in the corticosteroid-treated group : percentage predicted FEV1 after bronchodilation rose from 25.7 % ( 95 % CI 21.0 - 30.4 ) to 32.2 % ( 27.3 - 27.1 ) in the placebo group ( p<0.0001 ) compared with 28.2 % ( 23.5 - 32.9 ) to 41.5 % ( 35.8 - 47.2 ) in the corticosteroid-treated group ( p<0.0001 ) . Up to day 5 of hospital stay , FEV1 after bronchodilation increased by 90 mL daily ( 50.8 - 129.2 ) and by 30 mL daily ( 10.4 - 49.6 ) in the placebo group ( p=0.039 ) . Hospital stays were shorter in the corticosteroid-treated group . Groups did not differ at 6-week follow-up . INTERPRETATION These data provide evidence to support the current practice of prescribing low-dose oral corticosteroids to all patients with non-acidotic exacerbations of COPD requiring hospital admission Background Chronic obstructive pulmonary disease ( COPD ) is a complex condition with pulmonary and extra-pulmonary manifestations . This study describes the heterogeneity of COPD in a large and well characterised and controlled COPD cohort ( ECLIPSE ) . Methods We studied 2164 clinical ly stable COPD patients , 337 smokers with normal lung function and 245 never smokers . In these individuals , we measured clinical parameters , nutritional status , spirometry , exercise tolerance , and amount of emphysema by computed tomography . Results COPD patients were slightly older than controls and had more pack years of smoking than smokers with normal lung function . Co-morbidities were more prevalent in COPD patients than in controls , and occurred to the same extent irrespective of the GOLD stage . The severity of airflow limitation in COPD patients was poorly related to the degree of breathlessness , health status , presence of co-morbidity , exercise capacity and number of exacerbations reported in the year before the study . The distribution of these variables within each GOLD stage was wide . Even in subjects with severe airflow obstruction , a substantial proportion did not report symptoms , exacerbations or exercise limitation . The amount of emphysema increased with GOLD severity . The prevalence of bronchiectasis was low ( 4 % ) but also increased with GOLD stage . Some gender differences were also identified . Conclusions The clinical manifestations of COPD are highly variable and the degree of airflow limitation does not capture the heterogeneity of the disease Recommendation of the use of systemic steroids in chronic obstructive disease ( COPD ) exacerbation rely on trials that excluded patients requiring ventilatory support . In an open-label , r and omised evaluation of oral prednisone administration , 217 patients with acute COPD exacerbation requiring ventilatory support were r and omised ( with stratification on the type of ventilation ) to usual care ( n=106 ) or to receive a daily dose of prednisone ( 1 mg·kg−1 ) for up to 10 days ( n=111 ) . There was no difference regarding the primary end-point , intensive care unit mortality , which was 17 ( 15.3 % ) deaths versus 15 ( 14 % ) deaths in the steroid-treated and control groups , respectively ( relative risk 1.08 , 95 % CI 0.6–2.05 ) . Analysis according to ventilation modalities showed similar mortality rates . Noninvasive ventilation failed in 15.7 % and 12.7 % ( relative risk 1.25 , 95 % CI 0.56–2.8 ; p=0.59 ) , respectively . Both study groups had similar median mechanical ventilation duration and intensive care unit length of stay , which were 6 ( interquartile range 6–12 ) days versus 6 ( 3.8–12 ) days and 9 ( 6–14 ) days versus 8 ( 6–14 ) days , respectively . Hyperglycaemic episodes requiring initiation or alteration of current insulin doses occurred in 55 ( 49.5 % ) patients versus 35 ( 33 % ) patients in the prednisone and control groups , respectively ( relative risk 1.5 , 95 % CI 1.08–2.08 ; p=0.015 ) . Prednisone did not improve intensive care unit mortality or patient-centred outcomes in the selected subgroup of COPD patients with severe exacerbation but significantly increased the risk of hyperglycaemia . In COPD exacerbation needing ventilatory support , prednisone has no impact on ICU mortality or related patient outcome OBJECTIVE The aim of the study was to explore the clinical value of a step-wise application of methylprednisolone ( MP ) compared to dexamethasone ( DXM ) in acute exacerbations of COPD . METHODOLOGY One hundred and forty-two patients with an acute exacerbation of COPD were divided r and omly into two groups : 71 patients were treated with MP and the other 71 patients were treated with DXM . Otherwise each group was given the same basic treatments : antibiotics , bronchodilators , oxygen therapy as well as st and ard hospital care . The patients in the MP group were given a tapering dose of MP for 7 - 14 days , and the patients in the DXM group were given a corresponding tapering dose of DXM for 7 - 14 days . Then both groups were given a gradually reducing dose of oral prednisone for 2 - 3 weeks . Two weeks before the prednisone was tapered off , inhaled corticosteroid was introduced . The patients ' symptom scores , physical signs , per cent predicted FEV1 % , and arterial blood gases were monitored before treatment and after the seventh day of treatment . RESULTS There was an obvious improvement in symptoms after 1 - 3 days in all 71 patients in the MP group , with their wheezing being distinctly reduced or disappearing entirely . The maximum benefit that occurred in the MP group ( 90.14 % ) was considerably higher than that of the DXM group ( 25.35 % ) , P < 0.05 . The predicted FEV1 % in the MP group increased from 46.7 + /- 10.6 to 67.5 + /- 12.4 , compared with an increase in the DXM group from 50.1 + /- 7.6 to 58.9 + /- 10.8 . The difference between the two groups was significant ( P < 0.05 ) . CONCLUSIONS An adequate and tapering dose of MP used in acute exacerbations of COPD can relieve the inflammatory reaction in airways and reduce airway spasm more promptly than DXM Background : Chronic obstructive pulmonary disease ( COPD ) is characterised by both an accelerated decline in lung function and periods of acute deterioration in symptoms termed exacerbations . The aim of this study was to investigate whether these are related . Methods : Over 4 years ,  peak expiratory flow ( PEF ) and symptoms were measured at home daily by 109 patients with COPD ( 81 men ; median ( IQR ) age 68.1 ( 63–74 ) years ; arterial oxygen tension ( Pao2 ) 9.00 ( 8.3–9.5 ) kPa , forced expiratory volume in 1 second ( FEV1 ) 1.00 ( 0.7–1.3 ) l , forced vital capacity ( FVC ) 2.51 ( 1.9–3.0 ) l ) ; of these , 32 ( 29 men ) recorded daily FEV1 . Exacerbations were identified from symptoms and the effect of frequent or infrequent exacerbations ( > or < 2.92 per year ) on lung function decline was examined using cross sectional , r and om effects models . Results : The 109 patients experienced 757 exacerbations . Patients with frequent exacerbations had a significantly faster decline in FEV1 and peak expiratory flow ( PEF ) of –40.1 ml/year ( n=16 ) and –2.9 l/min/year ( n=46 ) than infrequent exacerbators in whom FEV1 changed by –32.1 ml/year ( n=16 ) and PEF by –0.7 l/min/year ( n=63 ) . Frequent exacerbators also had a greater decline in FEV1 if allowance was made for smoking status . Patients with frequent exacerbations were more often admitted to hospital with longer length of stay . Frequent exacerbations were a consistent feature within a patient , with their number positively correlated ( between years 1 and 2 , 2 and 3 , 3 and 4 ) . Conclusions : These results suggest that the frequency of exacerbations contributes to long term decline in lung function of patients with moderate to severe COPD BACKGROUND In this r and omized , double-blind , placebo-controlled trial , we studied the effectiveness of prednisone in reducing the risk of relapse after outpatient exacerbations of chronic obstructive pulmonary disease ( COPD ) . METHODS We enrolled 147 patients who were being discharged from the emergency department after an exacerbation of COPD and r and omly assigned them to 10 days of treatment with 40 mg of oral prednisone once daily or identical-appearing placebo . All patients received oral antibiotics for 10 days , plus inhaled bronchodilators . The primary end point was relapse , defined as an unscheduled visit to a physician 's office or a return to the emergency department because of worsening dyspnea , within 30 days after r and omization . RESULTS The overall rate of relapse at 30 days was lower in the prednisone group than in the placebo group ( 27 percent vs. 43 percent , P=0.05 ) , and the time to relapse was prolonged in those taking prednisone ( P=0.04 ) . After 10 days of therapy , patients in the prednisone group had greater improvements in forced expiratory volume in one second than did patients in the placebo group ( mean [ + /-SD ] increase from base line , 34+/-42 percent vs. 15+/-31 percent ; P=0.007 ) . Patients in the prednisone group also had significant improvements in dyspnea , as measured by the transitional dyspnea index ( P=0.04 ) and by the dyspnea domain of the Chronic Respiratory Disease Index Question naire ( P=0.02 ) , but not in health-related quality of life ( P=0.14 ) . CONCLUSIONS Outpatient treatment with oral prednisone offers a small advantage over placebo in treating patients who are discharged from the emergency department with an exacerbation of 
    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: BACKGROUND The value of azithromycin for treatment of acute bronchitis is unknown , even though this drug is commonly prescribed . We have investigated this question in a r and omised , double-blind , controlled trial . METHODS Adults diagnosed with acute bronchitis , without evidence of underlying lung disease , were r and omly assigned  azithromycin ( n=112 ) or vitamin C  ( n=108 ) for 5 days ( total dose for each 1.5 g ) . All individuals were also given liquid dextromethorphan and albuterol inhaler with a spacer . The primary outcome was improvement in health-related quality of life at 7 days ; an important difference was defined as 0.5 or greater . Analysis was by intention to treat . FINDINGS The study was stopped by the data -monitoring and safety committee when 220 patients had been recruited . On day 7 , the adjusted difference in health-related quality of life was small and not significant ( difference 0.03 [ 95 % CI -0.20 to 0.26 ] , p=0.8 ) . 86 ( 89 % ) of 97 patients in the azithromycin group and 82 ( 89 % ) of 92 in the vitamin C group had returned to their usual activities by day 7 ( difference 0.5 % [ -10 % to 9 % ] , p>0.9 ) . There were no differences in the frequency of adverse effects ; three patients in the vitamin C group discontinued the study medicine because of perceived adverse effects , compared with none in the azithromycin group . Most patients ( 81 % ) reported benefit from the albuterol inhaler . INTERPRETATION Azithromycin is no better than low-dose vitamin C for acute bronchitis . Further studies are needed to identify the best treatment for this disorder BACKGROUND The role of oral corticosteroids in treating patients with exacerbations of chronic obstructive pulmonary disease ( COPD ) remains contentious . We assessed in a prospect i ve , r and omised , double-blind , placebo-controlled trial the effects of oral corticosteroid therapy in patients with exacerbations of COPD requiring hospital admission . METHODS We recruited patients with non-acidotic exacerbations of COPD who were r and omly assigned oral prednisolone 30  mg once daily  ( n=29 ) or identical placebo ( n=27 ) for 14 days , in addition to st and ard treatment with nebulised bronchodilators , antibiotics , and oxygen . We did spirometry and recorded symptom scores daily in in patients . Time to discharge and withdrawals were noted in each group . We recalled patients at 6 weeks to repeat spirometry and collect data on subsequent exacerbations and treatment . Hospital stay was analysed by intention to treat and forced expiratory volume in 1 s ( FEV1 ) according to protocol . FINDINGS FEV1 after bronchodilation increased more rapidly and to a greater extent in the corticosteroid-treated group : percentage predicted FEV1 after bronchodilation rose from 25.7 % ( 95 % CI 21.0 - 30.4 ) to 32.2 % ( 27.3 - 27.1 ) in the placebo group ( p<0.0001 ) compared with 28.2 % ( 23.5 - 32.9 ) to 41.5 % ( 35.8 - 47.2 ) in the corticosteroid-treated group ( p<0.0001 ) . Up to day 5 of hospital stay , FEV1 after bronchodilation increased by 90 mL daily ( 50.8 - 129.2 ) and by 30 mL daily ( 10.4 - 49.6 ) in the placebo group ( p=0.039 ) . Hospital stays were shorter in the corticosteroid-treated group . Groups did not differ at 6-week follow-up . INTERPRETATION These data provide evidence to support the current practice of prescribing low-dose oral corticosteroids to all patients with non-acidotic exacerbations of COPD requiring hospital admission Background Chronic obstructive pulmonary disease ( COPD ) is a complex condition with pulmonary and extra-pulmonary manifestations . This study describes the heterogeneity of COPD in a large and well characterised and controlled COPD cohort ( ECLIPSE ) . Methods We studied 2164 clinical ly stable COPD patients , 337 smokers with normal lung function and 245 never smokers . In these individuals , we measured clinical parameters , nutritional status , spirometry , exercise tolerance , and amount of emphysema by computed tomography . Results COPD patients were slightly older than controls and had more pack years of smoking than smokers with normal lung function . Co-morbidities were more prevalent in COPD patients than in controls , and occurred to the same extent irrespective of the GOLD stage . The severity of airflow limitation in COPD patients was poorly related to the degree of breathlessness , health status , presence of co-morbidity , exercise capacity and number of exacerbations reported in the year before the study . The distribution of these variables within each GOLD stage was wide . Even in subjects with severe airflow obstruction , a substantial proportion did not report symptoms , exacerbations or exercise limitation . The amount of emphysema increased with GOLD severity . The prevalence of bronchiectasis was low ( 4 % ) but also increased with GOLD stage . Some gender differences were also identified . Conclusions The clinical manifestations of COPD are highly variable and the degree of airflow limitation does not capture the heterogeneity of the disease Recommendation of the use of systemic steroids in chronic obstructive disease ( COPD ) exacerbation rely on trials that excluded patients requiring ventilatory support . In an open-label , r and omised evaluation of oral prednisone administration , 217 patients with acute COPD exacerbation requiring ventilatory support were r and omised ( with stratification on the type of ventilation ) to usual care ( n=106 ) or to receive a daily dose of prednisone ( 1 mg·kg−1 ) for up to 10 days ( n=111 ) . There was no difference regarding the primary end-point , intensive care unit mortality , which was 17 ( 15.3 % ) deaths versus 15 ( 14 % ) deaths in the steroid-treated and control groups , respectively ( relative risk 1.08 , 95 % CI 0.6–2.05 ) . Analysis according to ventilation modalities showed similar mortality rates . Noninvasive ventilation failed in 15.7 % and 12.7 % ( relative risk 1.25 , 95 % CI 0.56–2.8 ; p=0.59 ) , respectively . Both study groups had similar median mechanical ventilation duration and intensive care unit length of stay , which were 6 ( interquartile range 6–12 ) days versus 6 ( 3.8–12 ) days and 9 ( 6–14 ) days versus 8 ( 6–14 ) days , respectively . Hyperglycaemic episodes requiring initiation or alteration of current insulin doses occurred in 55 ( 49.5 % ) patients versus 35 ( 33 % ) patients in the prednisone and control groups , respectively ( relative risk 1.5 , 95 % CI 1.08–2.08 ; p=0.015 ) . Prednisone did not improve intensive care unit mortality or patient-centred outcomes in the selected subgroup of COPD patients with severe exacerbation but significantly increased the risk of hyperglycaemia . In COPD exacerbation needing ventilatory support , prednisone has no impact on ICU mortality or related patient outcome OBJECTIVE The aim of the study was to explore the clinical value of a step-wise application of methylprednisolone ( MP ) compared to dexamethasone ( DXM ) in acute exacerbations of COPD . METHODOLOGY One hundred and forty-two patients with an acute exacerbation of COPD were divided r and omly into two groups : 71 patients were treated with MP and the other 71 patients were treated with DXM . Otherwise each group was given the same basic treatments : antibiotics , bronchodilators , oxygen therapy as well as st and ard hospital care . The patients in the MP group were given a tapering dose of MP for 7 - 14 days , and the patients in the DXM group were given a corresponding tapering dose of DXM for 7 - 14 days . Then both groups were given a gradually reducing dose of oral prednisone for 2 - 3 weeks . Two weeks before the prednisone was tapered off , inhaled corticosteroid was introduced . The patients ' symptom scores , physical signs , per cent predicted FEV1 % , and arterial blood gases were monitored before treatment and after the seventh day of treatment . RESULTS There was an obvious improvement in symptoms after 1 - 3 days in all 71 patients in the MP group , with their wheezing being distinctly reduced or disappearing entirely . The maximum benefit that occurred in the MP group ( 90.14 % ) was considerably higher than that of the DXM group ( 25.35 % ) , P < 0.05 . The predicted FEV1 % in the MP group increased from 46.7 + /- 10.6 to 67.5 + /- 12.4 , compared with an increase in the DXM group from 50.1 + /- 7.6 to 58.9 + /- 10.8 . The difference between the two groups was significant ( P < 0.05 ) . CONCLUSIONS An adequate and tapering dose of MP used in acute exacerbations of COPD can relieve the inflammatory reaction in airways and reduce airway spasm more promptly than DXM Background : Chronic obstructive pulmonary disease ( COPD ) is characterised by both an accelerated decline in lung function and periods of acute deterioration in symptoms termed exacerbations . The aim of this study was to investigate whether these are related . Methods : Over 4 years ,  peak expiratory flow ( PEF ) and symptoms were measured at home daily by 109 patients with COPD ( 81 men ; median ( IQR ) age 68.1 ( 63–74 ) years ; arterial oxygen tension ( Pao2 ) 9.00 ( 8.3–9.5 ) kPa , forced expiratory volume in 1 second ( FEV1 ) 1.00 ( 0.7–1.3 ) l , forced vital capacity ( FVC ) 2.51 ( 1.9–3.0 ) l ) ; of these , 32 ( 29 men ) recorded daily FEV1 . Exacerbations were identified from symptoms and the effect of frequent or infrequent exacerbations ( > or < 2.92 per year ) on lung function decline was examined using cross sectional , r and om effects models . Results : The 109 patients experienced 757 exacerbations . Patients with frequent exacerbations had a significantly faster decline in FEV1 and peak expiratory flow ( PEF ) of –40.1 ml/year ( n=16 ) and –2.9 l/min/year ( n=46 ) than infrequent exacerbators in whom FEV1 changed by –32.1 ml/year ( n=16 ) and PEF by –0.7 l/min/year ( n=63 ) . Frequent exacerbators also had a greater decline in FEV1 if allowance was made for smoking status . Patients with frequent exacerbations were more often admitted to hospital with longer length of stay . Frequent exacerbations were a consistent feature within a patient , with their number positively correlated ( between years 1 and 2 , 2 and 3 , 3 and 4 ) . Conclusions : These results suggest that the frequency of exacerbations contributes to long term decline in lung function of patients with moderate to severe COPD BACKGROUND In this r and omized , double-blind , placebo-controlled trial , we studied the effectiveness of prednisone in reducing the risk of relapse after outpatient exacerbations of chronic obstructive pulmonary disease ( COPD ) . METHODS We enrolled 147 patients who were being discharged from the emergency department after an exacerbation of COPD and r and omly assigned them to 10 days of treatment with 40 mg of oral prednisone once daily or identical-appearing placebo . All patients received oral antibiotics for 10 days , plus inhaled bronchodilators . The primary end point was relapse , defined as an unscheduled visit to a physician 's office or a return to the emergency department because of worsening dyspnea , within 30 days after r and omization . RESULTS The overall rate of relapse at 30 days was lower in the prednisone group than in the placebo group ( 27 percent vs. 43 percent , P=0.05 ) , and the time to relapse was prolonged in those taking prednisone ( P=0.04 ) . After 10 days of therapy , patients in the prednisone group had greater improvements in forced expiratory volume in one second than did patients in the placebo group ( mean [ + /-SD ] increase from base line , 34+/-42 percent vs. 15+/-31 percent ; P=0.007 ) . Patients in the prednisone group also had significant improvements in dyspnea , as measured by the transitional dyspnea index ( P=0.04 ) and by the dyspnea domain of the Chronic Respiratory Disease Index Question naire ( P=0.02 ) , but not in health-related quality of life ( P=0.14 ) . CONCLUSIONS Outpatient treatment with oral prednisone offers a small advantage over placebo in treating patients who are discharged from the emergency department with an exacerbation of 
    Output:
    