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 Studies of the use of anti-inflammatory asthma therapy have been limited to selected population s or have been unable to assess the appropriateness of therapy for individuals . OBJECTIVE We sought to describe the current use of asthma medication in the United States population and to examine the influence of symptoms and sociodemographics on medication use . METHODS This study was based on a cross-sectional , national , r and om-digit-dial household telephone survey in 1998 design ed to identify adult patients and parents of children with current asthma . Respondents were classified as having current asthma if they had a physician 's diagnosis of asthma and were either taking medication for asthma or had asthma symptoms during the past year . RESULTS One or more persons met the study criteria for current asthma in 3273 ( 7.8 % ) households in which a screening question naire was completed . Of these , 2509 persons ( 721 children < 16 years ) with current asthma were interviewed . Current use of anti-inflammatory medication  was reported by 507 ( 20.1 % ) . Of these , most were using  inhaled corticosteroids  ( 72.5 % ) , with use of antileukotrienes reported by 11.4 % and use of cromolyn-nedocromil reported by 18.6 % . Of persons with persistent asthma symptoms in the past month , 26.2 % reported current use of some form of anti-inflammatory medication .  In bivariate analysis persons reporting lower income , less education , and present unemployment , as well as smokers , were significantly ( P < .001 ) less likely to report current anti-inflammatory use than were other population s. In a multiple regression model nonsmokers and those of white , non-Hispanic ethnicity , as well as persons reporting less asthma control , were more likely to report current anti-inflammatory medication use . CONCLUSION In the United States use of appropriate asthma therapy remains inadequate . Strategies to increase use of anti-inflammatory therapy  among patients with asthma are needed . These might include methods to increase access to asthma care for minorities and the socioeconomically disadvantaged Although the inhalation of beta2-agonists has frequently been used to relieve acute asthma attacks , the efficacy of anticholinergic agents for acute asthma attacks still remains unclear . This study was design ed to compare the inhalation of fenoterol and the inhalation of fenoterol plus oxitropium bromide delivered by a metered-dose inhaler with holding chamber ( InspirEase ) to relieve acute asthma attacks . To accomplish this , 69 patients who had presented with an acute asthma attack were r and omized to receive either fenoterol ( 1 puff [ 200 microg/puff ] every 1 min for 5 min ; total 1000 microg ) or fenoterol plus oxitropium bromide ( 2 puffs [ 100 microg/puff ] every 1 min for 5 min ; total 1000 microg ) . The peak expiratory flow ( PEF ) and forced expiratory volume in 1 sec ( FEV1 ) values were measured before treatment , and 1 , 15 , 30 , and 60 min after the inhalation therapy . The ratios of improvement , PEF ( or FEV1 ) after treatment divided by PEF ( or FEV1 ) before treatment , were also calculated . Thirty-three patients were evaluated in the combination group and 31 patients were evaluated in the  fenoterol group . The PEF value at 60 min after inhalation therapy of the fenoterol plus oxitropium bromide group ( 261 + /- 18 L/min , mean + /- st and ard error ) was significantly higher compared to that of the fenoterol group ( 210 + /- 17 L/min ) . In addition , the ratios of improvement of PEF at 1 , 15 , 30 , and 60 min after inhalation therapy were significantly higher in the fenoterol plus oxitropium bromide group compared with the fenoterol group 103 patients with acute airflow obstruction ( 56 asthma , 47 chronic obstructive pulmonary disease [ COPD ] ) completed a double-blind trial of nebulised bronchodilator treatment in a hospital accident and emergency department . Each patient was r and omised to receive either 10 mg of salbutamol nebuliser solution in 2 ml of saline or 10 mg of salbutamol in 2 ml ( 0.5 mg ) of preservative-free ipratropium bromide .  Peak flow rate ( PFR ) was recorded before treatment and 1 hour after beginning nebulised treatment . In 23 asthmatic patients given salbutamol alone PFR rose by a mean 31 % 1 hour after treatment whereas in 33 such patients given combined treatment it rose by a mean 77 % ( 95 % confidence interval for the difference 8 - 84 % ) . Patients whose PFR was below 140 l/min at entry gained maximum benefit from the combined treatment . For COPD patients the PFR rise was almost identical for both treatments . In acute asthma the immediate PFR response to a mixture of salbutamol and ipratropium bromide was better than the response to nebulised salbutamol alone . For COPD patients , the two treatments were of equal benefit Combinations of beta-stimulant and anticholinergic drugs have been advocated as a potentially useful tool in the treatment of  reversible airway obstruction .  We investigated the effectiveness and safety of a metered aerosol preparation delivering fenoterol 100 micrograms and ipratropium bromide 40 micrograms per puff : two dosages ( 2 puffs and 4 puffs ) were used in 16 asthmatic patients , and their acute effects ( up to 420 min ) were investigated in a double-blind r and omized trial . The results point out a reasonably good response to both dosages , with no notable difference between them as far as vital capacity , FEV 1 , MMEF and Vmax75 are concerned . This finding indicates the possibility of achieving a satisfactory bronchodilation at beta-stimulant dosages far lower than the st and ard ones commonly used and therefore minimizing the risk of untoward cardiovascular effects OBJECTIVE To assess the effect on FEV1 and clinical outcomes of adding ipratropium bromide to salbutamol in the treatment of acute asthma . METHODS We conducted a pooled analysis of three r and omized double-blinded clinical trials conducted in the United States , Canada , and New Zeal and . The studies enrolled 1,064 patients aged 18 to 55 years who presented at the emergency department with acute asthma . Patients were r and omized to treatment with a combination of nebulized 2.5 mg salbutamol plus 0.5 mg ipratropium bromide , or 2.5 mg salbutamol alone .  Medications were administered at baseline and , in the US study , at 45 min . FEV1 was measured at baseline , 45 min , and 90 min . Patients were followed up for 48 h after hospital discharge for occurrence of asthma exacerbation and hospitalization . RESULTS Treatment groups were comparable at baseline . Of the 1,064 patients r and omized , 1,015 patients ( 95 % ) remained in the study for measurement at 45 min , and 961 patients ( 90 % ) completed the final measurement at 90 min . Comparison of overall improvement in FEV1 at 45 min indicated a better response for patients receiving combination therapy ( mean difference=43 mL , 95 % confidence interval [CI]=-20 , 107 ) . The distribution of change in FEV1 was skewed by a small number of patients with extreme values ( 38 of 1,064=3.6 % ) that may have been due to unreliable lung function testing . Removing these outliers produced a larger and more precise estimate of effect ( mean difference=55 mL , 95 % CI=2,107 ) . Because the distribution was skewed , we performed nonparametric analyses that showed evidence of a beneficial effect of combination therapy . The difference between median values at 45 min is 40 mL ( Wilcoxon p value=0.03 ) . In addition , 4.9 % ( 95 % CI=-1 % , 11 % ) more patients in the combination group achieved at least 20 % of their potential improvement , as measured by the difference between their baseline FEV1 and their predicted FEV1 . Patients receiving combination therapy had lower risk for each of three clinical outcomes : the need for additional treatment ( relative risk [RR]=0.92 , 95 % CI=0.84 , 1.0 ) , risk of asthma exacerbation ( RR=0.84 , 95 % CI=0.67 , 1.04 ) , and risk of hospitalization ( RR=0.80 , 95 % CI=0.61 , 1.06 ) . CONCLUSION Adding ipratropium bromide to salbutamol in the treatment of acute asthma produces a small improvement in lung function , and reduces the risk of the need for additional treatment , subsequent asthma exacerbations , and hospitalizations . These apparent benefits of adding ipratropium bromide were independent of the amount of beta-agonist that had been used earlier in the attack , and possibly related to a recent upper respiratory tract infection . Confirmatory studies are needed , especially for clinical outcomes OBJECTIVE To compare the outcome of patients with acute bronchospasm treated with continuously nebulized albuterol plus ipratropium bromide vs albuterol alone . SETTING The Emergency Department ( ED ) at the University of California San Francisco Medical Center . PARTICIPANTS Patients > or = 18 years old presenting to the ED with acute bronchospasm and a peak expiratory flow rate ( PEFR ) of < 70 % predicted . INTERVENTIONS This was a prospect i ve , r and omized , double-blind , placebo-controlled trial . Subjects were treated with either a combination of albuterol ( 10 mg/h ) plus ipratropium bromide ( 1.0 mg/h ) or albuterol alone via continuous nebulization for a maximum of 3 h. Vital signs , Borg dyspnea score , and PEFR were recorded hourly . Primary outcome measures were improvement in PEFR , hospital admission rates , and length of stay in the ED . MEASUREMENTS AND RESULTS Data was analyzed for 67 subjects . The mean age ( -/+ SD ) was 47.5+/-18.8 , and mean initial PEFR was 44.8+/-12.5 % of predicted . The median length of stay for all subjects was 225 min , and 31 % of all subjects were admitted . Patients given combination therapy averaged 6.3 % greater improvement in PEFR compared with control subjects ( 95 % confidence interval [ CI ] , -15 % to 27 % . The odds ratio for admission with combination therapy was 0.88 ( 95 % CI , 0.28 to 2.8 ) . The median length of stay in the ED was 35 min shorter for those receiving combination treatment ( 210 vs 245 min ; p = 0.03 ) . However , when adjusted for initial PEFR , there was no statistically significant difference ( p = 0.26 ) . CONCLUSION Although the direction of all three outcome measures favored combination therapy , there was no statistically significant difference between ED patients with acute bronchospasm receiving continuous albuterol plus ipratropium bromide and those receiving albuterol alone The efficacy of ipratropium and salbutamol was determined in 117 patients with acute asthma who presented to an emergency department to determine whether the order of administration of the two agents affects the improvement in peak flow rates . Patients were given two nebulized treatments at an interval of one hour in a r and omized , double-blind design . They received either 5 mg nebulized salbutamol followed by 0.5 mg ipratropium , ipratropium followed by salbutamol , or both drugs administered together followed by nebulized saline . Ipratropium was an effective bronchodilator when given as the first agent . Simultaneous administration with salbutamol was as effective as sequential administration . At one hour after treatment , there was no difference in peak flow between the combination of drugs and either drug given alone . Ipratropium given after salbutamol was not superior to saline solution given after the combination of drugs . Our data do not suggest a substantial therapeutic effect from addition of ipratropium to salbutamol in the immediate treatment of acute asthma In this study , the perceptions of asthmatics to change in their disease was associated with observed changes in clinical asthma measures , in order to identify the threshold where changes in clinical asthma measures are perceivable by patients . The study included 281 asthmatic patients , aged 18 - 63 yrs , in a r and omized , placebo-controlled clinical trial of a leukotriene antagonist .  Changes were related in : 1 ) asthma symptom scores ; 2 ) inhaled beta-agonist use ; 3 ) forced expiratory volume in one second ( FEV1 ) ; and 4 ) peak expiratory flow ( PEF ) to a global question that queried overall change in asthma since starting the study drug . Additional analyses examined differences in the group reporting minimal improvement by treatment ( active treatment versus placebo ) , sex and age groups . The average minimal patient perceivable improvement for each measure was : 1 ) -0.31 points for the symptom score on a scale of 0 - 6 ; 2 ) -0.81 puffs x day(-1 ) for inhaled beta-agonist use ; 3 )  
    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 Studies of the use of anti-inflammatory asthma therapy have been limited to selected population s or have been unable to assess the appropriateness of therapy for individuals . OBJECTIVE We sought to describe the current use of asthma medication in the United States population and to examine the influence of symptoms and sociodemographics on medication use . METHODS This study was based on a cross-sectional , national , r and om-digit-dial household telephone survey in 1998 design ed to identify adult patients and parents of children with current asthma . Respondents were classified as having current asthma if they had a physician 's diagnosis of asthma and were either taking medication for asthma or had asthma symptoms during the past year . RESULTS One or more persons met the study criteria for current asthma in 3273 ( 7.8 % ) households in which a screening question naire was completed . Of these , 2509 persons ( 721 children < 16 years ) with current asthma were interviewed . Current use of anti-inflammatory medication  was reported by 507 ( 20.1 % ) . Of these , most were using  inhaled corticosteroids  ( 72.5 % ) , with use of antileukotrienes reported by 11.4 % and use of cromolyn-nedocromil reported by 18.6 % . Of persons with persistent asthma symptoms in the past month , 26.2 % reported current use of some form of anti-inflammatory medication .  In bivariate analysis persons reporting lower income , less education , and present unemployment , as well as smokers , were significantly ( P < .001 ) less likely to report current anti-inflammatory use than were other population s. In a multiple regression model nonsmokers and those of white , non-Hispanic ethnicity , as well as persons reporting less asthma control , were more likely to report current anti-inflammatory medication use . CONCLUSION In the United States use of appropriate asthma therapy remains inadequate . Strategies to increase use of anti-inflammatory therapy  among patients with asthma are needed . These might include methods to increase access to asthma care for minorities and the socioeconomically disadvantaged Although the inhalation of beta2-agonists has frequently been used to relieve acute asthma attacks , the efficacy of anticholinergic agents for acute asthma attacks still remains unclear . This study was design ed to compare the inhalation of fenoterol and the inhalation of fenoterol plus oxitropium bromide delivered by a metered-dose inhaler with holding chamber ( InspirEase ) to relieve acute asthma attacks . To accomplish this , 69 patients who had presented with an acute asthma attack were r and omized to receive either fenoterol ( 1 puff [ 200 microg/puff ] every 1 min for 5 min ; total 1000 microg ) or fenoterol plus oxitropium bromide ( 2 puffs [ 100 microg/puff ] every 1 min for 5 min ; total 1000 microg ) . The peak expiratory flow ( PEF ) and forced expiratory volume in 1 sec ( FEV1 ) values were measured before treatment , and 1 , 15 , 30 , and 60 min after the inhalation therapy . The ratios of improvement , PEF ( or FEV1 ) after treatment divided by PEF ( or FEV1 ) before treatment , were also calculated . Thirty-three patients were evaluated in the combination group and 31 patients were evaluated in the  fenoterol group . The PEF value at 60 min after inhalation therapy of the fenoterol plus oxitropium bromide group ( 261 + /- 18 L/min , mean + /- st and ard error ) was significantly higher compared to that of the fenoterol group ( 210 + /- 17 L/min ) . In addition , the ratios of improvement of PEF at 1 , 15 , 30 , and 60 min after inhalation therapy were significantly higher in the fenoterol plus oxitropium bromide group compared with the fenoterol group 103 patients with acute airflow obstruction ( 56 asthma , 47 chronic obstructive pulmonary disease [ COPD ] ) completed a double-blind trial of nebulised bronchodilator treatment in a hospital accident and emergency department . Each patient was r and omised to receive either 10 mg of salbutamol nebuliser solution in 2 ml of saline or 10 mg of salbutamol in 2 ml ( 0.5 mg ) of preservative-free ipratropium bromide .  Peak flow rate ( PFR ) was recorded before treatment and 1 hour after beginning nebulised treatment . In 23 asthmatic patients given salbutamol alone PFR rose by a mean 31 % 1 hour after treatment whereas in 33 such patients given combined treatment it rose by a mean 77 % ( 95 % confidence interval for the difference 8 - 84 % ) . Patients whose PFR was below 140 l/min at entry gained maximum benefit from the combined treatment . For COPD patients the PFR rise was almost identical for both treatments . In acute asthma the immediate PFR response to a mixture of salbutamol and ipratropium bromide was better than the response to nebulised salbutamol alone . For COPD patients , the two treatments were of equal benefit Combinations of beta-stimulant and anticholinergic drugs have been advocated as a potentially useful tool in the treatment of  reversible airway obstruction .  We investigated the effectiveness and safety of a metered aerosol preparation delivering fenoterol 100 micrograms and ipratropium bromide 40 micrograms per puff : two dosages ( 2 puffs and 4 puffs ) were used in 16 asthmatic patients , and their acute effects ( up to 420 min ) were investigated in a double-blind r and omized trial . The results point out a reasonably good response to both dosages , with no notable difference between them as far as vital capacity , FEV 1 , MMEF and Vmax75 are concerned . This finding indicates the possibility of achieving a satisfactory bronchodilation at beta-stimulant dosages far lower than the st and ard ones commonly used and therefore minimizing the risk of untoward cardiovascular effects OBJECTIVE To assess the effect on FEV1 and clinical outcomes of adding ipratropium bromide to salbutamol in the treatment of acute asthma . METHODS We conducted a pooled analysis of three r and omized double-blinded clinical trials conducted in the United States , Canada , and New Zeal and . The studies enrolled 1,064 patients aged 18 to 55 years who presented at the emergency department with acute asthma . Patients were r and omized to treatment with a combination of nebulized 2.5 mg salbutamol plus 0.5 mg ipratropium bromide , or 2.5 mg salbutamol alone .  Medications were administered at baseline and , in the US study , at 45 min . FEV1 was measured at baseline , 45 min , and 90 min . Patients were followed up for 48 h after hospital discharge for occurrence of asthma exacerbation and hospitalization . RESULTS Treatment groups were comparable at baseline . Of the 1,064 patients r and omized , 1,015 patients ( 95 % ) remained in the study for measurement at 45 min , and 961 patients ( 90 % ) completed the final measurement at 90 min . Comparison of overall improvement in FEV1 at 45 min indicated a better response for patients receiving combination therapy ( mean difference=43 mL , 95 % confidence interval [CI]=-20 , 107 ) . The distribution of change in FEV1 was skewed by a small number of patients with extreme values ( 38 of 1,064=3.6 % ) that may have been due to unreliable lung function testing . Removing these outliers produced a larger and more precise estimate of effect ( mean difference=55 mL , 95 % CI=2,107 ) . Because the distribution was skewed , we performed nonparametric analyses that showed evidence of a beneficial effect of combination therapy . The difference between median values at 45 min is 40 mL ( Wilcoxon p value=0.03 ) . In addition , 4.9 % ( 95 % CI=-1 % , 11 % ) more patients in the combination group achieved at least 20 % of their potential improvement , as measured by the difference between their baseline FEV1 and their predicted FEV1 . Patients receiving combination therapy had lower risk for each of three clinical outcomes : the need for additional treatment ( relative risk [RR]=0.92 , 95 % CI=0.84 , 1.0 ) , risk of asthma exacerbation ( RR=0.84 , 95 % CI=0.67 , 1.04 ) , and risk of hospitalization ( RR=0.80 , 95 % CI=0.61 , 1.06 ) . CONCLUSION Adding ipratropium bromide to salbutamol in the treatment of acute asthma produces a small improvement in lung function , and reduces the risk of the need for additional treatment , subsequent asthma exacerbations , and hospitalizations . These apparent benefits of adding ipratropium bromide were independent of the amount of beta-agonist that had been used earlier in the attack , and possibly related to a recent upper respiratory tract infection . Confirmatory studies are needed , especially for clinical outcomes OBJECTIVE To compare the outcome of patients with acute bronchospasm treated with continuously nebulized albuterol plus ipratropium bromide vs albuterol alone . SETTING The Emergency Department ( ED ) at the University of California San Francisco Medical Center . PARTICIPANTS Patients > or = 18 years old presenting to the ED with acute bronchospasm and a peak expiratory flow rate ( PEFR ) of < 70 % predicted . INTERVENTIONS This was a prospect i ve , r and omized , double-blind , placebo-controlled trial . Subjects were treated with either a combination of albuterol ( 10 mg/h ) plus ipratropium bromide ( 1.0 mg/h ) or albuterol alone via continuous nebulization for a maximum of 3 h. Vital signs , Borg dyspnea score , and PEFR were recorded hourly . Primary outcome measures were improvement in PEFR , hospital admission rates , and length of stay in the ED . MEASUREMENTS AND RESULTS Data was analyzed for 67 subjects . The mean age ( -/+ SD ) was 47.5+/-18.8 , and mean initial PEFR was 44.8+/-12.5 % of predicted . The median length of stay for all subjects was 225 min , and 31 % of all subjects were admitted . Patients given combination therapy averaged 6.3 % greater improvement in PEFR compared with control subjects ( 95 % confidence interval [ CI ] , -15 % to 27 % . The odds ratio for admission with combination therapy was 0.88 ( 95 % CI , 0.28 to 2.8 ) . The median length of stay in the ED was 35 min shorter for those receiving combination treatment ( 210 vs 245 min ; p = 0.03 ) . However , when adjusted for initial PEFR , there was no statistically significant difference ( p = 0.26 ) . CONCLUSION Although the direction of all three outcome measures favored combination therapy , there was no statistically significant difference between ED patients with acute bronchospasm receiving continuous albuterol plus ipratropium bromide and those receiving albuterol alone The efficacy of ipratropium and salbutamol was determined in 117 patients with acute asthma who presented to an emergency department to determine whether the order of administration of the two agents affects the improvement in peak flow rates . Patients were given two nebulized treatments at an interval of one hour in a r and omized , double-blind design . They received either 5 mg nebulized salbutamol followed by 0.5 mg ipratropium , ipratropium followed by salbutamol , or both drugs administered together followed by nebulized saline . Ipratropium was an effective bronchodilator when given as the first agent . Simultaneous administration with salbutamol was as effective as sequential administration . At one hour after treatment , there was no difference in peak flow between the combination of drugs and either drug given alone . Ipratropium given after salbutamol was not superior to saline solution given after the combination of drugs . Our data do not suggest a substantial therapeutic effect from addition of ipratropium to salbutamol in the immediate treatment of acute asthma In this study , the perceptions of asthmatics to change in their disease was associated with observed changes in clinical asthma measures , in order to identify the threshold where changes in clinical asthma measures are perceivable by patients . The study included 281 asthmatic patients , aged 18 - 63 yrs , in a r and omized , placebo-controlled clinical trial of a leukotriene antagonist .  Changes were related in : 1 ) asthma symptom scores ; 2 ) inhaled beta-agonist use ; 3 ) forced expiratory volume in one second ( FEV1 ) ; and 4 ) peak expiratory flow ( PEF ) to a global question that queried overall change in asthma since starting the study drug . Additional analyses examined differences in the group reporting minimal improvement by treatment ( active treatment versus placebo ) , sex and age groups . The average minimal patient perceivable improvement for each measure was : 1 ) -0.31 points for the symptom score on a scale of 0 - 6 ; 2 ) -0.81 puffs x day(-1 ) for inhaled beta-agonist use ; 3 )  
    Output:
    