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: Exercise-induced bronchoconstriction was produced in 12 asthmatic patients after a 6 minutes run on a 10 % steep treadmill ergometer . FEV1 decreased by 12 - 73 % ( average 27 % ) of the control value measured before the run . The rather severe exercise-induced bronchoconstriction remained constant for 10 - 20 minutes after the run . 21 minutes after the run two puffs of a bronchodilator ( salbutamol 0.2 mg or pirbuterol 0.4 mg ) were inhaled in an open r and omized cross-over fashion at intervals of 1 to 3 days . Following both bronchodilators FEV1 returned to the control value within 5 minutes . There was no significant difference between the bronchodilating effect of salbutamol versus pirbuterol . Furthermore , no significant differences were observed in pulse rates after inhalation of the two selective beta-2-stimulators . In our trial both pirbuterol and salbutamol seemed to be well tolerated ; side effects were not observed for either drug We aim ed to compare the protective effect of single doses of 4.5 and 9 microg of formoterol fumarate ( F ) , 0.5 mg terbutaline sulphate ( T ) and placebo ( P ) , all via Turbuhaler , against exercise-induced bronchoconstriction ( EIB ) in children . Twenty-seven asthmatic children , showing a fall of > or = 20 % in FEV1 after a st and ardized exercise challenge test ( ECT ) combined with cold air ( -10 degrees C ) inhalation , were r and omized in this cross-over , double-blind study . They had a mean age of 12.6 years ( range 8 - 17 years ) , mean baseline FEV1 90 % ( 73.9 - 105.6 % ) of predicted normal value . Seventeen children used inhaled glucocorticosteroids ( 120 - 750 microg day(-1 ) ) . ECTs were performed 15 min and 4 , 8 , and 12 h after drug administration . F significantly reduced the fall in FEV1 after ECT to 5.4 % ( 15 min ) , 5.2 % ( 4 h ) , 8.2 % ( 8 h ) and 9.3 % ( 12 h ) after 4.5 microg , and 2.5 % , 3.0 % , 5.0 % and 5.4 % after 9 microg , compared with a fall of 18.4 % , 15.7 % , 15.6 % and 16.5 % in FEV1 after P. The fall after T was 3.3 % , 11.6 % , 14.4 % and 19.1 % after 15 min , 4 , 8 and 12 h respectively . The difference between F and T was statistically significant from 4 h and onward ( P-value for all comparisons < 0.05 ) . Children using a single dose of either formoterol Turbuhaler 4.5 or 9 microg had significantly better bronchoprotection against repeated exercise challenge up to 12 h compared with placebo and from 4 h onward compared with terbutaline Turbuhaler 0.5 mg Sixteen patients were included in the analysis of this double-blind crossover study comparing the effect of sodium cromoglycate , reproterol , sodium cromoglycate plus reproterol , and placebo in exercise-induced asthma . Both the sodium cromoglycate and the reproterol-containing treatment significantly inhibited  exercise-induced asthma .  The best protection is effected by the combination of sodium cromoglycate and reproterol . A synergistic effect of both medications could not be confirmed statistically so that their combined effect is simply additive The effect of single-dose inhaled terbutaline , sodium cromo-glycate and budesonide were compared with control in 11 exercise-induced asthma ( EIA ) patients , aged 9 - 14 years . Patients exercise for 6 minutes , 15 minutes after inhaling drugs . The FVC , FEV1 , PEFR and MMEF were recorded before exercise and after exercise at 5 minutes interval up to 25 minutes . After exercise , the mean ( SEM ) maximal percentage fall in FEV1 after placebo , 200 micrograms of terbutaline , 10 mg of sodium cromoglycate , and 100 micrograms of budesonide were 22.81 ( 3.45 ) , 4.05 ( 2.11 ) , 11.29 ( 1.18 ) , and 20.36 ( 2.33 ) respectively . It was concluded that single-dose inhaled terbutaline and sodium cromoglycate result ed in a significant protective effect on exerxide-induced asthma whereas budesonide did not Objective : This study was design ed to demonstrate that four weeks of fluticasone propionate ( FP ) 100 micrograms ( mcg ) combined with salmeterol 50 mcg twice daily ( BID ) via DISKUS ® result ed in protection against bronchospasm induced by activity , as measured by st and ardized exercise challenge testing in pediatric and adolescent subjects who required regular use of inhaled corticosteroids for the treatment of persistent asthma . Methods : Prior to study entry , all patients reported regular use of inhaled corticosteroids ( ICS ) . During screening all patients demonstrated ≥20 % fall in FEV1 following exercise . Results : A total of 231 subjects aged 4 to 17 were r and omized to the two study treatments : 113 to the FP/salmeterol combination group ( FSC ) and 118 to receive FP 100 mcg BID . Of the subjects r and omized , 106 ( 94 % ) subjects in the FSC 100/50 group and 108 ( 92 % ) subjects in the FP 100 group completed the study . At the end of treatment ( Week 4 ) , both FSC and FP  protected against a fall in FEV1 following exercise in patients who at baseline experienced ≥20 % fall in FEV1 following exercise . A mean decrease in FEV1 of 9.9 % was observed in the FSC 100/50 group as compared with a mean decrease of 11.1 % in the FP 100 group ; there was no statistical difference between treatments . Conclusion : Both FSC 100/50 and FP 100 provided protection against an exercised-induced fall in FEV1 ; but statistically significant differences we not noted . Both treatments were well-tolerated over four weeks and FSC 100/50 had an adverse event profile comparable to that observed with FP 100 Forty-nine asymptomatic asthmatic children who showed exercise induced bronchospasm ( EIB ) , received in a r and omized double-blind fashion one of the four following drugs administered through nebulizer and facial mask : salbutamol 4 mg ( 13 patients ) , disodium chromoglycate 20 mg ( 12 patients ) , ipratroprium bromide 0.4 mg ( 12 patients ) , placebo ( 12 patients ) . They performed exercise fifteen minutes after receiving the drugs and spirometries were done 0 , 5 , 10 , 15 and 20 minutes after the end of the exercise . Bronchodilation was noticed 15 minutes after the administration of salbutamol and ipratroprium bromide but not after cromoglycate or placebo . No patient receiving either salbutamol or cromoglycate had EIB whereas it occurred in 50 % of those receiving ipratroprium bromide and 91.6 % of those receiving placebo BACKGROUND Treatment guidelines recommend using an inhaled corticosteroid ( ICS ) plus a long-acting β(2)-agonist ( LABA ) for childhood asthma when the symptoms are not controlled by ICS alone , but the appropriate use of LABAs in children continues to be debated . OBJECTIVE To compare the efficacy of an inhaled salmeterol and fluticasone propionate combination , 50/100 μg twice daily , with fluticasone propionate , 100 μg twice daily , or salmeterol , 50 μg twice daily , in children with multiple-trigger wheeze . METHODS A total of 105 children 4 to 7 years of age with multiple-trigger wheezing based on respiratory symptoms and bronchodilator responsiveness and /or exercise-induced bronchoconstriction without a viral cold were r and omized to salmeterol-fluticasone , fluticasone propionate alone , or salmeterol alone via a metered-dose inhaler and a spacer device for 8 weeks . The primary efficacy outcome was exhaled nitric oxide level . Secondary outcomes were lung function measurements via impulse oscillometry , respiratory symptoms , and rescue medication use . RESULTS The exhaled nitric oxide levels decreased after all treatments , significantly more so after salmeterol-fluticasone and fluticasone than with salmeterol ( adjusted geometric means at 8 weeks : salmeterol-fluticasone , 9.4 ppb ; fluticasone , 9.3 ppb ; salmeterol , 13.9 ppb ; salmeterol-fluticasone vs salmeterol , P = .02 ; fluticasone vs salmeterol , P = .01 ) . No treatment differences were found with respect to respiratory symptoms or median rescue use . Salmeterol-fluticasone result ed in a small but statistically significant improvement in baseline lung function compared with fluticasone . All treatments were equally well tolerated . CONCLUSION The effects of salmeterol-fluticasone and fluticasone were comparable , although lung function improvement was better with salmeterol-fluticasone than with fluticasone alone . There is no obvious benefit in initiation therapy with salmeterol-fluticasone rather than fluticasone alone in the treatment of steroid-naive children with multiple-trigger wheeze . TRIAL REGISTRATION Pathway of clinical trial registry of Helsinki University : http://www.hus.fi/?Path=1;28;2530;9899;9900;23618;23903;33578 STUDY OBJECTIVES To compare pretreatment with albuterol versus montelukast added to the current asthma regimen for protection against exercise-induced bronchospasm in children with mild-to-moderate asthma , and to determine whether cysteinyl leukotriene ( Cys-LT ) concentrations measured in the exhaled breath condensate correlated with response to montelukast . DESIGN Prospect i ve , r and omized , double-blind , double-dummy , crossover study . SETTING Asthma clinic at a university-affiliated medical center . PATIENTS Eleven children aged 7 - 17 years with physician-diagnosed mild-to-moderate asthma for at least 6 months and with self-reported exercise-induced bronchospasm ( defined as > or = 15 % decrease in forced expiratory volume in 1 sec [ FEV(1 ) ] at screening and baseline visit ) . INTERVENTION Patients were r and omly assigned to receive 3 - 7 days of oral montelukast 5 - 10 mg/day or 2 puffs of an albuterol metered-dose inhaler just before an exercise challenge and then were crossed over to the alternate therapy for the last visit . MEASUREMENTS AND MAIN RESULTS Serial spirometry was performed before and at 0 , 5 , 10 , 15 , 30 , 45 , and 60 minutes after the exercise challenge at each visit . Measurement of exhaled breath condensate was performed at the screening visit and study visits 1 and 2 . The primary outcome was the maximum change in FEV(1 ) after exercise . Secondary outcomes were the area under the curve for FEV(1 ) ( expressed as percentage decrease from baseline ) during the first 60 minutes ( AUC(0 - 60 ) ) after exercise and the proportion of patients in whom exercise-induced bronchospasm was prevented ( defined as < 15 % decrease in FEV(1 ) after exercise challenge ) . The mean + /- SD maximum decrease in FEV(1 ) was 27.5 + /- 7.9 % at baseline . Patients receiving montelukast had an 18.3 + /- 13.7 % decrease in FEV(1 ) compared with 0.7 + /- 1.6 % in patients receiving albuterol ( p=0.002 , paired t test ) . Exercise-induced bronchospasm was prevented in 100 % of the patients receiving albuterol compared with 55 % receiving montelukast ( p<0.05 , McNemar 's test ) . The AUC(0 - 60 ) was significantly smaller with albuterol compared with montelukast ( p<0.001 , Wilcoxon signed rank test ) . No correlations were found between Cys-LT concentration and the severity of exercise-induced bronchospasm or the response to montelukast .  CONCLUSION Pretreatment with albuterol is more effective than montelukast for prevention of exercise-induced bronchospasm in children with asthma A number of drugs are known to inhibit exercise-induced asthma ( EIA ) , but the results in some cases have been difficult to interpret due to the techniques employed . A comparative study was carried out in a group of children to investigate the effects of  salbutamol , choline theophyllinate , cromolyn sodium , atropine , and placebo . The exercise test took the form of six minutes of st and ardized treadmill running . All the drugs , but not the placebo , were able to inhibit E 
    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: Exercise-induced bronchoconstriction was produced in 12 asthmatic patients after a 6 minutes run on a 10 % steep treadmill ergometer . FEV1 decreased by 12 - 73 % ( average 27 % ) of the control value measured before the run . The rather severe exercise-induced bronchoconstriction remained constant for 10 - 20 minutes after the run . 21 minutes after the run two puffs of a bronchodilator ( salbutamol 0.2 mg or pirbuterol 0.4 mg ) were inhaled in an open r and omized cross-over fashion at intervals of 1 to 3 days . Following both bronchodilators FEV1 returned to the control value within 5 minutes . There was no significant difference between the bronchodilating effect of salbutamol versus pirbuterol . Furthermore , no significant differences were observed in pulse rates after inhalation of the two selective beta-2-stimulators . In our trial both pirbuterol and salbutamol seemed to be well tolerated ; side effects were not observed for either drug We aim ed to compare the protective effect of single doses of 4.5 and 9 microg of formoterol fumarate ( F ) , 0.5 mg terbutaline sulphate ( T ) and placebo ( P ) , all via Turbuhaler , against exercise-induced bronchoconstriction ( EIB ) in children . Twenty-seven asthmatic children , showing a fall of > or = 20 % in FEV1 after a st and ardized exercise challenge test ( ECT ) combined with cold air ( -10 degrees C ) inhalation , were r and omized in this cross-over , double-blind study . They had a mean age of 12.6 years ( range 8 - 17 years ) , mean baseline FEV1 90 % ( 73.9 - 105.6 % ) of predicted normal value . Seventeen children used inhaled glucocorticosteroids ( 120 - 750 microg day(-1 ) ) . ECTs were performed 15 min and 4 , 8 , and 12 h after drug administration . F significantly reduced the fall in FEV1 after ECT to 5.4 % ( 15 min ) , 5.2 % ( 4 h ) , 8.2 % ( 8 h ) and 9.3 % ( 12 h ) after 4.5 microg , and 2.5 % , 3.0 % , 5.0 % and 5.4 % after 9 microg , compared with a fall of 18.4 % , 15.7 % , 15.6 % and 16.5 % in FEV1 after P. The fall after T was 3.3 % , 11.6 % , 14.4 % and 19.1 % after 15 min , 4 , 8 and 12 h respectively . The difference between F and T was statistically significant from 4 h and onward ( P-value for all comparisons < 0.05 ) . Children using a single dose of either formoterol Turbuhaler 4.5 or 9 microg had significantly better bronchoprotection against repeated exercise challenge up to 12 h compared with placebo and from 4 h onward compared with terbutaline Turbuhaler 0.5 mg Sixteen patients were included in the analysis of this double-blind crossover study comparing the effect of sodium cromoglycate , reproterol , sodium cromoglycate plus reproterol , and placebo in exercise-induced asthma . Both the sodium cromoglycate and the reproterol-containing treatment significantly inhibited  exercise-induced asthma .  The best protection is effected by the combination of sodium cromoglycate and reproterol . A synergistic effect of both medications could not be confirmed statistically so that their combined effect is simply additive The effect of single-dose inhaled terbutaline , sodium cromo-glycate and budesonide were compared with control in 11 exercise-induced asthma ( EIA ) patients , aged 9 - 14 years . Patients exercise for 6 minutes , 15 minutes after inhaling drugs . The FVC , FEV1 , PEFR and MMEF were recorded before exercise and after exercise at 5 minutes interval up to 25 minutes . After exercise , the mean ( SEM ) maximal percentage fall in FEV1 after placebo , 200 micrograms of terbutaline , 10 mg of sodium cromoglycate , and 100 micrograms of budesonide were 22.81 ( 3.45 ) , 4.05 ( 2.11 ) , 11.29 ( 1.18 ) , and 20.36 ( 2.33 ) respectively . It was concluded that single-dose inhaled terbutaline and sodium cromoglycate result ed in a significant protective effect on exerxide-induced asthma whereas budesonide did not Objective : This study was design ed to demonstrate that four weeks of fluticasone propionate ( FP ) 100 micrograms ( mcg ) combined with salmeterol 50 mcg twice daily ( BID ) via DISKUS ® result ed in protection against bronchospasm induced by activity , as measured by st and ardized exercise challenge testing in pediatric and adolescent subjects who required regular use of inhaled corticosteroids for the treatment of persistent asthma . Methods : Prior to study entry , all patients reported regular use of inhaled corticosteroids ( ICS ) . During screening all patients demonstrated ≥20 % fall in FEV1 following exercise . Results : A total of 231 subjects aged 4 to 17 were r and omized to the two study treatments : 113 to the FP/salmeterol combination group ( FSC ) and 118 to receive FP 100 mcg BID . Of the subjects r and omized , 106 ( 94 % ) subjects in the FSC 100/50 group and 108 ( 92 % ) subjects in the FP 100 group completed the study . At the end of treatment ( Week 4 ) , both FSC and FP  protected against a fall in FEV1 following exercise in patients who at baseline experienced ≥20 % fall in FEV1 following exercise . A mean decrease in FEV1 of 9.9 % was observed in the FSC 100/50 group as compared with a mean decrease of 11.1 % in the FP 100 group ; there was no statistical difference between treatments . Conclusion : Both FSC 100/50 and FP 100 provided protection against an exercised-induced fall in FEV1 ; but statistically significant differences we not noted . Both treatments were well-tolerated over four weeks and FSC 100/50 had an adverse event profile comparable to that observed with FP 100 Forty-nine asymptomatic asthmatic children who showed exercise induced bronchospasm ( EIB ) , received in a r and omized double-blind fashion one of the four following drugs administered through nebulizer and facial mask : salbutamol 4 mg ( 13 patients ) , disodium chromoglycate 20 mg ( 12 patients ) , ipratroprium bromide 0.4 mg ( 12 patients ) , placebo ( 12 patients ) . They performed exercise fifteen minutes after receiving the drugs and spirometries were done 0 , 5 , 10 , 15 and 20 minutes after the end of the exercise . Bronchodilation was noticed 15 minutes after the administration of salbutamol and ipratroprium bromide but not after cromoglycate or placebo . No patient receiving either salbutamol or cromoglycate had EIB whereas it occurred in 50 % of those receiving ipratroprium bromide and 91.6 % of those receiving placebo BACKGROUND Treatment guidelines recommend using an inhaled corticosteroid ( ICS ) plus a long-acting β(2)-agonist ( LABA ) for childhood asthma when the symptoms are not controlled by ICS alone , but the appropriate use of LABAs in children continues to be debated . OBJECTIVE To compare the efficacy of an inhaled salmeterol and fluticasone propionate combination , 50/100 μg twice daily , with fluticasone propionate , 100 μg twice daily , or salmeterol , 50 μg twice daily , in children with multiple-trigger wheeze . METHODS A total of 105 children 4 to 7 years of age with multiple-trigger wheezing based on respiratory symptoms and bronchodilator responsiveness and /or exercise-induced bronchoconstriction without a viral cold were r and omized to salmeterol-fluticasone , fluticasone propionate alone , or salmeterol alone via a metered-dose inhaler and a spacer device for 8 weeks . The primary efficacy outcome was exhaled nitric oxide level . Secondary outcomes were lung function measurements via impulse oscillometry , respiratory symptoms , and rescue medication use . RESULTS The exhaled nitric oxide levels decreased after all treatments , significantly more so after salmeterol-fluticasone and fluticasone than with salmeterol ( adjusted geometric means at 8 weeks : salmeterol-fluticasone , 9.4 ppb ; fluticasone , 9.3 ppb ; salmeterol , 13.9 ppb ; salmeterol-fluticasone vs salmeterol , P = .02 ; fluticasone vs salmeterol , P = .01 ) . No treatment differences were found with respect to respiratory symptoms or median rescue use . Salmeterol-fluticasone result ed in a small but statistically significant improvement in baseline lung function compared with fluticasone . All treatments were equally well tolerated . CONCLUSION The effects of salmeterol-fluticasone and fluticasone were comparable , although lung function improvement was better with salmeterol-fluticasone than with fluticasone alone . There is no obvious benefit in initiation therapy with salmeterol-fluticasone rather than fluticasone alone in the treatment of steroid-naive children with multiple-trigger wheeze . TRIAL REGISTRATION Pathway of clinical trial registry of Helsinki University : http://www.hus.fi/?Path=1;28;2530;9899;9900;23618;23903;33578 STUDY OBJECTIVES To compare pretreatment with albuterol versus montelukast added to the current asthma regimen for protection against exercise-induced bronchospasm in children with mild-to-moderate asthma , and to determine whether cysteinyl leukotriene ( Cys-LT ) concentrations measured in the exhaled breath condensate correlated with response to montelukast . DESIGN Prospect i ve , r and omized , double-blind , double-dummy , crossover study . SETTING Asthma clinic at a university-affiliated medical center . PATIENTS Eleven children aged 7 - 17 years with physician-diagnosed mild-to-moderate asthma for at least 6 months and with self-reported exercise-induced bronchospasm ( defined as > or = 15 % decrease in forced expiratory volume in 1 sec [ FEV(1 ) ] at screening and baseline visit ) . INTERVENTION Patients were r and omly assigned to receive 3 - 7 days of oral montelukast 5 - 10 mg/day or 2 puffs of an albuterol metered-dose inhaler just before an exercise challenge and then were crossed over to the alternate therapy for the last visit . MEASUREMENTS AND MAIN RESULTS Serial spirometry was performed before and at 0 , 5 , 10 , 15 , 30 , 45 , and 60 minutes after the exercise challenge at each visit . Measurement of exhaled breath condensate was performed at the screening visit and study visits 1 and 2 . The primary outcome was the maximum change in FEV(1 ) after exercise . Secondary outcomes were the area under the curve for FEV(1 ) ( expressed as percentage decrease from baseline ) during the first 60 minutes ( AUC(0 - 60 ) ) after exercise and the proportion of patients in whom exercise-induced bronchospasm was prevented ( defined as < 15 % decrease in FEV(1 ) after exercise challenge ) . The mean + /- SD maximum decrease in FEV(1 ) was 27.5 + /- 7.9 % at baseline . Patients receiving montelukast had an 18.3 + /- 13.7 % decrease in FEV(1 ) compared with 0.7 + /- 1.6 % in patients receiving albuterol ( p=0.002 , paired t test ) . Exercise-induced bronchospasm was prevented in 100 % of the patients receiving albuterol compared with 55 % receiving montelukast ( p<0.05 , McNemar 's test ) . The AUC(0 - 60 ) was significantly smaller with albuterol compared with montelukast ( p<0.001 , Wilcoxon signed rank test ) . No correlations were found between Cys-LT concentration and the severity of exercise-induced bronchospasm or the response to montelukast .  CONCLUSION Pretreatment with albuterol is more effective than montelukast for prevention of exercise-induced bronchospasm in children with asthma A number of drugs are known to inhibit exercise-induced asthma ( EIA ) , but the results in some cases have been difficult to interpret due to the techniques employed . A comparative study was carried out in a group of children to investigate the effects of  salbutamol , choline theophyllinate , cromolyn sodium , atropine , and placebo . The exercise test took the form of six minutes of st and ardized treadmill running . All the drugs , but not the placebo , were able to inhibit E 
    Output:
    