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: Summary Background Bacteria and viruses are equally associated with the risk of acute episodes of asthma-like symptoms in young children , suggesting antibiotics as a potential treatment for such episodes . We aim ed to assess the effect of azithromycin on the duration of respiratory episodes in young children with recurrent asthma-like symptoms , hypothesising that it reduces the duration of the symptomatic period . Methods In this r and omised , double-blind , placebo-controlled trial , we recruited children aged 1–3 years , who were diagnosed with recurrent asthma-like symptoms from the Copenhagen Prospect i ve Studies on Asthma in Childhood 2010 cohort ; a birth cohort consisting of the general Danish population of Zeal and , including Copenhagen . Exclusion criteria were macrolide allergy , heart , liver , neurological , and kidney disease , and , before each treatment , one or more clinical signs of pneumonia ( respiratory frequency of ≥50 breaths per min ; fever of ≥39 ° C ; C-reactive protein concentration of ≥476·20 nmol/L [ ≥50 mg/L ] ) . Each episode of asthma-like symptoms lasting at least 3 days was r and omly allocated to a 3-day course of azithromycin oral solution of 10 mg/kg per day or placebo after thorough examination by a study physician at the Copenhagen Prospect i ve Studies on Asthma research unit . Each episode was r and omly allocated independently of previous treatment from a computer-generated list of r and om numbers in blocks of ten ( generated at the Pharmacy of Glostrup ) . Investigators and children were masked until the youngest child turned 3 years of age and throughout the data validation and analysis phases . The primary outcome was duration of the respiratory episode after treatment , verified by prospect i ve daily diaries and analysed with Poisson regression . Analyses were per protocol ( excluding those without a primary outcome measure or who did not receive treatment ) . This trial is registered with Clinical Trials.gov , number NCT01233297 . Findings Between Nov 17 , 2010 , and Jan 28 , 2014 , we r and omly allocated 158 asthma-like episodes in 72 children ( 79 [ 50 % ] to azithromycin and 79 [ 50 % ] to placebo  ) . The mean duration of the episode after treatment was 3·4 days for children receiving azithromycin compared with 7·7 days for children receiving  placebo . Azithromycin  caused a significant shortening of the episode of 63·3 % ( 95 % CI 56·0–69·3 ; p<0·0001 ) . The effect size increased with early initiation of treatment , showing a reduction in episode duration of 83 % if treatment was initiated before day 6 of the episode compared with 36 % if initiated on or after day 6 ( p<0·0001 ) . We noted no differences in clinical adverse events between the azithromycin ( 18 [ 23 % ] of 78 episodes included in final analysis ) and placebo ( 24 [ 30 % ] of 79 ) groups ( p=0·30 ) , but we did not investigate bacterial resistance patterns after treatment . Interpretation Azithromycin reduced the duration of episodes of asthma-like symptoms in young children , suggesting that this drug could have a role in acute management of exacerbations . Further research is needed to disentangle the inflammatory versus antimicrobial aspects of this relation . Funding Lundbeck Foundation , Danish Ministry of Health , Danish Council for Strategic Research , Capital Region Research Foundation Introduction Patients with severe acute exacerbations of asthma often receive inappropriate antibiotic treatment . We aim ed to determine whether serum procalcitonin ( PCT ) levels can effectively and safely reduce antibiotic exposure in patients experiencing exacerbations of asthma . Methods In this r and omized controlled trial , a total of 216 patients requiring hospitalization for severe acute exacerbations of asthma were screened for eligibility to participate and 169 completed the 12-month follow-up visit . Patients were r and omized to either PCT-guided ( PCT group ) or st and ard ( control group ) antimicrobial therapy . In the control group , patients received antibiotics according to the attending physician ’s discretion ; in the PCT group , patients received antibiotics according to an algorithm based on serum PCT levels . The primary end point was antibiotic exposure ; secondary end points were clinical recovery , length of hospital stay , clinical and laboratory parameters , spirometry , number of asthma exacerbations , emergency room visits , hospitalizations and need for corticosteroid use due to asthma . Results PCT guidance reduced antibiotic prescription ( 48.9 % versus 87.8 % , respectively ; P < 0.001 ) and antibiotic exposure ( relative risk , 0.56 ; 95 % confidence interval , 0.44 to 0.70 ; P < 0.001 ) compared to st and ard therapy . There were no significant differences in clinical recovery , length of hospital stay or clinical , laboratory and spirometry outcomes in both groups . Number of asthma exacerbations , emergency room visits , hospitalizations and need for corticosteroid use due to asthma were similar during the 12-month follow-up period . Conclusion A PCT-guided strategy allows antibiotic exposure to be reduced in patients with severe acute exacerbation of asthma without apparent harm . Trial registration Chinese Clinical Trial Register ChiCTR-TRC-12002534 ( registered 26 September 2012 Background : Antibiotic overuse in respiratory illness is common and is associated with drug resistance and hospital-acquired infection . Biomarkers that can identify bacterial infections may reduce antibiotic prescription . We aim ed to compare the usefulness of the biomarkers procalcitonin and C-reactive protein ( CRP ) in patients with pneumonia or exacerbations of asthma or COPD . Methods : Patients with a diagnosis of community-acquired pneumonia or exacerbation of asthma or COPD were recruited during the winter months of 2006 to 2008 . Demographics , clinical data , and blood sample s were collected .  Procalcitonin and CRP concentrations were measured from available sera . Results : Sixty-two patients with pneumonia , 96 with asthma , and 161 with COPD were studied .  Serum procalcitonin and CRP concentrations were strongly correlated ( Spearman rank correlation coefficient [ rs ] = 0.56 , P < .001 ) . Patients with pneumonia had increased procalcitonin and CRP levels ( median [ interquartile range ] 1.27 ng/mL [ 2.36 ] , 191 mg/L [ 159 ] ) compared with those with asthma ( 0.03 ng/mL [ 0.04 ] , 9 mg/L [ 21 ] ) and COPD ( 0.05 ng/mL [ 0.06 ] , 16 mg/L [ 34 ] ) . The area under the receiver operating characteristic curve ( 95 % CI ) for distinguishing between patients with pneumonia ( antibiotics required ) and exacerbations of asthma ( antibiotics not required ) , for procalcitonin and CRP was 0.93 ( 0.88 - 0.98 ) and 0.96 ( 0.93 - 1.00 ) . A CRP value > 48 mg/L had a sensitivity of 91 % ( 95 % CI , 80%-97 % ) and specificity of 93 % ( 95 % CI , 86%-98 % ) for identifying patients with pneumonia . Conclusions : Procalcitonin and CRP levels can both independently distinguish pneumonia from exacerbations of asthma . CRP levels could be used to guide antibiotic therapy and reduce antibiotic overuse in hospitalized patients with acute respiratory illness BACKGROUND Clarithromycin is postulated to possess immunomodulatory properties in addition to its antimicrobial activity . OBJECTIVE To evaluate the effect of clarithromycin on serum and nasopharyngeal cytokine and chemokine concentrations in children with an acute exacerbation of recurrent wheezing . METHODS Children with a history of recurrent wheezing or asthma and who presented with an acute exacerbation of wheezing were enrolled in a double-blind , r and omized trial of clarithromycin vs placebo . Concentrations of tumor necrosis factor alpha ( TNF-alpha ) , interferon-gamma ( IFN-gamma ) , interleukin-1beta ( IL-1beta ) , IL-2 , IL-4 , IL-5 , IL-6 , IL-8 , IL-10 , granulocyte-macrophage colony-stimulating factor , RANTES , eotaxin , macrophage inflammatory protein 1alpha , macrophage inflammatory protein 1beta , and monocyte chemoattractant protein 1 were measured in serum and /or nasopharyngeal aspirates before , during , and after therapy . Mycoplasma pneumoniae and Chlamydophila pneumoniae infection were evaluated for by polymerase chain reaction and serologic testing . RESULTS Nasopharyngeal concentrations of TNF-alpha , IL-1beta , and IL-10 were significantly and persistently lower in children treated with clarithromycin compared with placebo . There tended to be a greater effect of clarithromycin on nasopharyngeal cytokine concentrations in patients with evidence of M. pneumoniae or C. pneumoniae infection . No significant differences were detected in serum cytokines for children treated with clarithromycin compared with placebo . CONCLUSION Clarithromycin therapy reduces mucosal TNF-alpha , IL-1beta , and IL-10 concentrations in children with an acute exacerbation of recurrent wheezing Background This r and omized controlled trial aim ed to evaluate whether the serum procalcitonin  ( PCT ) level can be utilized to guide the use of antibiotics in the treatment of acute exacerbations of asthma . Methods A total of 293 consecutive patients with suspected asthma attacks from February 2005 to July 2010 participated in this study . 225 patients completed the study . Serum PCT levels , and other inflammatory biomarkers of all patients were measured . In addition to the st and ard treatment , the control group received antibiotics according to the attending physicians ’ discretions , while the patients in the PCT group were treated with antibiotics according to serum PCT concentrations . Antibiotics usage was strongly discouraged when the PCT concentration was below 0.1 μg/L ; discouraged when the PCT concentration was between 0.1 μg/L and 0.25 μg/L ; or encouraged when the PCT concentration was above 0.25 μg/L. The primary endpoint was the determination of antibiotics usage . The second endpoints included the diagnostic accuracy of PCT and other laboratory biomarkers the effectiveness of asthma control , secondary ED visits , hospital re-admissions , repeated needs for steroids or dosage increase , needs for antibiotics , WBC count , PCT levels and FEV1 % . Results At baseline , two groups were identical regarding clinical , laboratory and symptom score . Probability of  the antibiotics usage in the PCT group ( 46.1 % ) was lower than that in the control group ( 74.8 % ) ( χ2 = 21.97 , p < 0.001 . RR = 0.561 , 95 % CI 0.441 - 0.713 ) . PCT and IL-6 showed good diagnostic significance for bacterial asthma ( r = 0.705 , p = 0.003 ) . The degrees of asthma control in patients were categorized to three levels and were comparable between the two groups at the six weeks follow-up period ( χ2 = 1.62 , p = 0.45 ) . There were no significant difference regarding other secondary outcomes ( p > 0.05 ) . Conclusions The serum PCT concentration can be used to effectively determine whether the acute asthma patients have bacterial infections in the respiratory tract , and to guide the use of antibiotics in the treatment of acute asthma exacerbations , which may substantially reduce unnecessary antibiotic use without compromising the therapeutic outcomes .Trial registration The dosage of 1:1,000 aqueous epinephrine is incorrectly given in the article by Shapiro et al. in the June issue ( Pediatrics , 53:867 , 1974 ) . The cor- rect dosage is 0.01 cc/kilo instead of 0.1 cc/kilo as given . The patient9s serum IgE level in the article by Albrecht et al. in the June issue ( Pediatrics , 53:907 , 1974 ) is incorrect . It should be given as 205 nanograms per milliliter instead of 205 mg/ml 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 ) 
    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: Summary Background Bacteria and viruses are equally associated with the risk of acute episodes of asthma-like symptoms in young children , suggesting antibiotics as a potential treatment for such episodes . We aim ed to assess the effect of azithromycin on the duration of respiratory episodes in young children with recurrent asthma-like symptoms , hypothesising that it reduces the duration of the symptomatic period . Methods In this r and omised , double-blind , placebo-controlled trial , we recruited children aged 1–3 years , who were diagnosed with recurrent asthma-like symptoms from the Copenhagen Prospect i ve Studies on Asthma in Childhood 2010 cohort ; a birth cohort consisting of the general Danish population of Zeal and , including Copenhagen . Exclusion criteria were macrolide allergy , heart , liver , neurological , and kidney disease , and , before each treatment , one or more clinical signs of pneumonia ( respiratory frequency of ≥50 breaths per min ; fever of ≥39 ° C ; C-reactive protein concentration of ≥476·20 nmol/L [ ≥50 mg/L ] ) . Each episode of asthma-like symptoms lasting at least 3 days was r and omly allocated to a 3-day course of azithromycin oral solution of 10 mg/kg per day or placebo after thorough examination by a study physician at the Copenhagen Prospect i ve Studies on Asthma research unit . Each episode was r and omly allocated independently of previous treatment from a computer-generated list of r and om numbers in blocks of ten ( generated at the Pharmacy of Glostrup ) . Investigators and children were masked until the youngest child turned 3 years of age and throughout the data validation and analysis phases . The primary outcome was duration of the respiratory episode after treatment , verified by prospect i ve daily diaries and analysed with Poisson regression . Analyses were per protocol ( excluding those without a primary outcome measure or who did not receive treatment ) . This trial is registered with Clinical Trials.gov , number NCT01233297 . Findings Between Nov 17 , 2010 , and Jan 28 , 2014 , we r and omly allocated 158 asthma-like episodes in 72 children ( 79 [ 50 % ] to azithromycin and 79 [ 50 % ] to placebo  ) . The mean duration of the episode after treatment was 3·4 days for children receiving azithromycin compared with 7·7 days for children receiving  placebo . Azithromycin  caused a significant shortening of the episode of 63·3 % ( 95 % CI 56·0–69·3 ; p<0·0001 ) . The effect size increased with early initiation of treatment , showing a reduction in episode duration of 83 % if treatment was initiated before day 6 of the episode compared with 36 % if initiated on or after day 6 ( p<0·0001 ) . We noted no differences in clinical adverse events between the azithromycin ( 18 [ 23 % ] of 78 episodes included in final analysis ) and placebo ( 24 [ 30 % ] of 79 ) groups ( p=0·30 ) , but we did not investigate bacterial resistance patterns after treatment . Interpretation Azithromycin reduced the duration of episodes of asthma-like symptoms in young children , suggesting that this drug could have a role in acute management of exacerbations . Further research is needed to disentangle the inflammatory versus antimicrobial aspects of this relation . Funding Lundbeck Foundation , Danish Ministry of Health , Danish Council for Strategic Research , Capital Region Research Foundation Introduction Patients with severe acute exacerbations of asthma often receive inappropriate antibiotic treatment . We aim ed to determine whether serum procalcitonin ( PCT ) levels can effectively and safely reduce antibiotic exposure in patients experiencing exacerbations of asthma . Methods In this r and omized controlled trial , a total of 216 patients requiring hospitalization for severe acute exacerbations of asthma were screened for eligibility to participate and 169 completed the 12-month follow-up visit . Patients were r and omized to either PCT-guided ( PCT group ) or st and ard ( control group ) antimicrobial therapy . In the control group , patients received antibiotics according to the attending physician ’s discretion ; in the PCT group , patients received antibiotics according to an algorithm based on serum PCT levels . The primary end point was antibiotic exposure ; secondary end points were clinical recovery , length of hospital stay , clinical and laboratory parameters , spirometry , number of asthma exacerbations , emergency room visits , hospitalizations and need for corticosteroid use due to asthma . Results PCT guidance reduced antibiotic prescription ( 48.9 % versus 87.8 % , respectively ; P < 0.001 ) and antibiotic exposure ( relative risk , 0.56 ; 95 % confidence interval , 0.44 to 0.70 ; P < 0.001 ) compared to st and ard therapy . There were no significant differences in clinical recovery , length of hospital stay or clinical , laboratory and spirometry outcomes in both groups . Number of asthma exacerbations , emergency room visits , hospitalizations and need for corticosteroid use due to asthma were similar during the 12-month follow-up period . Conclusion A PCT-guided strategy allows antibiotic exposure to be reduced in patients with severe acute exacerbation of asthma without apparent harm . Trial registration Chinese Clinical Trial Register ChiCTR-TRC-12002534 ( registered 26 September 2012 Background : Antibiotic overuse in respiratory illness is common and is associated with drug resistance and hospital-acquired infection . Biomarkers that can identify bacterial infections may reduce antibiotic prescription . We aim ed to compare the usefulness of the biomarkers procalcitonin and C-reactive protein ( CRP ) in patients with pneumonia or exacerbations of asthma or COPD . Methods : Patients with a diagnosis of community-acquired pneumonia or exacerbation of asthma or COPD were recruited during the winter months of 2006 to 2008 . Demographics , clinical data , and blood sample s were collected .  Procalcitonin and CRP concentrations were measured from available sera . Results : Sixty-two patients with pneumonia , 96 with asthma , and 161 with COPD were studied .  Serum procalcitonin and CRP concentrations were strongly correlated ( Spearman rank correlation coefficient [ rs ] = 0.56 , P < .001 ) . Patients with pneumonia had increased procalcitonin and CRP levels ( median [ interquartile range ] 1.27 ng/mL [ 2.36 ] , 191 mg/L [ 159 ] ) compared with those with asthma ( 0.03 ng/mL [ 0.04 ] , 9 mg/L [ 21 ] ) and COPD ( 0.05 ng/mL [ 0.06 ] , 16 mg/L [ 34 ] ) . The area under the receiver operating characteristic curve ( 95 % CI ) for distinguishing between patients with pneumonia ( antibiotics required ) and exacerbations of asthma ( antibiotics not required ) , for procalcitonin and CRP was 0.93 ( 0.88 - 0.98 ) and 0.96 ( 0.93 - 1.00 ) . A CRP value > 48 mg/L had a sensitivity of 91 % ( 95 % CI , 80%-97 % ) and specificity of 93 % ( 95 % CI , 86%-98 % ) for identifying patients with pneumonia . Conclusions : Procalcitonin and CRP levels can both independently distinguish pneumonia from exacerbations of asthma . CRP levels could be used to guide antibiotic therapy and reduce antibiotic overuse in hospitalized patients with acute respiratory illness BACKGROUND Clarithromycin is postulated to possess immunomodulatory properties in addition to its antimicrobial activity . OBJECTIVE To evaluate the effect of clarithromycin on serum and nasopharyngeal cytokine and chemokine concentrations in children with an acute exacerbation of recurrent wheezing . METHODS Children with a history of recurrent wheezing or asthma and who presented with an acute exacerbation of wheezing were enrolled in a double-blind , r and omized trial of clarithromycin vs placebo . Concentrations of tumor necrosis factor alpha ( TNF-alpha ) , interferon-gamma ( IFN-gamma ) , interleukin-1beta ( IL-1beta ) , IL-2 , IL-4 , IL-5 , IL-6 , IL-8 , IL-10 , granulocyte-macrophage colony-stimulating factor , RANTES , eotaxin , macrophage inflammatory protein 1alpha , macrophage inflammatory protein 1beta , and monocyte chemoattractant protein 1 were measured in serum and /or nasopharyngeal aspirates before , during , and after therapy . Mycoplasma pneumoniae and Chlamydophila pneumoniae infection were evaluated for by polymerase chain reaction and serologic testing . RESULTS Nasopharyngeal concentrations of TNF-alpha , IL-1beta , and IL-10 were significantly and persistently lower in children treated with clarithromycin compared with placebo . There tended to be a greater effect of clarithromycin on nasopharyngeal cytokine concentrations in patients with evidence of M. pneumoniae or C. pneumoniae infection . No significant differences were detected in serum cytokines for children treated with clarithromycin compared with placebo . CONCLUSION Clarithromycin therapy reduces mucosal TNF-alpha , IL-1beta , and IL-10 concentrations in children with an acute exacerbation of recurrent wheezing Background This r and omized controlled trial aim ed to evaluate whether the serum procalcitonin  ( PCT ) level can be utilized to guide the use of antibiotics in the treatment of acute exacerbations of asthma . Methods A total of 293 consecutive patients with suspected asthma attacks from February 2005 to July 2010 participated in this study . 225 patients completed the study . Serum PCT levels , and other inflammatory biomarkers of all patients were measured . In addition to the st and ard treatment , the control group received antibiotics according to the attending physicians ’ discretions , while the patients in the PCT group were treated with antibiotics according to serum PCT concentrations . Antibiotics usage was strongly discouraged when the PCT concentration was below 0.1 μg/L ; discouraged when the PCT concentration was between 0.1 μg/L and 0.25 μg/L ; or encouraged when the PCT concentration was above 0.25 μg/L. The primary endpoint was the determination of antibiotics usage . The second endpoints included the diagnostic accuracy of PCT and other laboratory biomarkers the effectiveness of asthma control , secondary ED visits , hospital re-admissions , repeated needs for steroids or dosage increase , needs for antibiotics , WBC count , PCT levels and FEV1 % . Results At baseline , two groups were identical regarding clinical , laboratory and symptom score . Probability of  the antibiotics usage in the PCT group ( 46.1 % ) was lower than that in the control group ( 74.8 % ) ( χ2 = 21.97 , p < 0.001 . RR = 0.561 , 95 % CI 0.441 - 0.713 ) . PCT and IL-6 showed good diagnostic significance for bacterial asthma ( r = 0.705 , p = 0.003 ) . The degrees of asthma control in patients were categorized to three levels and were comparable between the two groups at the six weeks follow-up period ( χ2 = 1.62 , p = 0.45 ) . There were no significant difference regarding other secondary outcomes ( p > 0.05 ) . Conclusions The serum PCT concentration can be used to effectively determine whether the acute asthma patients have bacterial infections in the respiratory tract , and to guide the use of antibiotics in the treatment of acute asthma exacerbations , which may substantially reduce unnecessary antibiotic use without compromising the therapeutic outcomes .Trial registration The dosage of 1:1,000 aqueous epinephrine is incorrectly given in the article by Shapiro et al. in the June issue ( Pediatrics , 53:867 , 1974 ) . The cor- rect dosage is 0.01 cc/kilo instead of 0.1 cc/kilo as given . The patient9s serum IgE level in the article by Albrecht et al. in the June issue ( Pediatrics , 53:907 , 1974 ) is incorrect . It should be given as 205 nanograms per milliliter instead of 205 mg/ml 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 ) 
    Output:
    