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: This work evaluates frequency of steroid induced osteoporosis  according to kind of steroid drugs ( systemic , inhaled ) , dose and duration of treatment . In group of 80 young patients with asthma and chronic bronchitis the following examinations have been used : biochemical markers of bone turnover , X-ray of thoracic lumbar part of vertebral column and bone density in quantitative computed tomography of vertebrae L2-L4 . Osteoporosis appeared in patients chronically treated with systemic steroids ( prednisone ) and in patients treated with inhaled steroids  in typical dose as well . Usefulness of biochemical markers of bone turnover in connection with quantitative computed tomography in diagnostic of steroid induced osteoporosis has been confirmed Airway inflammation is consistently present in patients with severe asthma . The combination of inhaled steroids and bronchodilators may be useful both for treating symptoms and improving the underlying inflammatory condition . We have compared the effect of beclomethasone dipropionate ( BDP ) combined with salbutamol ( S ) , BDP alone , and placebo , on the severity of bronchial responsiveness in 30 children with allergic asthma during the period of specific allergen exposure . In children treated with BDP alone , PC20-FEV1 methacholine was 0.66 + /- 0.54 at the beginning and 1.91 + /- 2.11 at the end of the study period ( p greater than 0.05 ) . In children treated with BDP + S PC20 , methacholine was 1.21 + /- 1.43 at the beginning and 4.22 + /- 3.88 at the end of the study ( p less than 0.05 ) . The group of children treated with placebo had a PC20-FEV1 methacholine of 0.79 + /- 0.61 at the beginning of the study and 0.80 + /- 0.46 at the end of the study . The results of the present study show that maintenance treatment with inhaled beclomethasone combined with salbutamol may lead to greater improvement in bronchial hyperreactivity than treatment with inhaled beclomethasone dipropionate alone BACKGROUND : A study was performed to compare the adrenal suppression caused by inhaled fluticasone propionate and budesonide on a microgram equivalent basis , each given by metered dose inhaler to asthmatic patients . METHODS : Twelve asthmatic patients of mean age 29.9 years , with a forced expiratory volume in one second ( FEV1 ) 92.9 % predicted and forced expiratory flow 25 - 75 % ( FEF25 - 75 ) 69.5 % predicted , on less than or equal to 400 micrograms/day inhaled corticosteroid , were studied in a double blind placebo controlled crossover design comparing single doses of inhaled budesonide 400 , 1000 , 1600 , 2000 micrograms and fluticasone propionate 500 , 1000 , 1500 , 2000 micrograms . Doses were administered at 22.00 hours by metered dose inhaler with mouth rinsing and measurements were made in the laboratory 10 hours later . RESULTS : Serum cortisol levels compared with placebo ( mean 325.2 nmol/l ) were suppressed by fluticasone at doses of 1500 micrograms ( 211.6 nmol/l ) and 2000 micrograms ( 112.3 nmol/l ) and by budesonide at 2000 micrograms ( 243.4 nmol/l ) . Fluticasone propionate 2000 micrograms produced lower absolute serum cortisol levels than budesonide 2000 micrograms ( 95 % CI for difference 42.9 to 219.2 ) . The dose ratio ( geometric mean ) for the relative potency was 2.89 fold ( 95 % CI 1.19 to 7.07 ) . In terms of percentage suppression versus placebo , fluticasone propionate also produced greater effects ( means and 95 % CI for difference ) : budesonide 1600 micrograms ( 16.0 ) versus fluticasone propionate 1500 micrograms ( 40.9 ) ( 95 % CI -0.6 to 50.6 ) , budesonide 2000 micrograms ( 26.0 ) versus fluticasone 2000 micrograms ( 65.2 ) ( 95 % CI 10.5 to 67.8 ) . Individual serum cortisol levels at the two highest doses showed 15 of 24 patients below the normal limit of the reference range ( 150 nmol/l ) for fluticasone and five of 24 for budesonide . Fluticasone propionate also caused greater ACTH suppression than budesonide ( as % versus placebo ) : budesonide 1600 micrograms ( 12.0 ) versus fluticasone propionate 1500 micrograms ( 31.9 ) ( 95 % CI 7.6 to 32.1 ) , budesonide 2000 micrograms ( 13.5 ) versus fluticasone propionate 2000 micrograms ( 44.4 ) ( 95 % CI 13.2 to 48.7 ) . For overnight 10 hour urinary cortisol ( nmol/10 hours ) there was a difference between the lowest doses of the two drugs : budesonide 400 micrograms ( 37.2 ) versus fluticasone propionate 500 micrograms ( 19.9 ) ( 95 % CI 6.9 to 27.8 ) . CONCLUSIONS : Like budesonide the systemic bioactivity of fluticasone propionate is mainly due to lung vascular absorption . Fluticasone propionate exhibited at least twofold greater adrenal suppression than budesonide on a microgram equivalent basis in asthmatic patients 77 children , aged 11 to 36 months ( mean 24 ) with moderately severe recurrent wheezing , were treated with budesonide pressurised aerosol 400 micrograms twice daily or placebo for 12 weeks in a double-blind , parallel-group trial . Aerosols were inhaled from a spacer with a facemask . Budesonide significantly improved symptom scores of wheezing , sleep disturbance , and patient happiness . The frequency of severe exacerbations that required a course of oral prednisolone was also significantly reduced . The treatment effect appeared to be fully established after 6 - 8 weeks and no side-effects could be ascribed to the active treatment . The findings indicate that young children below 3 years of age can inhale a pressurised aerosol from a spacer with a facemask . Use of topically active glucocorticosteroids with this simple device may reduce symptoms and distress in young children with moderately severe recurrent wheeze and dyspnoea , and possibly reduce their requirement for oral steroids Acute episodic wheeze related to viral infections is a common and distressing condition and treatment remains unsatisfactory . Although some benefit from the continuous use of inhaled steroids has been demonstrated in young wheezy children , their effect primarily on acute episodes has not been considered . In this study the effect of budesonide ( 400 micrograms/day ) was assessed in a four month double blind parallel trial , in 41 children ( 0.7 - 6.0 years ) with predominantly episodic viral wheeze . Analysis of the last three months showed no difference between budesonide or placebo in mean daily total symptom score ( median values 0.6 and 0.63 ) , episode number ( mean values 2.6 and 2.4 ) , or score/episode ( mean value 30 and 31 ) . Four months of treatment with inhaled budesonide had no effect on acute episodes of wheeze in this group of children The objectives of this study were to compare the efficacy of salbutamol delivered by either metered-dose inhaler plus spacer ( MDI-spacer ) or by wet nebulization ( NEB ) , and to determine the relationships between physiologic responses and plasma salbutamol concentrations . Asthmatic patients presenting to the emergency department ( ED ) with acute severe asthma ( forced expiratory volume in the first second [ FEV1 ] less than 50 % of predicted ) were enrolled in a r and omized , double-blind , parallel-group study . The MDI-spacer group received salbutamol , delivered via MDI into a spacer device , in four puffs actuated in rapid succession at 10-minute intervals ( 2.4 mg/h ) . The NEB group was treated with nebulized salbutamol , 1.5 mg , via nebulizer at 15-minute intervals ( 6 mg/h ) . Doses were calculated on the basis of the percentage of total dose that reaches the lower airway with both methods . The protocol involved 3 hours of this treatment . Mean peak expiratory flow rate ( PEFR ) and FEV1 improved significantly over baseline values for both groups ( P=.01 ) . However , there were no significant differences between both groups for PEFR and FEV1 at any point studied . The examination of the relationships between cumulative dose of salbutamol and change in FEV1 showed a significant linear relationship ( P=.01 ) for both methods ( MDI r=.97 ; NEB r=.97 ) . The regression equations showed that for every 1 mg of salbutamol by MDI-spacer , 2.5 mg are needed from nebulization to have equal therapeutic response . At the end of treatment , the salbutamol plasma levels were 10.1+/-1.6 ng/ml for the MDI-spacer group and 14.4+/-2.3 ng/ml for the NEB group ( P=.0003 ) . Both groups showed a nonsignificant heart rate decrease . A significant group-by-time interaction means that differences between groups increased with time ( P=.04 ) . Additionally , the NEB group presented a higher incidence of tremor ( P=.03 ) and anxiety ( P=.04 ) , reflecting larger systemic absorption of salbutamol . These data indicate that when doses used are calculated on the basis of the percentage of total drug that reaches the lower airway , there was equivalent bronchodilatation after salbutamol administered by either MDI-spacer or nebulization in patients with acute severe asthma . However , nebulizer therapy produced greater side effects related to the increase in salbutamol absorption and higher plasma level In a controlled prospect i ve study we have measured growth and pulmonary function in children with asthma during long-term treatment with inhaled budesonide  and compared these findings with those obtained from children not treated with corticosteroids . Two hundred and sixteen children were followed at 6 monthly intervals for 1 - 2 years without inhaled budesonide and then for 3 - 6 years on inhaled budesonide .  Sixty-two children treated with theophylline , beta 2-agonists and sodium-cromoglycate but not with inhaled steroids were also followed for 3 - 7 years ( controls ) . During the period of budesonide therapy the mean daily dose decreased from 710 to 430 micrograms ( P < 0.01 ) and no signs of tachyphylaxis to the treatment were seen . Budesonide treatment was associated with a significant reduction in the number of annual hospital admissions due to acute severe asthma ( from 0.03 to 0.004 per child , P < 0.001 ) . In patients not treated with budesonide an annual decrease in % predicted FEV1 of 1 - 3 % was seen . In contrast FEV1 improved significantly with time during budesonide treatment , both compared with the run-in period and with the control group ( P < 0.01 ) . Furthermore , there was a significant ( P = 0.01 ) relationship between the duration of asthma at the start of budesonide and the annual increase in FEV1 during budesonide therapy . After 3 years of treatment with budesonide , children who started this therapy later than 5 years after the onset of asthma had significantly lower FEV1 ( 96 % ) than the children who received budesonide within the first 2 years after the onset of asthma ( 101 % ) ( P < 0.05 ) . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND --High dose inhaled glucocorticosteroids are increasingly used in the management of patients with moderate to severe asthma . Although effective , they may cause systemic side effects .  Fluticasone propionate is a topically active inhaled glucocorticosteroid which has few systemic effects at high doses . METHODS --Fluticasone propionate , 1.5 mg per day , was compared with beclomethasone dipropionate at the same dose for one year in patients with symptomatic moderate to severe asthma ; 142 patients received fluticasone propionate and 132 received beclomethasone dipropionate .  The study was multicentre , double blind and of a parallel design . For the first three months patients attended the clinic every four weeks and completed daily diary cards . For the next nine months they were only seen at three monthly intervals in the clinic . RESULTS --During the first three months diary card peak expiratory flow ( PEF ) rate and lung function measurements in the clinic showed significantly greater improvement in patients receiving fluticasone propionate ( difference in morning PEF 15 l/min ( 95 % CI 6 to 25 ) ) , and these differences were apparent at the end of the 
    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: This work evaluates frequency of steroid induced osteoporosis  according to kind of steroid drugs ( systemic , inhaled ) , dose and duration of treatment . In group of 80 young patients with asthma and chronic bronchitis the following examinations have been used : biochemical markers of bone turnover , X-ray of thoracic lumbar part of vertebral column and bone density in quantitative computed tomography of vertebrae L2-L4 . Osteoporosis appeared in patients chronically treated with systemic steroids ( prednisone ) and in patients treated with inhaled steroids  in typical dose as well . Usefulness of biochemical markers of bone turnover in connection with quantitative computed tomography in diagnostic of steroid induced osteoporosis has been confirmed Airway inflammation is consistently present in patients with severe asthma . The combination of inhaled steroids and bronchodilators may be useful both for treating symptoms and improving the underlying inflammatory condition . We have compared the effect of beclomethasone dipropionate ( BDP ) combined with salbutamol ( S ) , BDP alone , and placebo , on the severity of bronchial responsiveness in 30 children with allergic asthma during the period of specific allergen exposure . In children treated with BDP alone , PC20-FEV1 methacholine was 0.66 + /- 0.54 at the beginning and 1.91 + /- 2.11 at the end of the study period ( p greater than 0.05 ) . In children treated with BDP + S PC20 , methacholine was 1.21 + /- 1.43 at the beginning and 4.22 + /- 3.88 at the end of the study ( p less than 0.05 ) . The group of children treated with placebo had a PC20-FEV1 methacholine of 0.79 + /- 0.61 at the beginning of the study and 0.80 + /- 0.46 at the end of the study . The results of the present study show that maintenance treatment with inhaled beclomethasone combined with salbutamol may lead to greater improvement in bronchial hyperreactivity than treatment with inhaled beclomethasone dipropionate alone BACKGROUND : A study was performed to compare the adrenal suppression caused by inhaled fluticasone propionate and budesonide on a microgram equivalent basis , each given by metered dose inhaler to asthmatic patients . METHODS : Twelve asthmatic patients of mean age 29.9 years , with a forced expiratory volume in one second ( FEV1 ) 92.9 % predicted and forced expiratory flow 25 - 75 % ( FEF25 - 75 ) 69.5 % predicted , on less than or equal to 400 micrograms/day inhaled corticosteroid , were studied in a double blind placebo controlled crossover design comparing single doses of inhaled budesonide 400 , 1000 , 1600 , 2000 micrograms and fluticasone propionate 500 , 1000 , 1500 , 2000 micrograms . Doses were administered at 22.00 hours by metered dose inhaler with mouth rinsing and measurements were made in the laboratory 10 hours later . RESULTS : Serum cortisol levels compared with placebo ( mean 325.2 nmol/l ) were suppressed by fluticasone at doses of 1500 micrograms ( 211.6 nmol/l ) and 2000 micrograms ( 112.3 nmol/l ) and by budesonide at 2000 micrograms ( 243.4 nmol/l ) . Fluticasone propionate 2000 micrograms produced lower absolute serum cortisol levels than budesonide 2000 micrograms ( 95 % CI for difference 42.9 to 219.2 ) . The dose ratio ( geometric mean ) for the relative potency was 2.89 fold ( 95 % CI 1.19 to 7.07 ) . In terms of percentage suppression versus placebo , fluticasone propionate also produced greater effects ( means and 95 % CI for difference ) : budesonide 1600 micrograms ( 16.0 ) versus fluticasone propionate 1500 micrograms ( 40.9 ) ( 95 % CI -0.6 to 50.6 ) , budesonide 2000 micrograms ( 26.0 ) versus fluticasone 2000 micrograms ( 65.2 ) ( 95 % CI 10.5 to 67.8 ) . Individual serum cortisol levels at the two highest doses showed 15 of 24 patients below the normal limit of the reference range ( 150 nmol/l ) for fluticasone and five of 24 for budesonide . Fluticasone propionate also caused greater ACTH suppression than budesonide ( as % versus placebo ) : budesonide 1600 micrograms ( 12.0 ) versus fluticasone propionate 1500 micrograms ( 31.9 ) ( 95 % CI 7.6 to 32.1 ) , budesonide 2000 micrograms ( 13.5 ) versus fluticasone propionate 2000 micrograms ( 44.4 ) ( 95 % CI 13.2 to 48.7 ) . For overnight 10 hour urinary cortisol ( nmol/10 hours ) there was a difference between the lowest doses of the two drugs : budesonide 400 micrograms ( 37.2 ) versus fluticasone propionate 500 micrograms ( 19.9 ) ( 95 % CI 6.9 to 27.8 ) . CONCLUSIONS : Like budesonide the systemic bioactivity of fluticasone propionate is mainly due to lung vascular absorption . Fluticasone propionate exhibited at least twofold greater adrenal suppression than budesonide on a microgram equivalent basis in asthmatic patients 77 children , aged 11 to 36 months ( mean 24 ) with moderately severe recurrent wheezing , were treated with budesonide pressurised aerosol 400 micrograms twice daily or placebo for 12 weeks in a double-blind , parallel-group trial . Aerosols were inhaled from a spacer with a facemask . Budesonide significantly improved symptom scores of wheezing , sleep disturbance , and patient happiness . The frequency of severe exacerbations that required a course of oral prednisolone was also significantly reduced . The treatment effect appeared to be fully established after 6 - 8 weeks and no side-effects could be ascribed to the active treatment . The findings indicate that young children below 3 years of age can inhale a pressurised aerosol from a spacer with a facemask . Use of topically active glucocorticosteroids with this simple device may reduce symptoms and distress in young children with moderately severe recurrent wheeze and dyspnoea , and possibly reduce their requirement for oral steroids Acute episodic wheeze related to viral infections is a common and distressing condition and treatment remains unsatisfactory . Although some benefit from the continuous use of inhaled steroids has been demonstrated in young wheezy children , their effect primarily on acute episodes has not been considered . In this study the effect of budesonide ( 400 micrograms/day ) was assessed in a four month double blind parallel trial , in 41 children ( 0.7 - 6.0 years ) with predominantly episodic viral wheeze . Analysis of the last three months showed no difference between budesonide or placebo in mean daily total symptom score ( median values 0.6 and 0.63 ) , episode number ( mean values 2.6 and 2.4 ) , or score/episode ( mean value 30 and 31 ) . Four months of treatment with inhaled budesonide had no effect on acute episodes of wheeze in this group of children The objectives of this study were to compare the efficacy of salbutamol delivered by either metered-dose inhaler plus spacer ( MDI-spacer ) or by wet nebulization ( NEB ) , and to determine the relationships between physiologic responses and plasma salbutamol concentrations . Asthmatic patients presenting to the emergency department ( ED ) with acute severe asthma ( forced expiratory volume in the first second [ FEV1 ] less than 50 % of predicted ) were enrolled in a r and omized , double-blind , parallel-group study . The MDI-spacer group received salbutamol , delivered via MDI into a spacer device , in four puffs actuated in rapid succession at 10-minute intervals ( 2.4 mg/h ) . The NEB group was treated with nebulized salbutamol , 1.5 mg , via nebulizer at 15-minute intervals ( 6 mg/h ) . Doses were calculated on the basis of the percentage of total dose that reaches the lower airway with both methods . The protocol involved 3 hours of this treatment . Mean peak expiratory flow rate ( PEFR ) and FEV1 improved significantly over baseline values for both groups ( P=.01 ) . However , there were no significant differences between both groups for PEFR and FEV1 at any point studied . The examination of the relationships between cumulative dose of salbutamol and change in FEV1 showed a significant linear relationship ( P=.01 ) for both methods ( MDI r=.97 ; NEB r=.97 ) . The regression equations showed that for every 1 mg of salbutamol by MDI-spacer , 2.5 mg are needed from nebulization to have equal therapeutic response . At the end of treatment , the salbutamol plasma levels were 10.1+/-1.6 ng/ml for the MDI-spacer group and 14.4+/-2.3 ng/ml for the NEB group ( P=.0003 ) . Both groups showed a nonsignificant heart rate decrease . A significant group-by-time interaction means that differences between groups increased with time ( P=.04 ) . Additionally , the NEB group presented a higher incidence of tremor ( P=.03 ) and anxiety ( P=.04 ) , reflecting larger systemic absorption of salbutamol . These data indicate that when doses used are calculated on the basis of the percentage of total drug that reaches the lower airway , there was equivalent bronchodilatation after salbutamol administered by either MDI-spacer or nebulization in patients with acute severe asthma . However , nebulizer therapy produced greater side effects related to the increase in salbutamol absorption and higher plasma level In a controlled prospect i ve study we have measured growth and pulmonary function in children with asthma during long-term treatment with inhaled budesonide  and compared these findings with those obtained from children not treated with corticosteroids . Two hundred and sixteen children were followed at 6 monthly intervals for 1 - 2 years without inhaled budesonide and then for 3 - 6 years on inhaled budesonide .  Sixty-two children treated with theophylline , beta 2-agonists and sodium-cromoglycate but not with inhaled steroids were also followed for 3 - 7 years ( controls ) . During the period of budesonide therapy the mean daily dose decreased from 710 to 430 micrograms ( P < 0.01 ) and no signs of tachyphylaxis to the treatment were seen . Budesonide treatment was associated with a significant reduction in the number of annual hospital admissions due to acute severe asthma ( from 0.03 to 0.004 per child , P < 0.001 ) . In patients not treated with budesonide an annual decrease in % predicted FEV1 of 1 - 3 % was seen . In contrast FEV1 improved significantly with time during budesonide treatment , both compared with the run-in period and with the control group ( P < 0.01 ) . Furthermore , there was a significant ( P = 0.01 ) relationship between the duration of asthma at the start of budesonide and the annual increase in FEV1 during budesonide therapy . After 3 years of treatment with budesonide , children who started this therapy later than 5 years after the onset of asthma had significantly lower FEV1 ( 96 % ) than the children who received budesonide within the first 2 years after the onset of asthma ( 101 % ) ( P < 0.05 ) . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND --High dose inhaled glucocorticosteroids are increasingly used in the management of patients with moderate to severe asthma . Although effective , they may cause systemic side effects .  Fluticasone propionate is a topically active inhaled glucocorticosteroid which has few systemic effects at high doses . METHODS --Fluticasone propionate , 1.5 mg per day , was compared with beclomethasone dipropionate at the same dose for one year in patients with symptomatic moderate to severe asthma ; 142 patients received fluticasone propionate and 132 received beclomethasone dipropionate .  The study was multicentre , double blind and of a parallel design . For the first three months patients attended the clinic every four weeks and completed daily diary cards . For the next nine months they were only seen at three monthly intervals in the clinic . RESULTS --During the first three months diary card peak expiratory flow ( PEF ) rate and lung function measurements in the clinic showed significantly greater improvement in patients receiving fluticasone propionate ( difference in morning PEF 15 l/min ( 95 % CI 6 to 25 ) ) , and these differences were apparent at the end of the 
    Output:
    