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: INTRODUCTION Inhaled asthma therapy is clinical ly preferable , offering low therapeutic dose , rapid action onset and minimal side effects ' . The metered dose inhaler ( MDI ) is the cheapest , most commonly available inhaler device . However , some practitioners are reluctant to prescribe it since usage difficulties can limit benefits 2 . This is a particular problem amongst the young , the elderly , and when large patient numbers , language barriers or cultural obstacles make teaching and assessment of inhaler technique difficult . Spacer devices simplify inhaler technique , improving MDI e f f i ~ a c y ~ . ~ . Unfortunately , spacers may be costly and inaccessible . We describe the use of a soft drinks bottle as an effective , low cost , alternative spacer A r and omized clinical crossover trial was carried out to compare the use in the home , during 1-week periods , of two commercially available chamber devices ( the Aerochamber and the Spacer ) and a st and ard metered-dose inhaler ( MDI ) in 24 patients with reversible bronchospasm and satisfactory inhaler technique . Measurements of peak flow , forced expiratory volume in 1 second ( FEV1 ) , forced vital capacity ( FVC ) , ratio of FEV1 to FVC and forced midexpiratory flow rate were made immediately before and 15 minutes after inhalation of terbutaline sulfate . No difference was noted in results of spirometry , peak flow readings or side effects between the devices . The results of spirometry were better during the trial than immediately before it ( p less than 0.01 ) . The mean score for inhaler technique was significantly lower at follow-up than during the trial ( p less than 0.001 ) . The results suggest that in this population there is no advantage to using either a chamber device rather than an MDI or one chamber device rather than the other Administration of the long-acting beta 2-adrenoceptor agonist salmeterol from a new , easy-to-operate , multidose powder inhaler ( Diskus ) containing 60 sealed doses in a foil strip has been compared with administration from a Diskhaler inhaler in a multicenter , double-blind , double-dummy , parallel-group study . Asthmatic patients taking anti-inflammatory treatment , with baseline FEV1 > or = 60 % and < or = 90 % predicted were treated for 4 weeks with salmeterol 50 micrograms twice daily from either the Diskus or Diskhaler inhaler . The two treatments were equivalent ( 90 % CLs for the difference in mean morning PEFR : -2.2 , 8.7 L/min ) . The Diskus inhaler was rated easier to use and was preferred by more patients than the Diskhaler inhaler ( 73 % vs. 15 % ) AIM The main objective of this study was to compare the in vitro delivery of salbutamol from a chlorofluorocarbon(CFC)-propelled pressurised metered-dose inhaler ( pMDI ) versus a newly developed hydrofluoroalkane(HFA)-propelled pMDI through various spacers . In addition , we aim ed to study the effect on bronchodilator response when using an optimal pMDI/spacer combination for aerosol delivery compared to a suboptimal combination . METHODS Particle size distribution and output from salbutamol pMDIs containing either CFC propellants ( Ventolin ) or HFA propellants ( Airomir ) were measured using a multistage liquid impinger ( MSLI ) and compared to that through both detergent-coated ( non-static ) or untreated ( static ) large volume ( Nebuhaler , Volumatic ) and small volume ( Aerochamber ) plastic spacers .  Flow-volume curves ( FEV1 ) were obtained from twelve asthmatic children with known significant bronchodilator response ( 8 males ) , aged 13 - 17 years , r and omly inhaling salbutamol from a CFC-pMDI through a static spacer  ( Nebuhaler ) and from  an HFA-pMDI through a non-static spacer  ( Nebuhaler ) . RESULTS In vitro output of particles in the respirable range ( < 6.8 microns ) from HFA-pMDIs was significantly higher than that from CFC-pMDIs using various spacers . Removal of electrostatic charge increased output from CFC- and HFA-pMDIs through all spacers by 17 - 82 % . The mean ( SD ) bronchodilator response after inhalation of salbutamol from a CFC-pMDI through a static spacer was 7.1 % ( 6.3 % ) compared to 17.5 % ( 7.9 % ) after inhalation from an HFA-pMDI through a non-static spacer ( p = 0.002 ) . CONCLUSIONS Use of a newly developed HFA-propelled pMDI greatly improves drug delivery through spacers compared to a CFC-propelled pMDI . However , electrostatic charge in plastic spacers remains the key determinant limiting delivery of salbutamol from a pMDI through spacers , and can be reduced by soaking the spacer in a household detergent . Using an optimal pMDI/spacer combination leads to a significantly improved bronchodilator response To evaluate patient satisfaction with two breath-actuated powder inhalers ( Diskhaler and Diskus ) , investigators asked patients to complete question naires as part of a r and omized , double-masked , double-dummy , placebo-controlled study of fluticasone propionate powder ( 500 mg twice daily ) in the treatment of chronic persistent asthma . At baseline , patients rated the importance of various inhaler attributes ( i.e. , ease of use , ease of loading with medication , ease of holding and operating , ease of cleaning , and ease of telling how many doses of medication are left ) . After 2 weeks of placebo and 6 and 12 weeks of active therapy , patients rated the inhalers on these same attributes . They also rated their general satisfaction with the inhalers and how comfortable they were using them . After 12 weeks , patients also rated the durability and convenience of carrying each device and were asked to indicate which they preferred . Data were available from 213 patients . All seven inhaler attributes measured were considered important by the majority of patients ( 71 % to 91 % ) , contributing to the validity of the patient-rated performance assessment s. After 12 weeks of use , 57 % to 88 % of patients expressed a high level of satisfaction with the performance of the Diskhaler on all attributes ; a high level of overall satisfaction ( 72 % ) and comfort ( 79 % ) was reported with this inhaler . Patients rated the performance of the  Diskus inhaler  very favorably , with 76 % to 96 % expressing a high level of satisfaction on all attributes ; a high level of overall satisfaction ( 87 % ) and comfort ( 85 % ) was reported with this inhaler . At end point , 61.4 % preferred the Diskus inhaler , 25.4 % preferred the Diskhaler inhaler , and 13.2 % expressed no preference . These breath-actuated powder inhalers may be acceptable alternatives to traditional metered-dose inhalers for the treatment of patients with asthma We compared terbutaline administered through an 80-mL , 10 X 3.2-cm tube spacer versus a conventional metered-dose inhaler in 34 asthmatic patients , aged 8 to 16 years . In this double-blind , single-dose study , three groups of children ( spacer active , conventional active , and placebo )  were assessed clinical ly and with spirometry before and at one-half hour intervals for two hours after therapy . One investigator taught inhaler use and monitored patients ' errors in technique . Compared with placebo , terbutaline delivered by either the tube spacer or the conventional inhaler significantly improved pulmonary function from one-half to two hours after treatment . Both the spacer and conventional inhaler were equally effective in improving pulmonary function from the baseline state . Only 4/34 ( 11.7 % ) children used both inhalers without any error . Adverse effects were mild , transient , and infrequent and did not differ between the groups . Terbutaline aerosol , whether delivered by the tube spacer or conventional actuator , provides effective bronchodilation for children with asthma , in spite of frequent errors in technique of inhaler use We compared the bronchodilator response of terbutaline delivered either by a dry powder inhaler , the Turbuhaler , or by a metered-dose inhaler attached to a Nebuhaler inhaler in 10 children with stable asthma who were 3 to 6 years of age . The bronchodilator response did not differ between the two inhalational devices . The dry powder inhaler Turbuhaler is a suitable alternative to a metered-dose inhaler in the delivery of terbutaline to preschool children with stable asthma if adequate inhalational technique is used In an open r and omised parallel-group study , 1004 patients with asthma in 7 countries were r and omised to receive asthma treatment via 2 different kinds of inhalers : an aerosol pressurised metered dose inhaler ( pMDI ) and a dry powder inhaler ( Turbuhaler ) . The patients were treated for 52 weeks with inhaled corticosteroids and /or inhaled beta 2-agonists . All patients were considered adequately treated with inhaled corticosteroids and /or inhaled beta 2-agonists via pMDI before inclusion in the study . Healthcare utilisation variables were attached to the case record forms of the patients , thus making an economic analysis possible . Because of the difficulty of comparing costs between countries , each country was analysed separately . Canadian patients constituted the largest sub population ( 445 patients ) and were therefore used in this analysis . From the analysis , we concluded that the effectiveness of treatment ( measured as the number of exacerbations and days with exacerbation ) was significantly better for patients treated via Turbuhaler than via a pMDI ( p = 0.03 ) . Furthermore , the total annual costs of treatment were , on average , $ Can331 less ( p < 0.01 ) for patients using Turbuhaler than for those using a pMDI ( mainly due to lower costs for hospitalisation and medication ) . The cost differences between inhaled corticosteroids and inhaled beta 2-agonists were significantly in favour of treatment via Turbuhaler ( p < 0.01 ) . Thus , the results of this study suggest that treatment via Turbuhaler is a cost-effective strategy in patients with asthma in Canada 14 children with severe asthma were studied for 2 months in a double-blind cross-over trial to compare the efficacy of beclomethasone dipropionate delivered as an aerosol and as a powder from a rotahaler . Inhalation via the aerosol was satisfactory in 13 patients , each of whom used the rotahaler correctly . Younger children preferred to use the rotahaler . Comparison of daily symptoms , twice daily peak expiratory flow rate ( PEFR ) , and use of salbutamol  during the 2 months of the trial showed that control of asthma was equally good , irrespective of the device used to deliver active beclomethasone A bronchodilator aerosol , terbutaline sulphate , was administered to 18 asthmatic children , mean age 8.0 years ( range 4.9 - 13.7 years ) in a cross-over trial using either a common actuator or a 750-ml collapsible spacer . With the spacer , peak expiratory flow rate was significantly higher ( p less than 0.05 ) at 5 , 20 , and 60 min after administration of 0.25 mg terbutaline sulphate . The mean maximum value during this period was 92 % of the predicted normal value with the spacer compared to 86 % with the common actuator . The difference was significant ( p less than 0.01 ) . This study confirms previous findings that a 750-ml spacer is beneficial in bronchodilator aerosol therapy in children with asthma Self-report is a frequently-used method of assessing compliance with prescribed medications in patients with chronic illnesses . Most research ers agree , however , that self-report misrepresents patient adherence to regimen prescription . In this r and omized , controlled study evaluating inhaler medication compliance , diary data was compared to electronic monitoring in 55 adults with asthma . Subjects r and omized to the treatment group received a six-week self-management program . An electronic monitor , the MDI Chronolog , was used in this study to assess inhaler use . The MDI Chronolog records the date and time of each inhaled activation . The self-report measure used was a daily asthma diary . Subjects were asked to use their inhaled medications as usual and record the date and time they administered their medication over a one-week period . Moderate correlations ( rs=.55 , Mdnd=95.8 , Mdnc=91.6 ) were found when comparing the number of administrations calculated using the MDI Chronolog to the number of administrations reported in the subject ’s diary . When the dosing interval was examined , however , the correlation was weaker ( rs=.44 , Mdndiary=92.8 , Mdnchronolog=37.5 ) . In each case , self-reported compliance was higher than monitored adherence Two hundred and forty one children with chronic perennial asthma , who had been treated with budesonide via a metered dose inhaler with a spacer device ( Nebuhaler )  , had their normal dose of budesonide reduced by 50 % to determine if they had been overtreated . Within three weeks , asthma control deteriorated in 126 patients to such an extent that budesonide had to be increased to the normal dose . After stabilising their asthma , these children were enrolled in a r and omised , double blind , double dummy , parallel study , performed to compare the effect of budesonide via Nebuhaler with that of half the dose of budesonide via Turbuhaler . The study started with a two week run-in during which patients were treated with their normal dose of budes 
    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: INTRODUCTION Inhaled asthma therapy is clinical ly preferable , offering low therapeutic dose , rapid action onset and minimal side effects ' . The metered dose inhaler ( MDI ) is the cheapest , most commonly available inhaler device . However , some practitioners are reluctant to prescribe it since usage difficulties can limit benefits 2 . This is a particular problem amongst the young , the elderly , and when large patient numbers , language barriers or cultural obstacles make teaching and assessment of inhaler technique difficult . Spacer devices simplify inhaler technique , improving MDI e f f i ~ a c y ~ . ~ . Unfortunately , spacers may be costly and inaccessible . We describe the use of a soft drinks bottle as an effective , low cost , alternative spacer A r and omized clinical crossover trial was carried out to compare the use in the home , during 1-week periods , of two commercially available chamber devices ( the Aerochamber and the Spacer ) and a st and ard metered-dose inhaler ( MDI ) in 24 patients with reversible bronchospasm and satisfactory inhaler technique . Measurements of peak flow , forced expiratory volume in 1 second ( FEV1 ) , forced vital capacity ( FVC ) , ratio of FEV1 to FVC and forced midexpiratory flow rate were made immediately before and 15 minutes after inhalation of terbutaline sulfate . No difference was noted in results of spirometry , peak flow readings or side effects between the devices . The results of spirometry were better during the trial than immediately before it ( p less than 0.01 ) . The mean score for inhaler technique was significantly lower at follow-up than during the trial ( p less than 0.001 ) . The results suggest that in this population there is no advantage to using either a chamber device rather than an MDI or one chamber device rather than the other Administration of the long-acting beta 2-adrenoceptor agonist salmeterol from a new , easy-to-operate , multidose powder inhaler ( Diskus ) containing 60 sealed doses in a foil strip has been compared with administration from a Diskhaler inhaler in a multicenter , double-blind , double-dummy , parallel-group study . Asthmatic patients taking anti-inflammatory treatment , with baseline FEV1 > or = 60 % and < or = 90 % predicted were treated for 4 weeks with salmeterol 50 micrograms twice daily from either the Diskus or Diskhaler inhaler . The two treatments were equivalent ( 90 % CLs for the difference in mean morning PEFR : -2.2 , 8.7 L/min ) . The Diskus inhaler was rated easier to use and was preferred by more patients than the Diskhaler inhaler ( 73 % vs. 15 % ) AIM The main objective of this study was to compare the in vitro delivery of salbutamol from a chlorofluorocarbon(CFC)-propelled pressurised metered-dose inhaler ( pMDI ) versus a newly developed hydrofluoroalkane(HFA)-propelled pMDI through various spacers . In addition , we aim ed to study the effect on bronchodilator response when using an optimal pMDI/spacer combination for aerosol delivery compared to a suboptimal combination . METHODS Particle size distribution and output from salbutamol pMDIs containing either CFC propellants ( Ventolin ) or HFA propellants ( Airomir ) were measured using a multistage liquid impinger ( MSLI ) and compared to that through both detergent-coated ( non-static ) or untreated ( static ) large volume ( Nebuhaler , Volumatic ) and small volume ( Aerochamber ) plastic spacers .  Flow-volume curves ( FEV1 ) were obtained from twelve asthmatic children with known significant bronchodilator response ( 8 males ) , aged 13 - 17 years , r and omly inhaling salbutamol from a CFC-pMDI through a static spacer  ( Nebuhaler ) and from  an HFA-pMDI through a non-static spacer  ( Nebuhaler ) . RESULTS In vitro output of particles in the respirable range ( < 6.8 microns ) from HFA-pMDIs was significantly higher than that from CFC-pMDIs using various spacers . Removal of electrostatic charge increased output from CFC- and HFA-pMDIs through all spacers by 17 - 82 % . The mean ( SD ) bronchodilator response after inhalation of salbutamol from a CFC-pMDI through a static spacer was 7.1 % ( 6.3 % ) compared to 17.5 % ( 7.9 % ) after inhalation from an HFA-pMDI through a non-static spacer ( p = 0.002 ) . CONCLUSIONS Use of a newly developed HFA-propelled pMDI greatly improves drug delivery through spacers compared to a CFC-propelled pMDI . However , electrostatic charge in plastic spacers remains the key determinant limiting delivery of salbutamol from a pMDI through spacers , and can be reduced by soaking the spacer in a household detergent . Using an optimal pMDI/spacer combination leads to a significantly improved bronchodilator response To evaluate patient satisfaction with two breath-actuated powder inhalers ( Diskhaler and Diskus ) , investigators asked patients to complete question naires as part of a r and omized , double-masked , double-dummy , placebo-controlled study of fluticasone propionate powder ( 500 mg twice daily ) in the treatment of chronic persistent asthma . At baseline , patients rated the importance of various inhaler attributes ( i.e. , ease of use , ease of loading with medication , ease of holding and operating , ease of cleaning , and ease of telling how many doses of medication are left ) . After 2 weeks of placebo and 6 and 12 weeks of active therapy , patients rated the inhalers on these same attributes . They also rated their general satisfaction with the inhalers and how comfortable they were using them . After 12 weeks , patients also rated the durability and convenience of carrying each device and were asked to indicate which they preferred . Data were available from 213 patients . All seven inhaler attributes measured were considered important by the majority of patients ( 71 % to 91 % ) , contributing to the validity of the patient-rated performance assessment s. After 12 weeks of use , 57 % to 88 % of patients expressed a high level of satisfaction with the performance of the Diskhaler on all attributes ; a high level of overall satisfaction ( 72 % ) and comfort ( 79 % ) was reported with this inhaler . Patients rated the performance of the  Diskus inhaler  very favorably , with 76 % to 96 % expressing a high level of satisfaction on all attributes ; a high level of overall satisfaction ( 87 % ) and comfort ( 85 % ) was reported with this inhaler . At end point , 61.4 % preferred the Diskus inhaler , 25.4 % preferred the Diskhaler inhaler , and 13.2 % expressed no preference . These breath-actuated powder inhalers may be acceptable alternatives to traditional metered-dose inhalers for the treatment of patients with asthma We compared terbutaline administered through an 80-mL , 10 X 3.2-cm tube spacer versus a conventional metered-dose inhaler in 34 asthmatic patients , aged 8 to 16 years . In this double-blind , single-dose study , three groups of children ( spacer active , conventional active , and placebo )  were assessed clinical ly and with spirometry before and at one-half hour intervals for two hours after therapy . One investigator taught inhaler use and monitored patients ' errors in technique . Compared with placebo , terbutaline delivered by either the tube spacer or the conventional inhaler significantly improved pulmonary function from one-half to two hours after treatment . Both the spacer and conventional inhaler were equally effective in improving pulmonary function from the baseline state . Only 4/34 ( 11.7 % ) children used both inhalers without any error . Adverse effects were mild , transient , and infrequent and did not differ between the groups . Terbutaline aerosol , whether delivered by the tube spacer or conventional actuator , provides effective bronchodilation for children with asthma , in spite of frequent errors in technique of inhaler use We compared the bronchodilator response of terbutaline delivered either by a dry powder inhaler , the Turbuhaler , or by a metered-dose inhaler attached to a Nebuhaler inhaler in 10 children with stable asthma who were 3 to 6 years of age . The bronchodilator response did not differ between the two inhalational devices . The dry powder inhaler Turbuhaler is a suitable alternative to a metered-dose inhaler in the delivery of terbutaline to preschool children with stable asthma if adequate inhalational technique is used In an open r and omised parallel-group study , 1004 patients with asthma in 7 countries were r and omised to receive asthma treatment via 2 different kinds of inhalers : an aerosol pressurised metered dose inhaler ( pMDI ) and a dry powder inhaler ( Turbuhaler ) . The patients were treated for 52 weeks with inhaled corticosteroids and /or inhaled beta 2-agonists . All patients were considered adequately treated with inhaled corticosteroids and /or inhaled beta 2-agonists via pMDI before inclusion in the study . Healthcare utilisation variables were attached to the case record forms of the patients , thus making an economic analysis possible . Because of the difficulty of comparing costs between countries , each country was analysed separately . Canadian patients constituted the largest sub population ( 445 patients ) and were therefore used in this analysis . From the analysis , we concluded that the effectiveness of treatment ( measured as the number of exacerbations and days with exacerbation ) was significantly better for patients treated via Turbuhaler than via a pMDI ( p = 0.03 ) . Furthermore , the total annual costs of treatment were , on average , $ Can331 less ( p < 0.01 ) for patients using Turbuhaler than for those using a pMDI ( mainly due to lower costs for hospitalisation and medication ) . The cost differences between inhaled corticosteroids and inhaled beta 2-agonists were significantly in favour of treatment via Turbuhaler ( p < 0.01 ) . Thus , the results of this study suggest that treatment via Turbuhaler is a cost-effective strategy in patients with asthma in Canada 14 children with severe asthma were studied for 2 months in a double-blind cross-over trial to compare the efficacy of beclomethasone dipropionate delivered as an aerosol and as a powder from a rotahaler . Inhalation via the aerosol was satisfactory in 13 patients , each of whom used the rotahaler correctly . Younger children preferred to use the rotahaler . Comparison of daily symptoms , twice daily peak expiratory flow rate ( PEFR ) , and use of salbutamol  during the 2 months of the trial showed that control of asthma was equally good , irrespective of the device used to deliver active beclomethasone A bronchodilator aerosol , terbutaline sulphate , was administered to 18 asthmatic children , mean age 8.0 years ( range 4.9 - 13.7 years ) in a cross-over trial using either a common actuator or a 750-ml collapsible spacer . With the spacer , peak expiratory flow rate was significantly higher ( p less than 0.05 ) at 5 , 20 , and 60 min after administration of 0.25 mg terbutaline sulphate . The mean maximum value during this period was 92 % of the predicted normal value with the spacer compared to 86 % with the common actuator . The difference was significant ( p less than 0.01 ) . This study confirms previous findings that a 750-ml spacer is beneficial in bronchodilator aerosol therapy in children with asthma Self-report is a frequently-used method of assessing compliance with prescribed medications in patients with chronic illnesses . Most research ers agree , however , that self-report misrepresents patient adherence to regimen prescription . In this r and omized , controlled study evaluating inhaler medication compliance , diary data was compared to electronic monitoring in 55 adults with asthma . Subjects r and omized to the treatment group received a six-week self-management program . An electronic monitor , the MDI Chronolog , was used in this study to assess inhaler use . The MDI Chronolog records the date and time of each inhaled activation . The self-report measure used was a daily asthma diary . Subjects were asked to use their inhaled medications as usual and record the date and time they administered their medication over a one-week period . Moderate correlations ( rs=.55 , Mdnd=95.8 , Mdnc=91.6 ) were found when comparing the number of administrations calculated using the MDI Chronolog to the number of administrations reported in the subject ’s diary . When the dosing interval was examined , however , the correlation was weaker ( rs=.44 , Mdndiary=92.8 , Mdnchronolog=37.5 ) . In each case , self-reported compliance was higher than monitored adherence Two hundred and forty one children with chronic perennial asthma , who had been treated with budesonide via a metered dose inhaler with a spacer device ( Nebuhaler )  , had their normal dose of budesonide reduced by 50 % to determine if they had been overtreated . Within three weeks , asthma control deteriorated in 126 patients to such an extent that budesonide had to be increased to the normal dose . After stabilising their asthma , these children were enrolled in a r and omised , double blind , double dummy , parallel study , performed to compare the effect of budesonide via Nebuhaler with that of half the dose of budesonide via Turbuhaler . The study started with a two week run-in during which patients were treated with their normal dose of budes 
    Output:
    