Postgraduate medical journal
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Type 2 diabetes mellitus (T2DM) is a progressive disorder caused by a combination of insulin resistance and beta cell dysfunction. It is associated with an increased and premature risk of cardiovascular disease as well as specific microvascular complications such as retinopathy, nephropathy and neuropathy. ⋯ This review looks at these new agents in terms of their mode of action, pharmacokinetics and use in clinical practice. This review also includes new agents in the area of weight loss that may have a positive effect for glucose management-for example, rimonabant.
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Exercise induced bronchoconstriction (EIB) describes the acute transient airway narrowing that occurs during and most often after exercise, and is prevalent in elite athletes. Prolonged hyperventilation of dry or cold air and increased inhalation of pollutants or allergens could account for the bronchoconstrictive reaction. The subsequent airway inflammation seems to differ from typical asthma. ⋯ Leukotriene receptor antagonists can be used in patients whose symptoms do not respond to inhaled steroids. The screening of high risk populations such as swimmers, cyclists, rowers and winter athletes is recommended by some authors. Drug doping regulations and practical recommendations for competitive athletes and their health care providers are explained.
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Cardiovascular disease (CVD) has become a major clinical and public health problem. South Asian countries, namely India, Pakistan, Sri Lanka, Bangladesh and Nepal, not only represent a quarter of the world's population but also contribute to the highest proportion of CVD burden when compared with any other regions globally. This population carries the increased risk even if they migrate to other countries and have increased mortality due to CVD at a younger age in comparison to the local population. In this review, the risk factors and reasons for the higher rate of CVD in South Asians are discussed.
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This article reviews the available evidence as to whether inhaled long acting beta-agonists (LABA) increase the risk of asthma mortality and considers the implications for the use of this treatment in the management of asthma. Randomised controlled trials suggest that LABAs prescribed as monotherapy may increase the risk of asthma death in certain circumstances, such as the unsupervised "off-label" use without concomitant inhaled corticosteroid (ICS) treatment in patients with unstable asthma. ⋯ The only way in which a prescriber can ensure that a patient with asthma takes LABA treatment in conjunction with ICS is through a combination ICS/LABA product, an approach which may have additional therapeutic advantages. We propose that in the management of asthma, a case can now be made to limit the availability of LABAs to combination LABA/ICS therapy.