Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Apr 2006
Review[Efficacy of combined treatment with corticosteroids and beta2 agonists in adults with asthma].
Asthma is characterised by chronic airway inflammation and variable airway obstruction. Maintenance therapy with inhaled corticosteroids and short-acting beta2 agonists on demand constituted the cornerstone of asthma management for many years. Since introduction of the long-acting form, beta2 agonists are currently also used as maintenance therapy. beta2 agonists and corticosteroids have complementary and synergistic effects in vitro and the combination also has increased efficacy clinically. ⋯ Studies of these combined preparations are based on two contradictory treatment strategies: one in which the dosage is increased gradually in a controlled manner, and one in which a variable dose is added to a maintenance regime. Both strategies seem more effective than fixed low dosages of the same preparations. A well-founded choice between the two strategies cannot be made, if only due to the lack of knowledge regarding the effects of these strategies on treatment compliance, airway remodelling, side effects and costs.
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Ned Tijdschr Geneeskd · Apr 2006
Comment[Caution recommended in prescribing long-acting beta2-adrenergic agonists to patients with asthma].
How safe is the use of long-acting beta2-adrenergic agonists in the treatment of asthma? Recently, several warnings have been issued by the US Food and Drug Administration and the World Health Organization concerning the safety of long-acting beta2-adrenergic agonists in the treatment of patients with asthma. These warnings were based on data from the 'Salmeterol multicenter asthma research trial' (SMART) published in January 2006. This randomized, placebo-controlled trial studied the effects of the addition of either salmeterol or placebo to the usual medication regime, with respiratory-related deaths and life-threatening events as primary endpoints. ⋯ It is not clear whether the concomitant use of inhaled corticosteroids prevents an increased risk of such events. If asthma is not well-controlled by moderate doses of inhaled steroids, the respiratory and non-respiratory factors that elicit asthma attacks should be reduced and special attention paid to therapy compliance and the correct use ofinhalers. Treatment options including intensifying anti-inflammatory treatment by the use of inhaled corticosteroids which give increased peripheral lung deposition or the addition ofleukotriene receptor antagonists should also be considered before prescribing long-acting beta2-adrenergic agonists.
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Ned Tijdschr Geneeskd · Apr 2006
Review[Coeliac plexus block in patients with pancreatic tumour pain].
Pancreatic cancer tends to be diagnosed at a relatively late stage of the disease when curative resection is precluded. In view of the poor prognosis and the severe pain, palliative care should be aimed at providing adequate pain relief and optimal quality of life. Pancreatic cancer pain is primarily treated by the combination of NSAIDs, adjuvant analgesic drugs, and oral or transdermal opioids. ⋯ More recently, new techniques such as thoracoscopic splanchnicectomy and endoscopic ultrasound-guided coeliac plexus block have emerged as efficient alternatives in terms of pain relief and quality-of-life improvement. The neurolytic coeliac plexus block has become a well-developed method of pain relief in patients with pain resulting from malignancies of the pancreas. To define the role of these new techniques in the palliative treatment of pancreatic cancer pain, comparative studies regarding efficacy, side effects, and complications have to be performed.