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Friday, December 28, 2012

Intermittent vs. daily inhaled corticosteroids

A Cochrane Collaboration article, published online on December 12, reviewed the efficacy and safety of intermittent versus daily inhaled corticosteroids for persistent asthma in children and adults. The authors concluded: 

In children and adults with persistent asthma and in preschool children suspected of persistent asthma, intermittent and daily ICS strategies did not significantly differ in the use of rescue oral corticosteroids and the rate of severe adverse health events, neither did they reach equivalence. Daily ICS was superior to intermittent ICS in several indicators of lung function, airway inflammation, asthma control and reliever use. Both treatments appeared safe, but a modest growth suppression was associated with daily, compared to intermittent, inhaled budesonide and beclomethasone. The clinician should carefully weigh the potential benefits and harm of each treatment option, taking into account the unknown long-term (> one year) impact of intermittent therapy on lung growth and lung function decline.

This is a matter of very interesting debate. What are your views?

Thursday, December 13, 2012

Varenicline (Chantix) in smoking cessation: to be or not to be?

Tobacco smoking is a major risk factor for cardiovascular and many other chronic diseases. The health benefits of quitting smoking are substantial. Varenicline, as part of a program, is an effective tool to help patients quit smoking. The cardiovascular safety of varenicline was questioned. The results of a meta-analysis conducted by the US Food and Drug Administration (FDA) from 7,002 patients (4,190 Chantix and 2,812 placebo) enrolled in 15 Pfizer-sponsored, randomised, double-blind, placebo-controlled clinical trials (December 12, 2012). Although “cardiovascular events were uncommon in both” groups and the “increased risk was not statistically significant,” “a higher occurrence of major adverse cardiovascular events (a combined outcome of cardiovascular-related death, nonfatal myocardial infarction [MI], and nonfatal stroke) was observed in patients using varenicline (Chantix) to aid in smoking cessation, compared with placebo.”

What should we say to the patients on treatment?
When should we initiate a varenicline treatment?