Posted by James
The LABAs are approved for chronic maintenance therapy of asthma, chronic obstructive pul¬monary disease and exercise-induced bronchospasm (EIB). Numerous trials have demonstrated the superiority of maintenance therapy with an inhaled LABA (administered twice daily) to maintenance therapy with an inhaled short-acting beta-2 agonist (administered four times daily). Therapy with LABAs improves lung function, bronchial hyperre-sponsiveness and symptom control during chronic administration. The LABAs also provide superior control of asthma with fewer adverse effects than sustained-release theophylline. However, the LABAs are less effective than low-dose inhaled corticosteroids as monotherapy for persistent asthma, particularly in preventing asthma exacerbations. In the studies comparing monotherapy with LABAs to inhaled corticosteroids, no improvement in bronchial hyperresponsiveness compared to placebo was noted, and one 12-month trial in children reported a decrease in lung function and increase in bronchial hyperresponsiveness for LABA therapy. However, there was no placebo group and the differences between active treatments were similar to those seen in the other studies that showed no difference in these outcomes from the placebo control group. This suggests the changes were most likely a result of patients not receiving the inhaled corticosteroid as opposed to the putative effect of LABAs on worsening asthma.
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Posted by James
LABAs differ from short-acting inhaled beta-2 agonists principally in having large side chains, increasing their lipophilicity. The greater water solubility of short-acting inhaled beta-2 agonists, such as albuterol, leads them to diffuse away from the beta-2-adrenergic receptors, limiting their duration of action. The greater lipophilicity of formoterol and salmeterol facilitates their partitioning and retention in the phospholipid region of the cell membrane lipid bilayer, prolonging the duration of action.
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Posted by James
National and international guidelines for the management of asthma concur on the goals of therapy (Table 1) and on the components of the care necessary to achieve them (Table 2). The components of care involve eliminating or avoiding disease exacerbating factors, monitoring, education and pharmacotherapy. The guidelines agree that pharmacotherapy should consist of the treatment that can most effectively reduce symptoms, prevent exacerbations and maintain lung function as near to normal as possible while producing the least amount of adverse effects.
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Posted by James
The role of inhaled beta-2 agonists in the management of asthma has changed significantly over the last several years. This review outlines the most recent understanding of the pathophysiology of asthma and the studies that define the roles lhat both short- and long-acting beta-2 agonists play in therapy for this disease. A concentration on the clinical pharmacology and genetic implications for clinical use of this class of drugs in accordance with the national and international guidelines are described.
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Posted by Alex
Underscreened populations. Women are inadequately screened for several reasons. For women to enjoy the benefits of screening, they must first undergo the test. In Prince Edward Island, 57% of women diagnosed with invasive cancer of the cervix had not previously been screened. Eighty-six percent of women older than 60 diagnosed with invasive cancer had never been screened. Despite a population-based screening program in British Columbia since 1955, 15% of all women in that province have never had a Pap test. Nationally, twice as many women between the ages of 25 and 44 were not screened in 1990 as were not screened in 1985.
Many of the unscreened women are from immigrant communities, aboriginal communities, or core areas of our cities. Other groups shown to be under-screened include those living in remote areas; single, unemployed women; low-income earners; and older women.1213 The challenge these groups of women present to family physicians is more than a lack of compliance with cervical cancer screening. They frequently feel uncomfortable and unwelcome in physicians’ offices and thus attend infrequently.
There are both physician-specific and patient-specific barriers to cervical screening. To overcome these barriers, family physicians need to make preventive care a priority. When patients attend for any reason, family physicians need to encourage all women due for screening to undergo Pap tests, especially those who have never been screened. This requires effective communication of the purpose of screening as well as of the mechanics of the test.
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Posted by Alex
Most Pap smears in Canada are performed by family physicians. Despite the tremendous success of the Pap test in reducing the incidence of cancer of the cervix in Canada, 1350 new cases and 390 deaths were predicted to occur in 1996. Incidence rates have dropped from 21.6 per 1000 in 1969 to 10.4 per 1000 in 1990. To further reduce the incidence of invasive carcinoma of the cervix, we need to examine the role of family physicians as the primary providers of screening services.
The success of screening is directly related to the percentage of the target population who are screened and the reliability of the screening test performance. Family physicians have the opportunity and responsibility to influence both of these factors.
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Posted by Alex
Jumbled anatomy lab box: sticks, knots
Ivory polished by years of touch
Fingered, fitted, laid in rows, decades
from the proper rest of graves.
Carpal, tarsal, incus, stapes,
Ilium, ischium, rib.
Conjure-names for destiny,
Spells with a terrible grace.
Grandma said her friend didn’t have a single mean bone,
So for years I thought of one small bone, a spiky knot
Of meanness caught in certain people, maybe in the throat,
Making rattled ugliness whenever they talked.
Never Lower Tillie’s Pants
Grandma Could Come Home
Navicular, lunate, triquetrium, pisiform
Scaphoid, capitate, cuboid, hamate.
Grandma got to be the scaphoid;
necessary bone, essential
for the proper use of hands:
knit, stir, spank, hug.
Wire-strung, castanet Mr. Bones
in the comer dressed for Halloween
Groucho glasses and cigar
Say the secret woid, Mr. Bones.
The ankle bone’s connected to the knee bone
Fibula, tibia, femoral condyle
Dry bones have no remorse -
Always the last stone along the path.
Sinew-strung blocks, rag-tag scraps,
flesh a banner too-long flown
tattered by the years hanging from a staff.
Bones grow stronger under strain.
Until the day they snap and life rains down,
sculptured beauty splinters into pain.
Meanness is a given, soaks to the bone
but beauty doesn’t stop at the skin.
CATHARINE CLARK-SAYLES
Mill Valley, California
