Pet health insurances and contract services: the potential for practice involvement.

Pet medical insurance has appreciable advantages and the existing policies appear to provide a beneficial service. But administrative costs of the small premiums involved make it of doubtful commercial attraction or benefit to the client. However, practice contract service schemes reduce administrative costs and can provide many of the advantages of insurance. Such a scheme is described. A coordinating agency outside the practice to produce promotional material, contracts, formulae for setting premiums and exclusions and to act as an arbitration agency for disputes could be established given the demand.

Comparison of the efficacy, tolerability and patient acceptability of once-daily bambuterol tablets against twice-daily controlled release salbutamol in nocturnal asthma. ACROBATICS Research Group.

The aim of the study was to compare the efficacy, tolerability and patient acceptability of bambuterol (Bambec) against controlled release (CR) salbutamol (Volmax) in the treatment of nocturnal asthma. One hundred and fifty two asthmatic patients aged 17-78 years, using > or = 800 micrograms/day of an inhaled steroid, with nocturnal asthma symptoms, openly received three weeks of bambuterol 20 mg nocte and three weeks of salbutamol CR 8 mg b.i.d. in a randomised, cross over sequence. Both bambuterol and salbutamol CR treatment produced a significant 63% decrease in the severity of baseline nocturnal asthma symptoms. This improved control of nocturnal asthma was reflected by significant improvements in baseline lung function. Both the severity and number of days of tremor during the first week of treatment was significantly lower with bambuterol than with salbutamol CR. Patients considered bambuterol to cause less shakiness and treatment preference was bambuterol 49%, salbutamol CR 36%, no preference 15%. The predominant reason for patient treatment preference was control of asthma symptoms, however a significant sub-group of patients (27%) chose bambuterol because of fewer adverse effects compared to 11% choosing salbutamol CR. Fifty six percent of patients preferred taking their medication once-daily and 7% preferred twice-daily. This study shows that both bambuterol and salbutamol CR are equally effective treatments for nocturnal asthma in patients already receiving inhaled steroid. The most important factor in terms of patient treatment acceptability appears to be control of symptoms. Sub-groups of patients may chose bambuterol due to its better adverse effect profile and once-daily regimen.

Once-daily budesonide: 400 micrograms once daily is as effective as 200 micrograms twice daily in controlling childhood asthma. PETITE Research Group.

One hundred and sixty seven children on 0-200 microgram/day of inhaled steroid with asthma symptoms and sub-optimal peak flow values (less than 90% of that predicted for their height) were randomly allocated either 400 microgram once daily (nocte with placebo o.m.) or 200 mircrogram twice daily of budesonide Turbohaler for 8 weeks. Bronchdilator usage and symptoms were reduced in both groups at 4 and 8 weeks compared with baseline. There was a significant increase within both groups in morning and evening PEF after 4 and 8 weeks. The increase in evening PEF after 8 weeks was greater in the once-daily group than in the twice-daily group but there were no other significant differences between the groups (morning: +24.6 l/min vs 15.2 l/min, p = 0.059; evening: + 19.7 l/min vs +8.31 l/min; p = 0.013). Budesonide Turbohaler 400 microgram once daily is therefore as effective as 200 microgram twice daily in achieving asthma control in children.