Effect of budesonide/formoterol maintenance and reliever therapy on asthma exacerbations.

This randomised, double-blind, 6-month study compared budesonide/formoterol for maintenance and relief with salmeterol/fluticasone and a fixed maintenance dose of budesonide/formoterol, both with terbutaline for relief. Following a 2-week run-in, 3335 symptomatic adults and adolescents (mean FEV1 73% predicted, mean inhaled corticosteroid dose 745 microg/day) received budesonide/formoterol 160/4.5 microg one inhalation bid plus additional inhalations as needed, salmeterol/fluticasone 25/125 microg two inhalations bid plus as-needed terbutaline or budesonide/formoterol 320/9 microg one inhalation bid plus as-needed terbutaline. Budesonide/formoterol for maintenance and relief prolonged the time to first severe exacerbation requiring hospitalisation, emergency room treatment or oral steroids (primary variable) vs. fixed-dose salmeterol/fluticasone and budesonide/formoterol (p=0.0034 and p=0.023 respectively; log-rank test). Exacerbation rates were 19, 16 and 12 events/100 patients/6 months for salmeterol/fluticasone, fixed-dose budesonide/formoterol and budesonide/formoterol for maintenance and relief, respectively, [rate reduction vs. fixed-dose salmeterol/fluticasone (0.61; 95% CI 0.49-0.76, p<0.001) and vs. fixed-dose budesonide/formoterol (0.72; 95% CI 0.57-0.90, p=0.0048)]. Budesonide/formoterol maintenance and relief patients used less inhaled corticosteroid vs. salmeterol/fluticasone and fixed-dose budesonide/formoterol patients. All treatments provided similar marked improvements in lung function, asthma control days and asthma-related quality of life. Budesonide/formoterol for maintenance and relief reduces asthma exacerbations and maintains similar daily asthma control at a lower overall drug load compared with fixed-dose salmeterol/fluticasone and budesonide/formoterol.

[Apoptosis in allergic disease]. / Apoptosis en la enfermedad alérgica.

Apoptosis (cell programmed death) it is a mechanism that implicate a physiological suicide, to keep the cellular homeostasis in big amount of tissues. Fas (APO-1; CD95) system is one of the most important cellular responsible via to induce apoptosis on different tissues. Eosinophillia on peripheral blood and tissues are the main characteristics on allergic like asthma. Eosinophil apoptosis is upper regulated in those diseases by IL-5 y GM-CSF. Corticoids, teophyllin and some macrolids have been used like apoptosis inductors on eosinophills, these could be a novel mechanism to promote a better solution on inflammatory allergic diseases.

[Cell surface markers in patients with allergic rhinitis versus Der p and Der f challenge]. / Estudio de marcadores de superficie celular en pacientes con rinitis alérgica frente a reto con Der p y Der f.

The allergic condition is determined genetically and they affect of the general population's 20-30% in developed countries, in the last decade have been increased the prevalence. Inside the imbalance that is manifested in the atopic patients it is on one hand the antigen-presenting cells (monocytes and B cells) and on the other hand, the lymphocytes T CD4+. The association of molecules like CD80, CD 86 (co-stimulatory molecules) in monocytes and B cells and CD30, CD62L, ALL, CD11a, CD28, CD124 and CD152 in CD4+, they have shown to be of particular interest in allergic sufferings. However we don't find a difference statistically significant among patient and controls and among nasal challenges with saline solution with specific allergen. For what we suggest that the changes in the activation, proliferation and cooperation are given in the les ion place, without an apparent repercussion in cells of peripheral blood.

[The TH2 theory in allergy]. / Teoría Th2 en alergia.

The allergic diseases are determined by genetics and thought to affect between 20 to 30 percent of general people in developed countries. The prevalence has increased in the last decade. The allergic diseases are characterised by an increase of B-lymphocytes' ability to produce IgE antibody; this synthesis of human IgE is a result of collaboration between subsets of T helper cells CD4+ and B cells. The functional property of Th cells has been studied recently, fundamentally Type 2, in the cooperation among IgE-producing B cells, mast cell, basophils and eosinophil in the allergic reaction. This concept is known as the Th2 theory in allergy.