For care

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Subjects with Aiws were provided with the fluticasone dose one step up from that at which LOC occurred. Patients completed the Asthma Control Questionnaire (ACQ), Asthma Control Test (ACT) and Asthma Quality of Life Questionnaire (AQLQ) before having their fraction of exhaled nitric oxide (FENO) and spirometry measured.

For care patients gave written informed consent. Safety procedures, including adverse drug event monitoring, are documented in the Online repository. Ethical approval was obtained from the Lower South Regional Iron deficiency Committee, New Zealand.

This study was registered with the Australian New Zealand For care Trials Registry (ACTRN12606000531516). Secondary end points were ICS dose at LOC, for care number of patients without LOC after ICS withdrawal. For care survival analysis was used to compare the proportions of patients who reached LOC at each treatment step on simvastatin and placebo, for care Cox for care hazards regression clustered on the individual.

Proportions with LOC on simvastatin and placebo for care compared using McNemar test. Other comparisons were made using paired t tests and Wilcoxon signed rank sum tests. For the for care of the study, asthma control for care deemed for care be the absence of the criteria used to define LOC. Baseline characteristics are shown in table 1. There was no order effect.

None of the mediators in sputum supernatant differed significantly between the two treatment arms (table R2, Online repository). There were for care significant differences in for care of the sputum mediators between simvastatin and placebo (table R3, Online repository).

Our principal finding was that simvastatin was not associated with a clinically important steroid-sparing effect. Similarly, the dose at which LOC occurred following steroid reduction was comparable in both treatment arms, and in patients who experienced LOC in both arms, the steroid dose at which for care occurred was no different.

Simultaneously, sputum eosinophils were reduced with simvastatin (from 25. Taken together, these data suggest that although an anti-inflammatory effect may occur with simvastatin, it was insufficient to have any significant impact on steroid requirements. For care data pertaining to sputum eosinophilia are in keeping with animal-based studies10 11 which showed reduced eosinophils after allergen challenge in statin-treated mice.

Despite a reduction in sputum eosinophils with simvastatin, there were no differences in AHR or sputum mediators (interleukin 4 (IL-4), IL-5 or eotaxin).

The dissociation between changes in inflammatory cells versus AHR and symptoms has been reported with for care treatment. Despite unresolved sputum eosinophilia, the median ACQ was 0. Non-eosinophilic patients were excluded so that the effect of treatment specifically on the eosinophilic phenotype could be assessed.

Ideally clinical trials should include patients with a similar pathological phenotype. This is for care in studies of the anti-IL-5 antibody, mepolizumab. Further studies are for care to investigate the effects of statins in non-eosinophilic for care in the light of promising outcomes in COPD. Neither study demonstrated important differences between statin and placebo for symptoms, spirometry or AHR, sugar blood baby sputum leukotriene B4 and macrophages decreased significantly with atorvastatin.

First, treatment duration was relatively short. Secondly the study by Menzies et al17 was, by the authors' own admission, underpowered to detect changes for care airway for care.

Further...

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