The treatment of acute severe asthma in the adult: an overview
September 1st 2003Asthma is a chronic inflammatory disease of the airways affecting 5%–7% of the US and European populations. It accounts for nearly 400,000 hospitalizations and 5,000 deaths per year. Acute asthma comprises those asthmatics with severe symptoms, despite attempts at appropriate control. Typically these patients will present to a local emergency department for evaluation and treatment. This review examines the pharmaceutical treatment options made available to these patients in emergency settings, including their risks, benefits, side effects and overall effectiveness. (Formulary 2003;38:537–543.)
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Lumiracoxib A COX-2 inhibitor for the treatment of arthritis and acute pain
September 1st 2003Lumiracoxib (Prexige, Novartis) appears to be the next COX-2 specific inhibitor that will be marketed in the United States. Currently, lumiracoxib is being studied for the treatment of osteoarthritis, rheumatoid arthritis, and acute pain. Lumiracoxib has been shown in vitro to be more selective for the COX-2 isoenzyme compared to rofecoxib and celecoxib, but clinical head-to-head studies between these agents are lacking. Small controlled trials, presented in abstract form, have shown lumiracoxib to have comparable efficacy to diclofenac and celecoxib in osteoarthritis. It has an adverse effect profile similar to other COX-2 inhibitors and superior to traditional NSAIDs concerning gastrointestinal safety, but cardiovascular and renal safety data are still not available. While existing clinical data on lumiracoxib are minimal and only published in abstract form, research is ongoing, including comparing lumiracoxib to ibuprofen and naproxen in the largest arthritis trial undertaken to date. When the results of this study are published, lumiracoxib?s efficacy and safety profile will be better understood. (Formulary 2003;38:528?536.)
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Students who aspire to become medical directors because they think it's a laid-back desk job are in for a rude awakening. Unlike the clinical executives of the past, today's medical directors and chief medical officers (CMOs) have enterprising issues on their desks, sprawling out to the remotest edges in the continuum of care.
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All of the computer information technology in the world does no good if you don't have the discipline to act on what it's telling you to do. Not only does Kent Clapp, chairman, president and CEO of Medical Mutual of Ohio, apply this principle to running his own organization, he believes it's equally relevant to healthcare consumers.
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