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Regular steroid benefits, Long-term HIV boost, Workplace asthma risks, New combination aids BP, Chlamydia screen doubts

Regular steroid benefits

Regular use of the inhaled steroid budesonide controls asthma better than budesonide given as needed in mild, persistent childhood asthma, according to a Finnish trial. The study randomised 176 newly diagnosed children aged five to 10 years to one of three treatment groups.

It found fewer exacerbations among the children taking regular budesonide compared with those on intermittent inhaled steroid treatment or treatment with disodium cromoglycate. But the number of asthma-free days did not differ with regular and as-needed budesonide treatment.

Archives of Disease in Childhood; 18 July early online publication

Long-term HIV boost

Patients infected with HIV and treated with combined antiretroviral therapy over the long term have levels of CD4 cells in their immune system which are similar to those seen in uninfected individuals. The study of 1,835 patients from a European observational cohort study looked at CD4 counts over a period of four to five years.

The biggest increase in CD4 counts was in the first year after the start of treatment but there were increases over up to five years, as suppression of HIV was maintained.

The Lancet 2007; 19 July early online publication

Workplace asthma risks

Workplace conditions could be responsible for a quarter of new asthma cases in developed countries, a Europe-wide study of respiratory health has found.

The study followed up a population who had not reported any history or symptoms of asthma over nine years. Individuals were particularly at risk if they had been exposed to incidents such as fire, mixing cleaning products, or chemical spills.

The Lancet 2007;370:336-41

New combination aids BP

The combination of the ARB valsartan with the experimental treatment aliskiren, which directly inhibits plasma renin, reduces blood pressure more than either drug used alone, a US study reports.

The trial studied 1,797 hypertensive patients. At the end of eight weeks, the combination reduced sitting diastolic blood pressure by 12mmHg over baseline compared with a fall over baseline of 9-10mmHg for the individual treatments and 4mmHg for placebo.

But an editorial commentator warned against potential side-effects of the combination, in particular the risk of elevated serum potassium.

The Lancet 2007;370:221-9 and 195-6

Chlamydia screen doubts

GP register-based population screening programmes for chlamydia infection are poor value for money, according to a new economic model. It would cost about £22,300 to prevent one 'major outcome' ­ most commonly pelvic inflammatory disease leading to hospital admission.

Having the disease would have to be 'equivalent to being in a state equivalent to death' for nearly nine months for a GP register-based programme to meet NICE's cost-effectiveness threshold of £30,000 per QALY, said researchers from the universities of Birmingham and Bristol.

BMJ; 26 July early online publication

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