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This review aims to determine the effectiveness of long‐acting beta‐agonists, salmeterol or formoterol, in the treatment of COPD (emphysema/chronic bronchitis). These drugs improve airflow in the lungs, and enable people with COPD to get on with their daily activities. Twenty‐four studies (6061 participants) reported the effects of LABAs in people with COPD. People taking salmeterol 50 mcg daily do have fewer exacerbations than those on placebo, and some improvement in lung function and certain quality of life scores. The findings were not consistent enough to support a general recommendation for the use of these drugs in the group of people with COPD with minimal variation in their lung function, although there is some evidence of improvement in important outcomes and these findings require further exploration in additional trials.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Using a pilot system we have categorised this review as: Current question ‐ no update intended (topic covered in another review. Refer to: Sinclair D, Zani B, Donegan S, Olliaro P, Garner P. Artemisinin‐based combination therapy for treating uncomplicated malaria. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD007483. DOI: 10.1002/14651858.CD007483.pub2.) Please see "Published notes" section of the review for more details.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

This review looks at studies that compare the regular use for at least four weeks of different types of bronchodilator medicine (long acting beta‐2 agonist medicines and ipratropium) in people with stable chronic obstructive pulmonary disease (COPD, or emphysema/chronic bronchitis).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Combinations of two classes of medication (long‐acting beta2‐agonists (LABAs) and inhaled corticosteroids (ICS)) in one inhaler have been developed to treat people with COPD, as this may make it easier to take the medication. Three brands of combined inhaler are currently available: budesonide/formoterol (BDF-'Symbicort'), fluticasone propionate/salmeterol (FPS-'Advair' or 'Seretide') and mometasone furoate/formoterol (MF/F-'Dulera'). Both the ICS part and the LABA component of each inhaler are aimed at reducing flare‐ups of COPD, which can be debilitating and costly. In addition, the LABA component may improve day‐to‐day symptoms such as breathlessness and exercise tolerance.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

This Cochrane Review summarises trials evaluating the effects of artemisinin‐naphthoquine compared to other artemisinin‐based combination therapies (ACTs) recommended by the World Health Organization (WHO) for treating adults and children with uncomplicated P. falciparum malaria. After searching for relevant trials up to January 2015, we included four randomized controlled trials, enrolling 740 adults and children.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

The use of long‐acting ß2‐agonists (LABAs) as 'add‐on' medication to inhaled corticosteroids is recommended for poorly‐controlled asthma where asthma exacerbations may require additional treatment with oral steroids. The purpose of this review was to assess the efficacy and safety of adding long‐acting ß2‐agonists to inhaled corticosteroids in asthmatic children and adults. Based on the identified randomised trials, in people who remain symptomatic while on inhaled corticosteroids, the addition of long‐acting ß2‐agonists improves lung function and reduces the risk of asthma exacerbations compared to ongoing treatment with a similar dose of inhaled corticosteroids alone in adults. We could not find evidence of increased serious adverse events or withdrawal rates due to adverse health events with the combination of long‐acting ß2‐agonists at usual doses and inhaled corticosteroids in adults. This provides some indirect evidence, but not total reassurance, regarding the short‐ and medium‐term safety of this treatment strategy. There have not been enough children studied to assess the risks and benefits of adding LABAs in this age group.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Malaria is a major cause of illness and death in many of the world's poorest countries. It is spread from person to person by the bite of mosquitoes infected with a microorganism called Plasmodium. The Plasmodium species P. falciparum is the most common cause of malaria worldwide and causes the majority of deaths. Uncomplicated malaria is the mild form of the disease which, if left untreated, can progress rapidly to become life threatening. The drugs traditionally used to treat uncomplicated malaria have become ineffective in many parts of the world due to the development of drug resistance.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

To help prevent the malaria parasite from developing resistance to antimalarial medicines, the WHO recommends the use of combination therapy, where malaria infections are treated with more than one drug simultaneously. As azithromycin is an antibiotic that also has an effect on the malaria parasite, we assessed its efficacy and tolerability as an antimalarial when used alone or as part of combination therapy with other antimalarials. Our review of studies conducted over the past 14 years suggests that azithromycin is a relatively weak antimalarial whose efficacy depends on the drug dose and the partner drug in the combination therapy. The data suggest that, among adults, the higher doses needed to achieve an acceptable level of treatment success with malaria may be less well tolerated. Unless the ongoing product and dose optimisation process results in a universally efficacious product or identifies a specific niche application that is complementary to the current scala of more efficacious antimalarial combinations, azithromycin's future as an antimalarial does not look promising.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Asthma is a condition that affects the airways – the small tubes that carry air in and out of the lungs. When a person with asthma comes into contact with an asthma trigger, their airways become irritated and the muscles around the walls of the airways tighten so that the airways become narrower (bronchoconstriction) and the lining of the airways becomes inflamed and starts to swell. Sometimes, sticky mucus or phlegm builds up, which can further narrow the airways. These reactions cause the airways to become narrower and irritated ‐ making it difficult to breathe and leading to coughing, wheezing, shortness of breath and tightness in the chest. People with asthma are generally advised to take inhaled steroids to combat the underlying inflammation, but if asthma is still not controlled, current clinical guidelines for people with asthma recommend the introduction of an additional medication to help. A common strategy in these situations is to use a long‐acting beta‐agonists: formoterol or salmeterol. A long‐acting beta‐agonist is an inhaled drug which opens the airways (bronchodilator) making it easier to breath.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

People with persistent asthma often require an additional treatment to regular inhaled steroids. Some preparations of long‐acting beta‐agonists are delivered in the same inhaler device as the inhaled corticosteroids. Inhaled steroids help to treat inflammation of the airway and long‐acting beta‐agonists help the airway to relax, improving symptoms and lung function. This systematic review examined randomised controlled trials comparing two commonly available combinations administered at a fixed dose through a single inhaler, fluticasone/salmeterol and budesonide/formoterol. We included five studies which recruited 5537 people. The trials were generally well designed but only recruited adults and adolescents and not children. Participants were already taking regular inhaled steroids before the studies commenced and had mild or moderate asthma based on tests of their airway. We found that the number of people who required treatment with oral steroids and admission to hospital was similar between the treatments, but due to the statistical uncertainty of this result we could not rule out important differences in favour of either drug combination. Additional trials would enable us to draw more reliable conclusions about how well these drugs work compared with each other. We also looked at serious adverse events. Again, the results did not indicate that one combination was clearly better than the other, but again these results were imprecise so we cannot be certain. However, lung function and rescue medication use were similar between the treatments. We could not assess the relative effects of these drugs on mortality because there were so few deaths which leads to statistical uncertainty; out of the five studies, one person died. Quality of life was measured in different ways in two studies and we could not determine how the treatments compared in this respect. Further studies are needed to strengthen and better explain these findings. In particular studies which assess the effects of these therapies in children and studies which measure quality of life are a priority.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Uncomplicated malaria is the milder form of malaria which usually causes fever, with or without headache, tiredness, muscle pains, abdominal pains, nausea, and vomiting. If left untreated, uncomplicated malaria can rapidly develop into severe malaria with kidney failure, fitting, unconsciousness, and eventually death. Plasmodium falciparum is the most common parasite causing malaria in sub‐Saharan Africa and causes most of the severe malaria worldwide.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

P. vivax is one of five species of the malaria parasite known to cause clinical illness. It is a common cause of malaria in Asia, South America and Oceania. Unlike P. falciparum (the commonest cause of malaria in Africa), P. vivax has a liver stage which is not treated by most common antimalarial drugs. This liver stage can become active and cause a relapse of clinical illness weeks or even years after the initial illness.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Asthma is a disease of the lungs. Symptoms include wheezing, breathlessness and chest tightness. Two main features of asthma have been identified: underlying inflammation, which can be treated with daily steroids, and bronchoconstriction (tightening of the muscles around small tubes in the lungs), which can be treated with a beta2‐agonist to relax the muscles.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

We looked at previous Cochrane reviews on long‐acting beta2‐agonists and also searched for additional trials on long‐acting beta2‐agonists in children. We found a total of 21 trials involving 7318 children that provided information on the safety of formoterol or salmeterol given alone or combined with corticosteroids. We also found one trial on 156 children which directly compared formoterol to salmeterol.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Most consensus statements recommend use of long‐acting beta2‐agonists (LABA) as adjunct therapy to inhaled corticosteroids (ICS) for poorly controlled asthma, despite the use of low‐dose ICS.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Malaria is a parasitic disease spread by mosquitoes. It affects millions of people worldwide and causes significant illness and mortality. Uncomplicated malaria presents with symptoms such as fever, headache, muscle pain, and vomiting. The parasite has become resistant to a number of previously effective drugs, and so combinations of drugs are used to try to prevent further resistance. Artemether‐lumefantrine is one such drug combination. This review of trials showed that, although the four‐dose artemether‐lumefantrine regimen was superior to chloroquine, in general the four‐dose regimen was less effective compared with the six‐dose regimen or other drug combinations. The fact that the four‐dose regimen is generally less effective means it is unlikely that it would be used for treating uncomplicated malaria.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Patients with chronic asthma are generally treated with a 'preventer medication' to reduce the underlying airways inflammation but often require bronchodilators for their symptoms. Treatment with regular long acting Beta‐agonist bronchodilator agents, such as salmeterol (Serevent) or formoterol (Foradil, Oxis), leads to fewer asthma symptoms during the day and the night, less bronchodilator medication requirement for symptoms, better lung function measurements and better quality of life measurements compared to short acting Beta‐agonist bronchodilators such as salbutamol (Ventolin, Asmol, Airomir) or terbutaline (Bricanyl). There were no major adverse effects but there is little information on the effects in patients who do not use a 'preventer medication'.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Short‐acting beta‐agonists are traditionally used to ease symptoms when people experience wheezing and breathlessness during asthma exacerbations. Formoterol is a bronchodilator that works quickly to relieve symptoms and the effect lasts longer. We are interested in whether there are any benefits or disadvantages associated with using formoterol instead of more traditional treatments to relieve symptoms.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Combined formoterol and budesonide inhalers can be used for maintenance treatment of asthma and relief of symptoms. Three trials involving 5905 participants were included. We found very little evidence in relation to the use of formoterol and budesonide for relief of symptoms in people with mild asthma, but in people with more severe asthma who had suffered exacerbations in spite of regular treatment with inhaled corticosteroids, we found that reliever formoterol and budesonide compared favourably with terbutaline in reducing asthma exacerbations that required a course of oral corticosteroids. However only a small proportion of the 'severe asthma exacerbations' as defined in the trials led to hospital admissions, and no significant overall benefit has yet been shown for this outcome. In children with asthma that was not controlled with regular inhaled corticosteroids, there were fewer serious adverse events when formoterol and budesonide were used to relieve symptoms as well as for maintenance treatment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Asthma is a common condition that affects the airways – the small tubes that carry air in and out of the lungs. When a person with asthma comes into contact with an irritant (an asthma trigger), the muscles around the walls of the airways tighten, the airways become narrower, and the lining of the airways becomes inflamed and starts to swell. This leads to the symptoms of asthma ‐ wheezing, coughing and difficulty in breathing. They can lead to an asthma attack or exacerbation. People can have underlying inflammation in their lungs and sticky mucus or phlegm may build up, which can further narrow the airways. There is no cure for asthma; however there are medications that allow most people to control their asthma so they can get on with daily life.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

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