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Objective: To assess the short-term direct medical costs and effectiveness associated with achieving recommended glycaemic goals using commonly prescribed first-line oral antihyperglycaemic medications in type 2 diabetes mellitus.Materials and Methods: A literature-based, decision-tree model was developed to project the number of patients achieving glycosylated haemoglobin values of <7% on oral therapies and the associated costs over a 3-year timeframe. For each first-line strategy, patients could progress to combination therapy using two or more agents prior to the introduction of insulin. The overall cost of treatment included costs (2001/2002 values; US dollars) of comprehensive medical care, laboratory tests, patient education, drug therapy, home glucose monitoring and adverse events.Results: At 3 years, the overall cost of treatment for the various first-line strategies was 6,106 US dollars for glipizide gastrointestinal therapeutic system, 6,727 US dollars for metformin immediate release, 6,826 US dollars for metformin extended release, 7,141 US dollars for glibenclamide (glyburide)/metformin, 7,759 US dollars for rosiglitazone and 9,298 US dollars for repaglinide. Costs of comprehensive routine medical care ranged from approximately 1,538-2,128 US dollars in year 1 and from approximately 952-1,543 US dollars in subsequent years, for controlled and uncontrolled patients, respectively. Adverse events represented <1%, and drug therapies represented approximately 50%, of the overall cost, respectively. Substantial cost differences between the strategies were seen within the first year. Regardless of first-line therapy, patients progressed quickly to combination therapies, with effectiveness among the agents being similar.Conclusions: Short-term costs required to provide comprehensive diabetes care and achieve glycemic goals can be substantial. The model suggests a sulphonylurea strategy may provide similar effectiveness with cost savings over other agents and should be considered when selecting an initial drug therapy in newly diagnosed patients with type 2 diabetes mellitus. [ABSTRACT FROM AUTHOR]

Editorials. Discusses the role of adenosine in mediating airway hyperactivity. Association of adenosine hyperactivity in asthmatic patients with sputum eosinophilia; Bronchial constriction; Activation of mast cells; Bronchodilation.

People with Chronic Obstructive Pulmonary Disease are at risk for low body weight and the subsequent sequelae of cachexia. The goal of this study was to define the relationship between of degree of emphysema as measured by high resolution chest computerized tomography, body mass index and caloric intake. Subjects from San Diego County were recruited to participate in a multi-center randomized clinical trial to test the Feasibility of Retinoids in the Treatment of Emphysema (FORTE). Forty subjects with Chronic Obstructive Pulmonary Disease, participated in a nutrition substudy and were ex-smokers with FEV1 between 20%–80% predicted. Body mass index was correlated with the degree of emphysema as measured by high resolution chest tomography (CT), r2 = 0.171 p < 0.01 across the full spectrum of disease severity. Dietary intake averaged over four days using 24-hour recalls was inversely correlated with BMI, r2 = 0.471, p < 0.001, indicating a higher energy intake in subjects with low BMI. Pulmonary function tests of percent predicated FEV1 was mildly related to BMI (r2 = 0.086, p < 0.06). A regression model was developed to define the relationship of BMI and degree of emphysema and calorie per kilogram body weight, which accounted for 60% of the variability, p < 0.001. Low body weight in the COPD is related to the degree of emphysema, not due to decreased caloric intake. Subjects with low body weight have compensated by increasing their caloric intake and are meeting their nutritional needs. [ABSTRACT FROM AUTHOR]

Context. This case series reports the changes in the respiratory health of eight asthmatic subjects and the relationship with air quality associated with the October 2007 firestorm in San Diego County of California. Case presentation. Participants were eight subjects with asthma enrolled in Asthma Clinical Research Network (ACRN) (NIH# U10-HL074218) studies at the University of California San Diego (UCSD), School of Medicine, who had study data collected immediately prior, during and 1 month after the 5-day firestorm in San Diego County. Air quality deteriorated to an extreme average of 71.5 mg/m3 small particulate matter less than 2.5 μm (PM2.5) during the firestorm. Respiratory health data included morning and evening peak expiratory flow rates (PEFR), morning and evening Forced Expiratory Volume in one second (FEV1), rescue medication usage, and sputum eosinophils. Morning and evening PEFR and FEV1 rates remained stable. The two subjects tested during the fires had elevated eosinophil counts and rescue medication usage was increased in five of the eight subjects. Discussion. Pulmonary function test values were stable during the wildfires for all eight subjects but there was a statistically significant increase in rescue medication usage during the wildfires that correlated with PM2.5 values. The two subjects tested during the fires showed increases in sputum eosinophil counts consistent with increased airways inflammation. Relevance. These findings suggest that poor air quality associated with wildfires resulted in an increase in airways inflammation in these asthmatic subjects, but pulmonary function tests remained stable, possibly due to increased rescue medication usage. This is especially pertinent as there is an increase in incidence of wildfires this decade. [ABSTRACT FROM AUTHOR]

The article discusses the study on the feasibility of retinoids for the treatment of emphysema. The study involves 148 subjects with lung diseases and a primary component of emphysema, defined by diffusing capacity of the lung for carbon monoxide and CT density mask. Furthermore, there are no definitive clinical benefits related to the administration of retinoids were observed in the feasibility study.