Objective: to study the ability of inhaled Symbicort to reduce daily oral steroids (OS) requirements in patients with severe steroid-dependent asthma.
Methods: 16 patients with severe steroid-dependent asthma were included into the study (5 males, 11 females, mean age 53 ± 8 years, mean dose of OS 10.9 ± 5.2 mg / day, mean OS treatment duration 9.3 ± 4.1 years, mean FEV1 59.3 ± 15.1%). All patients received Symbicort administered by means of a multidose poder inhaler 4.5 / 160 mkg 2 inhalations twice daily, every 2 weeks patients underwent controlled OS reduction on the basis of predetermined asthma stability criteria.
Results: OS was eliminated or reduced in 14 patients (87.5 %), the OS dose was reduced to 3.3 ± 6.8 mg / day (р < 0.001). At the end of 12 weeks of Symbicort therapy FEV₁ and FVC increased by 18.6 % and 8.9 %, respectively. Daytime and nighttime asthma symptom severity scores improved in average by 1 point (р < 0.001). The number of inhalations of short-acting β₂-agonists reduced from 3.4 ± 1.7 to 1.5 ± 1.3 puffs / day (р < 0.001). Statistically and clinically significant improvements were seen in all 4 domains of quality of life scores (AQLQ) (р < 0.001). The level of NOex reduced significantly form 18.6 ± 11.4 ppb at baseline to 7.9 ± 2.8 ppb after 12 weeks (р = 0.001). The side effects of OS were reduced to the end of study.
Conclusion: in patients with severe steroid-dependent asthma therapy with Symbicort allows to eliminate or reduce OS therapy with improved lung function, improved daytime and nighttime asthma symptoms, improved asthma-specific quality of life, reduction of short-acting β₂-agonists use and reduction of side effects of OS.

Inefficient inhaler technique is a common problem resulting in decreased disease control and increased inhaler use. The aim of this study was to assess patients' use of different inhaler devices and to ascertain whether patient preference is indicative of ease of use and whether current inhaler use has any influence on either technique or preference. We also wished to define the most appropriate method of selecting an inhaler for a patient, taking into account observed technique and device cost. One hundred patients received instruction, in randomized order, in the use of seven different inhaler devices. After instruction they were graded (using predetermined criteria) in their inhaler technique. After assessment patients were asked which three inhalers they most preferred and which, if any, they currently used. Technique was best using the breath-actuated inhalers; the Easi-Breathe and Autohaler, with 91 % seen to have good technique. The pressurized metered dose inhaler (pMDI) fared poorly, in last position with only 79 % of patients showing good technique, despite being the most commonly prescribed. The Easi-Breathe was by far the most popular device with the patients. The Autohaler came in second position closely followed by the Clickhaler and Accuhaler. The majority of patients (55 %) currently used the pMDI but the pMDI did not score highly for preference or achieve better grades than the other devices. Only 79 % of patients tested could use the pMDI effectively even after expert instruction yet it continues to be commonly prescribed. This has important repercussions for drug delivery and hence disease control. Prescribing a patient's preferred device increases cost but can improve efficiency and therefore be cost effective in the long term. Using an inexpensive device (pMDI) when technique is good and the patient's preferred inhaler device when not is one way to optimize delivery and may even reduce cost.

The efficacy of salmeterol/fluticasone propionate (S / FP) (Seretid, GlaxoSmithKline) was studied in a randomized open comparative trial in parallel groups. The study involved 36 patients with severe COPD (GOLD, 2003). The 1st group patients (n = 18) received S / FP f 50 / 500 mcg daily using dose-metered aerosol inhaler 25 / 250 mcg and salbutamol (Ventolin, GlaxoSmithKline) if needed for 6 months. The 2nd group patients (n = 18) kept receiving short-acting beta-2-agonists alone (salbutamol, Berotec, Berodual, or Atrovent) in the mode as before the study. The efficacy of the treatment was evaluated with regards to severity of dyspnea and cough, sputum production, FEV1, physical tolerability (6-minute walk test — 6MWT), quality of life (QoL). The QoL was assessed using a Russian version of the St. George's Respiratory Questionnaire (SGRQ). The study showed a high efficacy of S / FP for treatment in severe COPD resulted in significant reduction in the COPD signs and symptoms, bronchial obstruction, exacerbation rate, improvement of the physical tolerability and the QoL when compared both to the baseline parameters and to the control group.

A regional branch programme "Improvement of quality of life of COPD patients" had been developed and adopted at Novosibirsk region. Its content is financial support and organization of COPD treatment using thiotropium bromide.
The study involved 35 COPD patients, 31of them (28 males and 3 females) completed the treatment. The average age of participants was 53.2 ± 3.9 yrs. We assessed severity of clinical signs using a 3-point scale; spirometry parameters, physical tolerability in 6-minute walk test. We also calculated cost of therapy of COPD patients. The follow-up duration was 6 months. Results demonstrated a significant reduction in clinical severity of COPD, improvement in functional capacity during the treatment with Spiriva. The rate of seeking for aid, number of seek days and length of staying in a hospitals decreased. Medical expenses for COPD treatment increased when used Spiriva due to its high cost but with regards to a total expenditure (direct and indirect) the cost-efficacy was 32.7 %.