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- W2085146548 abstract "This review has highlighted the major contributions of the ACRN and CARE Network trials to the current NAEPP asthma treatment guidelines, as depicted in Fig 1. First, the stepwise positioning (level of severity between intermittent and persistent) of as-needed short-acting β2-agonists was established (BAGS), and later, whether a subgroup of patients might be at risk if these agents were used on a regular basis (the BARGE trial) was established. Second, the use of the long-acting β-agonist salmeterol was evaluated to determine whether it could be used as monotherapy in mild persistent asthma (SOCS) and whether it would enable steroid reduction, elimination, or both in more moderate disease (the SLIC trial). Both studies clearly demonstrated that long-acting β-agonists should not be used as monotherapy, and later retrospective analyses based on β-adrenergic receptor genotypes indicated that the results seen in the BARGE trial with short-acting β-agonists were applicable to long-acting β-agonists as well. Third, models for standardized assessment of controller therapy side-effect comparisons and risk/benefit calculations were established (the MICE and DICE studies). Fourth, for individuals with mild persistent asthma (using strict NAEPP2 guideline criteria), intermittent ICS use directed by symptoms was found not to be associated with higher rates of exacerbations compared with daily use with ICSs (IMPACT). Fifth, despite concerns of the transient effects on growth, ICS use in school-aged children and in adolescence was found to be safe and preferable to montelukast for improving pulmonary function and establishing symptom control (CLIC and PACT). Finally, in preschool-aged children at high risk of having asthma, daily treatment with an ICS was able to control symptom burden and exacerbations but was unable to alter the natural history of asthma once the therapy was discontinued (the PEAK trial). Both the ACRN and CARE Network continue to develop protocols that will provide answers to questions regarding both the short- and long-term management of asthma in both adults and children that will assist clinicians in providing optimal care for their patients.Fig 1Past and present ACRN and CARE Network clinical trials separated by NAEPP severity steps. The acronyms refer to trials reviewed herein. Escalation of controller therapy selection and dose is appropriate for the moderate and severe strata. Patients who remain symptomatic despite oral corticosteroids and other agents in the severe class should be reevaluated for medication compliance issues, aggressive treatment of other coexisting conditions (eg, vocal cord dysfunction, gastroesophageal reflux, or chronic sinusitis), or both.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
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- W2085146548 date "2007-01-01" @default.
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- W2085146548 title "Guideline-defining asthma clinical trials of the National Heart, Lung, and Blood Institute's Asthma Clinical Research Network and Childhood Asthma Research and Education Network" @default.
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- W2085146548 doi "https://doi.org/10.1016/j.jaci.2006.10.015" @default.
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