Adjustable maintenance dosing with either budesonide/formoterol or budesonide was compared in asthma patients. This double-blind trial randomized 133 patients (mean forced expiratory volume in 1s 66% predicted) to receive 2 inhalations twice daily of budesonide/formoterol 160/4.5 microg (640/18 microg/day) or budesonide 320 microg (1280 microg/day) for 4 weeks. The study drug was adjusted in both groups according to symptoms to 2-4 inhalations daily during Weeks 5-8 and 1-4 inhalations daily during Weeks 9-20. Asthma was well controlled in both groups, with minimal levels of treatment failure (5 budesonide/formoterol vs. 2 budesonide patients; P=NS) and minimal use of reliever therapy. Clinically important improvements in health-related quality of life (HRQL) occurred in the physical functioning and emotional role functioning domains (both P<0.05) for the budesonide/formoterol group compared with budesonide. Physician and patient treatment satisfaction favored budesonide/formoterol (both P<0.05). Budesonide/formoterol patients used fewer daily inhalations of study drug (P=0.024). The median average daily inhaled corticosteroid dose during the study was 448 microg with budesonide/formoterol and 1152 microg with budesonide. Adjustable maintenance dosing with budesonide/formoterol and budesonide resulted in high levels of asthma control. Adjustable budesonide/formoterol treatment achieved greater HRQL benefits and patient satisfaction, with lower overall drug use.

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Research on repetitive transcranial magnetic stimulation (rTMS) indicates that the treatment of non-psychotic depression is comparable to electroconvulsive therapy (ECT) in terms of short-term outcome. We report on a woman who exerted a recurrent moderate major depressive episode, 6 months after discontinuation of maintenance ECT. She responded to acute rTMS treatment which was followed by the rTMS maintenance-protocol. Within 2 months of continuation rTMS she relapsed suffering from a severe non psychotic depressive episode and had to be switched to a successful ECT. In this patient rTMS had a good clinical impact as an acute treatment strategy, but failed to prevent relapse as the continuation ECT previously did in the same patient.

ResumenLa investigación sobre la estimulación magnética transcraneal repetitiva (EMTr) indica que el tratamiento de la depresión no psicótica es comparable a la terapia electroconvulsiva (TEC) desde el punto de vista de la evolución a corto plazo. Informamos sobre una mujer que experimentó un episodio depresivo mayor moderado recurrente 6 meses después de la interrupción de TEC de mantenimiento. La paciente respondió al tratamiento de EMTr aguda, que se siguió por el protocolo de mantenimiento de EMTr. A los 2 meses de la EMTr de continuación, la paciente recayó, sufriendo un episodio depresivo no psicótico grave y hubo que cambiarla a una TEC, que tuvo éxi-to. En esta paciente la EMTr tuvo un buen impacto clínico como estrategia de tratamiento agudo, pero no impidió la recaída, como hizo la TEC de continuación antes en la misma paciente.