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Whether airway hyperresponsiveness is a symptom of airway inflammation or airway remodeling, or whether it is the cause of long-term loss of lung function, remains controversial. Some investigators have hypothesized that aggressive treatment with anti-inflammatory therapies improves the long-term course of asthma beyond their salutary effects on parameters of asthma control and rates of exacerbation over time. 13 This contention has been supported by an observational study 14 that found long-term exposure to ICS was associated with an attenuation of the accelerated decline in lung function previously reported in asthmatics; more studies are required to substantiate these findings.

SOURCES:
National Jewish Medical and Research Center: "Inhaled Medication with a Metered Dose Inhaler (MDI)." 
Asthma Society of Canada: "How to Use Your Inhaler."
Science Daily: "New Asthma Inhaler Propellant Effective, But Costlier." 
American College of Chest Physicians: "Using Your MDI-Closed Mouth Technique, Patient Education Guide." 
American Academy of Allergy, Asthma & Immunology (AAAAI): "Cumulative effects of formoterol administered by a dry powder inhaler;" "Inhalers;" and "Anti-inflammatory effects of inhaled steroids delivered by HFA-MDI vs delivery by dry powder inhaler."
News release, Merck.
Boehringer Ingelheim: "US FDA Expands Approval of Tiotropium Respimat® for Maintenance Treatment of Asthma in Children."
FDA. Prescribing Information: Spiriva Respimat.

Albuterol inhaler steroid

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