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13 The majority of participants preferred Ellipta overall Patients rating inhaler very easy or easy to use: Ellipta compared with Diskus (97% vs. 60%), MDI (92% vs. 44%), Turbuhaler (96% vs. 55%), Handihaler (98% vs. 38%) or Breezhaler (94% vs. 55%; all p<). Patient preference: Patients preferred the ELLIPTA inhaler overall compared with the comparator devices (figure). The majority of patients also preferred the ELLIPTA inhaler for most individual criteria (number of steps for correct use, time taken to use, size of the device, dose counter, comfort of mouthpiece and ease of opening; p<). There was no difference for the size of the inhaler. Proportion of participants (%) p< Ellipta vs. Diskus (n=171) Ellipta Comparator No preference p< Ellipta vs. MDI (n=80) p< Ellipta vs. Turbuhaler (n=100) p< Ellipta vs. Handihaler (n=118) p< Ellipta vs. Breezhaler (n=98) Illustration is reproduced from ref. 1. Overall device preference reported in each sub study among patients w ith COPD. Reference: 1. van der Palen J et al. Prim Care Respir J 2016: (26) doi: /npjpcrm

In common with other topical corticosteroids, prednicarbate has anti-inflammatory, antipruritic, and vasoconstrictive properties. In general, the mechanism of the anti-inflammatory activity of topical steroids is unclear. However, corticosteroids are thought to act by the induction of phospholipase A2 inhibitory proteins, collectively called lipocortins. It is postulated that these proteins control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes by inhibiting the release of their common precursor arachidonic acid. Arachidonic acid is released from membrane phospholipids by phospholipase A 2 .

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