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namespace Example_15_2_ _ _ _Concatenating_Strings { class Tester { public void Run( ) { string s1 = "abcd"; string s2 = "ABCD"; // concatenation method string s3 = string.Concat(s1, s2); Console.WriteLine("s3 concatenated from s1 and s2: {0}", s3); // use the overloaded operator string s4 = s1 + s2; Console.WriteLine("s4 concatenated from s1 + s2: {0}", s4); } static void Main( ) { Tester t = new Tester( ); t.Run( ); }

Only drugs available in the United States are listed Average wholesale price (AWP, for AB-rated generic when available) for quantity listed Source: Red Book Update, Vol 26, No 3 March 2007 AWP may not accurately represent actual pharmacy cost because wide contractual variations exist among institutions 3 Dosing should be individualized See text 4 Not for acute relief of symptoms MDI, metered-dose inhaler

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Side effects are minimal at standard doses The use of longacting 2-agonists has been associated in two large studies with a small but statistically significant increased risk of severe or fatal asthma attacks This increased risk has not been fully explained and remains an area of controversy Current research does not define the specific population at risk or address the role of disease severity, cotreatment with corticosteroids, and medication adherence in contributing to adverse events c Phosphodiesterase inhibitors Theophylline provides mild bronchodilation in asthmatic patients This drug may also have anti-inflammatory properties, enhance mucociliary clearance, and strengthen diaphragmatic contractility Sustained-release theophylline preparations are effective in controlling nocturnal asthma and are usually reserved for use as adjuvant therapy in patients with moderate or severe persistent asthma They can also be used as alternative long-term preventive therapy in patients with mild persistent asthma Theophylline serum concentrations need to be monitored closely owing to the drug s narrow toxic-therapeutic range, individual differences in metabolism, and the effects of many factors on drug absorption and metabolism Decreases in theophylline clearance accompany the use of cimetidine, macrolide and quinolone antibiotics, and oral contraceptives Increases in theophylline clearance are caused by rifampin, phenytoin, barbiturates, and tobacco Adverse effects at therapeutic doses include insomnia, upset stomach, aggravation of dyspepsia and gastroesophageal reflux symptoms, and urination difficulties in elderly men with prostatism Dose-related toxicities are common and include nausea, vomiting, tachyarrhythmias, headache, seizures, hyperglycemia, and hypokalemia 3 Leukotriene modifiers Leukotrienes are potent biochemical mediators that contribute to airway obstruction and asthma symptoms by contracting airway smooth muscle, increasing vascular permeability and mucus secretion, and attracting and activating airway inflammatory cells Zileuton is a 5-lipoxygenase inhibitor that decreases leukotriene production, and zafirlukast and montelukast are

cysteinyl leukotriene receptor antagonists They cause modest improvements in lung function and reductions in asthma symptoms and lessen the need for -agonist rescue therapy These agents may be considered as alternatives to low-dose inhaled corticosteroids in patients with mild persistent asthma Zileuton can cause reversible elevations in plasma aminotransferase levels, and Churg-Strauss syndrome has been diagnosed in a small number of patients who have taken montelukast or zafirlukast, although this is suspected to be an effect of corticosteroid withdrawal as opposed to a direct drug effect 4 Desensitization Immunotherapy for specific allergens may be considered in selected asthma patients who have exacerbations of asthma symptoms when exposed to allergens to which they are sensitive and who do not respond to environmental control measures or other forms of conventional therapy Studies show a reduction in asthma symptoms in patients treated with single-allergen immunotherapy Because of the risk of immunotherapyinduced bronchoconstriction, it should be administered only in a setting where such complications can be treated 5 Miscellaneous agents Oral sustained-release 2agonists are reserved for patients with bothersome nocturnal asthma symptoms or moderate to severe persistent asthma who do not respond to other therapies Omalizumab is a recombinant antibody that binds IgE without activating mast cells In clinical trials, it reduces the need for corticosteroids in moderate to severe asthmatic patients with elevated IgE levels Corticosteroid-sparing anti-inflammatory agents such as troleandomycin, methotrexate, cyclosporine, intravenous immunoglobulin, and gold should be used only in selected severe asthmatic patients These and other agents have variable benefit and worrisome toxicities

Short-acting bronchodilators and systemic corticosteroids comprise the important medications in this group of agents (Table 9 5)

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