The United States of America known as the United States or America, is a country composed of 50 states, a federal district, five major self-governing territories, various possessions. At 3.8 million square miles, the United States is the world's third or fourth largest country by total area and is smaller than the entire continent of Europe's 3.9 million square miles. With a population of over 327 million people, the U. S. is the third most populous country. The capital is Washington, D. C. and the largest city by population is New York City. Forty-eight states and the capital's federal district are contiguous in North America between Canada and Mexico; the State of Alaska is in the northwest corner of North America, bordered by Canada to the east and across the Bering Strait from Russia to the west. The State of Hawaii is an archipelago in the mid-Pacific Ocean; the U. S. territories are scattered about the Pacific Ocean and the Caribbean Sea, stretching across nine official time zones. The diverse geography and wildlife of the United States make it one of the world's 17 megadiverse countries.
Paleo-Indians migrated from Siberia to the North American mainland at least 12,000 years ago. European colonization began in the 16th century; the United States emerged from the thirteen British colonies established along the East Coast. Numerous disputes between Great Britain and the colonies following the French and Indian War led to the American Revolution, which began in 1775, the subsequent Declaration of Independence in 1776; the war ended in 1783 with the United States becoming the first country to gain independence from a European power. The current constitution was adopted in 1788, with the first ten amendments, collectively named the Bill of Rights, being ratified in 1791 to guarantee many fundamental civil liberties; the United States embarked on a vigorous expansion across North America throughout the 19th century, acquiring new territories, displacing Native American tribes, admitting new states until it spanned the continent by 1848. During the second half of the 19th century, the Civil War led to the abolition of slavery.
By the end of the century, the United States had extended into the Pacific Ocean, its economy, driven in large part by the Industrial Revolution, began to soar. The Spanish–American War and World War I confirmed the country's status as a global military power; the United States emerged from World War II as a global superpower, the first country to develop nuclear weapons, the only country to use them in warfare, a permanent member of the United Nations Security Council. Sweeping civil rights legislation, notably the Civil Rights Act of 1964, the Voting Rights Act of 1965 and the Fair Housing Act of 1968, outlawed discrimination based on race or color. During the Cold War, the United States and the Soviet Union competed in the Space Race, culminating with the 1969 U. S. Moon landing; the end of the Cold War and the collapse of the Soviet Union in 1991 left the United States as the world's sole superpower. The United States is the world's oldest surviving federation, it is a representative democracy.
The United States is a founding member of the United Nations, World Bank, International Monetary Fund, Organization of American States, other international organizations. The United States is a developed country, with the world's largest economy by nominal GDP and second-largest economy by PPP, accounting for a quarter of global GDP; the U. S. economy is post-industrial, characterized by the dominance of services and knowledge-based activities, although the manufacturing sector remains the second-largest in the world. The United States is the world's largest importer and the second largest exporter of goods, by value. Although its population is only 4.3% of the world total, the U. S. holds 31% of the total wealth in the world, the largest share of global wealth concentrated in a single country. Despite wide income and wealth disparities, the United States continues to rank high in measures of socioeconomic performance, including average wage, human development, per capita GDP, worker productivity.
The United States is the foremost military power in the world, making up a third of global military spending, is a leading political and scientific force internationally. In 1507, the German cartographer Martin Waldseemüller produced a world map on which he named the lands of the Western Hemisphere America in honor of the Italian explorer and cartographer Amerigo Vespucci; the first documentary evidence of the phrase "United States of America" is from a letter dated January 2, 1776, written by Stephen Moylan, Esq. to George Washington's aide-de-camp and Muster-Master General of the Continental Army, Lt. Col. Joseph Reed. Moylan expressed his wish to go "with full and ample powers from the United States of America to Spain" to seek assistance in the revolutionary war effort; the first known publication of the phrase "United States of America" was in an anonymous essay in The Virginia Gazette newspaper in Williamsburg, Virginia, on April 6, 1776. The second draft of the Articles of Confederation, prepared by John Dickinson and completed by June 17, 1776, at the latest, declared "The name of this Confederation shall be the'United States of America'".
The final version of the Articles sent to the states for ratification in late 1777 contains the sentence "The Stile of this Confederacy shall be'The United States of America'". In June 1776, Thomas Jefferson wrote the phrase "UNITED STATES OF AMERICA" in all capitalized letters in the headline of his "original Rough draught" of the Declaration of Independence; this draft of the document did not surface unti
Salmeterol is a long-acting β2 adrenergic receptor agonist used in the maintenance and prevention of asthma symptoms and maintenance of chronic obstructive pulmonary disease symptoms. Symptoms of bronchospasm include shortness of breath, wheezing and chest tightness, it is used to prevent breathing difficulties during exercise. It was patented in 1983 and came into medical use in 1990, it is marketed as Serevent in the US. It is available as a dry powder inhaler, it was available as a metered-dose inhaler but was discontinued in the US in 2002. It is still available as an MDI in the UK as of 2013. Salmeterol is used in moderate-to-severe persistent asthma following previous treatment with a short-acting β2 adrenoreceptor agonist such as salbutamol. LABAs should not be used as a monotherapy, they should be used concurrently with an inhaled corticosteroid, such as beclometasone dipropionate or fluticasone propionate in the treatment of asthma to minimize serious reactions such as asthma-related deaths.
In chronic obstructive pulmonary disease, LABAs may be used as monotherapy or in combination with corticosteroids. In exercise-induced bronchospasm monotherapy may be indicated in patients without persistent asthma. LABAs should not be used to treat acute symptoms; the primary noticeable difference of salmeterol from salbutamol, other short-acting β2 adrenoreceptor agonists, is its duration of action. Salmeterol lasts 12 hours in comparison with the salbutamol, which last about 4–6 hours; when used every day as prescribed, inhaled salmeterol decreases the number and severity of asthma attacks. However, like all LABA medications, it is not for use in relieving an asthma attack that has started. Inhaled salmeterol works like other β2 agonists, causing bronchodilation by relaxing the smooth muscle in the airway so as to treat the exacerbation of asthma; the long duration of action occurs by the molecules diffusing into the plasma membrane of the lung cells, slowly being released back outside the cell where they can come into contact with the β2 adrenoreceptors, with the long carbon chain forming an anchor in the membrane.
Salmeterol binding to the β2 adrenoreceptor does not induce desensitization or internalization of receptors which may contribute to its long therapeutic duration of action. Formoterol has been demonstrated to have a faster onset of action than salmeterol as a result of a lower lipophilicity, has been demonstrated to be more potent—a 12 µg dose of formoterol has been demonstrated to be equivalent to a 50 µg dose of salmeterol; the FDA assigns a Category C to salmeterol in pregnancy. Salmeterol use during pregnancy must be decided based on the risks versus benefits to the mother. There are no well-controlled studies with salmeterol in pregnant women; some animal studies showed developmental malformation when the mother was given several clinical doses orally. In rats, salmeterol xinafoate is excreted in the milk. However, since there are no data to show excretion of salmeterol in a mother's breast milk, a decision on whether to continue or discontinue therapy should be decided based on the important benefits it provides to the mother.
Pregnant and lactating women should consult their doctors before using salmeterol. Due to its vasodilation properties, the common side effects of salmeterol are dizziness, sinus infection, migraine headaches. In most cases, salmeterol side effects are minor and either don't require treatment or can be treated. Certain side effects, should be reported to a healthcare provider immediately; some of these more serious side effects include a fast heart rate, high blood pressure, worsening breathing problems. Salmeterol has an aryl alkyl group with a chain length of 11 atoms from the amine; this bulkiness makes the compound more lipophilic and it makes it selective to β2 adrenergic receptors. Salmeterol, first marketed and manufactured by Glaxo in the 1980s, was released as Serevent in 1990; the product is marketed by GSK under the Allen & Hanburys brand in the UK. In November 2005, the US Food and Drug Administration released a health advisory, alerting the public to findings that show the use of long-acting β2 agonists could lead to a worsening of symptoms, in some cases death.
While the use of inhaled LABAs are still recommended in asthma guidelines for the resulting improved symptom control, further concerns have been raised. A large meta-analysis of pooled results from 19 trials with 33,826 participants, suggests that salmeterol may increase the small risks of asthma-related deaths, this additional risk is not reduced with the additional use of inhaled steroids; this seems to occur because although LABAs relieve asthma symptoms, they promote bronchial inflammation and sensitivity without warning. Combinations of inhaled steroids and these long-acting bronchodilators are becoming more widespread. Vilanterol — an ultra-long-acting β2 adrenoreceptor agonist with a similar chemical structure
Food and Drug Administration
The Food and Drug Administration is a federal agency of the United States Department of Health and Human Services, one of the United States federal executive departments. The FDA is responsible for protecting and promoting public health through the control and supervision of food safety, tobacco products, dietary supplements and over-the-counter pharmaceutical drugs, biopharmaceuticals, blood transfusions, medical devices, electromagnetic radiation emitting devices, animal foods & feed and veterinary products; as of 2017, 3/4th of the FDA budget is paid by people who consume pharmaceutical products, due to the Prescription Drug User Fee Act. The FDA was empowered by the United States Congress to enforce the Federal Food and Cosmetic Act, which serves as the primary focus for the Agency; these include regulating lasers, cellular phones and control of disease on products ranging from certain household pets to sperm donation for assisted reproduction. The FDA is led by the Commissioner of Food and Drugs, appointed by the President with the advice and consent of the Senate.
The Commissioner reports to the Secretary of Human Services. Scott Gottlieb, M. D. is the current commissioner, who took over in May 2017. The FDA has its headquarters in Maryland; the agency has 223 field offices and 13 laboratories located throughout the 50 states, the United States Virgin Islands, Puerto Rico. In 2008, the FDA began to post employees to foreign countries, including China, Costa Rica, Chile and the United Kingdom. In recent years, the agency began undertaking a large-scale effort to consolidate its 25 operations in the Washington metropolitan area, moving from its main headquarters in Rockville and several fragmented office buildings to the former site of the Naval Ordnance Laboratory in the White Oak area of Silver Spring, Maryland; the site was renamed from the White Oak Naval Surface Warfare Center to the Federal Research Center at White Oak. The first building, the Life Sciences Laboratory, was dedicated and opened with 104 employees on the campus in December 2003. Only one original building from the naval facility was kept.
All other buildings are new construction. The project is slated to be completed by 2021, assuming future Congressional funding While most of the Centers are located in the Washington, D. C. area as part of the Headquarters divisions, two offices – the Office of Regulatory Affairs and the Office of Criminal Investigations – are field offices with a workforce spread across the country. The Office of Regulatory Affairs is considered the "eyes and ears" of the agency, conducting the vast majority of the FDA's work in the field. Consumer Safety Officers, more called Investigators, are the individuals who inspect production and warehousing facilities, investigate complaints, illnesses, or outbreaks, review documentation in the case of medical devices, biological products, other items where it may be difficult to conduct a physical examination or take a physical sample of the product; the Office of Regulatory Affairs is divided into five regions, which are further divided into 20 districts. Districts are based on the geographic divisions of the federal court system.
Each district comprises a main district office and a number of Resident Posts, which are FDA remote offices that serve a particular geographic area. ORA includes the Agency's network of regulatory laboratories, which analyze any physical samples taken. Though samples are food-related, some laboratories are equipped to analyze drugs and radiation-emitting devices; the Office of Criminal Investigations was established in 1991 to investigate criminal cases. Unlike ORA Investigators, OCI Special Agents are armed, don't focus on technical aspects of the regulated industries. OCI agents pursue and develop cases where individuals and companies have committed criminal actions, such as fraudulent claims, or knowingly and willfully shipping known adulterated goods in interstate commerce. In many cases, OCI pursues cases involving Title 18 violations, in addition to prohibited acts as defined in Chapter III of the FD&C Act. OCI Special Agents come from other criminal investigations backgrounds, work with the Federal Bureau of Investigation, Assistant Attorney General, Interpol.
OCI receives cases from a variety of sources—including ORA, local agencies, the FBI—and works with ORA Investigators to help develop the technical and science-based aspects of a case. OCI is a smaller branch; the FDA works with other federal agencies, including the Department of Agriculture, Drug Enforcement Administration and Border Protection, Consumer Product Safety Commission. Local and state government agencies work with the FDA to provide regulatory inspections and enforcement action; the FDA regulates more than US$2.4 trillion worth of consumer goods, about 25% of consumer expenditures in the United States. This includes $466 billion in food sales, $275 billion in drugs, $60 billion in cosmetics and $18 billion in vitamin supplements. Much of these expenditures are for goods imported into the United States; the FDA's federal budget request for fiscal year 2012 totaled $4.36 billion, while the proposed 2014 budget is $4.7 billion. About $2 billion of this budget is generated by user fees.
Pharmaceutical firms pay th
International Standard Serial Number
An International Standard Serial Number is an eight-digit serial number used to uniquely identify a serial publication, such as a magazine. The ISSN is helpful in distinguishing between serials with the same title. ISSN are used in ordering, interlibrary loans, other practices in connection with serial literature; the ISSN system was first drafted as an International Organization for Standardization international standard in 1971 and published as ISO 3297 in 1975. ISO subcommittee TC 46/SC 9 is responsible for maintaining the standard; when a serial with the same content is published in more than one media type, a different ISSN is assigned to each media type. For example, many serials are published both in electronic media; the ISSN system refers to these types as electronic ISSN, respectively. Conversely, as defined in ISO 3297:2007, every serial in the ISSN system is assigned a linking ISSN the same as the ISSN assigned to the serial in its first published medium, which links together all ISSNs assigned to the serial in every medium.
The format of the ISSN is an eight digit code, divided by a hyphen into two four-digit numbers. As an integer number, it can be represented by the first seven digits; the last code digit, which may be 0-9 or an X, is a check digit. Formally, the general form of the ISSN code can be expressed as follows: NNNN-NNNC where N is in the set, a digit character, C is in; the ISSN of the journal Hearing Research, for example, is 0378-5955, where the final 5 is the check digit, C=5. To calculate the check digit, the following algorithm may be used: Calculate the sum of the first seven digits of the ISSN multiplied by its position in the number, counting from the right—that is, 8, 7, 6, 5, 4, 3, 2, respectively: 0 ⋅ 8 + 3 ⋅ 7 + 7 ⋅ 6 + 8 ⋅ 5 + 5 ⋅ 4 + 9 ⋅ 3 + 5 ⋅ 2 = 0 + 21 + 42 + 40 + 20 + 27 + 10 = 160 The modulus 11 of this sum is calculated. For calculations, an upper case X in the check digit position indicates a check digit of 10. To confirm the check digit, calculate the sum of all eight digits of the ISSN multiplied by its position in the number, counting from the right.
The modulus 11 of the sum must be 0. There is an online ISSN checker. ISSN codes are assigned by a network of ISSN National Centres located at national libraries and coordinated by the ISSN International Centre based in Paris; the International Centre is an intergovernmental organization created in 1974 through an agreement between UNESCO and the French government. The International Centre maintains a database of all ISSNs assigned worldwide, the ISDS Register otherwise known as the ISSN Register. At the end of 2016, the ISSN Register contained records for 1,943,572 items. ISSN and ISBN codes are similar in concept. An ISBN might be assigned for particular issues of a serial, in addition to the ISSN code for the serial as a whole. An ISSN, unlike the ISBN code, is an anonymous identifier associated with a serial title, containing no information as to the publisher or its location. For this reason a new ISSN is assigned to a serial each time it undergoes a major title change. Since the ISSN applies to an entire serial a new identifier, the Serial Item and Contribution Identifier, was built on top of it to allow references to specific volumes, articles, or other identifiable components.
Separate ISSNs are needed for serials in different media. Thus, the print and electronic media versions of a serial need separate ISSNs. A CD-ROM version and a web version of a serial require different ISSNs since two different media are involved. However, the same ISSN can be used for different file formats of the same online serial; this "media-oriented identification" of serials made sense in the 1970s. In the 1990s and onward, with personal computers, better screens, the Web, it makes sense to consider only content, independent of media; this "content-oriented identification" of serials was a repressed demand during a decade, but no ISSN update or initiative occurred. A natural extension for ISSN, the unique-identification of the articles in the serials, was the main demand application. An alternative serials' contents model arrived with the indecs Content Model and its application, the digital object identifier, as ISSN-independent initiative, consolidated in the 2000s. Only in 2007, ISSN-L was defined in the
The European Union is a political and economic union of 28 member states that are located in Europe. It has an area of an estimated population of about 513 million; the EU has developed an internal single market through a standardised system of laws that apply in all member states in those matters, only those matters, where members have agreed to act as one. EU policies aim to ensure the free movement of people, goods and capital within the internal market, enact legislation in justice and home affairs and maintain common policies on trade, agriculture and regional development. For travel within the Schengen Area, passport controls have been abolished. A monetary union was established in 1999 and came into full force in 2002 and is composed of 19 EU member states which use the euro currency; the EU and European citizenship were established when the Maastricht Treaty came into force in 1993. The EU traces its origins to the European Coal and Steel Community and the European Economic Community, established by the 1951 Treaty of Paris and 1957 Treaty of Rome.
The original members of what came to be known as the European Communities were the Inner Six: Belgium, Italy, the Netherlands, West Germany. The Communities and its successors have grown in size by the accession of new member states and in power by the addition of policy areas to its remit; the latest major amendment to the constitutional basis of the EU, the Treaty of Lisbon, came into force in 2009. While no member state has left the EU or its antecedent organisations, the United Kingdom signified the intention to leave after a membership referendum in June 2016 and is negotiating its withdrawal. Covering 7.3% of the world population, the EU in 2017 generated a nominal gross domestic product of 19.670 trillion US dollars, constituting 24.6% of global nominal GDP. Additionally, all 28 EU countries have a high Human Development Index, according to the United Nations Development Programme. In 2012, the EU was awarded the Nobel Peace Prize. Through the Common Foreign and Security Policy, the EU has developed a role in external relations and defence.
The union maintains permanent diplomatic missions throughout the world and represents itself at the United Nations, the World Trade Organization, the G7 and the G20. Because of its global influence, the European Union has been described as an emerging superpower. During the centuries following the fall of Rome in 476, several European States viewed themselves as translatio imperii of the defunct Roman Empire: the Frankish Empire and the Holy Roman Empire were thereby attempts to resurrect Rome in the West; this political philosophy of a supra-national rule over the continent, similar to the example of the ancient Roman Empire, resulted in the early Middle Ages in the concept of a renovatio imperii, either in the forms of the Reichsidee or the religiously inspired Imperium Christianum. Medieval Christendom and the political power of the Papacy are cited as conducive to European integration and unity. In the oriental parts of the continent, the Russian Tsardom, the Empire, declared Moscow to be Third Rome and inheritor of the Eastern tradition after the fall of Constantinople in 1453.
The gap between Greek East and Latin West had been widened by the political scission of the Roman Empire in the 4th century and the Great Schism of 1054. Pan-European political thought emerged during the 19th century, inspired by the liberal ideas of the French and American Revolutions after the demise of Napoléon's Empire. In the decades following the outcomes of the Congress of Vienna, ideals of European unity flourished across the continent in the writings of Wojciech Jastrzębowski, Giuseppe Mazzini or Theodore de Korwin Szymanowski; the term United States of Europe was used at that time by Victor Hugo during a speech at the International Peace Congress held in Paris in 1849: A day will come when all nations on our continent will form a European brotherhood... A day will come when we shall see... the United States of America and the United States of Europe face to face, reaching out for each other across the seas. During the interwar period, the consciousness that national markets in Europe were interdependent though confrontational, along with the observation of a larger and growing US market on the other side of the ocean, nourished the urge for the economic integration of the continent.
In 1920, advocating the creation of a European economic union, British economist John Maynard Keynes wrote that "a Free Trade Union should be established... to impose no protectionist tariffs whatever against the produce of other members of the Union." During the same decade, Richard von Coudenhove-Kalergi, one of the first to imagine of a modern political union of Europe, founded the Pan-Europa Movement. His ideas influenced his contemporaries, among which Prime Minister of France Aristide Briand. In 1929, the latter gave a speech in favour of a European Union before the assembly of the League of Nations, precursor of the United Nations. In a radio address in March 1943, with war still raging, Britain's leader Sir Winston Churchill spoke warmly of "restoring the true greatness of Europe" once victory had been achieved, mused on the post-war creation of a "Council of Europe" which would bring the European nations together to build peace. After World War II, European integration was seen as an antidote to the extreme nationalism which had devastated the continent.
In a speech delivered on 19
Russia the Russian Federation, is a transcontinental country in Eastern Europe and North Asia. At 17,125,200 square kilometres, Russia is by far or by a considerable margin the largest country in the world by area, covering more than one-eighth of the Earth's inhabited land area, the ninth most populous, with about 146.77 million people as of 2019, including Crimea. About 77 % of the population live in the European part of the country. Russia's capital, Moscow, is one of the largest cities in the world and the second largest city in Europe. Extending across the entirety of Northern Asia and much of Eastern Europe, Russia spans eleven time zones and incorporates a wide range of environments and landforms. From northwest to southeast, Russia shares land borders with Norway, Estonia, Latvia and Poland, Ukraine, Azerbaijan, China and North Korea, it shares maritime borders with Japan by the Sea of Okhotsk and the U. S. state of Alaska across the Bering Strait. However, Russia recognises two more countries that border it, Abkhazia and South Ossetia, both of which are internationally recognized as parts of Georgia.
The East Slavs emerged as a recognizable group in Europe between the 3rd and 8th centuries AD. Founded and ruled by a Varangian warrior elite and their descendants, the medieval state of Rus arose in the 9th century. In 988 it adopted Orthodox Christianity from the Byzantine Empire, beginning the synthesis of Byzantine and Slavic cultures that defined Russian culture for the next millennium. Rus' disintegrated into a number of smaller states; the Grand Duchy of Moscow reunified the surrounding Russian principalities and achieved independence from the Golden Horde. By the 18th century, the nation had expanded through conquest and exploration to become the Russian Empire, the third largest empire in history, stretching from Poland on the west to Alaska on the east. Following the Russian Revolution, the Russian Soviet Federative Socialist Republic became the largest and leading constituent of the Union of Soviet Socialist Republics, the world's first constitutionally socialist state; the Soviet Union played a decisive role in the Allied victory in World War II, emerged as a recognized superpower and rival to the United States during the Cold War.
The Soviet era saw some of the most significant technological achievements of the 20th century, including the world's first human-made satellite and the launching of the first humans in space. By the end of 1990, the Soviet Union had the world's second largest economy, largest standing military in the world and the largest stockpile of weapons of mass destruction. Following the dissolution of the Soviet Union in 1991, twelve independent republics emerged from the USSR: Russia, Belarus, Uzbekistan, Azerbaijan, Kyrgyzstan, Tajikistan and the Baltic states regained independence: Estonia, Lithuania, it is governed as a federal semi-presidential republic. Russia's economy ranks as the twelfth largest by nominal GDP and sixth largest by purchasing power parity in 2018. Russia's extensive mineral and energy resources are the largest such reserves in the world, making it one of the leading producers of oil and natural gas globally; the country is one of the five recognized nuclear weapons states and possesses the largest stockpile of weapons of mass destruction.
Russia is a great power as well as a regional power and has been characterised as a potential superpower. It is a permanent member of the United Nations Security Council and an active global partner of ASEAN, as well as a member of the Shanghai Cooperation Organisation, the G20, the Council of Europe, the Asia-Pacific Economic Cooperation, the Organization for Security and Co-operation in Europe, the World Trade Organization, as well as being the leading member of the Commonwealth of Independent States, the Collective Security Treaty Organization and one of the five members of the Eurasian Economic Union, along with Armenia, Belarus and Kyrgyzstan; the name Russia is derived from Rus', a medieval state populated by the East Slavs. However, this proper name became more prominent in the history, the country was called by its inhabitants "Русская Земля", which can be translated as "Russian Land" or "Land of Rus'". In order to distinguish this state from other states derived from it, it is denoted as Kievan Rus' by modern historiography.
The name Rus itself comes from the early medieval Rus' people, Swedish merchants and warriors who relocated from across the Baltic Sea and founded a state centered on Novgorod that became Kievan Rus. An old Latin version of the name Rus' was Ruthenia applied to the western and southern regions of Rus' that were adjacent to Catholic Europe; the current name of the country, Россия, comes from the Byzantine Greek designation of the Rus', Ρωσσία Rossía—spelled Ρωσία in Modern Greek. The standard way to refer to citizens of Russia is rossiyane in Russian. There are two Russian words which are commonly
Formoterol known as eformoterol, is a long-acting β2 agonist used as a bronchodilator in the management of asthma and COPD. Formoterol has an extended duration of action compared to short-acting β2 agonists such as salbutamol, which are effective for 4 h to 6 h. LABAs such as formoterol are used as "symptom controllers" to supplement prophylactic corticosteroid therapy. A "reliever" short-acting β2 agonist is still required, since LABAs are not recommended for the treatment of acute asthma, it was patented in 1972 and came into medical use in 1998. It is marketed in the combination formulations budesonide/formoterol and mometasone/formoterol. In November 2005, the US FDA released a health advisory alerting the public to findings that show the use of long-acting β2 agonists could lead to a worsening of wheezing symptoms in some patients. At the current time, available long-acting β2 agonists include salmeterol, formoterol and sustained-release oral salbutamol. Combinations of inhaled steroids and long-acting bronchodilators are becoming more widespread – combination preparations include fluticasone/salmeterol and budesonide/formoterol.
Inhaled formoterol works like other β2 agonists, causing bronchodilation by relaxing the smooth muscle in the airway so as to treat the exacerbation of asthma. It is marketed in three forms: a dry-powder inhaler, a metered-dose inhaler and an inhalation solution, under various trade names including Atock, Atimos/Atimos Modulite, Foradil/Foradile, Oxeze/Oxis, Perforomist. Foradil/Foradile capsules for oral inhalation Oxeze/Oxis Turbuhaler DPI Atock Atimos/Atimos Modulite MDI Perforomist inhalation solution Arformoterol — an enantiopure compound used in the management of COPD Combination drugs: Aclidinium bromide/formoterol Budesonide/formoterol Mometasone furoate/formoterol