Primary VZV infection typically occurs during childhood and causes chickenpox (varicella). Following primary VZV infection, the virus enters the sensory nerves and travels along the nerve to the sensory dorsal root ganglia and establishes a permanent latent infection. It is not known what causes reactivation of the latent virus, which leads to the clinical manifestations of shingles, but reactivation is usually associated with conditions that depress the immune system such as immunosuppressive therapy, HIV infection and/or old age.
Numerous studies have demonstrated excellent control of moderate persistent asthma with combination therapy in patients 12 years and older. 7 Combination therapy has not been studied in children younger than four years. Strong evidence in patients 12 years and older indicates that the combination of inhaled corticosteroids and longacting beta 2 agonists leads to clinically meaningful improvements in lung function and symptoms and a reduced need for quickrelief short-acting beta 2 agonists. Adding a leukotriene receptor antagonist or theophylline to inhaled corticosteroids or doubling the dose of inhaled corticosteroids also improves outcomes, but the evidence is not as substantial as with the addition of long-acting beta 2 agonists. 34 , 35