Adherence to inhaled corticosteroids and long-acting β2-agonists in asthma: A MASK-air study

B Sousa-Pinto^{1

2}, R Louis^{3

4}, J M Anto^{5

6

7}, R Amaral^{1

2}, A Sá-Sousa^{1

2}, W Czarlewski^{8

9}, L Brussino^{10

11}, G W Canonica^{12

13}, C Chaves Loureiro¹⁴, A A Cruz¹⁵, B Gemicioglu¹⁶, T Haahtela¹⁷, M Kupczyk¹⁸, V Kvedariene^{19

20}, D E Larenas-Linnemann²¹, Y Okamoto^{22

23}, M Ollert^{24

25}, O Pfaar²⁶, N Pham-Thi^{27

28

29}, F Puggioni³⁰, F S Regateiro^{31

32

33}, J Romantowski³⁴, J Sastre³⁵, N Scichilone³⁶, L Taborda-Barata^{37

38}, M T Ventura^{39

40}, I Agache⁴¹, A Bedbrook^{9

42}, S Becker⁴³, K C Bergmann^{44

45}, S Bosnic-Anticevich^{46

47}, M Bonini^{48

49

50}, L-P Boulet⁵¹, G Brusselle⁵², R Buhl⁵³, L Cecchi⁵⁴, D Charpin⁵⁵, F de Blay^{56

57}, S Del Giacco⁵⁸, J C Ivancevich⁵⁹, M Jutel^{60

61}, L Klimek^{62

63}, H Kraxner⁶⁴, P Kuna¹⁸, D Laune⁶⁵, M Makela¹⁷, M Morais-Almeida⁶⁶, R Nadif^{67

68}, M Niedoszytko⁶⁹, N G Papadopoulos⁷⁰, A Papi⁷¹, V Patella^{72

73

74}, B Pétré⁷⁵, D Rivero Yeverino⁷⁶, C Robalo Cordeiro¹⁴, N Roche^{77

78}, P W Rouadi^{79

80}, B Samolinski⁸¹, M Savouré^{67

68}, M H Shamji^{50

82}, A Sheikh⁸³, C Suppli Ulrik^{84

85}, O S Usmani^{50

86}, A Valiulis^{87

88}, A Yorgancioglu⁸⁹, T Zuberbier^{44

45}, J A Fonseca^{1

2}, E M Costa⁹⁰, J Bousquet^{44

45

68

91}

Affiliations

¹ MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal.
² CINTESIS@RISE - Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal.
³ Department of Pulmonary Medicine, CHU Liège, Liège, Belgium.
⁴ GIGA I3 Research Group, University of Liège, Liège, Belgium.
⁵ ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.
⁶ Universitat Pompeu Fabra (UPF), Barcelona, Spain.
⁷ CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
⁸ Medical Consulting Czarlewski, Levallois, France.
⁹ MASK-air, Montpellier, France.
¹⁰ Department of Medical Sciences, University of Torino, Torino, Italy.
¹¹ Allergy and Clinical Immunology Unit, Mauriziano Hospital, Torino, Italy.
¹² Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
¹³ IRCCS Humanitas Research Center, Rozzano, Milan, Italy.
¹⁴ Department of Pneumology, University of Coimbra, Medicine Faculty, Coimbra, Portugal.
¹⁵ Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil.
¹⁶ Department of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey.
¹⁷ Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland.
¹⁸ Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland.
¹⁹ Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
²⁰ Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
²¹ Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico.
²² Chiba Rosai Hospital, Chiba, Japan.
²³ Chiba University Hospital, Chiba, Japan.
²⁴ Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg.
²⁵ Odense Research Center for Anaphylaxis (ORCA), and Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.
²⁶ Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.
²⁷ Ecole Polytechnique de Palaiseau, Palaiseau, France.
²⁸ IRBA (Institut de Recherche Bio-Médicale des Armées), Brétigny sur Orge, France.
²⁹ Université Paris Cité, Paris, France.
³⁰ IRCCS Humanitas Research Center, Personalized Medicine Asthma & Allergy, Rozzano, Milan, Italy.
³¹ Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
³² Center for Innovative Biomedicine and Biotechnology (CIBB), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
³³ Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
³⁴ Medical University of Gdańsk, Department of Allergology, Gdansk, Poland.
³⁵ Allergy Service, Fundacion Jimenez Diaz, Autonoma University of Madrid, CIBERES-ISCIII, Madrid, Spain.
³⁶ PROMISE Department, University of Palermo, Palermo, Italy.
³⁷ Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal.
³⁸ UBIAir - Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.
³⁹ Allergy and Clinical Immunology, University of Bari Medical School, Bari, Italy.
⁴⁰ Institute of Sciences of Food Production, National Research Council (ISPA-CNR), Bari, Italy.
⁴¹ Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania.
⁴² ARIA, Montpellier, France.
⁴³ Department of Otorhinolaryngology, University of Tübingen, Tübingen, Germany.
⁴⁴ Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
⁴⁵ Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
⁴⁶ Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia.
⁴⁷ Macquarie Medical School, Macquarie University, Macquarie Park, NSW, Australia.
⁴⁸ Department of Cardiovascular and Respiratory Sciences, Universita Cattolica del Sacro Cuore, Rome, Italy.
⁴⁹ Department of Neurological, ENT and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli - IRCCS, Rome, Italy.
⁵⁰ National Heart and Lung Institute (NHLI), Imperial College London, London, UK.
⁵¹ Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
⁵² Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
⁵³ Department of Pulmonary Medicine, Mainz University Hospital, Mainz, Germany.
⁵⁴ SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy.
⁵⁵ Clinique des Bronches, Allergie et Sommeil, Hôpital Nord, Marseille, France.
⁵⁶ Allergy Division, Chest Disease Department, University Hospital of Strasbourg, Strasbourg, France.
⁵⁷ Federation of Translational Medicine, University of Strasbourg, Strasbourg, France.
⁵⁸ Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy.
⁵⁹ Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina.
⁶⁰ Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland.
⁶¹ ALL-MED Medical Research Institute, Wroclaw, Poland.
⁶² Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany.
⁶³ Center for Rhinology and Allergology, Wiesbaden, Germany.
⁶⁴ Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary.
⁶⁵ KYomed INNOV, Montpellier, France.
⁶⁶ Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal.
⁶⁷ Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France.
⁶⁸ Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France.
⁶⁹ Department of Allergology, Medical University of Gdańsk, Gdansk, Poland.
⁷⁰ Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
⁷¹ Respiratory Medicine, Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
⁷² Division of Allergy and Clinical Immunology, Department of Medicine, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy.
⁷³ Agency of Health ASL, Salerno, Italy.
⁷⁴ Postgraduate Programme in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy.
⁷⁵ Department of Public Health, University of Liège, Liège, Belgium.
⁷⁶ Servicio de Alergia e Inmunología clínica, Hospital Universitario de Puebla, Puebla, México.
⁷⁷ Pneumologie, AP-HP Centre Université de Paris Cité, Hôpital Cochin, Paris, France.
⁷⁸ UMR 1016, Institut Cochin, Paris, France.
⁷⁹ Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon.
⁸⁰ Department of Otorhinolaryngology-Head and Neck Surgery, Dar Al Shifa Hospital, Salmiya, Kuwait.
⁸¹ Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland.
⁸² NIHR Imperial Biomedical Research Centre, London, UK.
⁸³ Usher Institute, The University of Edinburgh, Edinburgh, UK.
⁸⁴ Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark.
⁸⁵ Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁸⁶ Royal Brompton Hospital, Airways Disease Section, London, UK.
⁸⁷ Interdisciplinary Research Group of Human Ecology, Institute of Clinical Medicine and Institute of Health Sciences, Medical Faculty of Vilnius University, Vilnius, Lithuania.
⁸⁸ European Academy of Paediatrics (EAP/UEMS-SP), Brussel, Belgium.
⁸⁹ Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey.
⁹⁰ UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing), Porto, Portugal.
⁹¹ University Hospital Montpellier, Montpellier, France.

PMID: 37543524
DOI: 10.1016/j.pulmoe.2023.07.004

Free article

Adherence to inhaled corticosteroids and long-acting β2-agonists in asthma: A MASK-air study

B Sousa-Pinto et al. Pulmonology. 2025.

Free article

. 2025 Dec 31;31(1):2416869.

doi: 10.1016/j.pulmoe.2023.07.004. Epub 2024 Oct 25.

Authors

Affiliations

¹ MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal.
² CINTESIS@RISE - Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal.
³ Department of Pulmonary Medicine, CHU Liège, Liège, Belgium.
⁴ GIGA I3 Research Group, University of Liège, Liège, Belgium.
⁵ ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.
⁶ Universitat Pompeu Fabra (UPF), Barcelona, Spain.
⁷ CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
⁸ Medical Consulting Czarlewski, Levallois, France.
⁹ MASK-air, Montpellier, France.
¹⁰ Department of Medical Sciences, University of Torino, Torino, Italy.
¹¹ Allergy and Clinical Immunology Unit, Mauriziano Hospital, Torino, Italy.
¹² Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
¹³ IRCCS Humanitas Research Center, Rozzano, Milan, Italy.
¹⁴ Department of Pneumology, University of Coimbra, Medicine Faculty, Coimbra, Portugal.
¹⁵ Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil.
¹⁶ Department of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey.
¹⁷ Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland.
¹⁸ Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland.
¹⁹ Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
²⁰ Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
²¹ Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico.
²² Chiba Rosai Hospital, Chiba, Japan.
²³ Chiba University Hospital, Chiba, Japan.
²⁴ Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg.
²⁵ Odense Research Center for Anaphylaxis (ORCA), and Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.
²⁶ Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.
²⁷ Ecole Polytechnique de Palaiseau, Palaiseau, France.
²⁸ IRBA (Institut de Recherche Bio-Médicale des Armées), Brétigny sur Orge, France.
²⁹ Université Paris Cité, Paris, France.
³⁰ IRCCS Humanitas Research Center, Personalized Medicine Asthma & Allergy, Rozzano, Milan, Italy.
³¹ Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
³² Center for Innovative Biomedicine and Biotechnology (CIBB), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
³³ Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
³⁴ Medical University of Gdańsk, Department of Allergology, Gdansk, Poland.
³⁵ Allergy Service, Fundacion Jimenez Diaz, Autonoma University of Madrid, CIBERES-ISCIII, Madrid, Spain.
³⁶ PROMISE Department, University of Palermo, Palermo, Italy.
³⁷ Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal.
³⁸ UBIAir - Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.
³⁹ Allergy and Clinical Immunology, University of Bari Medical School, Bari, Italy.
⁴⁰ Institute of Sciences of Food Production, National Research Council (ISPA-CNR), Bari, Italy.
⁴¹ Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania.
⁴² ARIA, Montpellier, France.
⁴³ Department of Otorhinolaryngology, University of Tübingen, Tübingen, Germany.
⁴⁴ Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
⁴⁵ Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
⁴⁶ Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia.
⁴⁷ Macquarie Medical School, Macquarie University, Macquarie Park, NSW, Australia.
⁴⁸ Department of Cardiovascular and Respiratory Sciences, Universita Cattolica del Sacro Cuore, Rome, Italy.
⁴⁹ Department of Neurological, ENT and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli - IRCCS, Rome, Italy.
⁵⁰ National Heart and Lung Institute (NHLI), Imperial College London, London, UK.
⁵¹ Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
⁵² Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
⁵³ Department of Pulmonary Medicine, Mainz University Hospital, Mainz, Germany.
⁵⁴ SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy.
⁵⁵ Clinique des Bronches, Allergie et Sommeil, Hôpital Nord, Marseille, France.
⁵⁶ Allergy Division, Chest Disease Department, University Hospital of Strasbourg, Strasbourg, France.
⁵⁷ Federation of Translational Medicine, University of Strasbourg, Strasbourg, France.
⁵⁸ Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy.
⁵⁹ Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina.
⁶⁰ Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland.
⁶¹ ALL-MED Medical Research Institute, Wroclaw, Poland.
⁶² Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany.
⁶³ Center for Rhinology and Allergology, Wiesbaden, Germany.
⁶⁴ Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary.
⁶⁵ KYomed INNOV, Montpellier, France.
⁶⁶ Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal.
⁶⁷ Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France.
⁶⁸ Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France.
⁶⁹ Department of Allergology, Medical University of Gdańsk, Gdansk, Poland.
⁷⁰ Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
⁷¹ Respiratory Medicine, Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
⁷² Division of Allergy and Clinical Immunology, Department of Medicine, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy.
⁷³ Agency of Health ASL, Salerno, Italy.
⁷⁴ Postgraduate Programme in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy.
⁷⁵ Department of Public Health, University of Liège, Liège, Belgium.
⁷⁶ Servicio de Alergia e Inmunología clínica, Hospital Universitario de Puebla, Puebla, México.
⁷⁷ Pneumologie, AP-HP Centre Université de Paris Cité, Hôpital Cochin, Paris, France.
⁷⁸ UMR 1016, Institut Cochin, Paris, France.
⁷⁹ Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon.
⁸⁰ Department of Otorhinolaryngology-Head and Neck Surgery, Dar Al Shifa Hospital, Salmiya, Kuwait.
⁸¹ Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland.
⁸² NIHR Imperial Biomedical Research Centre, London, UK.
⁸³ Usher Institute, The University of Edinburgh, Edinburgh, UK.
⁸⁴ Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark.
⁸⁵ Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁸⁶ Royal Brompton Hospital, Airways Disease Section, London, UK.
⁸⁷ Interdisciplinary Research Group of Human Ecology, Institute of Clinical Medicine and Institute of Health Sciences, Medical Faculty of Vilnius University, Vilnius, Lithuania.
⁸⁸ European Academy of Paediatrics (EAP/UEMS-SP), Brussel, Belgium.
⁸⁹ Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey.
⁹⁰ UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing), Porto, Portugal.
⁹¹ University Hospital Montpellier, Montpellier, France.

PMID: 37543524
DOI: 10.1016/j.pulmoe.2023.07.004

Abstract

Introduction: Adherence to controller medication is a major problem in asthma management, being difficult to assess and tackle. mHealth apps can be used to assess adherence. We aimed to assess the adherence to inhaled corticosteroids+long-acting β2-agonists (ICS+LABA) in users of the MASK-air® app, comparing the adherence to ICS+formoterol (ICS+F) with that to ICS+other LABA.

Materials and methods: We analysed complete weeks of MASK-air® data (2015-2022; 27 countries) from patients with self-reported asthma and ICS+LABA use. We compared patients reporting ICS+F versus ICS+other LABA on adherence levels, symptoms and symptom-medication scores. We built regression models to assess whether adherence to ICS+LABA was associated with asthma control or short-acting beta-agonist (SABA) use. Sensitivity analyses were performed considering the weeks with no more than one missing day.

Results: In 2598 ICS+LABA users, 621 (23.9%) reported 4824 complete weeks and 866 (33.3%) reported weeks with at most one missing day. Higher adherence (use of medication ≥80% of weekly days) was observed for ICS+other LABA (75.1%) when compared to ICS+F (59.3%), despite both groups displaying similar asthma control and work productivity. The ICS+other LABA group was associated with more days of SABA use than the ICS+F group (median=71.4% versus 57.1% days). Each additional weekly day of ICS+F use was associated with a 4.1% less risk in weekly SABA use (95%CI=-6.5;-1.6%;p=0.001). For ICS+other LABA, the percentage was 8.2 (95%CI=-11.6;-5.0%;p<0.001).

Conclusions: In asthma patients adherent to the MASK-air app, adherence to ICS+LABA was high. ICS+F users reported lower adherence but also a lower SABA use and a similar level of control.

Keywords: Adherence; Asthma; Formoterol; Inhaled corticosteroids; Long-acting-β2 agonist.

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Adherence to inhaled corticosteroids and long-acting β2-agonists in asthma: A MASK-air study

Affiliations

Adherence to inhaled corticosteroids and long-acting β2-agonists in asthma: A MASK-air study

Authors

Affiliations

Abstract

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical