Use of QVAR with a spacer device in children less than 5 years of age is not recommended. In vitro dose characterization studies were performed with QVAR 40 mcg/actuation with the OptiChamber and AeroChamber Plus ® spacer utilizing inspiratory flows representative of children under 5 years old. These studies indicated that the amount of medication delivered through the spacing device decreased rapidly with increasing wait times of 5 to 10 seconds as shown in Table 2. If QVAR is used with a spacer device, it is important to inhale immediately.
Drugs can inhibit PCSK9, leading to lowered circulating LDL particle concentrations. Since LDL particle concentrations are a driver of cardiovascular disease like heart attacks , it is plausible that these drugs may also reduce the risk of such diseases. Clinical studies, including phase III clinical trials , are now underway to describe the effect of PCSK9 inhibition on cardiovascular disease, and the safety and efficacy profile of the drugs.      Among those inhibitors under development in December 2013 were the antibodies alirocumab , evolocumab , 1D05-IgG2 ( Merck ), RG-7652 and LY3015014, as well as the RNAi therapeutic inclisiran .  PCSK9 inhibitors are promising therapeutics for the treatment of people who exhibit statin intolerance, or as a way to bypass frequent dosage of statins for higher LDL concentration reduction.  
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