‘However, results for single behavioral goals consistently favored the simultaneous group.’ For instance, after half a year, 29.6 % in the simultaneous, 16.5 % in the sequential and 13.4 % in the usual-care groups had reached the urine sodium goal. After 18 months, 20.3 % in the simultaneous, 16.9 % in the sequential and 10.1 % in the usual-care groups tested harmful for urine cotinine, which the physical body produces when it metabolizes nicotine, indicating they had stopped smoking. ‘Long-term multiple behavior change is difficult in primary treatment,’ the authors conclude. ‘This study provides strong proof that addressing multiple behaviors sequentially is not superior to, and could be inferior compared to, a simultaneous approach.’.. Addressing multiple harmful behaviors at once may be more effective than sequential approach Physicians trying to help patients change several behavioral risk factor may have more achievement approaching several topics at once instead of addressing them separately over time, according to a report in the June 11 problem of Archives of Internal Medication.However, Seemungal and colleagues discovered that in the control group the median time to the first acute exacerbation was 89 times, whereas inside our study it had been 174 days, maybe because almost 40 percent of the participants in their research had got three or more acute exacerbations in the entire year before enrollment, more were current smokers, and fewer had been receiving long-acting muscarinic antagonists. Since approximately 80 percent of our participants were taking inhaled glucocorticoids with or without long-acting beta2-agonists or long-acting muscarinic antagonists throughout the study, the ability of azithromycin to diminish the frequency of acute exacerbations would seem to be additive to these other therapies.