European journal of respiratory diseases最新文献

To obtain information on the extent and severity of asthmatic symptoms during daily life in winter, a simple questionnaire was sent to 57 asthmatic patients and a control group of 180 age-matched men and women in Göteborg. The average winter temperature there is about freezing point. About two-thirds of the asthmatic patients reported cold to be a factor causing breathing difficulties. In 37%, these symptoms made the patients avoid going out during the winter. Cold, damp air was reported by the asthmatic patients to cause more symptoms than cold, dry air. The control group reported very few respiratory symptoms.

Responses to pathogenic and environmental mycobacteria were assessed in 2680 children in India and Sri Lanka using quadruple skin-testing with new tuberculins. Statistical analysis of the results, by fitting a log-linear mixture model, confirmed the presence of three different categories of response: category 2 non-responders (about 55%) did not react to any component of the mycobacteria; category 3 responders (about 40%) were sensitive to the species-specific group iv antigens; and category 1 responders (about 5%) were sensitive to the group i antigens which are common to all mycobacteria. The proportions of the three response categories vary with age and with BCG status. BCG vaccination and increasing age act independently to decrease the proportion of category 2 non-responders and increase the proportion of category 3 individuals. BCG vaccination and increasing age interact to increase the proportion of category 1 responders.

We report the results of a double-blind controlled study of 20 asthmatic patients to determine the optimum dose of fenoterol given by nebuliser. Lung function was monitored after four different doses (0.5 mg, 1.25 mg, 2.5 mg, 5 mg) and placebo. All four doses of fenoterol were found to be significantly superior to placebo. Doses of 5 mg and 2.5 mg were also significantly more effective than the 0.5 mg dose up to 3 h. There was no significant difference between the three highest doses. In this study of relatively stable asthmatics, the increased bronchodilatation obtained with the higher doses of fenoterol (5 mg and 2.5 mg) was not sufficient to offset the higher incidence of side-effects, and we therefore recommend 1.25 mg as a starting dose. Higher doses may be needed for severely ill patients in whom side-effects are not such an important consideration.

Temporal arteritis is a well-recognized multi-systemic disease. Pulmonary manifestations, however, are extremely rare. In two patients with biopsy-proven temporal arteritis, lung involvement was observed. One patient presented with multinodular pulmonary lesions, while the second had a diffuse interstitial pattern. Both patients responded well to corticosteroid treatment. In a review of the literature, only four additional cases associating lung involvement with temporal arteritis were found. The possibility of primary pulmonary vasculitis should be considered in elderly patients with temporal arteritis.

The progression of pulmonary hypertension secondary to chronic airflow obstruction is thought to be related to the degree of nocturnal oxygen desaturation. We have studied 11 patients with severe smoking-related hypoxic chronic airflow obstruction (mean FEV1 0.67 L, mean arterial PO2 6.83 kPa) who showed less than 15% reversibility to 200 micrograms inhaled salbutamol delivered by a pressurised aerosol. There was no difference in nocturnal oxygen saturation when a control normal saline was compared to intravenous aminophylline given according to the BNF recommended dosages, despite theophylline levels of 9.20 and 9.03 micrograms ml-1 at the beginning and end of the infusion. There was no improvement overall in FEV1 and FVC by aminophylline, but in individual patients an improvement of FEV1 could be associated with an improvement in mean oxygen saturation. We conclude 1) that there is no benefit in the short-term administration of theophylline in chronic airflow obstruction, 2) that indiscriminate use of theophylline preparation in irreversible airways disease is not justified, but 3) that theophyllines may benefit individual patients.

In order to determine the duration of action of the inhaled anticholinergic agent oxitropium bromide, a controlled study of the effect of pre-treatment with oxitropium bromide 200 micrograms against cholinergic challenge was carried out in ten asthmatic subjects (6 children, 4 adults). After baseline measurements of lung function (FEV1 and sGaw) and methacholine PC20 (the concentration of methacholine to produce a 20% fall in FEV1) oxitropium bromide or placebo were inhaled double-blind on 2 separate days. Lung function and methacholine PC20 were then measured at 1, 3 and 6 h post dosing. Oxitropium bromide caused significant protection from methacholine challenge for 6 h (p less than 0.05).

Specimens were obtained from 25 patients who developed tracheostomy site wound infections. Aerobic bacteria only were isolated in 4 (16%) instances, anaerobic bacteria only in 2 (8%), and mixed aerobic and anaerobic isolates were recovered in 19 (76%). A total of 145 isolates (72 aerobes and 73 anaerobes) were recovered, an average of 5.8 isolates per specimen (2.9 aerobes and 2.9 anaerobes). The most frequently recovered isolates were Peptostreptococcus sp., Bacteroides sp., alpha-hemolytic streptococci, Fusobacterium sp., and Pseudomonas aeruginosa. Twenty-nine isolates recovered from 19 (72%) patients produced beta-lactamase. These included all isolates of Staphylococcus aureus and Bacteroides fragilis group and 4 of 11 (36%) of Bacteroides melaninogenicus group. The polymicrobial aerobic-anaerobic flora of tracheostomy site wound infection, and the presence of beta-lactamase-producing bacteria in most of these infections, may have important implications for their management.

Glucose tolerance tests were performed in 80 cases; 30 with active pulmonary tuberculosis, 24 with nonspecific pulmonary infection and 26 controls. The new criteria were used for the diagnosis of impaired glucose tolerance (IGT). There was IGT in 4 cases in the tuberculous group, in 3 cases in the nonspecific pulmonary infection group and in none of the controls. The IGT returned to the normal limits in 3 tuberculous patients after 2 months of chemotherapy. This suggests that the higher incidence of IGT in tuberculosis is only associated with the active phase.

The absolute bioavailability of prednisolone was assessed in ten asthmatic patients who responded poorly to ordinary doses of corticosteroids so-called "steroid-resistant" bronchial asthma. Plasma levels of prednisolone were measured by a high pressure liquid chromatographic method after oral (20 mg) and intravenous (18.6 mg) single-dose administration. Determination of the number of eosinophils in the blood was used as an estimate of the effect of the drug. The total plasma clearance, plasma half-life and volume of distribution determined from intravenous data were similar to those reported earlier for healthy volunteers and asthmatic patients. Orally administered prednisolone was rapidly absorbed and found to have complete bioavailability. There was a similar decrease in the number of eosinophils in the blood both after oral and after intravenous administration. Thus, the present study does not support the hypothesis that resistance of asthmatic symptoms to oral corticosteroids is due in some cases to poor absorption or rapid elimination of these drugs.