Scandinavian journal of respiratory diseases. Supplementum最新文献

Fifty-four bronchial carcinoma patients in clinico-anatomical stages 1-3 of the disease (localized disease) were randomly assigned to groups for radiotherapy, cyclophosphamide and placebo treatment, respectively. The results were assessed by the survival time and the quality of survival. The median survival time was 6.7 months for radiotherapy, 12.4 months for cyclophosphamide and 11.3 months for placebo. The median total sum of vitagram points was 44.5 for radiotherapy, 90.2 for cyclophosphamide and 81.8 for placebo. When calculated per month, the median sum of vitagram points was 6.2 for radiotherapy, 6.6 for cyclophosphamide and 7.0 for placebo. No significant differences were found between the treatment groups with respect to average survival time and and average vitagram point sums.

The anticholinergic drug ipratropium bromide (Atrovent) can be described as having pharmacologically a high degree of activity and a certain bronchoselectivity when administered intravenously. Inhalation studies, however, indicate that this is the most suitable route of administration. Inhalation provides with small doses the most effective concentration locally at the smooth muscle of the airways without producing anticholinergic side effects due to absorption from the airways or from the gastrointestinal tract. In certain experimental models of allergic asthma, ipratropium bromide was shown to be capable of influencing favourably bronchoconstriction and mediator release. Extensive toxicological examinations revealed with high doses all typical symptoms of overdosing an anticholinergic drug, like mydriasis, dryness of the mucosae and meteorism with coprostasis. Acute and long term inhalation studies gave no evidence for a functional and morphological impairment of the lungs and airways.

8 normals, 8 asthmatics and 8 bronchitics inhaled comparable doses of ipratropin and salbutamol. Five different flow-volume parameters were measured before and at intervals from 3 to 360 minutes after inhalation, on a total number of 2880 maximal effort expiratory flow-volume curves. Arterial blood gas tensions were measured before and 60 minutes after inhalation. In all parameters a significant larger effect (p less than 0.05) of ipratropin was found in normals, but in different time intervals. The parameter FEV1 and MEF at 50% of FVC showed the largest effect of salbutamol during the interval from 3 to 60 minutes in the asthma patients. None of the parameters showed significant difference in drug effects in the bronchitis patients. The findings suggested a more peripheral action of ipratropin than of salbutamol in the normals. No significant change in gas tensions were found after inhalation in any of the three groups.

A range for the airway resistance (R), reference resistance (Rref), quotient (R/Rref) measured by whole body plethysmography is given for unspecific inhalative provocation in asthmatic patients. 1. In patients with an initial R/Rref value less than 2 (R about 0,6 kPa/l/s) the non allergic reaction did not exceed an R/Rref quotient of 2,7. 2. Those patients with an initial R/Rref quotient greater than 2 but less than 5 reached an R/Rref value of 8.5 after non allergic provocation, which equals an R of about 1,75 kPa/l/s. It is recommended to provoke only those patients in whom the initial R/Rref quotient is in the beginning smaller than 2; because it is otherwise difficult to separate allergic from non allergic reactions and the necessary allergen induced bronchospasm might be harmful. Reference values for specific airway resistance have the advantage that we do not need a panting manouvre against a closed shutter which is often difficult to achieve especially with children during an asthmatic attack.