British journal of diseases of the chest最新文献

Forty adult patients with chronic asthma completed a 3-month double-blind crossover study to compare the effect of sustained-release theophylline given both as a fixed 300 mg twice daily dose (standard) and an individually titrated dose (titrated) with placebo. Theophylline was given in addition to other usual therapy, inhaled bronchodilators, inhaled steroids and, in 12 patients, oral steroids. The 3-month period was preceded by a run-in phase to determine the dose of theophylline which each subject required to achieve peak serum levels of 12–20 mg/litre and trough levels of 8–12 mg/litre. Doses ranged from 300 mg to 700 mg twice daily. Twenty-one patients needed more than the standard dose to achieve satisfactory serum levels. Patients recorded daily peak flow rates and symptom scores and were seen at monthly intervals to measure lung function, check serum theophylline levels and change treatments, which were given in random order. FEV₁ was significantly higher for the whole group after standard (2.11 litres) and titrated (2.15 litres) theophylline therapy than after placebo (1.89 litres), as was FVC, but in the large subgroup whose titrated dose was greater than the standard dose, the FEV₁ only improved with the titrated dose. Peak flow measurements at home showed the same pattern. Patients taking oral steroids appeared to derive less benefit from theophylline than others. It is concluded that theophylline can usefully be added as a third-line drug in chronic asthma, but that since half the patients are likely only to benefit from a dose greater than 300 mg twice daily, while the other half may have high serum levels above this dose, it is essential to measure serum levels in order to use the drug effectively and safely.

The effect of steroids on the ciliogenesis of bronchial epithelium has not previously been studied in asthmatics. Bronchial biopsies were taken during bronchoscopy from five asthmatics before and after oral steroid treatment, and studied by transmission electron microscopy. Two untreated healthy subjects served as controls. After treatment ciliogenesis was abundant in all patients.

Infection of the chondrocostal junction occurs infrequently nowadays. However, with the increasing incidence in the last years of intravenous drug addiction, more cases have been reported recently. The authors studied two groups of patients with costal chondritis, one of heroin addicts and the other of patients who had undergone thoracic surgery previously. While in the postsurgical group the patients need some kind of resection for their treatment, in the heroin addicts an early drainage is usually enough.

We have investigated the use of subcutaneous terbutaline in 17 patients with brittle asthma and five patients with chronic severe asthma. Twelve of the 17 patients with brittle asthma improved both subjectively and objectively (mean lowest daily PEF rising from 142 litres/min to 297 litres/min), with reduction in oral steroid dose, nebulized β-agonist dose and number of hospital admissions. Both continuous infusion and 6-hourly divided dose regimens were equally effective.

Only one of the five with chronic severe asthma showed any lasting response.

Eighteen patients have continued to use subcutaneous terbutaline over long periods (2–40 months). Overall 11 patients suffered side-effects of usually minor degree, although one patient had to withdraw because of the development of painful subcutaneous nodules.

We conclude that subcutaneous terbutaline delivered by infusion or by intermittent injections is a useful addition to the therapy of some patients with brittle asthma.