PubMed Health⌕ Search

Biomedical subjects

A C Roldaan

Publications and source records attributed to A C Roldaan.

16 recordsLinked to original sources
PubMed2006

Dry powder inhalation of colistin in cystic fibrosis patients: a single dose pilot study.

BACKGROUND: Dry powder inhalation (DPI) may be an alternative to nebulisation of drugs in the treatment of chest infections in cystic fibrosis (CF) patients. In a pilot study the feasibility of a colistin dry powder inhaler (prototype Twincer) by a single dose in CF-patients was assessed and compared to nebulised colistin. METHODS: Ten CF-patients, chronically infected with P. aeruginosa, participated in a randomised cross over study. On two visits to the outpatient clinic, patients inhaled colistin sulphomethate as 25 mg dry powder (Twincer) or as 158 mg nebulised solution (Ventstream nebuliser, PortaNeb compressor). Pulmonary function tests were performed before, 5 and 30 min after inhalation. Serum samples were drawn prior to each dose and at 15, 45 min, 1.5; 2.5; 3.5 and 5.5 h after inhalation. RESULTS: The DPI was well tolerated by the patients: no significant reduction in FEV1 was observed. Relative bioavailability of DPI to nebulisation was approx. 140% based on actual dose and approx. 270% based on drug dose label claim. CONCLUSIONS: The colistin DPI (Twincer inhaler) is well tolerated and appreciated by CF-patients. Optimisation with respect to particle size and internal resistance of the inhaler is necessary to attain equivalent pulmonary deposition to liquid nebulisation.

Administration, Inhalation↗
PubMed2006

Prevalence of nutritional depletion in a large out-patient population of patients with COPD.

OBJECTIVE: The present study focuses on the prevalence of nutritional depletion in relation to functional performance, airflow limitation, experienced dyspnoea and health status in a large multi-center out-patient population with chronic obstructive pulmonary disease (COPD). METHODS: In 39 out-patient centers in The Netherlands, 389 patients with moderate to severe COPD (217 men) were recruited. The study evaluated on the baseline characteristics of the COSMIC study. Measurements included body composition by bioelectrical impedance analysis, dyspnoea by MRC-score, peripheral muscle function by isometric handgrip strength and disease-specific health status by St. George Respiratory Questionnaire. RESULTS: The prevalence of nutritional depletion (defined as body mass index (BMI)<or=21 kg/m2 and/or fat-free mass index (FFMI)<or=15 (females) or <or=16 (males) kg/m2) was high (27%). Prevalence of normal BMI and low FFMI was 15%, and of low BMI and low FFMI 11%. The prevalence of low BMI as well as low FFMI was significantly higher in female than in male COPD patients, 18% and 40% vs. 10% and 20%, respectively (both P<0.01). No differences in FEV1%predicted, dyspnoea score and health status were observed between depleted and non-depleted COPD patients. Multiple linear regression analysis in the total group showed that handgrip strength correlated with FFMI after correction for sex distribution and age, but not FEV1%predicted. CONCLUSIONS: The prevalence of nutritional depletion was high in a large out-patient COPD population in The Netherlands, especially in female COPD patients. Depletion of FFM was associated with impaired peripheral muscle strength, independent of disease severity.

Adult↗
PubMed2003

[Severe chronic obstructive pulmonary disease in young women who smoke].

Chronic obstructive pulmonary disease (COPD) was diagnosed in three women aged 39, 41 and 41 years who were all heavy smokers. They presented with symptoms of dyspnoea. At the time of diagnosis they already had advanced pulmonary emphysema and signs of systemic impairment. At the last follow-up one woman had a very limited range of action, the second was awaiting a lung transplant after several periods of hospitalization, and the third had died. Nowadays pneumologists are increasingly encountering severe COPD in young female patients. Increased tobacco consumption in women has run parallel to the rising mortality rates from COPD in females over the last decades. Cigarette smoking is probably associated with a higher risk of obstructive lung disease in women than in men. Moreover women with COPD maintain exercise capacity longer than men with similar degrees of airway obstruction, leading to a risk of them waiting too long before seeking medical help. Actions aimed at discouraging smoking especially in adolescence are without doubt the intervention of choice for prevention of this highly disabling disease.

Adult↗
PubMed2001

Benefits of high altitude allergen avoidance in atopic adolescents with moderate to severe asthma, over and above treatment with high dose inhaled steroids.

Some patients with severe asthma cannot be controlled with high doses of inhaled steroids (ICS), which may be related to ongoing environmental allergen exposure. We investigated whether 10 weeks of high altitude allergen avoidance leads to sustained benefits regarding clinical and inflammatory markers of disease control in adolescents with persistent asthma despite treatment with high dose ICS. Eighteen atopic asthmatic adolescents (12-18 yr, 500-2000 microg ICS daily) with established house dust mite allergy, participated in a parallel-group study. Quality of life (PAQL), lung function, bronchial hyperresponsiveness (BHR) to adenosine and histamine, induced sputum and urine samples were collected repeatedly from 10 patients during a 10-week admission period to the Swiss Alps (alt. 1560 m) and at 6 weeks after return to sea level. Results were compared with those in eight patients, studied in their home environment at sea level for a similar time period. Throughout the study, asthma medication remained unchanged in both groups. During admission to high altitude, PAQL, lung function, BHR to adenosine and histamine, and urinary levels of eosinophil protein X (U-EPX), leukotriene E4 (U-LTE4) and 9alpha11beta prostaglandin F2 (U-9alpha11beta PGF2) improved significantly (P < 0.05), with a similar tendency for sputum eosinophils (P < 0.07). Furthermore, the changes in PAQL and BHR to adenosine and histamine were greater in the altitude than in the control group (P < 0.05). At 6 weeks after renewed allergen exposure at sea level, the improvements in PAQL (P < 0.05), BHR to adenosine (P < 0.07) and histamine (P < 0.05), as well as U-EPX (P < 0.05) and U-LTE4 (P < 0.05) were maintained. A short period of high altitude allergen avoidance, on top of regular treatment with ICS and long-acting beta2-agonists, results in improvement of asthma, as assessed by clinical and inflammatory markers of disease severity. These findings indicate that short-term, rigorous allergen avoidance can improve the long-term control of severe asthma over and above what can be achieved even by high doses of inhaled steroids.

Administration, Inhalation↗
PubMed2000

The relationship between airways inflammation and asthma severity.

In order to investigate the relationship between airways inflammation and disease severity, and improve the understanding of persistent asthma, 74 asthmatics, with disease severity ranging from intermittent, to mild to moderate and severe persistent (classified according to the Global Initiative for Asthma [GINA] guidelines), and 22 nonatopic control subjects were studied using the method of induced sputum. Sputum was analyzed for total and differential cell counts concentrations of albumin, and levels of eosinophil cationic protein (ECP), myeloperoxidase (MPO), and tryptase, inflammatory mediators reflecting eosinophil, neutrophil, and mast cell activation. Asthma severity (assessed by FEV(1), peak expiratory flow [PEF] variability, and daily symptom scores) and methacholine airways responsiveness were related to sputum eosinophilia and ECP. In addition, sputum neutrophilia and MPO levels correlated, albeit weakly, with PEF variability and symptom scores, respectively. Tryptase concentrations were raised in mild to moderate asthmatics. Albumin concentrations were significantly raised across the spectrum of asthma severity and correlated with those of tryptase and ECP. Despite treatment with either high doses of inhaled corticosteroids or oral corticosteroids, prominent eosinophilic inflammation with raised ECP was noted. This study points to persistent, disease severity-related airways inflammation in asthma, involving eosinophils, mast cells, and neutrophils, which is evident despite treatment with corticosteroids.

Adult↗
PubMed1999

Induced sputum in adolescents with severe stable asthma. Safety and the relationship of cell counts and eosinophil cationic protein to clinical severity.

This study examined the safety of sputum induction and the relation between sputum cell counts and clinical parameters in adolescents with severe persistent asthma. Within 5 days, induced sputum and reversibility in forced expiratory volume in one second (FEV1), quality of life, provocative concentration causing a 20% fall in FEV1 (PC20) of adenosine monophosphate and histamine, exercise-induced bronchoconstriction, overall asthma severity index, and blood eosinophils were collected in 20 atopic adolescents with moderate-to-severe persistent asthma (12-18 yrs of age, FEV1 65-110% of predicted, on 500-2,000 microg inhaled steroids daily). FEV1 was reversible by 13.3-2.3% pred. After sputum induction, FEV1 was still increased by 9.0+/-2.6% pred as compared to the pre-salbutamol baseline. Sputum contained, median (range): 12.4 (0.4-59.5)% squamous cells, 47.3 (6.8-84.0)% macrophages, 39.0 (4.6-84.8)% neutrophils, 4.8 (1.0-12.4)% lymphocytes, 0.4 (0-10.8)% eosinophils and 3.6 (0-23.4)% bronchial epithelial cells. Sputum eosinophils showed a trend towards a significant association with the overall asthma severity index (r=0.46, p=0.06) and correlated inversely with baseline FEV1 (r=-0.51, p=0.03). In conclusion, sputum can be induced safely in adolescents with moderate-to-severe persistent asthma, if pretreated with beta2-agonists. Despite relatively low sputum eosinophil counts in these patients on inhaled steroids, the association of eosinophil numbers with baseline forced expiratory volume in one second and asthma severity index favours a role of induced sputum in monitoring adolescents with severe asthma.

Adolescent↗
PubMed1997

Enhanced expression of neutral endopeptidase (NEP) in airway epithelium in biopsies from steroid- versus nonsteroid-treated patients with atopic asthma.

The expression of the endogenous neuropeptide-degrading enzyme, neutral endopeptidase (NEP; CALLA, CD10, E.C.3.4.24.11) on cultured human airway epithelial cells can be upregulated by corticosteroids. We examined whether NEP expression in the airway epithelium or lamina propria in bronchial biopsies is enhanced in atopic asthmatics on regular inhaled steroids as compared with those without steroid treatment. Forty nonsmoking adults (age 19 to 48 yr) with mild to moderate asthma (forced expiratory volume in 1 s > or = 50% pred., histamine PC20 range 0.02 to 7.6 mg/ml) with (n = 23) or without (n = 17) regular inhaled steroids treatment entered the study. Biopsies were taken at (sub)segmental level from the right lower lobe, the middle lobe, and the main carina. Immunohistochemical staining was performed on cryostat sections using the VIL-A1 monoclonal antibody against CD10 (NEP). Intra- and inter-observer repeatability of a semiquantitative scoring method was good as assessed by weighted kappa (kappa(w) ranging from 0.66 to 0.81). In the airway epithelium, NEP-positive sites were within the basal layer and, in contrast with studies applying other antibodies, also at apical sites and within the lamina propria. In both the epithelium and lamina propria, NEP expression was not significantly different between the three biopsy sites (Friedman's nonparametric two-way analysis of variance; P > 0.68), nor was expression in the lamina propria associated with inhaled steroid usage (Mann-Whitney U test; P = 0.98). However, NEP expression was significantly enhanced in the airway epithelium in patients using inhaled steroids as compared with nonsteroid users (mean rank: 23.4 and 15.5, respectively; P = 0.02). Among nonsteroid-using subjects, NEP expression was related to symptoms and the methacholine PC20 (Rs: -0.69 and 0.49, respectively; P < or = 0.04). We conclude that the expression of NEP is enhanced in airway epithelium in bronchial biopsy specimens from patients with atopic asthma who are regularly using inhaled steroids as compared with patients who do not. This fits the hypothesis that the anti-inflammatory effect of corticosteroids within the airways is partially mediated by the upregulation of the endogenous neuropeptide-degrading enzyme NEP.

Adrenergic beta-Agonists↗
PubMed1993

[Liver damage during administration of itraconazole (Trisporal)].

Three case histories are described of patients, two women aged 62 and 57 and a man aged 75 years, who developed symptomatic hepatic injury five to six weeks after starting itraconazole treatment. In two of them the biochemical pattern of liver injury was cholestatic. Other causes of hepatic injury were excluded. Monitoring serum liver enzymes is advisable in patients treated with itraconazole for one month or longer.

Aged↗
PubMed1991

[The breathing casette; a useful aide in hyperventilation].

The breathing cassette (Hyperfree) was tested on 10 persons suffering from hyperventilation syndrome. Each subject performed a hyperventilation provocation of two minutes on three separate occasions. Immediately after the hyperventilation provocation the subject was asked to terminate the hyperventilation, firstly with no aid at all, later using a plastic bag or the breathing cassette. The %vol. CO2 in the exhaled air was recorded with a capnograph. The use of the plastic bag and the breathing cassette resulted in an equal restoration of the %vol. CO2. After using the cassette for six weeks the patients completed a questionnaire. All patients stated that they intended to continue using the breathing cassette, and that it was easy and handy to use. Most patients carried the cassette always with them, since it made them feel comfortable.

Adult↗
PubMed1991

[An unusual form of recurring pneumothorax].

Two cases of catamenial pneumothorax are described. This syndrome is characterized by recurring right-sided pneumothorax associated with menstruation. In one of our patients endometriosis of the diaphragm could be diagnosed in a biopsy, taken during thoracoscopy. Some clinical, etiologic and therapeutic implications are discussed.

Adult↗
PubMed1989

[Pulmonary and extra-pulmonary forms of tuberculosis; clinical experiences in the 80s].

In the period 1980-1984, 85 patients with tuberculosis were seen at Leyden University Hospital. In this retrospective study clinical data of 76 patients with pulmonary, extrapulmonary, miliary and disseminated tuberculosis are presented. 43 patients suffered from pulmonary tuberculosis. Three patients suffered from miliary tuberculosis and three patients from disseminated tuberculosis. Eight patients suffered from pleuritis tuberculosa, of whom three also suffered from pulmonary tuberculosis. The heterogeneity and often rather non-specific, sometimes surprising clinical aspects of tuberculosis are highlighted by a variety of clinical case histories.

Adolescent↗
PubMed1982

Viral respiratory infections in asthmatic children staying in a mountain resort.

In 32 mainly atopic children (aged 9-16 years) staying in a mountain resort the effects of viral infections on the course of asthma were studied. Daily surveillance was made of respiratory infection symptoms and clinical parameters for asthma, including forced expiratory volume in 1s (FEV1). Serology for several respiratory viruses. Mycoplasma pneumoniae and Chlamydia psittaci was done. In 58 symptomatic respiratory infections (SRI) 39 asthmatic exacerbations occurred (67%). Eighteen SRIs of viral origin caused 16 exacerbations (89%). Twenty-one seroconversions with mild or absent symptoms of infection gave six exacerbations (29%). Five flare-ups of asthma in eight episodes of seroconversion (63%) during which patients were not under observation were reported. Streptococcal pharyngitis did not cause asthmatic reactions. Thirteen SRIs due to influenza A all caused asthmatic exacerbations. The similarity of these data to those in children with "intrinsic" asthma suggests that the development of viral excerbations in asthmatics is not determined by whether the patient is allergic or not.

Adolescent↗