Biomedical subjects
Publications and source records attributed to A Lahdensuo.
We report a 68 yr old woman with hypertension who developed a dry cough on enalapril but not on captopril therapy. Pulmonary function tests, methacholine inhalation challenges, total blood eosinophil counts, and changes in plasma concentrations of prostaglandin E2 and thromboxane B2 did not explain the difference in the adverse reaction between these two angiotensin converting enzyme inhibitors.
Twenty six hypoxaemic patients with severe and stable chronic obstructive pulmonary disease (COPD) were treated with continuous domiciliary oxygen for a six month period. The patients were evaluated 1, 3 and 6 months after the start of oxygen therapy. In addition to blood gas analysis, 15 coping skills were evaluated by the patient and by the nurse, who also rated the general activity of the patients. Depression was measured by Beck Depression Inventory (BDI) at the start of the trial and after six months' oxygen therapy. The general psychosocial response was meagre; no significant changes were observed in any psychosocial measures. The response was slightly better in younger and less hypoxaemic patients. We conclude that the psychosocial response to oxygen therapy in severely hypoxaemic COPD patients is limited.
We studied the clinical effect of a combination aerosol containing salbutamol and beclomethasone dipropionate in comparison to doubling the standard dose of salbutamol from an inhaler. Fifty-seven patients completed the double-blind, crossover study. They were treated with either an aerosol of 100 micrograms beclomethasone dipropionate and 200 micrograms salbutamol or 400 micrograms salbutamol alone. Both regimens were administered four times a day for 4 weeks. The patients showed significant improvement in FEV1, PEFR, and symptom scores after treatment with beclomethasone dipropionate and salbutamol compared with pre-trial values and with treatment with double the dose of salbutamol. The patients demonstrated a clear preference for treatment with the combination of beclomethasone dipropionate and salbutamol. Regular treatment with beclomethasone dipropionate in addition to salbutamol as a combination inhaler provides much better control of asthma than merely increasing the dose of salbutamol in those patients poorly controlled on standard doses of inhaled bronchodilators.
A new inhalation synchronised dosimeter triggered by low inspiratory flow rates has been assessed. The methacholine challenge test using dosimeter nebulisation with controlled tidal breathing was compared with continuous nebulisation using De Vilbiss No 40 nebulisers with deep inhalations in 11 asthmatic subjects. Within subject PD20 FEV1 values were lower with the dosimeter method than with the continuous nebulisation method (geometric means 158 and 588 micrograms). The repeatability of the dosimeter method with controlled tidal breathing was studied in 11 asthmatic subjects, and the 95% range for a single measurement was +/- 0.72 doubling doses of methacholine. The dosimeter method has greater efficacy because aerosol is delivered during the first part of an inhalation, minimising loss of aerosol outside the respiratory tract. The dosimeter technique combined with controlled tidal breathing appears to be a useful method for carrying out standardised non-specific bronchoprovocation tests.
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Twenty-four patients with severe steroid-dependent asthma participated in a double-blind cross-over study performed in two centers. After a run-in period of 2 weeks when beclomethasone dipropionate (BDP) (400 micrograms/day) was used, the patients were treated for 4 weeks with either a high-dose (1600 micrograms/day) or a low-dose (400 micrograms/day) of budesonide (Pulmicort). Thereafter the doses of budesonide were switched and the treatment continued for a further 4-week period. Patients treated with high-dose budesonide displayed significant improvements in airway functions. In addition, subjective scores for cough, sputum production and dyspnoea were more improved in the high-dose group than in the low-dose group. The need for concomitant beta 2-agonist therapy was also significantly reduced during the high-dose treatment. No significant changes in plasma cortisol levels were detected and no adverse effects of importance were registered. The results indicate that high-dose budesonide treatment improves the clinical status of patients with severe steroid-dependent asthma more than a low-dose therapy but without causing systemic side-effects.
The aim of this study was to discover the subsequent histories and ultimate diagnoses in 182 patients studied in a chest clinic because of unexplained cough. Twenty-nine patients (16%) developed asthma during the mean follow-up time of 4.4 years. Chronic bronchitis was diagnosed in 18 patients (10%) and sporadic instances of some other diseases were also seen. The development of asthma was studied both by calculating simple relative risks and using a multiple logistic model. Circadian changes in peak expiratory flow (PEF)-values and total blood eosinophil count were found to be the best variables for predicting the risk of developing asthma in a patient with unexplained cough, whereas mild bronchial hyperreactivity had only a low predictive value. If the risk of developing asthma in a patient presenting with unexplained cough is to be estimated, attention should be paid simultaneously to a number of variables. Even mild abnormalities in several variables can be significant when they occur together.
A new dosimeter nebulization method was studied in 10 asthmatics and 8 normal volunteers by delivering fixed doses of 99mTc-traced radioaerosol in 0.2 s periods of tidal breathing. Two separate inspiratory phases were studied with the onset of nebulization, when in the earlier phase 15% and in the later phase 60% of tidal volume was inhaled. Further, bronchodilator administration was analogically assessed in the asthmatics. In healthy subjects, the total lung deposition was 17% greater in the earlier phase (p less than 0.005) than in the later one. In asthmatics, the difference was not significant. The losses of aerosol outside the lower respiratory tract were minimized, in the mouthwashing 0.3% and in the exhaled air 1.4%. The onset of nebulization (early or late) had no significant effect on bronchodilation with salbutamol in asthmatics. We conclude that the present dosimeter method is useful for efficient delivery of radioaerosols and drugs, and for standardization of bronchoprovocation.
The efficacy of 281.7 mg of theophylline monohydrate and a combination of theophylline (240 mg) + hydroxyzine (7.5 mg) were compared in a double-blind, crossover, placebo-controlled study in 15 patients with chronic reversible bronchial asthma. The patients took the drugs tested at 7.00 a.m., 3.00 p.m. and 10.00 p.m. During the 3-day trial period, the patients measured their peak expiratory flow (PEF) values every day at 7.00 a.m., 10.00 a.m. and 10.00 p.m., and during the last trial day, theophylline serum levels were also determined. Use of theophylline monohydrate resulted in slightly steadier serum theophylline levels than with theophylline + hydroxyzine and morning levels of theophylline were significantly higher (p less than 0.01) during the former treatment. Despite this, only the theophylline + hydroxyzine combination had a significant effect (p less than 0.05 at 7.00 a.m., p less than 0.01 at 10.00 a.m. and 10.00 p.m.) on PEF values at each time of measurement. There was a significant difference (p less than 0.05) in PEF values at 10.00 a.m. between the trial preparations in favour of the theophylline + hydroxyzine combination. Theophylline + hydroxyzine significantly decreased (p less than 0.05) nocturnal dyspnoea and most patients preferred this preparation. The differences in side effects were not statistically significant. The addition of hydroxyzine to theophylline increases the clinical efficacy of the latter.
Thirty-seven per cent of 204 consecutive asthmatic patients using metered dose inhalers (MDI) regularly had faulty inhaler technique. Twenty patients with poor technique volunteered for bronchomotor tests. The bronchodilator effects of 0.2 mg of fenoterol in MDI form, 0.2 mg of fenoterol in powder form and a placebo powder were compared. Mean peak expiratory flow (PEF) and forced expiratory volume in 1 s (FEV1) values after 0.2 mg of fenoterol in MDI form were only slightly different from those after placebo. Inhalation of 0.2 mg of fenoterol powder was, however, followed by a highly significant (p less than 0.001) increase in measured expiratory indices. PEF and FEV1 values were significantly higher after fenoterol powder than after fenoterol in MDI form (PEF, p less than 0.01 at 5 min, p less than 0.001 at 15 min, and p less than 0.05 at 60 min, FEV1, p less than 0.01 1 h after drug administration). Poor MDI technique can severely impair the effect of bronchodilator drugs. Use of a bronchodilator in powder form is more reliable in these patients.
Bronchography was performed together with a fibre-optic bronchoscopic study in 98 patients with persistent cough, 33 of whom also had haemoptysis. Finally there were chronic bronchitis in 62 patients, bronchiectasis in 21, subacute bronchitis in 9, inflammatory residuals in 3, pulmonary tuberculosis in 2 patients and metastases in one. In chronic bronchitis, the value of plain chest radiography was low. It was normal in 34 of 62 cases (55%), bronchography in 12 cases (19%). Mild cases of bronchitis were more numerous in bronchography than seen by scopist. Bronchiectasis was found in 21 patients, four of these unexpectedly (two in a tbc scar). Additionally, three cases were overdiagnosed by the radiologist on chest films and eight cases by the scopist with bronchoscopy. In patients with persistent cough and haemoptysis, bronchography mainly revealed alterations of bronchitis.
11 patients with asthma and 3 with chronic bronchitis participated in a comparison, over 15 treatment periods, of the efficacy of 0.5 mg fenoterol and 5 mg of salbutamol, administered using intermittent positive pressure breathing. Both drugs produced marked bronchodilation. No differences could be detected between their effects. There were no drug-related side effects.
Bronchiolitis in association with rheumatoid arthritis has been reported, to our knowledge, in 18 patients to date. In some cases use of penicillamine has been strongly associated with the development of bronchiolitis. Most of the reported cases are described as having marked irreversible airways obstruction and hyperinflation. We describe a patient with rheumatoid arthritis whose respiratory tract symptoms began during gold therapy. Physiologic studies showed marked lung hyperinflation without pathologic findings in forced dry spirometric study. On open lung biopsy a mild degree of granulomatous bronchiolitis was found. Immunofluorescent microscopy showed IgM- and IgG-containing plasma cells in the bronchiolar walls.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
PGF2 alpha challenge tests were performed in twenty-three patients with bronchial and six patients with chronic bronchitis; two patients with allergic rhinitis and four healthy volunteers also participated in the trial. FEV1 measurements were used in assessing the reactions. PGF2 alpha challenge proved safe and practical in clinical use. A wide scattering in PGF2 alpha reactivity was seen, but sensitivity to PGF2 alpha did not correlate to several clinical criteria. Comparison with an ordinary histamine challenge revealed that the sensitivity of the patients to PGF2 alpha and histamine was not uniform.