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Biomedical subjects

B R Feldman

Publications and source records attributed to B R Feldman.

9 recordsLinked to original sources
PubMed1996

Physicians' metered dose inhaler technique after a single teaching session.

BACKGROUND: It is known that many housestaff physicians are unable to demonstrate perfect metered dose inhaler (MDI) technique. OBJECTIVE: This study assessed whether a single teaching session for house staff physicians would significantly improve their MDI technique. METHODS: Thirty-eight pediatric house staff physicians were asked to demonstrate MDI technique with a placebo MDI. The physicians were evaluated on the following seven steps: (1) shaking the MDI and removing the cap, (2) exhaling prior to MDI use, (3) holding the MDI upright, (4) proper timing of actuation, (5) a slow inspiratory effort, (6) one MDI actuation per breath, and (7) holding the breath > or = 5 seconds. A 20-minute teaching session and demonstration of proper MDI technique was then given. At the end of this session all residents were eventually able to demonstrate proper technique. Two months following this educational session the same house staff physicians were re-evaluated on their MDI technique. RESULTS: Initially, ten participants (26%) demonstrated perfect technique. Two months postinstruction the same number of physicians (ten) demonstrated perfect technique. Only six physicians demonstrated perfect technique at both evaluations. Three of the seven steps showed enough change from the first evaluation to the second to permit statistical analysis. Step 4 (timing of actuation) had 11 Physicians' performances improve while three worsened (P=.03). Step 5 (a slow inspiratory effort) had nine physicians' performances improve while three worsened (P=.073). For step 7 (holding the breath > or = 5 seconds), 11 physicians improved while 2 worsened (P=.006). Comparing global performance, there were 17 physicians that improved, 8 that worsened, and 13 with no change (P=.054). CONCLUSIONS: This study confirmed that many housestaff physicians do not demonstrate optimal MDI technique. While one educational session may somewhat improve their future performance, it is not sufficient to guarantee perfect technique. This suggests that repeated education needs to be given to housestaff physicians.

Administration, Inhalation↗
PubMed1984

Fenoterol dose-response study in children with asthma.

We have studied the effect of fenoterol, a selective beta-2 adrenergic agent, on airway obstruction in children with asthma. The drug was administered orally in single doses of 2.5, 5, and 7.5 mg to 20 children with chronic stable asthma of moderate severity. The mean age of the children was 11.6 yr. Pulmonary function tests were performed as baseline at zero time and at intervals over a 6-hour period after drug administration. Onset of action for all doses was within 1 hr with a peak effect noted at 1.5 to 3 hr, and sustained improvement was observed over the entire 6 hr. The doses of 5 mg and 7.5 mg were equally effective in producing significant improvement of pulmonary function compared to 2.5 mg (p less than 0.05). Side effects remained acceptable for all patients. The 5 and 7.5 mg doses produced significant adverse effects that involved the central nervous and musculoskeletal systems, whereas the 7.5 mg dose caused a significant incidence of tachycardia. Our findings indicate: (1) fenoterol is a potent oral bronchodilator for large and small airways in children, (2) the 7.5 mg dose does not achieve any additive effect over a 5 mg dose; and (3) 5 mg is the optimal oral dose of fenoterol for children from age 8 to 12 yr.

Adolescent↗
PubMed1982

Theophylline blood levels as a guide to intravenous therapy in children.

A retrospective analysis of the records of 56 children admitted in status asthmaticus was done to assess the impact of serum theophylline levels on subsequent therapeutic decisions. In 39% of the cases, levels obtained following the initial theophylline bolus were below therapeutic range and in 6% they were above therapeutic range. In 31% of instances of theophylline levels obtained during the phase of continuous aminophylline infusion, the physician decided to administer additional theophylline. The median hospital stay was 2.65 days. Monitoring serum theophylline levels following intravenous loading and during continuous infusion provides the physician with a valuable clinical tool and may help to shorten the period of hospitalization for patients in status asthmaticus.

Adolescent↗
PubMed1982

Interaction between nutrition and theophylline metabolism in children.

The influences on theophylline metabolism are multifactorial, resulting in significant inter- and intrapatient variability in drug responsiveness. Clinical investigations with adult patients have demonstrated the influence of diet on theophylline metabolism following a single drug dose. We have undertaken this study to examine the effect of nutritional factors on theophylline pharmacokinetics in 14 asthmatic children receiving the drug on a chronic basis. For 12-day periods each patient received three separate diets with different proportions of protein and carbohydrate but with constant fat and caloric intake. Significant differences were detected for theophylline half-life, apparent volume of distribution, and metabolic clearance rate. The high-protein diet markedly shortened the drug-elimination half-life relative to a normal diet, and high carbohydrate significantly increased it (both p less than 0.001). Other kinetic parameters confirmed this pattern. Our findings in children clearly establish that nutritional factors have a significant environmental influence on theophylline metabolism during the drug's steady-state pharmacokinetics.

Adolescent↗
PubMed1980

Effect of dietary protein and carbohydrate on theophylline metabolism in children.

Theophylline metabolism can be altered by a variety of abnormal physiologic states as well as by exogenous factors. Adult studies demonstrate a significant influence of dietary composition on theophylline biotransformation. To examine this effect of diet, 14 children with bronchial asthma were studied during long-term theophylline administration. Each patient was maintained for 12 days on three separate diets with varying proportions of protein and carbohydrate and with constant calories and fat. Results showed significant differences in drug half-life and metabolic clearance rate parameters. Compared to the normal diet, high protein diet markedly decreased the half-life, and high carbohydrate diet greatly prolonged it (P < .001). Multiple regression analysis demonstrated these differences to correlate only with the dietary alterations. Adverse reactions and blood chemistry abnormalities were not detected during any test period. These findings firmly establish that nutritional factors exert a significant influence on theophylline pharmacokinetics in children.

Adolescent↗
PubMed1976

Treatment of asthma with theophylline and beta adrenergic agents.

The understanding of the properties of adrenergic receptors and modification of ring and the N-alkyl side chain constituents have resulted in adrenergic agents with a high degree of specificity for the lung and few cardiac and central nervous system stimulating problems. These agents are useful by aerosol and oral routes, alone and in addition to theophylline for asthma. Theophylline, which acts to increase cyclic AMP by inhibition of phosphodiesterase and beta 2 adrenergic agents which increase cyclic AMP by stimulating adenylate cyclase, are the mainstays of asthma therapy. Therapy is usually begun with theophylline. Persistent symptoms with adequate theophylline levels (10-20 mug/ml) indicates the need for a beta 2 adrenergic agent by aerosol or orally as a supplement. Occasional patients will not tolerate theophylline in any preparation and can be treated with beta 2 adrenergic agents with success. The future holds great promise for improved and safer beta 2 adrenergic agents which will offer the physician a more effective means of treating asthma.

Adrenergic beta-Agonists↗