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Biomedical subjects

D Daughton

Publications and source records attributed to D Daughton.

15 recordsLinked to original sources
PubMed1997

Smoking cessation is associated with an increase in exhaled nitric oxide.

STUDY OBJECTIVES: Nitric oxide (NO), a gas produced by cells lining the respiratory tract, has been reported to be decreased in the exhaled air of cigarette smokers. We hypothesized that smoking cessation would result in an increase in exhaled NO. DESIGN: Comparison of exhaled NO measured from nonsmokers, cigarette smokers, and smokers after smoking cessation. SETTING: University outpatient smoking cessation clinic. PATIENTS OR PARTICIPANTS: Twenty-five cigarette smokers and 23 normal, nonsmokers. INTERVENTIONS: Exhaled NO was measured by three techniques: (1) a peak oral method; (2) a mean oral method; and (3) a nasal method. The smokers were given nicotine patches and instructed to return after 1 and 8 weeks. The exhaled NO determinations were repeated on each visit. MEASUREMENTS AND RESULTS: Compared with nonsmokers, smokers had decreased NO levels measured by all three methods (p<0.05, each comparison). Nineteen smokers returned after 1 week. Fourteen were successfully abstinent from cigarettes and their exhaled NO increased compared with baseline (p<0.01 for each method) but not in the five subjects who had not successfully quit smoking (p>0.05 for each method). Ten subjects returned after 8 weeks. The exhaled NO levels increased further and were not significantly different from the normal nonsmokers for the peak oral and nasal NO methods (p>0.2), but were still lower than the normal nonsmoker mean oral NO (p=0.018). CONCLUSIONS: These data demonstrate that smoking cessation is associated with an increase in exhaled NO.

Administration, Cutaneous↗
PubMed1994

Smoking reduction: an alternative approach for smokers who cannot quit.

Cigarette smoking is the foremost cause of death in the United States and is a major health problem worldwide. Clearly, the best way to eliminate the risk of smoking-related diseases, is to quit smoking. Smoking cessation has immediate and long-term benefits and substantially reduces the risk of many smoking-related diseases. Unfortunately, quitting smoking is rarely easy. For those smokers who cannot or do not wish to quit, reduction in their total smoking may represent a potential health benefit. Reduction in total smoking can, theoretically, be achieved by: 1) reducing the number of cigarettes smoked daily; and/or 2) switching to a low tar/low nicotine cigarette. Smokers, however, tend to self-adjust nicotine to maintain relatively constant levels. Reduction in tar/nicotine content or number of cigarettes, therefore, may not produce health benefits. Smoking reduction with alternative nicotine delivery, however, may represent an alternative option for smokers who cannot, or do not, wish to quit.

Humans↗
PubMed1992

Regional distribution of emphysema: correlation of high-resolution CT with pulmonary function tests in unselected smokers.

High-resolution computed tomography (CT) was correlated with pulmonary function tests in the evaluation of regional emphysema in 59 smokers. The lung was divided into upper (above the carina tracheae) and lower (below the carina tracheae) zones, and the degree of emphysema was graded with a subjective and an objective measurement. Functional emphysema was defined as a diffusion capacity less than 75% of predicted and forced expiratory volume in 1 second less than 80% of predicted. Three of 15 (20%) subjects with functional emphysema had no subjective evidence of emphysema at high-resolution CT, and 10 of 25 (40%) with emphysema at high-resolution CT had no functional abnormalities consistent with emphysema. Even though the upper lung zones were more severely affected by emphysema, the degree of emphysema in the lower zones had a stronger correlation with pulmonary function abnormalities. The upper lung zones are a relatively silent region where extensive destruction may occur before functional abnormalities become known.

Aged↗
PubMed1992

Aerosolized beclomethasone in chronic bronchitis. Improved pulmonary function and diminished airway inflammation.

Chronic bronchitis is associated with airways obstruction and inflammation. In order to determine whether aerosolized beclomethasone can modulate airway inflammation and diminish airway obstruction, subjects with chronic bronchitis performed spirometry and underwent bronchoalveolar lavage (BAL) before and after receiving 6 wk of therapy (five puffs four times a day) with either aerosolized beclomethasone (n = 20) or placebo (n = 10) in a double-blinded, randomized fashion. All subjects received aerosolized albuterol before each use of the study medications. Before BAL, the airways were visually assessed for the appearance of inflammation and assigned a score, the bronchitis index. BAL was performed by instilling five 20-ml aliquots of saline into each of three sites and pooling and separately analyzing the returns from the first aliquots to yield a "bronchial sample." The bronchial lavages were repeated in an additional three sites to increase the volume of fluid available for analysis. The fluid was prepared for cytologic examination by cytocentrifugation. Albumin (as a measure of epithelium permeability) and lactoferrin and lysozyme (as measures of serous cell activity) were measured in unconcentrated BAL fluid by enzyme-linked immunosorbent assay, and concentrations in epithelial lining fluid were estimated using urea as an internal marker for dilution. After treatment, the beclomethasone group, but not the placebo group, showed improvement in FVC (p = 0.02), FEV1 (p = 0.002), and 25 to 75% forced expiratory flow (p = 0.006). Associated with the improvement in spirometry, the bronchitis index fell (13.5 +/- 1.0 versus 10.75 +/- 1.1, p = 0.02) in the beclomethasone-treated group, but not the placebo-treated group.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation↗
PubMed1991

Bronchoalveolar lavage fluid obtained from smokers exhibits increased monocyte chemokinetic activity.

Alveolar macrophages, which are cells derived from blood monocytes, accumulate within the lower respiratory tract of cigarette smokers. One mechanism to account for this accumulation of alveolar macrophages may be an increase in the migration of blood monocytes into the lungs of smokers. To evaluate this hypothesis, bronchoalveolar lavage fluid (BALF) was obtained from 15 smokers and 16 nonsmokers. The smokers' BALF possessed a significantly increased capacity to attract normal blood monocytes when evaluated using a blind-well chamber technique (26.2 +/- 7.6 vs 14.8 +/- 6.9 cells/high-power field, P less than 0.01). Checkerboard analysis of the activity revealed that it was predominantly chemokinetic. Partial characterization of the activity in smokers' BALF revealed that it was lipid soluble but only partially sensitive to trypsin and heat. The chemokinetic activity correlated with alveolar macrophage numbers in the BALF (r = 0.4391, P = 0.009). Furthermore, both the chemokinetic activity and alveolar macrophage number correlated with alterations of respiratory function (forced expiratory volume in 1 s, diffusing capacity for carbon monoxide, and forced expiratory flow at 75% of the vital capacity). These results suggest that the increase in alveolar macrophage number present in the BALF of cigarette smokers may be due, at least in part, to an increased amount of chemokinetic factor(s) in the smokers' BALF, and these factor(s) may participate in the decline of respiratory function associated with cigarette smoking, probably by recruiting monocytes into lung.

Adult↗
PubMed1990

Short-term smoking reduction is associated with reduction in measures of lower respiratory tract inflammation in heavy smokers.

The beneficial effect of short-term smoking reduction in reducing lower respiratory tract inflammation was assessed in 15 healthy heavy smokers. All underwent fibreoptic bronchoscopy and bronchoalveolar lavage and were then treated with at least 20 mg of nicotine gum daily. Self-reported cigarette consumption decreased from 50.7 +/- 2.3 to 18.8 +/- 1.5 (p less than 0.001) cigarettes daily, and expired CO decreased from 48.5 +/- 2.5 to 27.3 +/- 2.5 ppm (p less than 0.001). After two months, repeat bronchoscopy and bronchoalveolar lavage revealed that bronchial inflammation, as assessed by direct inspection, neutrophilia of bronchial lavage fluid, and the number of alveolar macrophages, the number of alveolar neutrophils and the concentration of neutrophil elastase alpha 1-antiprotease complex in alveolar lavage fluid, had improved significantly. The present study suggests that smoking reduction may be associated with an improvement in lower respiratory tract inflammation in heavy smokers and may, if persistent, be an alternative for smokers who cannot, or do not wish, to quit.

Adult↗
PubMed1989

Intraluminal airway inflammation in chronic bronchitis. Characterization and correlation with clinical parameters.

In order to characterize intraluminal airway inflammation in subjects with chronic bronchitis, bronchoscopy and bronchoalveolar lavage were performed in 28 subjects with chronic bronchitis with fixed airway obstruction and, for comparison, 15 asymptomatic smokers and 25 normal nonsmoking volunteers. The chronic bronchitics had a cough productive of sputum on most days of the month for 6 months in the preceding 2 yr, had at least one exacerbation requiring medical intervention in each of the previous 2 yr, and had an FEV1 less than 76% of predicted without response to bronchodilator. During bronchoscopy the airways were assessed for visual evidence of inflammation by assigning them a score, the bronchitis index, that graded the airways according to the apparent severity of airway edema, erythema, friability, and secretions. Bronchoalveolar lavage was performed by sequentially instilling and retrieving with gentle suction five 20-ml aliquots of sterile normal saline into each of three separate lobes. The first aliquots, the "bronchial" sample, were pooled and processed separately from the final four aliquots, the "distal" sample. Cell counts, cell differentials, and albumin were determined for both the bronchial and distal samples. In order to correlate inflammation with clinical parameters, sputum was collected for 24 h prior to bronchoscopy; spirometry was performed just prior to bronchoscopy, and smoking histories were obtained. Visual inspection of the airways, as quantified by the bronchitis index, demonstrated significantly more evidence for inflammation in the chronic bronchitics than in either the asymptomatic smokers or the normal subjects. The bronchial sample lavage fluids from the chronic bronchitics tended to contain more cells (6.1 +/- 2.2 x 10(6) cells) than the bronchial sample fluids from the asymptomatic smokers (3.6 +/- 0.6 x 10(6) cells) or normal subjects (3.7 +/- 0.5 x 10(6) cells). Furthermore, the chronic bronchitics had a higher percentage of neutrophils in their bronchial lavage fluid (35.8 +/- 5.6%) than did either the asymptomatic smokers (20.7 +/- 2.6%, p = 0.0001) or the normal subjects (10.3 +/- 5.6%). The distal sample lavage fluid also recovered more neutrophils from both the chronic bronchitics (15.0 +/- 4.2%, p = 0.0012) and asymptomatic smokers (5.7 +/- 1.3%, p = 0.002) than from the normal subjects (2.8 +/- 0.4%). The chronic bronchitics were divided into two groups: those with low (less than 20%) and those with high (greater than 20%) bronchial sample neutrophils. Those with higher bronchial sample neutrophils had significantly more sputum production and lower FEV1, FEV1/FVC, and FEF25-75 than did the subjects with lower bronchial sample neutrophils.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1985

Cognitive functioning and survival among patients with chronic obstructive pulmonary disease.

An earlier study by the authors had demonstrated neuropsychological impairment among 66 clinically stable patients suffering from chronic obstructive pulmonary disease (COPD), and had found that the deficits were directly associated with the amount of oxygen available to body tissue. We were able to follow 62 of the patients for three years when retrospective analyses were performed to determine the relationship of the neuropsychological test scores with the patients' three-year survival status. Patients who survived had scored significantly (p less than 0.01) higher on the neuropsychological tests than those who had died. Individual analyses of variance indicated that the significant relationship between the neuropsychological tests and survival status was attributable primarily to the Benton Visual Motor Retention Test and the digit symbol subtest of the Wechsler Adult Intelligence Scale. The latter test had, in the earlier study, shown the strongest relationship with partial pressure of oxygen and with a pulmonary function test. These findings suggest that certain neuropsychological tests may reflect both the progress of COPD and three-year survival probability among the patients.

Carbon Dioxide↗
PubMed1983

Urinary alkalinization and smoking cessation.

Previous studies have shown that large doses of a urinary alkalinizing agent reduced cigarette consumption spontaneously among smokers. After establishing a safe daily dose of an alkalinizing agent, sodium bicarbonate, its effect upon smoking cessation rates among 72 enrollees in a smoking cessation program was studied. In the first study, we determined that sodium bicarbonate (3900 mg per day) significantly increased urinary pH (from 6.0 to 6.7) and lowered titratable acidity. Ascorbic acid (1500 mg per day) had no effect of pH or acidity. In a second study, a group given sodium bicarbonate surpassed a placebo control group (who were given 1500 mg per day ascorbic acid) in total daily cigarette reduction after 5 weeks and in week-to-week smoking reduction. The groups did not, however, differ in the number who achieved total abstinence.

Adult↗
PubMed1983

Relationship between a pulmonary function test (FEV1) and the ADAPT quality-of-life scale.

In a previous study the Additive Daily Activities Profile Test (ADAPT) correlated .83 with maximum oxygen consumption among pulmonary rehabilitation patients. The present study expanded the pulmonary population base and compared the ADAPT scores of 41 patients at two independent centers with a more readily available parameter, the forced expiratory volume in the first second of forced exhalation (FEV1). The relationships between the two major ADAPT subscales and FEV1 were significant but lower in magnitude than that found with maximum oxygen consumption. The ADAPT continues to be sensitive to physical impairment and in translating the effect of impairment upon daily physical activity.

Activities of Daily Living↗
PubMed1982

Neuropsychological deficits among patients with chronic obstructive pulmonary disease.

Sixty-six patients with chronic obstructive pulmonary disease (COPD) were evaluated for neuropsychological functioning. While the patients showed normal skills on broad intellectual tasks, they displayed mild cerebral deficits on several neuropsychological tests. Multiple regression analyses revealed that the neuropsychological test battery scores were significantly related to partial pressure of arterial oxygen (PaO2), and to degree of pulmonary impairment. Although the cognitive deficits were real, they were generally small. This result may explain why the widely assumed link between chronic lung disorders and cognitive deficit has been difficult to demonstrate. The general pattern was similar to deficits produced by chronic alcoholism and childhood asthma, with complex skills suffering the greatest insult. Because the cognitive deficits among COPD patients in stable condition are small, it is uncertain whether they have importance clinically or for accomplishing daily activities.

Aged↗
PubMedDate not supplied

Transdermal nicotine therapy and primary care. Importance of counseling, demographic, and participant selection factors on 1-year quit rates. The Nebraska Primary Practice Smoking Cessation Trial Group.

OBJECTIVE: To evaluate the smoking cessation efficacy of nicotine patch therapy as an adjunct to low-intensity, primary care intervention. DESIGN: Randomized, placebo-controlled, double-blind, multisite trial. SETTINGS: Twenty-one primary care sites in Nebraska. PATIENTS: A total of 369 smokers of 20 or more cigarettes per day. INTERVENTION: Two brief primary care visits for smoking intervention with 10 weeks of active or placebo-patch therapy. MAIN OUTCOME MEASURES: Confirmed self-reported abstinence 3, 6, and 12 months after the quit day. RESULTS: Compared with placebo control subjects, participants assigned nicotine patches had higher 3-month (23.4% vs 11.4%; P < .01) and 6-month (18.5% vs 10.3%; P < .05) abstinence rates. The 1-year abstinence rates for the active and placebo patch groups were 14.7% and 8.7%, respectively (P = .07). Of smokers aged 45 years and older, 9 (18.8%) of 48 using active patches compared with 0 of 31 using placebo patches achieved 12-month abstinence (chi 2 = 6.56; P < .05). Among those with high nicotine dependency scores (Fagerstrom score > or = 7), 1-year abstinence rates were significantly higher in the nicotine patch group (19.1%) compared with the placebo group (5.0%) (chi 2 = 10.7; P = .001). However, there was no significant difference in 1-year quit rates for participants with low Fagerstrom scores (< 7). CONCLUSIONS: Nicotine patch therapy enhanced 6 month quit rates as an adjunct to brief primary care intervention. The highest quit rates were achieved by participants who specifically contacted the site to enroll in the study or to obtain a prescription for nicotine patches. Differences in participant selection factors may account, in part, for the lower smoking cessation rates associated with primary care intervention. Duration of counseling, patient age, and Fagerstrom scores may be important factors related to the long-term smoking cessation success of nicotine patch therapy.

Administration, Cutaneous↗