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Biomedical subjects

D Tashkin

Publications and source records attributed to D Tashkin.

14 recordsLinked to original sources
PubMed2004

One-year analysis of longitudinal changes in spirometry in patients with COPD receiving tiotropium.

BACKGROUND: Airway medications have not been shown to reduce the loss of lung function in patients with COPD. We explored whether tiotropium 18 microg once daily could slow the rate of decline of lung function over a 1-year period. METHODS: We performed a post-hoc analysis of data from 921 ambulatory COPD patients participating in two, 1-year, double-blind, tiotropium vs. placebo-controlled trials. Serial spirometry was obtained at baseline (before first dose of study drug), on day 8, at 6 weeks, and at 3, 6, 9 and 12 months after start of the study. RESULTS: Baseline demographics and lung function were comparable. Baseline FEV1 was 1.01+/-0.41 (SD) L (39+/-14% predicted). Mean decline in trough FEV1 (i.e. FEV1 23-24 h after prior use of medication) between days 8 and 344 was 58 ml/year in the placebo group and 12 ml/year in the tiotropium group (p=0.005 vs. placebo); and between days 50 and 344 was 59 ml/year in the placebo group and 19 ml/year in the tiotropium group (p=0.036 vs. placebo). CONCLUSIONS: Based on a retrospective analysis of 1-year, placebo-controlled clinical trials, tiotropium was associated with a reduced rate of loss of FEV1. Longer-term trials specifically designed to study this effect are required to confirm this observation.

Administration, Inhalation↗
PubMed2001

Smoking cessation in patients with chronic obstructive pulmonary disease: a double-blind, placebo-controlled, randomised trial.

BACKGROUND: Tobacco smoking is associated with chronic obstructive pulmonary disease (COPD) in more than 80% of cases. Our aim was to investigate the effect of sustained-release bupropion (amfebutamone) (SR) in promoting abstinence from smoking in patients with COPD. METHODS: In a double-blind, randomised, placebo-controlled trial 404 individuals with mild or moderate COPD who smoked 15 or more cigarettes per day, were assigned bupropion SR (150 mg twice daily) or placebo for 12 weeks. All patients received smoking cessation counselling. Study medication was taken for 1 week before patients attempted to stop smoking. The primary efficacy endpoint was the complete and continuous abstinence from smoking from the beginning of week 4 to the end of week 7. Participants were followed up at month 6. Analysis was by intention to treat. FINDINGS: All patients were chronic smokers with a smoking history of about 51 pack-years. Continuous smoking abstinence rates from week 4 to 7 were significantly higher in participants receiving bupropion SR than in those receiving placebo (28% [57/204] vs 16% [32/200], p=0.003). Continuous abstinence rates from weeks 4 to 12 (18% [36/204] vs 10% [20/200]) and weeks 4 to 26 (16% [32/204] vs 9% [18/200]) were also higher in participants receiving bupropion SR than in those taking placebo (p<0.05). Furthermore, symptoms of tobacco craving and withdrawal were attenuated in those receiving bupropion SR. Seven individuals discontinued study medication because of adverse events. INTERPRETATION: Bupropion SRis a well-tolerated and effective aid to smoking cessation in people with mild to moderate COPD.

Adult↗
PubMed1999

Oxidative stress produced by marijuana smoke. An adverse effect enhanced by cannabinoids.

Marijuana (MJ) smoking produces inflammation, edema, and cell injury in the tracheobronchial mucosa of smokers and may be a risk factor for lung cancer. Because oxidative stress may mediate some of these effects, this study was designed to test the hypothesis that cannabinoids in MJ smoke contribute to cellular oxidative stress. Oxidative stress was evaluated in an endothelial cell line (ECV 304) following exposure to smoke produced from MJ cigarettes containing either 0, 1.77, or 3.95% Delta9-tetrahydrocannabinol (Delta9-THC). Brief exposure to smoke from 3.95% MJ cigarettes stimulated the formation of reactive oxygen species (ROS) by 80% over control levels and lowered intracellular glutathione levels by 81%. Smoke-induced ROS generation increased in a dose- and time-dependent manner. In contrast, exposure to smoke from MJ containing 0% Delta9-THC produced no increase in ROS despite a 70% decline in glutathione levels. Smoke from MJ containing 1.77% Delta9-THC stimulated intermediate levels of ROS. A brief, 30-min exposure to MJ smoke, regardless of the Delta9-THC content, also induced necrotic cell death that increased steadily up to 48 h of observation. MJ smoke passed through a Cambridge filter that removed particulate matter was 3.4-fold more active in ROS production compared with unfiltered smoke, suggesting that most of the oxidative effects are produced by the gaseous phase. Alveolar macrophages obtained from habitual MJ smokers displayed low levels of glutathione compared with macrophages from nonsmokers. We conclude that MJ smoke containing Delta9-THC is a potent source of cellular oxidative stress that could contribute significantly to cell injury and dysfunction in the lungs of smokers.

Antioxidants↗
PubMed1998

Inhalation by nebulization of albuterol-ipratropium combination (Dey combination) is superior to either agent alone in the treatment of chronic obstructive pulmonary disease. Dey Combination Solution Study Group.

Combination bronchodilator therapy for chronic obstructive pulmonary disease (COPD) potentially can provide increased benefit over single-agent therapy. The objective of this double-blind, randomized, positive-control trial was to determine the effectiveness of an albuterol-ipratropium solution aerosol combination (Dey combination solution, Dey LP, Napa, Calif., USA) compared with solution aerosols of both component medications administered alone in patients with COPD. The trial consisted of a 6-week, 3-period crossover phase followed by a 6-week parallel phase during which patients self-administered study medications by inhalation from a nebulizer. A total of 863 patients were initially randomized to each of the six possible treatment sequences of the three study medications in the crossover phase and received each study medication in turn for a 2-week period. Patients continued to receive the same treatment administered during the last 2-week period of the crossover phase for an additional 6 weeks in the parallel phase. Assessment of 1-second forced expiratory volume (FEV1) curves before and after dosing on the last day of each 2-week period indicated that the combination was superior to either single agent in peak effect and area under the curve up to 8 h after dosing (FEV1-AUC0-8), in both phases of the trial. The use of Dey combination during the crossover phase resulted in 24% more improvement in peak FEV1 than was seen with albuterol alone (p < 0.001), and 37% more than was seen with ipratropium alone (p < 0.001). Similarly, when examining FEV1-AUC0-8, Dey combination resulted in 30% more improvement than was seen with albuterol alone (p < 0.001), and 32% more than was seen with ipratropium alone (p < 0.001). The combination affords a convenient dosing regimen and incorporates enhanced benefit without compromising the safety profile of either component agent.

Adult↗
PubMed1990

Comparison of safety and efficacy of inhaled pirbuterol with metaproterenol.

This multicenter study was performed to compare the safety and efficacy of a new beta-2 selective beta agonist, pirbuterol, with metaproterenol. The study followed a double-blind parallel design evaluating 133 asthmatic patients for 12 weeks. There were essentially no clinical differences between groups and no differences in onset of action, peak effect, side effects, or development of tolerance between these two agents. Our conclusion is that pirbuterol is at least as effective and safe under conditions of chronic administration to asthmatics as metaproterenol and therefore can be considered a suitable alternative for therapy.

Administration, Inhalation↗
PubMed1989

Demand oxygen delivery for patients with restrictive lung disease.

The demand oxygen delivery system has been reported to improve oxygen delivery 7:1 vs steady flow during rest and exercise in COPD patients. The present study evaluates the DODS during rest and exercise in eight patients with restrictive lung disease. It was concluded that the DODS provides substantial oxygen savings in RLD patients, particularly during exercise.

Exercise↗
PubMed1988

Veracity of disability claimants' self-reports of current smoking status. Comparison of carboxyhemoglobin levels from disability claimant and reference population.

Carboxyhemoglobin level (%COHB) obtained during pulmonary function testing was used as a measure of recent tobacco smoking among persons claiming to be nonsmokers and ex-smokers. Asbestos disability applicants and reference routine clinical patients had similar mean %COHB (2.09 +/- 1.34 and 1.99 +/- 0.88, respectively) and proportions with abnormally elevated %COHB (35 and 46 percent, respectively, had %COHB greater than 2 percent). However, comparisons of persons claiming to be ex-smokers and nonsmokers showed that the ex-smokers had higher mean %COHB (p less than 0.001 by analysis of variance) and proportions with elevated %COHB. This study suggests that disability applicants and routine clinical patients do not differ in veracity of self-stated smoking information, but many persons claiming to be ex-smokers are actually not.

Asbestosis↗
PubMed1987

Pulmonary leukosequestration without hypoxemia during hemodialysis.

Dialysis-associated hypoxemia is frequently of clinically significant magnitude and is incompletely understood. In order to investigate the hypoxemia directly we labelled a patient's white blood cells with 111Indium-oxine prior to hemodialysis with acetate or bicarbonate baths. Both dialysate buffers were associated with similar degrees of early peripheral neutropenia, complement activation and elevation of lactoferrin levels, with simultaneous lung localization of radionuclide activity. However, there was not widening of the alveolar to arterial oxygen gradient, or increased wasted ventilatory fraction during this early time period. Significant hypoxemia occurred later in the dialysis, was associated with a decreased respiratory exchange ratio and only occurred with the acetate dialysate buffer. Thus, initial pulmonary leukosequestration was documented but did not have an adverse impact on gas exchange. Hypoxemia during acetate dialysis occurred instead as a consequence of alveolar hypoventilation.

Humans↗
PubMed1981

The relationship arrhythmias and conduction disturbances to other manifestations of cardiopulmonary disease in progressive systemic sclerosis (PSS).

Disorders of rhythm and conduction are characteristic of the cardiac involvement in progressive systemic sclerosis (PSS), but their over-all frequency in PSS is not well established. Therefore, 46 ambulatory patients with PSS underwent several tests of cardiopulmonary function, including a 24-hour continuous electrocardiogram (Holter monitor). Conduction disturbances (sinus node dysfunction, first-degree heart block, pre-excitation), supraventricular arrhythmias (supraventricular tachycardia, atrial fibrillation, premature contractions of atrial or junctional origin) and ventricular arrhythmias (ventricular tachycardia, multifocal premature contractions) were observed on Holter monitoring in 26 subjects. Although these arrhythmias and conduction disorders were predictably observed in patients who complained of palpitations or syncope, or who had an electrocardiogram which showed first-degree heart block, ventricular bigeminy, left anterior superior hemiblock, prolonged p wave, right or left axis deviation, right or left ventricular hypertrophy, pathologic Q waves or low voltage, they were often found in patients who lacked other clinical evidences of heart disease. Arrhythmias and conduction disturbances were not significantly more frequent among patients with cardiomegaly or interstitial change on chest roentgenogram nor were they related to the presence or severity of abnormal lung function. This study suggests that Holter monitoring may be a valuable adjunct in evaluating heart disease in PSS.

Adult↗
PubMed1975

Fatal lung scan in a case of pulmonary hypertension due to obliterative pulmonary vascular disease.

A young woman with pulmonary hypertension due to sclerodermatous pulmonary vascular disease died immediately following the injection of macroaggregated albumin labeled with 99-TC for a perfusion lung scan. Review of the literature suggests that patients with chronic pulmonary hypertension due to an obliterative pulmonary vascular disease are at risk of developing a serious reaction to perfusion lung scanning. Important factors which predispose to an adverse reaction to lung scanning are the size and dose of macroaggregated albumin particles in relation to the total cross-sectional area of the pulmonary vascular bed and a critical arteriolar lumen size.

Adult↗
PubMedDate not supplied

Reliability of plethysmography, the single breath oxygen test, and spirometry in population studies.

Three thousand five hundred and twenty-eight residents of a census tract in Los Angeles, California underwent pulmonary function testing in a mobile laboratory (the Breathmobile). Tests included respiratory questionnaire, electronic spirometry, the single breath O2 test and body plethysmography. The reliability and sensitivity of the tests performed in the Breathmobile was measured by repeating the same tests and others on a 3% probability sample at the University of California at Los Angeles Pulmonary Function Laboratory. The reliability of the FVC and FEV1 was excellent; of the FEF 25-75% and the FEF 50-75% -- good; and of the VTG, RA and delta N2 -- reasonably good. As yet the reliability of the closing volume fraction is inadequate in our study. Grouping by individual reported symptom complexes identified different groups of people. The questionnaire and the forced expiratory flow rates identified the most people as having decreased respiratory function. Selection of the best breath or average of the two best breaths affected results of spirometry very little.

Adolescent↗