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Biomedical subjects

E P Munch

Publications and source records attributed to E P Munch.

At least 19 recordsLinked to original sources
PubMed2001

[Reliability of recorded deaths from asthma in Denmark during a 1-year period 1994-1995].

INTRODUCTION: The aim of this study was to evaluate the accuracy of death certificates over a one-year period, where asthma was given as the cause of death. METHODS: All medical information available was collected on 218 patients by reviewing hospital records, records from general practitioners, and sometimes by interviewing close relatives. A panel of four pulmonologists each examined the information and independently assessed the cause of death. RESULTS: Thirty-nine were excluded, as the cause of death could not be validated. In 16 (9%) of the subjects, asthma was judged to be the definite cause of death and in 12 (7%) a possible cause. Of 151 non-asthma deaths, but registered as asthma, 109 were judged to have suffered or died from COPD and 14 from heart disease. DISCUSSION: The accuracy of Danish death certification in asthma deaths is poor, especially in the elderly, where COPD is often classified as asthma. We conclude that the true mortality from asthma in Denmark is substantially lower than that officially recorded.

Adult↗
PubMed2000

Accuracy of recorded asthma deaths in Denmark in a 12-months period in 1994/95.

Many studies of asthma mortality rely on official registration. The aim of this study was to evaluate the accuracy of death certificates, where asthma was coded as cause of death. In a 12-month period, medical information on all subjects with asthma officially coded as the underlying cause of death in Denmark, was obtained by reviewing hospital records, contacting general practitioners and sometimes close relatives. A panel of four pulmonologists each examined the obtained information and independently assessed the cause of death. Of a total of 218 death certificates, 39 were excluded as the cause of death could not be validated. In 16 (9%) of the subjects death from asthma was judged to be the definite cause of death and in 12 (7%) death from asthma was possible. Of 151 non-asthma deaths coded as due to asthma, 109 were judged to have suffered or died from COPD and 14 from heart disease. The accuracy of Danish death certification in asthma deaths is poor, especially in the elderly, where COPD is often classified as asthma. We conclude that the true asthma mortality in Denmark is substantially lower than officially recorded.

Adult↗
PubMed1998

Serum concentrations of lignocaine and its metabolite monoethylglycinexylidide during fibre-optic bronchoscopy in local anaesthesia.

Fibre-optic bronchoscopy was performed in local anaesthesia using lignocaine. Serum concentrations of lignocaine and its active metabolite monoethylglycinexylidide (MEGX) were measured in 16 patients at regular intervals up to 120 min after administration. Lignocaine was administered as an aerosol in the upper respiratory tract and as a solution in the bronchial tree. The total dose of lignocaine ranged from 243 to 608 mg (2.4-8.0 mg kg-1 body weight). The dose of lignocaine given as an aerosol ranged from 163 to 508 mg (1.6-6.6 mg kg-1) and the dose given as a solution ranged from 60 to 180 mg (0.8-2.5 mg kg-1). The highest median serum lignocaine concentration, 10.5 mumol l-1, was measured 20 min after administration. None of the patients had toxic serum lignocaine levels (> 26 mumol l-1) or adverse effects. The highest median serum MEGX concentration, 1.7 mumol l-1, was measured 120 min after administration. The dose of lignocaine, expressed in mg per kg body weight correlated with serum lignocaine and serum MEGX (rs = 0.47 and rs = 0.39, respectively). Lignocaine is a clinically safe, local anaesthetic agent provided the total dose does not exceed 6-7 mg kg-1 body weight.

Aged↗
PubMed1994

Transbronchial lung biopsy through the fibre optic bronchoscope. Results and complications in 452 examinations.

During 1986-1989, diagnostic fibre optic bronchoscopy (FOB) was performed in local anaesthesia in 1144 consecutive patients. Of these, 405 (35%) patients, median age 59 years, had transbronchial lung biopsy (TBB) performed under fluoroscopic guidance; 47 patients had a rebronchoscopy, i.e. in total 452 FOB were evaluated. The indication for TBB was localized pulmonary lesions in 279 (69%) patients, and diffuse pulmonary lesions in 126 (31%) patients. Localized lesions: TBB yielded a clinically relevant diagnosis in 55.2% of the patients. Of the 110 patients with malignancy, the overall diagnostic strength was 45.5%. Of the 159 patients with non-malignant lesions, 65.4% were diagnosed by TBB. The diagnostic yield increased with the number of biopsy specimens (< or = 4 biopsies, 52%; > 4 biopsies, 70%. P < 0.05). In 155 patients with well defined, circumscribed lesions, the diagnostic yield of TBB increased with the size of the lesion (< 31 mm, 47%; 31-60 mm, 54%; > 60 mm, 60%, P = 0.09), and decreased with the distance of the lesion from the main carina < 61 mm, 70%; 61-100 mm, 52%; > 100 mm, 40% P < 0.02). Diffuse lesions: TBB yielded a clinically relevant diagnosis in 66.7% of the patients. Of the 15 patients with malignancy, 73.3% were diagnosed by TBB. Of the 93 patients with non-malignant lesions, 78.5% were diagnosed by TBB. The diagnostic yield showed a trend to increase with the number of biopsy specimens (< or = 4 biopsies, 65%; > 4 biopsies, 71%, P = 0.11).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Alternative treatment of lung diseases].

A total of 671 patients attending two outpatient clinics for pulmonary medicine received a questionnaire about possible alternative treatment of the pulmonary disease for which they were receiving treatment. Six hundred and five questionnaires were answered anonymously. Among the 605 patients, 75 (12%) had received alternative treatment. No differences in the frequencies were observed between men and women. Employment of alternative treatment was most frequent in the age groups 20-29 and 50-59 years. Prolonged illness without definite prospects of cure such as chronic bronchitis and asthma resulted in employment of alternative treatment more frequently than briefer illness without possibility of cure (cancer of lung) or with the possibility of cure (tuberculosis, pneumonia). The patients had practically always consulted their general practitioner before the alternative therapist (94%). Half of the patients had improved, half were unchanged and only a few per cent had deteriorated. In the majority of cases, the expenses were moderate but isolated patients had, however, paid more than 10,000 Danish crowns (approximately pounds 1,000) for the alternative treatment.

Adult↗
PubMed1991

[Serum concentration of lidocaine and its active metabolite monoethylglycinexylidine during fiberoptic bronchoscopy under local anesthesia].

Fiberoptic bronchoscopy was performed in local anaesthesia with lidocaine in 16 patients. Serum concentrations of lidocaine and its active metabolite monoethylglycinexylidide (MEGX) were measured at regular intervals up to 120 min. after administration. Lidocaine was administered as aerosol in the upper respiratory tract and as solution in the bronchial tree. The total lidocaine dose was 243-608 mg (2.4-8.0 mg/kg); 163-508 mg (1.6-6.6 mg/kg) was given as aerosol, and 60-180 mg (0.8-2.5 mg/kg) as solution. The highest median S-lidocaine concentration, 10.5 mumol/l, was measured 20 min. after administration. None of the patients had toxic S-lidocaine levels (greater than 26 mumol/l) and no adverse effects were observed. The highest median S-MEGX concentration, 1.7 mumol/l, was measured 120 min. after administration. The highest individual S-MEGX was 3.5 mumol/l. The highest, although insignificant, correlation coefficients were found between lidocaine dose expressed in mg/kg body weight and S-lidocaine and S-MEGX.

Aerosols↗
PubMed1989

Chronic non-asthmatic cough is not affected by inhaled beclomethasone dipropionate. A controlled double blind clinical trial.

Thirty-one patients with a dry cough for at least 1 h duration in more than half of the last 30 days and with no recent respiratory infection participated in a clinical trial to evaluate the effect of inhaled beclomethasone dipropionate (BDP). Lung function was normal and reversibility was excluded by spirometry before and after bronchodilator and by no diurnal variation in home peak flow monitoring. Only one had significant eosinophilia and only three were mildly hyperreactive by bronchial provocation with histamine. After a 1-week run-in period the patients were randomly allocated to receive either BDP 4 puffs of 50 micrograms b.i.d., or placebo. After 2 weeks the patients were crossed over and received the alternative treatment for another 2-week period. The degree of cough, disturbance of night sleep and peak expiratory flow morning and evening were recorded daily in a diary. Spirometry was performed at each control visit. A significant period effect from run-in to period 1 and/or from period 1 to period 2 was demonstrated for cough and disturbance at night but not for peak flow or spirometry. However, no significant treatment effect was found for any of the measured variables.

Administration, Inhalation↗
PubMed1988

Immunotherapy with partially purified and standardized tree pollen extracts. I. Clinical results from a three-year double-blind study of patients treated with pollen extracts either of birch or combinations of alder, birch and hazel.

Fifty-four adult patients with tree pollen-induced rhinitis (28), asthma (1), or rhinitis and asthma (25) were selected for immunotherapy with standardized and partly purified tree pollen extracts using a double blind protocol. The selection was based on clinical history, results of nasal or bronchial challenge, skin prick tests and RAST. Further, based on crossed radio-immunoelectrophoresis, sex, age and severity of symptoms, the patients were allocated in matched pairs and the treatment alternatives were randomly distributed within the pairs. Twenty-three patients treated with extracts composed of any combination of alder, birch and hazel pollen which matched their IgE response in CRIE (Group 1 (ABC)) and 22 patients receiving birch pollen extracts (Group 2 (B)) completed all 3 years of treatment. The in vivo results comprising symptom and medicine consumption scores are given here. Changes in specific skin and nasal reactivity as well as in immunological parameters are presented separately. No significant differences were demonstrated between the treatment groups in the two parameters. Both extracts were effective and reduced in general the symptom scores to one tenth of the starting level. Expressed another way, at the end of the study, the patients tolerated 30 times more pollen until symptoms of the same severity were elicited, compared to before. In the Nordic countries, spring-time asthma and rhino-conjunctivitis caused by pollen from deciduous trees can be effectively treated with an extract of birch pollen alone.

Adolescent↗
PubMed1988

Immunotherapy with partially purified and standardized tree pollen extracts. II. Results of skin prick tests and nasal provocation tests from a three-year double-blind study of patients treated with pollen extracts either of birch or combinations of alder, birch and hazel.

Patients allergic to tree pollen entered a 3-year course of immunotherapy (1980-83) with either birch pollen extracts alone (n = 26) or patient-tailored extracts of birch, alder and hazel pollen (n = 27). The clinical and immunological results of this study are published elsewhere. This paper contains an evaluation of skin prick test and nasal provocation test results. There were no significant differences between the two treatment groups concerning these two parameters. In both groups the allergen-specific sensitivity in the skin showed seasonal variations but a significant decrease. During the years of treatment there was also a significant decrease in the specific sensitivity of the nasal mucosa. With the present demands for purification and standardization of allergen extracts it is of practical and economic interest to know that tree pollen-allergic patients showing positive reactions to birch, alder and hazel extracts can be effectively treated using birch pollen extract alone.

Asthma↗
PubMed1988

Immunotherapy with partially purified and standardized tree pollen extracts. III. Specific IgE response to the major allergens of alder, birch and hazel pollen during immunotherapy.

Patients allergic to pollen from alder, birch and hazel were hyposensitized during a 3-year period with either birch pollen extract alone (n = 24) or a mixture of one or more of alder, birch and hazel pollen extracts (n = 27). The effect of the treatment was evaluated by RAST and tandem crossed-radioimmunoelectrophoresis (tandem-CRIE). The patient' specific IgE response to the major allergens of alder (Aln g I), birch (Bet v I) and hazel (Cor a I and Cor a II), as measured by tandem-CRIE, and the total specific IgE response, measured by RAST, decreased significantly (Pc less than 0.05) during immunotherapy, irrespective of the extract used during the treatment. There was no significant difference (Pc less than 0.05) between the two treatment groups. The results obtained indicate either that birch pollen extract alone is adequate in the treatment of the studied patient group or the patients had been sensitized towards birch pollen alone.

Clinical Trials as Topic↗
PubMed1988

Intramuscular betamethasone dipropionate vs. topical beclomethasone dipropionate and placebo in hay fever.

A double-blind, double-dummy comparative study was made of 30 adult birch pollen-allergic outpatients with seasonal rhinoconjunctivitis. They were treated with either topically applied beclomethasone dipropionate 100 micrograms in each nostril twice daily for 4 weeks, placebo, or an injection of 2 ml of a suspension containing 5 mg betamethasone dipropionate and 2 mg betamethasone disodium phosphate per ml (Diprospan) immediately prior to the birch pollen season. Placebo- and topical steroid-treated patients experienced an increase in rhinoconjunctivitis symptoms, i.e. nasal blockage, nasal itching, rhinorrhea, sneezing and eye symptoms, and placebo-treated patients used significantly more antihistamine tablets during the pollen season. Diprospan-treated patients experienced fewer symptoms on all measured parameters. We concluded that one injection of Diprospan immediately prior to the birch pollen season produces significantly fewer rhinoconjunctivitis symptoms than does placebo and topical steroid treatment.

Administration, Intranasal↗
PubMed1988

Imaging of the airways by bronchoscintigraphy for the study of mucociliary clearance.

A method for functional imaging of the large airways (bronchoscintigraphy) has been developed. It is based on the administration of aerosolised albumin labelled with technetium-99m using a special inhalation technique to produce central airway deposition. The method was evaluated as a measure of mucociliary clearance by recording the movement of radioactivity in the airways of 11 healthy, non-smoking subjects on two separate days. A series of bronchoscintigrams was acquired at five minute intervals for two hours after termination of the inhalation. After the first bronchoscintigram 1.25 mg terbutaline or placebo was administered from a metered dose inhaler (five puffs) according to a randomised, double blind, crossover design. The scintigrams were evaluated blind. After terbutaline the segmental bronchi were no longer visible after a median time of 10 minutes, the lobar bronchi after 20 minutes and the main bronchi after 30 minutes. In six cases the trachea was cleared after two hours. After placebo the segmental bronchi disappeared after a median of 15 minutes, but at two hours half the lobar bronchi remained visible. In only two cases was it no longer possible to see the main bronchi or the trachea. It is concluded that bronchoscintigraphy can be used to examine regional mucociliary clearance in healthy subjects and that terbutaline significantly increases the clearance of the deposited radioactive aerosol.

Administration, Inhalation↗
PubMed1985

Immunochemical characterization of reference alder (Alnus glutinosa) and hazel (Corylus avellana) pollen extracts and the partial immunochemical identity between the major allergens of alder, birch and hazel pollens.

Dialysed extracts of alder (Alnus glutinosa) and hazel (Corylus avellana) pollens were characterized by immunochemical methods. The alder pollen extract contained at least 33 distinct antigens of which one, antigen 5, was classified as a major allergen, three, antigens 4, 10, and 17, were classified as intermediate allergens and two, antigens 19 and 23, were classified as minor allergens. The molecular weight and pI of the major allergen were determined to be 19,000 D and 5.2, respectively. The hazel pollen extract contained at least 40 distinct antigens, two of which were classified as major allergens, antigens 8 and 13, three as intermediate allergens, antigens 12, 17, and 26, and seven as minor allergens, antigens 6, 11, 16, 18, 29, 39, and 40. The molecular weights and pI's of the major allergens of hazel pollen were determined to be: antigen 8; Mw = 12,000 D, pI = 5.1 and less than 3.5, antigen 13; Mw = 26,000 D, pI = 5.1. Further, crossed line immunoelectrophoresis and tandem crossed immunoelectrophoresis of alder, birch and hazel strongly indicate that there exists an immunochemical partial identity between the major allergens (antigens 5 (alder), 23 (birch), and 13 (hazel)) from these tree pollens.

Allergens↗
PubMed1985

Non-hereditary angioedema treated with tranexamic acid. A 6-month placebo controlled trial with follow-up 4 years later.

Ten patients with frequent attacks of non-hereditary angioedema were treated with tranexamic acid or placebo in a double blind manner, each period lasting 3 months. During the tranexamic acid period nine patients became symptom-free, or substantially improved, while one was unaffected (P less than 0.05). In four patients itching was a major accompanying complaint which was relieved in three. Diarrhoea and abdominal discomfort were more pronounced during tranexamic acid treatment (P less than 0.05), but only necessitated dose reduction in one patient. Four years later contact was obtained with eight of the nine responders and six were still taking tranexamic acid regularly, while in two patients the attacks were so infrequent that the drug was not taken regularly.

Adult↗
PubMed1985

Dose frequency in the treatment of asthmatics with inhaled topical steroids. Comparison between a twice daily and a once daily dosing regimen.

In 23 stable asthmatic patients sensitivity to inhaled beclomethasone dipropionate (BDP) was demonstrated during single blind gradual tapering off of BDP. After a 2 week stabilization period the patients were randomly allocated to receive either 4 puffs of 50 micrograms BDP twice daily (AM/PM) or 8 puffs of 50 micrograms once daily (AM). After 4 weeks the patients were crossed over. Fifteen patients preferred the twice daily regimen, 5 preferred once daily and 3 had no preference (p less than 0.05). During the once daily dosing regimen a decrease in morning and evening peak expiratory flow (p less than 0.05) and an increase in nighttime and daytime symptom score (p less than 0.05) was found, while the number of inhaled beta 2-agonist doses did not change significantly (p = 0.05). It is concluded that a twice daily regimen controls the asthmatic symptoms significantly better than a once daily regimen.

Administration, Topical↗
PubMed1984

Cumulative dose response study comparing clinical effects of two doses of terbutaline sulphate administered via a 750 ml spacer to asthmatic patients.

Thirteen out-patients suffering from chronic reversible bronchial obstruction were treated on two separate days with two doses of terbutaline aerosol, administered with a 750 ml spacer interposed between the actuator and the mouth, in order to evaluate whether clinical responses showed a dose dependency during a 4-h period. On each day the two different doses (65 micrograms versus 250 micrograms) were inhaled three times at 15-min intervals. Fifteen minutes after the first dose there was a significant difference in FEV1 increase between the small dose and the normal dose, FEV1 being higher after 250 micrograms, but no significant differences in increase after the 2nd and 3rd inhalations. This study indicates that the bronchodilating effect of terbutaline administered via the spacer is dose-dependent at the first inhalation, and that succeeding inhalations show no dose-response effects.

Adult↗