Monitoring peak expiratory flow rate.
Explore the source record for details and available documents.
Asthma↗
Biomedical subjects
F Chmelik
Publications and source records attributed to F Chmelik.
Ragweed immunotherapy in adult asthma.
Explore the source record for details and available documents.
Adult↗
Objective measurements of compliance in asthma treatment.
BACKGROUND: Self-management protocols and home peak expiratory flow rate monitoring are thought to improve asthma care. OBJECTIVE: Compliance and accuracy of patients' record keeping were measured during a guided self-management protocol. Video, face-to-face instruction, and written protocols were part of the educational program. METHODS: Twenty patients participated in a 5-week study using memory capable peak expiratory flow rate meters and inhalers. During the baseline week all patients followed their customary approach to treatment and kept written diaries of peak expiratory flow rate and inhaler usage results; thereafter, they followed an individually designed self-management protocol. RESULTS: Good technique and knowledge were found during the baseline visit and improved by the last visit. Compliance with the protocol during the fifth week occurred in 40% of patients with underusage of inhalers in 50% and overusage in 10% despite allowing for a 10% inaccuracy in recording. Patients keeping inaccurate records early in care tend not to improve. Errors in recording inhaler usage increased from 47% to 58% of days during the final week. Patients inflated peak expiratory flow rate scores (P < .01) over time. Slight improvement in the peak expiratory flow rate was found for the entire group (baseline week 371 L/min versus final week 386 L/min P < .05). CONCLUSIONS: Despite an extensive educational program in the self-management of asthma, compliance with recommended treatment was only 40%. Electronic monitoring of peak expiratory flow rate and inhaler usage can provide early identification of patients who do not comply.
Adolescent↗
Evolutionary changes in the electrocardiogram of severe progressive hypothermia.
A patient is reported who developed progressive hypothermia during therapy for adult respiratory distress syndrome. Electrocardiographic changes (sinus bradycardia, prolonged PR interval, prolonged QTc interval, "Osborn waves") were documented and correlated with body temperature. The significance of these changes is discussed and the relationship between the degree of hypothermia and the presence of "Osborn waves" is noted.
Adult↗
A one-year trial of triamcinolone acetonide aerosol in severe steroid-dependent asthma.
Twenty-three steroid-dependent severely asthmatic patients, ranging in age from 20 to 67 years, tolerated reduction in their oral dosage of steroids during a one-year trial of triamcinolone acetonide aerosol. Sixteen patients maintained their initial one-second forced expiratory volume without oral therapy with steroids, two required resumption of daily steroid dosage because of lethargy and arthralgia, and four required 2.5 to 20 mg of prednisone every other day to control their asthma. Five-day oral courses of steroids were occasionally required because of episodes of asthma from a variety of external causes. One patient failed to benefit within two months and withdrew from the study. One patient had precipitins to Candida albicans prior to the study, and he developed transient oropharyngeal culture-positive thrush, which subsided with use of a gargle containing nystatin. None of the other patients had oral candidiasis, and laryngoscopic examination revealed no lesions attributed to the aerosol. The mean fasting cortisol level did not increase throughout the one-year trial. Thus, the use of triamcinolone acetonide aerosol (2,000 microgram or less daily) can eliminate or greatly reduce oral requirements for steroids in patients with severe steroid-dependent asthma. Side effects are mild, but adrenal recovery may be exceedingly slow.
Administration, Oral↗
The value of precipitating antibodies in screening for hypersensitivity pneumonitis.
To evaluate the usefulness of precipitin tests as a screening method to detect hypersensitivity pneumonitis, we compared persons with precipitins to organic antigens with precipitin-negative subjects from the same population of 1,072 office workers participating in a health survey examination. Thirty-three of the 53 persons with preciptins to Micropolyspora faeni, Thermoactinomyces vulgaris, T. candidus, pigeon serum, aspergillus, alternaria, pullularia, penicillium, cephalosporium, trichoderma, and phoma were matched according to age, sex, height, and smoking habits with precipitin-negative subjects. The subjects completed a self-administered standard questionnaire, they were interviewed and examined, chest radiograms were taken, and pulmonary functions were evaluated at rest and during mild and moderate exercise. No significant differences were found between the 2 populations in any of the pulmonary function measurements. In addition, clinical and radiologic evidence failed to distinguish between the 2 groups. No cases of hypersensitivity pneumonitis were found. In this population, precipitins had no apparent relationship to long disease. The frequency of precipitins was considerably higher than the frequency of hypersensitivity pneumonitis. We concluded that the detection of hypersensitivity pneumonitis in population surveys attempting to establish prevalence of the disease cannot be accomplished by the simple analysis of serum precipitating antibodies but requires, in addition, a more complex analysis of historical, radiologic, and immunologic data.
Antigens↗
Lymphocyte subpopulations in the peripheral blood of patients with farmer's lung.
The numbers of mononuclear cells having receptors for sheep red blood cells (T lymphocytes) or complement (B lymphocytes) in the peripheral blood of farmer's lung patients were determined. In patients recovering from a clinical episode of farmer's lung or exposed to moldy hay or fodder, both the percentage of T lymphocytes and the T lymphocytes per mm3 were reduced, whereas the number of B lymphocytes remained within normal limits. Farmer's lung patients having no exposure to moldy hay or fodder had T and B lymphocyte numbers similar to a normal population.
Adult↗
A short-term double-blind trial of aerosol triamcinolone acetonide in steroid-dependent patients with severe asthma.
Twenty-five steroid-dependent severely asthmatic patients, ranging in age from 20 to 67 years, were hospitalized. Baseline laboratory and pulmonary function testing was followed by reduction of prednisone therapy to 5 mg daily and by entry into a randomized double-blind study of placebo vs active aerosol triamcinolone acetonide (300mug four times daily). In this four-week trial, aerosol triamcinolone acetonide further reversed airway obstruction and proved to be an effective substitute for large oral doses of steroids in steroid-dependent patients with severe asthma. No significant improvement occurred in the maximum midexpiratory flow or the maximum velocity of air flow after 50 percent or 75 percent of the vital capacity had been expelled. There was no significant difference in the frequency of untoward effects between the groups taking aerosol triamcinolone acetonide and its vehicle. No patient demonstrated any definite return of adrenal function.
Adrenal Cortex Function Tests↗
Precipitating antibodies in office workers and hospitalized patients directed toward antigens causing hypersensitivity pneumonitis.
The frequency of precipitating antibodies to Aspergillus, thermophilic actinomycetes, and pigeon serum was studied in hospitalized patients and in employees of the state of Wisconsin. Precipitins to Aspergillus were detected in 9 per cent of the hospitalized patients and 3 per cent of the state employees. The majority of the serologically reactive hospitalized patients were diagnosed as having carcinoma with metastases, lymphoma, or leukemia. No evidence of hypersensitivity pneumonitis or invasive aspergillosis was seen in these patients. The frequency of antibodies to thermophilic actinomycetes (3 per cent) and pigeon serum (1 per cent) was similar in both groups. Women from 17 to 25 years of age and men from 52 to 66 years of age demonstrated an increased incidence of positive precipitins.
Adolescent↗
Farmer's lung.
Explore the source record for details and available documents.
Actinomycetales Infections↗