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Biomedical subjects

J F O'Reilly

Publications and source records attributed to J F O'Reilly.

12 recordsLinked to original sources
PubMed1990

Comparative assessment of enprofylline and theophylline for chronic obstructive airways disease in the elderly.

Enprofylline, a recently developed xanthine derivative, is a more potent bronchodilator than theophylline. This study compares the efficacy and safety of enprofylline with theophylline for chronic obstructive airways disease (COAD) in elderly subjects. The study was of a randomized double-blind parallel design and commenced with a 1-week reference period when oral bronchodilators were withdrawn. Patients were then treated with either enprofylline or theophylline 150 mg bd for 2 weeks (period 1) followed by 300 mg bd for a further 3 weeks (period 2). Patients recorded peak expiratory flow rate (PEFR) and adverse experiences, if any, in a diary, daily. Of 111 patients recruited for the study, 85 entered active treatment (theophylline, n = 44; enprofylline, n = 41). Mean age was 72 years and mean bronchodilator reversibility was 22%. Enprofylline increased mean morning PEFR by 11% (period 1) and 19% (period 2) whereas theophylline increased PEFR by 13% and 19%, respectively. From the enprofylline group 29% were withdrawn from the study due mainly to headache and nausea/vomiting and from the theophylline group 7% were withdrawn due mainly to nausea/vomiting. Mean plasma concentrations of enprofylline were 2.0 mg l-1 and 3.4 mg l-1, and with theophylline 5.4 mg l-1 and 10.0 mg l-1 at the end of periods 1 and 2, respectively. Enprofylline and theophylline produced similar improvements in lung functions and symptoms of chronic obstructive airways disease, but enprofylline was less well tolerated than theophylline.

Aged↗
PubMed1989

Etoposide compared with the combination of vincristine, doxorubicin, and cyclophosphamide in the treatment of small cell lung cancer.

One hundred and three patients with small cell lung carcinoma were stratified according to stage of disease (47 limited disease, 56 extensive disease) and then randomised to receive etoposide 300 mg/m2 alone for two days or a combination (VAC) of vincristine 1 mg/m2, doxorubicin (Adriamycin) 50 mg/m2, and cyclophosphamide 1000 mg/m2. The drugs were given at three week intervals. Patients were assessed after three cycles of treatment and continued with the same regimen if in complete remission and with the alternative regimen if in partial remission; they were withdrawn if the disease had progressed. Twenty four patients (23%) achieved complete remission and this occurred more often when patients were receiving VAC (19 of 82) than etoposide (5 of 75). There was no difference, however, in overall survival between those initially treated with etoposide and those having combination chemotherapy, whether for limited disease (both 8 months) or extensive disease (7 and 5.5 months). Toxicity was less with etoposide. Survival was disappointing, especially with limited disease, even in patients who showed a complete response to treatment.

Actuarial Analysis↗
PubMed1988

Lung function and exercise performance in hyperthyroidism before and after treatment.

In order to investigate the mechanism of dyspnoea in hyperthyroidism measurements of spirometry, lung volume, transfer factor for carbon monoxide and its subdivisions, maximal respiratory pressures, methacholine challenge, arterial blood gases were made and exercise studies performed on 16 patients before treatment for hyperthyroidism. Methacholine challenge showed that only three of 14 patients increased airway reactivity, which was mild. Maximal pressures which could be generated by the respiratory muscles were reduced in some patients, as was functional residual capacity. Exercise ventilation and breathing frequency were increased and the respiratory exchange ratio was abnormally high. Anaerobic threshold was measured in nine of 15 subjects and was below normal in each case. All but two subjects stopped exercise because of dyspnoea, and the maximum oxygen uptake achieved by the group was 53 per cent (n = 15, range 26-66 per cent) of predicted maximum oxygen consumption. The maximum ventilation averaged only 43 per cent (n = 15, range 16-96 per cent) of the maximal breathing capacity predicted from spirometric tests. Nine patients were studied shortly after being rendered euthyroid by treatment. At rest, only maximal respiratory pressures increased significantly. On exercise, the maximal workload attained and the ventilation achieved increased significantly. Breathing patterns, maximal oxygen consumption, ventilation, anaerobic threshold and cardiac frequency remained unchanged. We conclude that: patients with hyperthyroidism do not generally have increased airway reactivity; when hyperthyroid, respiratory muscles are weak, and improve following treatment; exercise capacity is impaired in hyperthyroid patients probably because of a combination of an inefficiently rapid and shallow breathing pattern, an increase of anaerobic metabolism and discomfort associated with the act of breathing. Although exercise capacity increases and the sensation of dyspnoea may decrease after treatment the pattern of breathing does not immediately return to normal.

Adult↗
PubMed1986

Domiciliary comparison of terbutaline treatment by metered dose inhaler with and without conical spacer in severe and moderately severe chronic asthma.

The bronchodilator response to cumulative doses of terbutaline administered by metered dose inhaler with and without a conical spacer device and by Acorn nebuliser has been compared in groups of patients with chronic severe and moderately severe asthma. After laboratory studies the patients undertook a randomised domiciliary crossover comparison of bronchodilator response to terbutaline given by metered dose inhaler with and without a spacer device, during which the severity of asthma was assessed by thrice daily recordings of peak expiratory flow (PEF) and symptom score. Improvement in FEV1 produced in the laboratory by the metered dose inhaler with spacer device was significantly greater than by metered dose inhaler alone (p less than 0.001) and similar to that from the nebuliser in both asthmatic groups throughout a range of terbutaline doses. In the domiciliary comparison mean midday and evening PEF rates were significantly higher with the use of the spacer device both in those with severe (p less than 0.01) and in those with moderately severe (p less than 0.05) asthma, and mean morning PEF was significantly higher in the severe group (p less than 0.05). The spacer device also produced a significant improvement in symptom score in both the severe and the moderately severe groups (p less than 0.05). Regular domiciliary use of the spacer device with the metered dose inhaler improves bronchodilator response, particularly in patients with chronic severe asthma, and may be a useful alternative to nebuliser treatment.

Administration, Inhalation↗
PubMed1984

Prolonged coma and delayed peripheral neuropathy after ingestion of phenoxyacetic acid weedkillers.

A case of prolonged coma and delayed peripheral neuropathy is reported following self-poisoning with a widely available domestic weedkiller containing phenoxyacetic acids. Attention is drawn to the potential toxicity of these weedkillers which may be delayed in onset, and to the possibility of spontaneous recovery from neurological abnormalities which may be severe and prolonged or late in onset.

Coma↗
PubMed1982

Assessment of steroid responsiveness in patients with chronic airflow obstruction.

A simple steroid trial was conducted to assess whether 31 patients with chronic airflow obstruction would benefit from oral steroid therapy. Peak expiratory flow (PEF), forced expired volume in 1 s (FEV1), and ratio of FEV1, to forced vital capacity (FVC) were monitored during a 6-month period (when patients were on maximum bronchodilator therapy), after 2 weeks on placebo and after 2 weeks on prednisolone 30 mg daily. Patients also measured that PEF at home thrice daily. None had a significant degree of steroid reversible airflow obstruction. The preliminary observation period (of at least 3 months) is important to prevent an improvement being attributed to steroids, when it has in fact occurred spontaneously or is the result of bronchodilator therapy or cessation of smoking.

Administration, Oral↗
PubMed1982

The use of the 12 minute walking test in assessing the effect of oral steroid therapy in patients with chronic airways obstruction.

The reproducibility of the 12 minute walking distance (12 MD) was assessed in ten men with chronic airways obstruction, and the 12 MD was used, together with spirometry, transfer factor and three subjective assessments of breathlessness to evaluate the effects on respiratory function of prednisone 30 mg daily given orally in double-blind placebo-controlled fashion for two weeks. Like others, we found the 12 MD reproducible on a single day with a mean variation of 3.1%. Tests performed two weeks apart showed greater variability ranging from 0.2% to 30.9%, (mean 9.1%). During placebo and prednisone therapy the 12 MD and assessments of breathlessness correlated significantly with each other and with TLCO, but not with spirometry. Following steroid therapy there was a significant increase in mean TLCO but no significant change in 12 MD, spirometry or subjective assessments. Changes in 12 MD and TLCO correlated significantly with each other and with changes in subjective assessments. Changes in FEV1 correlated with changes in breathlessness, and also with variability in FEV1 while receiving placebo. Individuals with the greatest changes in 12 MD and FEV1 were those with the greatest variability on placebo. The variability of the 12 MD and FEV1 should be measured in individuals before using these tests to assess response to steroid therapy.

Aged↗