Smoking among hospital nurses.
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Cross-Sectional Studies↗
Biomedical subjects
J Marsac
Publications and source records attributed to J Marsac.
[Sulfidopeptide leukotrienes and asthma].
The role of sulfidopeptide leukotrienes in asthma alone or in association with other mediators is still debated. Sulfidopeptide leukotrienes (s-LT) C4, D4 and E4 are 5-lipoxygenase derivatives of membrane arachidonic acid. All s-LT contract bronchial smooth muscle in vitro and provoke an acute bronchial obstruction in vivo in both healthy and asthmatic subjects. Numerous cells, including mast cells, alveolar macrophages, polynuclear basophils and eosinophils, are capable of secreting s-LT following such diverse stimuli as allergen exposure, platelet activating factor and calcium ionophore A 23187. In addition to constricting bronchial smooth muscle, s-LT promote the occurrence of mucosal oedema increase micro-vascular permeability in the bronchial wall, and cause hypersecretion of mucus by tracheo-bronchial glands. These effects lead to worsening of airways obstruction. s-LT increase non specific bronchial hyper-responsiveness. Clinical trials aiming to test the efficacy of new anti-leukotrienes are currently under way. In general these products have a real antagonistic effect on exogenous s-LT. Their efficacy vis-a-vis other types of stimulus such as allergens, histamine and exercise does not seem to be constant and depends largely on the composition and perhaps the route of administration (inhaled versus oral). The contribution of s-LT as part of the therapeutic arsenal for the long term treatment of asthma remains to be established.
Asthma↗
Treatment compliance and self-medication in asthma in France.
A study was carried out among asthmatic patients in order to determine their compliance to treatment and self-medication. Data collection used a self-administered postal questionnaire as tested in a previous study. The population under study included 450 asthmatic patients; 370 answered; their mean age was 47 +/- 16 yrs and 44% were men. An aerosol was the preferred route of administration (41%). Eighty two percent of the patients tended to reduce the doses following improvement; 80% claimed to know treatment for attacks; 90% had already been using an inhaler, although only 62% had been shown how to use one. Forty eight percent had already bought drugs without prescription, especially patients within the 25-34 yrs age group. This study is consistent with similar surveys performed in other populations. Improved quality of information about treatments and how to use drugs is higher in patients with chronic forms of asthma involving unpredictable acute attacks.
Adolescent↗
[Mechanism of action and effects of corticoids in asthma].
The value of oral or inhaled glucocorticoids (GCS) in asthma is well recognized. Their use has remained empirical for a long time. However, some progress has been achieved recently in the understanding of their general mode of action and of their bronchial effects suggesting that in the near future ther may be some new therapeutic perspectives. The fundamental action of GCS involves a close intracellular interaction between the specific glucocorticoid hormone receptor and the cellular genome which results in the activation of the genes coding the proteins responsible for the phenotypic response of the cell and thus for their biological action. The place of the extra-genomic mechanisms remains ill understood. The immunomodulating action of GCS is difficult to dissociate from their anti-inflammatory and anti-allergic effects which seem to predominate in asthma. They inhibit all stages of the inflammatory reaction in acting on the key mediators of the inflammatory response, the pharmacologically active lipids (LPA: prostaglandins, leukotrienes, PAF-acether) which are a result of the catabolism of arachidonic acid which occurs during the course of membrane activation. The phospholipid A2 (PLA2), a membrane enzyme responsible for the splitting of the phospholipids in the presence of calcium and leading to the liberation of LPA is the driving force of the reaction in such a way that the products of the nuclear activation subsequently reactivated. GCS is considered as a natural modulator of inflammation, inducing the synthesis of lipocortin, an inhibitory protein of PLA2, which explains the blockage in the generation of LPA and thus the inflammatory reaction. The regulation of the activity of these or of the lipocortin seems to lead to the intervention of the phosphorylation. But numerous questions remain concerning the precise action of PLO2, the existence of endogenous lipocortin, their secretion and their extra-cellular action. In spite of these unknown facts it is not impossible to envisage a clinical potential for lipocortin, once sequenced and produced, when the pharmacological and immunological problems have been surmounted. In asthma the effect of GCS essentially involve: the inhibition of all the bronchial components of inflammation: the synthesis, liberation and peripheral action of the mediators; the oedema and mucous congestion.(ABSTRACT TRUNCATED AT 400 WORDS)
Asthma↗
[Aerosol therapy in asthma].
Today there is a general use of aerosols in the treatment of asthma. To understand their importance it is necessary to know the make-up of an aerosol, physical and chemical factors as well as anatomical factors that influence its deposition and clearance in the tracheo-bronchial tree. In the therapy of asthma, small, easy-to-handle and reliable inhalers are prescribed. Other methods of administering these drugs by inhalation are available: these include nebulisation of the active substance in a liquid form and inhalation of the drug in a powder form. Their efficacy and the rareness of side effects (owing to the fact of minimal systemic absorption) makes them the preferred form of treatment of crises as well as for basic treatment. Nevertheless, to obtain the best therapeutic results the inhalation technique of the aerosol should be correct and some practical improvements are envisaged to alleviate any disadvantages: mixing chambers, mouth pieces, etc. Several drugs are commercially available in aerosol form (beta-agonists, atropine-like drugs, corticosteroids and chromones) which have a place both in the treatment of crises and in the basic treatment of asthma.
Aerosols↗
[Evaluation of the medical costs of asthma in adults during a l-year follow-up in a hospital environment].
The medical cost of asthma is difficult to measure because this syndrome is generally studied in amongst a large group of patients with chronic respiratory disease. The aim of this study was to assess the theoretical cost of the medical treatment of asthma in a group of young adults who are free from any other disease; the study lasted for one year of follow up and the treatment was given in the public hospital service. Four particular situations are identified corresponding to four stages of severity of the disease and each of these stages was given a treatment selected as the usual therapeutic regime given in a respiratory service in a public hospital. The first stage was to suit patients suffering from quarterly paroxysmal crises which tended to resolve quickly after a few days of treatment. The second stage was more severe involving patients suffering from monthly paroxysmal attacks and for whom maintenance treatment was necessary. The third stage was for those with unstable asthma with twice monthly asthmatic crises, frequent hospitalisation and continuous treatment between the attacks. In the fourth stage the patients were suffering from continuous dyspnoea which required inpatient hospital care and also intensive care. In all these cases the asthmatic disorder is burdensome both for the patient and for society, a fact which should be appreciated both by doctors and by decision makers in public health. In the average or mild cases the essential annual costs are made up of the cost of diagnosis and follow up.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Opinions and behavior of asthmatic patients towards treatment using aerosols].
An ever increasing number of drugs prescribed in the treatment of asthma are presented as aerosols, so that patients may be requested to inhale many puffs every day. In this study, the opinion of asthmatic patients was sought and their behaviour towards aerosols during attacks and in long-term treatment was recorded by means of a questionnaire. The answers confirmed that asthmatics liked aerosols and found them usually effective, but 60% of these patients exceeded the stated dose, and if the drug failed to bring the expected relief, 30% waited 24 hours before calling for a doctor. In long-term treatments, 80% of the patients studied said that 10 puffs a day were a nuisance, and 12% were switched to another treatment for that reason. These results are very important. Doctors should reinforce the patients' education and limit the number of daily puffs they prescribe to obtain better compliance of asthmatics with their treatment.
Administration, Inhalation↗
[Exercise-induced asthma].
Exercise-induced asthma only differs from common asthma in its causative factor. It is a typical asthmatic attack which follows a strenuous and continuous physical exercise lasting 5 to 10 minutes, most often in cold and dry weather. The prevalence of exercise-induced asthma has not yet been firmly established; its pathophysiological mechanisms are still debated, and the respective roles of heat and water losses by the airways are not clearly defined. However, the influence of the type of exercise as a precipitating factor of exercise-induced asthma is now well-known. All things being equal, swimming generates less asthma than running and cycling. This enables the subjects to be directed towards the most suitable sports and encouraged to improve their physical fitness. Drug treatment of exercise-induced asthma must preferentially be preventive; it relies on cromoglycate and beta-2 adrenergic agonists, the latter being also capable of treating acute exercise-induced bronchial obstruction. Education of the patients and their family is also important.
Adrenergic beta-Agonists↗
Effect of theophylline on gastroesophageal reflux in patients with asthma.
A possible role of methylxanthines in the high incidence of gastroesophageal reflux (GER) in patients with asthma has been suggested. Therefore, we used a randomized, double-blind, crossover design to compare the effects of a 1-week conventional theophylline treatment and a 1-week placebo treatment in 16 adult patients with asthma. No oral or parenteral glucocorticoids were administered, but seven patients were taking inhaled corticoids. All patients needed inhaled adrenergic drugs. At the end of each period of theophylline or placebo treatment, the patients were carefully questioned with respect to respiratory and digestive symptoms, forced expiratory flows were measured, and GER was assessed by prolonged nocturnal intraesophageal pH monitoring. Peak expiratory flow was measured three times a day throughout the study. No significant increase in GER was found with theophylline compared to placebo, and forced expiratory flows improved with theophylline (p less than 0.05 for FEV1 and p less than 0.01 for peak expiratory flow rate). There was no correlation between GER, the duration of asthma, and forced expiratory flows. Thus, our study failed to demonstrate any adverse effect of a slow-release theophylline preparation on GER in patients with asthma. These results further suggest that the presence of GER is not a contraindication to the use of a slow-release theophylline in subjects with asthma.
Adrenergic beta-Agonists↗
Comparison of the effects of epithelium removal and of an enkephalinase inhibitor on the neurokinin-induced contractions of guinea-pig isolated trachea.
1. The influence of epithelium removal and/or thiorphan on the effects of neurokinins (substance P (SP), neurokinin A (NKA), neurokinin B (NKB)) and related peptides on airway contractility was investigated on the guinea-pig isolated trachea. 2. Removing the tracheal epithelium significantly enhanced the sensitivity but not the maximum contractile responses to the peptides. 3. After removal of the epithelial layer, the shifts to the left of the log concentration response curves were greater for SP and SP-OMe (1.62 and 1.94 log units, respectively) than for two SP analogues substituted in position 9 namely [Pro9]SP sulfone and [beta-Ala4, Sar9]SP(4-11) sulfone (0.66 and 0.68 log units, respectively). The leftward shifts for compounds related to NKA or NKB lay between 0.58 and 0.73 log units. 4. The leftward shifts of the log concentration-response curves for SP, SP-OMe, [Pro9]SP sulfone, [beta-Ala4, Sar9]SP(4-11) sulfone and NKA were of similar magnitude after removal of the epithelium or after pretreatment with thiorphan (10(-5) M), an enkephalinase inhibitor, in the presence of epithelium. No significant additional shift of the curves to the left was observed with thiorphan plus epithelium removal. 5. The results obtained with the selective agonists for each of the three classes of neurokinin receptor (i.e NK1, NK2, NK3) suggest that the guinea-pig trachea contains receptors for SP and NKA but few if any for NKB. 6. It was concluded that neurokinins and related peptides (especially SP and analogues not substituted in position 9) are degraded by enkephalinase mainly located in the tracheal epithelium and that the addition of thiorphan or epithelium removal results in an inhibition or loss of enkephalinase activity, thereby increasing similarly the potencies of these peptides. It was, therefore, suggested that the supersensitivity to neurokinins produced by epithelium removal was due neither to the elimination of a permeability barrier nor to reduced production of a relaxant factor, but mainly to reduced peptide degradation.
Airway Resistance↗
Evidence that the histamine sensitivity and responsiveness of guinea-pig isolated trachea are modulated by epithelial prostaglandin E2 production.
1. Guinea-pig isolated tracheal preparations in which the epithelium had been removed exhibited a greater contractile response to histamine (intact: 1.91 +/- 0.12 g; n = 6 and rubbed: 2.76 +/- 0.15 g; n = 11; P less than 0.001). The histamine sensitivity (pD2 value) of these preparations was also significantly greater (intact: 4.80 +/- 0.04 and rubbed: 5.40 +/- 0.08; P less than 0.01). 2. Indomethacin suppressed the basal tone of both intact and rubbed preparations but was more effective in the former tissues (intact: -0.70 +/- 0.14 g; n = 22 and rubbed: -0.17 +/- 0.05 g; n = 12; P less than 0.02). 3. Arachidonic acid (AA; 10 microM) suppressed the basal tone of intact tissues but contracted such preparations following indomethacin treatment (1.7 microM; 30 min). However, in rubbed tissues AA (10 microM) induced a contraction which was attenuated following indomethacin treatment. 4. Prostaglandin E2 (PGE2; 0.01 and 0.1 microM) suppressed the basal tone of intact preparations and always evoked contraction of rubbed tissues. Following indomethacin treatment PGE2 (0.01 and 0.1 microM) generally evoked spasm of intact and rubbed tissues while at higher concentrations (1 microM) relaxant effects were observed. 5. Removal of the epithelium did not alter the relaxant effect of PGE2 (pD2 value) on histamine (50 microM)-contracted tissues (intact: 6.86 +/- 0.08 and rubbed: 7.10 +/- 0.3; n = 4; P greater than 0.1). 6. In rubbed preparations treated with indomethacin, PGE2 (0.01 and 0.1 microM) evoked spasm. However, when added to preparations contracted with 5 microM histamine, PGE2 always caused relaxation. 7. The release of immunoreactive PGE2 by rubbed preparations during histamine and/or AA stimulation was significantly less than that produced by intact stimulated tissues. 8. Exogenous PGE2 (0.01-1 microM) decreased the maximal response and sensitivity of rubbed tracheal preparations to histamine. 9. These results suggest that release of an epithelial derived cyclo-oxygenase product, namely PGE2, may regulate basal tone, histamine response and sensitivity of the guinea-pig isolated trachea.
Animals↗
Allergy and occupational exposure to hydroquinone and to methionine.
Respiratory manifestations have been reported after exposure to hydroquinone and to methionine. One hundred and three men in the same chemical plant were divided into three groups according to their exposure and compared by questionnaire, respiratory functional tests with methacholine then salbutamol challenges, and measurements of serum immunoglobulins G and E. Group H included 33 workers exposed to hydroquinone, trimethyl-hydroquinone, and retinene-hydroquinone. Group M included 15 workers exposed to methionine. Group C was a control group of 55 workers. The prevalence of respiratory symptoms was higher in the two exposed groups. Before challenges, pulmonary function values were significantly lower in groups H and M than those in group C. The challenges induced significant variations in the three groups but these variations were less pronounced in group M than in the other groups. The level of immunoglobulin G in group H (m +/- SD = 12.5 gram/liter +/- 2.6) was significantly higher than in group C (10.6 gram/liter +/- 2.4; p less than 0.002). The level of immunoglobulin E in group H (m = 140 IU/l) was also higher in group C (109 IU/l) but this difference was not significant. These findings suggest that exposure to methionine and to hydroquinone and its derivatives induce ventilatory impairment, perhaps by an immunological mechanism.
Adult↗
Nasal response to substance P and methacholine in subjects with and without allergic rhinitis.
We compared the rise in nasal airway resistance (NAR) provoked by topical application of substance P (SP) and of methacholine (MCH) in seventeen patients suffering from rhinitis and fourteen control subjects. Challenges with SP or MCH were separated by a week or more. NAR was measured by posterior rhinomanometry before and 10 min after intranasal administration of SP (10-40 nmol) or MCH (3-12 mumol). The two groups of subjects had similar baseline levels of NAR and similar small responses to buffered saline. Substance P but not MCH provoked cutaneous flushing in all subjects. Both SP and MCH provoked a significantly greater increase in NAR in patients suffering from rhinitis than in control subjects. The increase in NAR was dose-dependent, and on a molar basis, SP was 375-500-fold more potent than MCH. Pretreatment with 200 micrograms of a topically active anticholinergic agent, oxytropium bromide, prevented the rise in NAR caused by 12 mumol of MCH but not that caused by 40 nmol of SP in six patients suffering from rhinitis. We conclude that SP is absorbed across the nasal mucosa and causes cutaneous vasodilation, that MCH and SP cause a greater rise in NAR in patients suffering from rhinitis than in control subjects, that SP is about 500-fold more potent than MCH in increasing NAR, and that the rise in NAR caused by SP is not mediated by postganglionic parasympathetic mechanisms.
Administration, Intranasal↗
[The nonadrenergic, noncholinergic neuropeptide system and asthma].
An understanding of the non adrenergic non cholinergic nervous system and its implication in the pathogenesis of asthma would benefit by the identification and localisation of the numerous natural bioactive peptides at the pulmonary level. In the past few years two components of the non adrenergic non cholinergic nervous system have been characterised. A bronchodilator component which would be mediated by "vaso-active intestinal peptide" (VIP) and the "peptide histidine methionine" (PHM). A broncho-constrictor component which would be mediated by the neurokinins (substance P (SP), neurokinin A (NKA) and the "calcitonin gene related peptide" (CGRP)). These neuropeptides, in vitro as well as in vivo, have effects which are not limited to the regulation of bronchial smooth muscle tone. In effect, they may intervene in the regulation of vascular tone, in the production of mucous and in the expression of immediate hypersensitivity reactions at pulmonary level. Several neuropeptides are present or co-exist with classical neurotransmitter in the afferent nerve endings of the pulmonary efferents. This co-existence of several neurotransmitters in the same nervous fibres raised the questions as to their interactions at the pre or post synaptic level. The implication of these neuropeptides in the pathogenesis of asthma rests on numerous experimental arguments. This recent aspect in the pathophysiology of asthma allows us to hope for new therapeutic approaches.
Asthma↗
Cumulative dose-response curves for assessing combined effects of salbutamol and ipratropium bromide in chronic asthma.
We investigated whether salbutamol (S) and ipratropium bromide (IB) exerted a true additive bronchodilator effect in asthma. In fifteen selected chronic asthmatics, individual cumulative dose-response curves to S and IB were performed on two separate days (linear regression of bronchodilator response (delta FEV1) between 20 and 80% of maximal response, versus log dose), and the dose of S equipotent to the IB dose giving the maximal bronchodilator effect (IBopt) was calculated by interpolation of each S curve. On two other days, each patient received IBopt or the equipotent S dose followed by an additional 400 micrograms S. On day 1 or 2, FEV1 reached 220 +/- 410 ml and 2410 +/- 380 ml (p less than 0.05) after the maximal dose of IB and S respectively. On day 3 or 4 after pretreatment by IB or S an additional 400 micrograms S gave a further increase, which was similar in both series (315 and 320 ml, respectively). FEV1 after combination treatment reached 238 +/- 350 ml and was not significantly different from the maximal effect of S (2440 +/- 290 ml). We conclude that S and IB exert a true pharmacological additive effect, since the combination effect is as great as the maximal effect of the most potent drug (S) and greater than the maximal effect of IB, and that the same additional dose of S gives the same increase after equipotent doses of S and IB.
Adult↗
[Multicenter study of the clinical efficacy and tolerance of roxithromicin compared to doxycycline in lower respiratory infections].
In a double-blind, randomised investigation in 305 in-patients, roxithromycin and doxycycline were compared in two groups of patients with low respiratory tract infections. Three hundred cases were analyzable for safety and 276 for clinical efficacy. Mean duration of treatment was 9 days in both groups. Clinical effectiveness was 83% (112/135) for roxithromycin (150 mg bd) and 84% (118/141) for doxycycline (200 mg once daily), the difference not being statistically significant. A 90% clinical response rate was obtained with roxithromycin in pneumoniae. Safety and tolerance were good and comparable in both groups.
Adolescent↗
Habits and attitudes towards smoking among the health staff of a large Parisian hospital.
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Adult↗
[Smoking among nursing students].
The aim of this work is to study smoking habits in young adults in a particularly sensitive environment. The data were collected in 28 nursing schools of the Public Hospital System in Paris by means of anonymous self-administered questionnaire. The questions focused on smoking habits, knowledge of risks and student attitudes. The 5,598 respondents (mean age of 22.6 years) were 89 per cent female. The results showed a high prevalence of current smoking (44%) especially amongst the younger students. Students preferred brands with a medium range tar level. Most of the students knew the smoking risk, agreed with the policy of prohibiting smoking in the hospital and thought that it is the role of nurses to counsel patients to stop smoking, but only one third hold a positive view of this role.
Adult↗