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Biomedical subjects

P Diggory

Publications and source records attributed to P Diggory.

At least 19 recordsLinked to original sources
PubMed1995

Avoiding unsuspected respiratory side-effects of topical timolol with cardioselective or sympathomimetic agents.

Topical timolol given for the treatment or chronic simple glaucoma may cause unrecognised bronchospasm among elderly people. We recruited 80 patients aged over 60 years, who were without a history of airways disease and already used timolol, into a randomised crossover study comparing the effects on spirometry and exercise tolerance of changing to betaxolol or dipivefrine therapy. Results showed an increase of 13% and 8% in mean peak flow rate and forced expiratory volume in 1 s (FEV1), respectively, when using betaxolol; and of 14% and 11% when using dipivefrine. There was also improved exercise tolerance with both agents. More than a quarter of the patients showed at least a 15% improvement in FEV1 when changed from timolol. Analysis of enrolment symptoms and response to nebulised salbutamol failed to produce a method of identifying these patients. Timolol may impair respiratory function and exercise tolerance of elderly patients even if they have no history of reversible airways disease.

Aged↗
PubMed1994

Unsuspected bronchospasm in association with topical timolol--a common problem in elderly people: can we easily identify those affected and do cardioselective agents lead to improvement?

The extent of impairment of respiratory function in a group of 52 elderly, glaucomatous patients receiving topical timolol therapy was investigated. To predict those patients who were likely to benefit from changing therapy, symptoms were elicited by direct questioning, and lung spirometry was measured before and after inhalation of salbutamol. Changing from timolol to either pilocarpine or the cardioselective betaxolol produced improvement in lung function tests. Mean peak flow increased from 278 l/min to 328 l/min (p < 0.001), forced expiratory volume in 1s (FEV1) from 1.66 l to 1.85 l (p < 0.001) and forced vital capacity (FVC) from 2.41 to 2.64 l (p < 0.001). Spirometry in a control group of 20 subjects was unchanged. Nineteen of 47 patients demonstrated a clinically significant (defined as 15% or more) increase in all values of lung function tests. Change to pilocarpine or betaxolol was equally effective in producing improvement but betaxolol had fewer side-effects. The presence of exertional dyspnoea, cough with sputum, raised dyspnoea score and improved lung function tests after salbutamol identified those patients experiencing clinically significant bronchospasm with an 89% specificity and 74% sensitivity.

Aged↗
PubMed1993

Improved lung function tests on changing from topical timolol: non-selective beta-blockade impairs lung function tests in elderly patients.

Fifty-two elderly glaucomatous patients, without a history of asthma or obstructive airways disease, who were using topical timolol for control of intraocular pressure were recruited. Their topical therapy was changed to either betaxolol or pilocarpine. The change was associated with improvement in mean peak flow from 278 l/min to 328 l/min (t = 5.73, p < 0.001), mean FEV1 from 1.66 l to 1.85 l (t = 7.09, p < 0.001) and mean FVC from 2.40 l to 2.64 l (t = 5.07, p < 0.001). Change to either betaxolol or pilocarpine was associated with improved lung function tests. Lung function tests in a control group of 20 showed no significant changes. Both drugs maintained control of intraocular pressure but betaxolol had fewer ocular side effects.

Administration, Topical↗
PubMed1991

Effectiveness of inhaled bronchodilator delivery systems for elderly patients.

A prospective study of inhaler technique using aerosol metered dose inhalers (MDIs), Rotahalers and a breath-activated device (Aerolin Autohaler) was undertaken to assess how effectively elderly patients use their inhalers. Fifty-one patients aged 67-89 years (mean 77.4 years) were enrolled. Peak flow, FEV1 and FVC were recorded, before and after inhalation of 2.5 mg of salbutamol via a nebulizer, to assess the extent of reversible airways obstruction. Inhaler technique was assessed using a scoring system, based on performance in five aspects of inhaler use. Those with poor technique were randomly allocated to an alternative inhaler and reassessed. Twenty-nine of 51 patients demonstrated reversibility in their airways disease. Twenty-one of 47 had poor technique using an MDI and were given Rotahaler or Aerolin devices to use. Ten of 11 given Aerolin Autohalers improved but seven of ten using Rotahaler showed no improvement (p = 0.006). Subsequently, five of these seven were able to improve their technique with the breath-activated autohaler. The breath-activated Aerolin Autohaler is a better delivery system than Rotahalers for inhaled bronchodilators for elderly patients.

Age Factors↗