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Biomedical subjects

R I Gove

Publications and source records attributed to R I Gove.

11 recordsLinked to original sources
PubMed1991

Response to corticosteroids in chronic airflow obstruction: relationship to emphysema and airways collapse.

We have studied the relationship between emphysema and airways collapse, and response to corticosteroids in patients with chronic airflow obstruction. One hundred and seven patients completed a placebo-controlled trial comparing 2 wks treatment with oral prednisolone 40 mg.day-1 to inhaled beclomethasone dipropionate 500 micrograms t.d.s. Response to corticosteroids was defined on the basis of changes in forced expiratory volume in one second (FEV1), and/or forced vital capacity (FVC), and/or mean peak expiratory flow (PEF) after treatment. Patients were categorized as those with physiologically defined emphysema (carbon monoxide transfer coefficient (KCO) less than 70% predicted and total lung capacity greater than 120% predicted), and those with pressure dependent airways collapse on the flow-volume loop (ratio of inspiratory to expiratory flow at 50% vital capacity [I:E50] greater than 10). The response to placebo showed a significant order effect, probably due to a carry-over effect of active treatment of at least 3 wks. Hence, the efficacy of active treatment over placebo in the subgroups defined was assessed by analysis of data generated from the first treatment phase of the trial. The presence or absence of physiologically defined emphysema did not affect the response to oral prednisolone. Inhaled beclomethasone dipropionate, however, was less effective in the emphysema group. Pressure dependent airways collapse did not affect the response to either prednisolone or beclomethasone. However, when data from all three treatment phases were analysed there was no significant difference in the response to either drug in any of the subgroups defined.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation↗
PubMed1990

Corticosteroid trials in non-asthmatic chronic airflow obstruction: a comparison of oral prednisolone and inhaled beclomethasone dipropionate.

One hundred and twenty seven adults considered on clinical grounds to have non-asthmatic chronic airflow obstruction entered a randomised, double blind, placebo controlled, crossover trial comparing the physiological response to inhaled beclomethasone dipropionate 500 micrograms thrice daily with oral prednisolone 40 mg a day, both given for two weeks. One hundred and seven patients completed the study. Response was assessed as change in FEV1 and FVC measured on the last treatment day, and as change in mean peak expiratory flow (PEF) over the final seven days of treatment from home PEF recordings performed five times daily. A full response to treatment was defined as an increase in FEV or FVC, or an increase in mean daily PEF over the final seven days of treatment, of at least 20% from baseline values. An improvement in one measurement of at least 15%, or of 10% in any two measurements, was defined as a partial treatment response. Response to placebo showed a significant order effect, suggesting a carry over effect of active treatment of at least three weeks. Response to active treatment was therefore related to initial baseline values, and compared with placebo by considering responses in the first treatment phase only. A full response to oral prednisolone (16/38) was significantly more common than to placebo (3/35). The number of full responses to inhaled beclomethasone (8/34) did not differ significantly from the number responding to oral prednisolone or placebo in the first treatment phase, though full and partial responses to inhaled beclomethasone (12/34) were significantly more common than those to placebo (4/35). When all three treatment phases were considered 44/107 patients showed a full response to one or both forms of corticosteroid treatment, a response to prednisolone (39) occurring more frequently than to inhaled beclomethasone (26). Only 21 of the 44 responders showed a response to both forms of treatment. Inhaled beclomethasone dipropionate 500 micrograms thrice daily was inferior to oral prednisolone 40 mg per day, but better than placebo, in producing improvement in physiological measurements in patients thought to have nonasthmatic chronic airflow obstruction. It was, however, an effective alternative in over half of those showing a response to prednisolone.

Administration, Inhalation↗
PubMed1990

Time course of response to oral and inhaled corticosteroids in non-asthmatic chronic airflow obstruction.

One hundred and twenty one patients considered on clinical grounds to have non-asthmatic chronic airflow obstruction completed a double blind, crossover trial comparing oral prednisolone 40 mg per day with inhaled beclomethasone dipropionate 500 micrograms thrice daily, each given for 14 days, with a 14 day washout period between treatments. The time course of response was analysed for the 57 occasions where there was a significant increase in mean daily peak expiratory flow (PEF) over the treatment period. Mean daily PEF was still rising at day 14 on 12 occasions. After withdrawal of treatment mean daily PEF remained above pretreatments levels for more than two weeks in half the responses analysed. The peak response occurred earlier with inhaled beclomethasone (median 9.5 (range 3-14) days) than with oral prednisolone (median 12 (range 1-14) days), though both treatments produced a response that was sustained for a similar period. The results suggest that a trial of treatment with corticosteroids in this group of patients should last more than 14 days, and that in a study with a crossover design the washout period should be longer than two weeks.

Administration, Inhalation↗
PubMed1988

The effects of ketotifen on beta-adrenergic activity in asthmatics.

In order to examine a possible mechanism of action of ketotifen in asthma, a double-blind study was undertaken to determine whether ketotifen showed any effects on the beta-adrenergic system in asthmatic patients. The effects of ketotifen 1 mg b.i.d. for one month on the changes in spirometry, plasma potassium and serum glucose nebulized salbutamol was compared with placebo. In addition the degree of inhibition caused by local salbutamol on the wheal volume due to intradermal prostaglandin E and bradykinin, was compared following ketotifen and placebo. Nebulized salbutamol produced consistent improvements in spirometry and changes in potassium and glucose levels. Local salbutamol significantly decreased the wheal volume induced by intradermal prostaglandin E and bradykinin. However, none of these salbutamol-induced effects were altered following ketotifen or placebo. Ketotifen, in the doses used, has no demonstrable effect on the beta-adrenergic system in asthmatic patients.

Adolescent↗
PubMed1987

Variability and reversibility of the slow and forced vital capacity in chronic airflow obstruction.

The variability of the forced (FVC) and slow vital capacity (SVC) manoeuvres were compared in 33 adult patients with chronic airflow obstruction. The reversibility of the two manoeuvres to nebulized salbutamol were compared in 18 of the patients. Both manoeuvres had equally small variances both before and after bronchodilator. The degree of reversibility of the FVC was however significantly greater (P less than 0.05) than the SVC. Although both measurements are equally variable, the FVC has a greater capacity for reversibility, which may have clinical significance.

Albuterol↗
PubMed1986

Behçet's disease presenting as benign intracranial hypertension.

Two siblings with Behçet's disease presenting as benign intracranial hypertension are reported and the literature is reviewed. We suggest that raised intracranial pressure should be added to the clinical criteria considered for the diagnosis of Behçet's disease.

Adult↗
PubMed1986

A double-blind comparison of oral prednisolone 40 mg/day with inhaled beclomethasone dipropionate 1500 ug/day in patients with adult onset chronic obstructive airways disease.

A double-blind cross-over trial was carried out on 83 sequential out-patients presenting with adult onset chronic airflow obstruction who were not clearly asthmatic. The study consisted of three treatment phases each lasting two weeks with a two week interval between each phase. The treatment phases were prednisolone 40 mg daily, beclomethasone dipropionate 500 ug three times a day and placebo, administered in a random order. FEV1 and FVC were measured at the end of each of the treatment phases and peak expiratory flow rate five times a day throughout. Over the study period 25 (30%) patients responded with an improvement of greater than or equal to 20% in at least one of the parameters measured as compared with the best of either baseline or placebo measurements. A further eight patients were classified as partial responders with an improvement of greater than 15% in any single parameter or greater than 10% in any two parameters. A similar number responded to beclomethasone [15] as responded to prednisolone [16]. Only six patients, however, responded fully to both forms of steroid therapy. A number of patients responded to one form of steroid treatment only which was also comparable between the two groups (prednisolone 10, beclomethasone 9). For full and partial responders mean improvement in FEV1, FVC and PEFR was greater during the prednisolone phase than during the beclomethasone phase, however, the difference did not achieve statistical significance.

Aged↗
PubMed1985

A study of the use of ultrasonically nebulized lignocaine for local anaesthesia during fibreoptic bronchoscopy.

The use of nebulized lignocaine, with and without intravenous diazepam premedication, was compared with lignocaine given by bolus in 52 patients undergoing fibreoptic bronchoscopy (FOB). Changes in airflow, cardiac rhythm, and transcutaneous PO2 were recorded, and patient acceptability, blood lignocaine levels, and the duration of the procedure were also monitored. Nebulized lignocaine alone provide adequate anaesthesia and the procedures were performed more quickly (P less than 0.05) than when bolus lignocaine was used. Nebulized lignocaine without diazepam was acceptable to the patients and was not associated with the significant (P less than 0.03) falls in transcutaneous PO2 which followed diazepam administration. Nebulized lignocaine, with and without, diazepam premedication is a safe, effective and acceptable method of inducing topical anaesthesia for FOB.

Aerosols↗
PubMed1985

A double-blind comparison of amoxycillin with trimethoprim in acute exacerbations of chronic bronchitis.

Thirty-seven patients with untreated acute exacerbations of severe chronic bronchitis (mean FEV1 0.81), were entered into a double-blind randomized trial comparing amoxycillin 250 mg three times a day with trimethoprim 200 mg twice a day, each given for seven days. Seventeen patients received amoxycillin, from which there was one treatment failure, and 18 patients received trimethoprim, amongst which there were six treatment failures. There were no major differences between the treatments, in this small group of patients, although a significant difference (in favour of amoxycillin) was demonstrated in the patients' subjective dyspnoea score. Because of the difficulties in collecting sufficient patients from a single centre, the definition of the possible role of trimethoprim alone in the treatment of acute axacerbations of chronic bronchitis may have to await multicentre trials.

Aged↗