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Biomedical subjects

R L ZuWallack

Publications and source records attributed to R L ZuWallack.

24 records · Page 2Linked to original sources
PubMed1992

A comparison of the effects of bid and qid dosing on compliance with inhaled flunisolide.

Noncompliance with inhaled steroids is a well-recognized problem in asthma therapy. We compared compliance with bid and qid regimens of inhaled flunisolide in 16 asthmatic subjects. Patients were instructed to take four inhalations bid for T1 to establish baseline compliance. During T2, half (group A) continued this dosing regimen, while the other half (group B) switched to two inhalations qid. Group A compliance did not significantly change from T1 to T2. The percentage of days with less than eight inhalations (underuse) for group B, however, increased from 20.2 +/- 40.3 in T1 (bid dosing) to 57.1 +/- 49.6 in T2 (qid dosing) (p less than 0.001). Concomitantly, the number of daily inhalations decreased from 7.9 +/- 2.5 to 6.8 +/- 3.1 (p less than 0.01). Reduced compliance with qid dosing was due in large part to an increase in frequency of six inhalations per day, resulting from tid use. Compliance with inhaled flunisolide, therefore, was worse with qid than bid dosing.

Administration, Inhalation↗
PubMed1992

An evaluation of severity-modulated compliance with q.i.d. dosing of inhaled beclomethasone.

Although the asthmatic subject's compliance with a regimen of inhaled corticosteroids is often poor, it has been suggested this may improve during periods of increased severity. To test this, we measured daily peak expiratory flow rates (PEFRs), asthma symptoms, and the use of an albuterol inhaler over nine weeks period in ten patients with moderately severe asthma. The effect of changes in these severity indices on compliance with a q.i.d. regimen of inhaled beclomethasone was evaluated. The PEFR was measured in the morning before bronchodilator administration, and symptoms were graded on a scale of 4 to 16, while albuterol and beclomethasone inhalations were electronically recorded. Three measures of compliance with the beclomethasone regimen were used: (1) mean daily compliance ([number of inhalations/number of prescribed inhalations] x 100); (2) underuse, ie, the percentage of days with less than the prescribed number of inhalations; and (3) overuse, ie, the percentage of days with greater than the prescribed number of inhalations. Mean daily compliance was 67 +/- 36 percent, while underuse was observed in 69 percent and overuse in 11 percent of the days. Despite clinical exacerbations in six of the ten patients and considerable variation in the severity indices, no significant relationship was found between the change in asthma severity and compliance with the beclomethasone regimen. These findings do not support the concept of severity-modulated compliance with inhaled corticosteroids.

Administration, Inhalation↗
PubMed1976

Acquired continuous murmur associated with acute pulmonary thromboembolism.

Two cases of a continuous murmur following an acute pulmonary embolic episode are presented, and eight previously reported cases with an acquired postembolic continuous murmur (found in a review of the literature) are discussed. This finding is present in both chronic and acute pulmonary embolism and is suggestive of significant embolic obstruction. Although the continuous murmur is an unusual sign in patients with pulmonary embolism, its auscultation is often quite distinctive, and its appearance may lead to more definitive diagnostic studies when the presentation or associated clinical findings are nonspecific.

Acute Disease↗
PubMedDate not supplied

A comparison of outpatient cardiac and pulmonary rehabilitation patients.

PURPOSE: Although cardiac and pulmonary rehabilitation are frequently considered together, differences in the two populations have not been evaluated adequately. METHODS: This study compared patients who were referred to outpatient cardiac and pulmonary rehabilitation over a 1-year period at the authors' institution. Fifty-five cardiac rehabilitation patients (CR) and 47 pulmonary rehabilitation patients (PR) were studied with respect to age, gender, weight, smoking history, functional status, employment status, numbers and types of diagnoses and medications, and number of recent hospitalizations and hospital days. RESULTS: Cardiac rehabilitation patients were approximately 7 years younger, smoked less, were somewhat heavier, had a markedly better functional status, and were more likely employed than their counterparts in pulmonary rehabilitation. In addition, this group had fewer diagnoses and used fewer medications than PR patients. The number of hospitalizations and hospital days in the year preceding rehabilitation, however, were greater in CR patients than in PR patients. CONCLUSIONS: CR patients and PR patients are quite distinct with respect to demographics, functional status, comorbidity, and hospital resource consumption.

Age Distribution↗
PubMedDate not supplied

Functional status and survival in COPD.

A limitation in functional status is an important factor in the handicap caused by advanced chronic lung disease such as COPD. Indicators of functional status in these patients include exercise performance levels common to everyday activity (such as the six minute walk distance) and scores on self-completed questionnaires rating interference with daily activities (such as the Functional Activities component of the PFSS). Both a longer timed walk distance and a higher functional performance score were highly predictive of survival in independent studies of pulmonary rehabilitation patients. This probably reflects the ability of measures of functional status to quantify non-pulmonary as well as morbidity, both of which contribute to the overall mortality in individuals with advanced lung disease.

Humans↗