Biomedical subjects
Publications and source records attributed to W B Klaustermeyer.
The authors have demonstrated that patients with bronchial asthma may react to diluent provocative challenge. The pattern of airway response to diluent was found to be reproducible. The data herewith presented suggest that the baseline airway obstruction in adult asthma is highly variable but the degree of baseline obstruction is not related to the response to diluent challenge.
To investigate the mechanism underlying the airway response to diluent challenge, three adult asthmatic patients who were known to be reactive to inhaled diluent were studied. Airway response as measured by conventional pulmonary function testing was measured under the conditions of time, inhalation of room air, diluent and placebo. Two of the patients responded to time or to room air, suggesting that the response was not due to the phenol-buffered diluent. The third subject reacted primarily to the diluent and not to time, room air or normal saline. Two of the three patients were placebo responders.
The airway response to methacholine was measured in 27 asthmatics. Selected indices of airway response were measured at 5-, 10- and 20-minute intervals and at three concentrations of methacholine. The mean change from control was significant at all three concentrations and there were no significant differences between time intervals. High correlations were obtained between all indices of airway response to methacholine challenge.
In two cases of baker's asthma pulmonary hypersensitivity was found to the fungi Alternaria and Aspergillus. Provocative bronchial challenge revealed a dual response; an immediate and an Arthus type hypersensitivity to Aspergillus in the first case. A primary binding assay revealed high titres of anti-Aspergillus antibody in the serum. In the second case intradermal and bronchial challenge suggested an immediate type I hypersensitivity response to Alternaria. The suspected organisms were present in the room air of the bakeries. It is suggested that an immunological response to these airborne fungi may have contributed to the pathogenesis of baker's asthma.
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The intent of this investigation was to determine the acute effect on the airways of a single dose of intravenous corticosteroid in patients with severe bronchospasm. Following the intravenous injection of corticosteroid the initial response occurred at one to two hours and peaked at four hours. Significant changes occurred at four to six hours in central airways and in smaller airways.
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Changes in lung mechanics were measured in asthmatic adults before and after a 10-day course of daily and a three-week course of alternate day adrenocortical steroid therapy. All patients improved after the 10 days of therapy. This response continued during the a.m. measurements on the alternate day regimen with further improvement through the afternoon of the treatment day. In the afternoon of the day off corticosteroid therapy there was a deterioration in flow rates.
Intravenous isoproterenol was infused into 7 adult asthmatic patients with refractory bronchial obstruction. Over a dose range of 0.0375 to 0.225 mug per kilogram per minute, maximal bronchodilator effect (or reversal of effect) occurred within 2 to 5 minutes of starting (or stopping) the infusion. Obstruction to airflow improved with each increment of dose. Average heart rate reached a maximum at 0.075 mug per kilogram per minute. Over the lower dose range alveolar to arterial oxygen gradients widened and heart rate increased; over the higher dose range, as heart rate plateaued, bronchodilator effect continued and oxygen gradient narrowed. When combined with adequate oxygenation and continual monitoring of cardiac rhythm and blood pressure, intravenous isoproterenol appears safe for asthmatic patients. Major advantages are (1) administration of bronchodilator to airways not reached by inhalation, (2) prompt onset and offset of effects, and (3) reversal of undesirable side effects. The use of intravenous isoproterenol may obviate the need for intubation and ventilatory assist.
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We studied 24 corticosteroid dependent asthmatic patients over a period of 10 months to establish a baseline for future therapeutic trials with corticosteroid sparing agents. Clinical symptoms, steroid dose, peak expiratory flow rate (PF), forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC) were recorded at clinic visits. Correlation was sought between PF and FEV1, steroid dose versus PF and symptom severity, and PF versus time and symptoms. There was considerable weekly variability of PF and FEV1. However, when viewed over almost a year, 54% had no significant change in PF. 29% actually worsened and 17% improved. The data suggest that to assess the effect of a steroid-sparing agent accurately, one must first establish a reliable baseline over several months to eliminate weekly variability. The current trend of obtaining a baseline over a 1 to 2 month interval is inadequate in this study population. We also found that neither patient assessment of severity of symptoms nor corticosteroid dosage correlate with objective spirometric measurements.