Chronic bronchitis in general practice.

Abstract

hospital. This decision would be hastened by a history of previous resistant attacks. On admission attention must first be directed towards relief of bronchial spasm. Adrenaline when used " in adequate dosage " must still be considered the most effective bronchodilator. It should be stressed that many allegedly resistant cases have been shown to be due to too small a dose. In the absence of obvious cardiovascular contraindications we would recom mend the immediate injection of 20 minims (1.2 ml.) of 1:1,000 adrenaline hydrochloride as advised by Herxheimer, and used by one of us (C. K. R.) Where contraindications exist 0.25 g. of theophylline with ethylenediamine may be given intravenously. For the severe, acute, cyanosed asthmatic sufferer from anoxic anoxaemia the early use of oxygen/carbon-dioxide mixture 95.5% is obviously indicated at a rate of 6 litres a minute. This mixture is used in preference to pure oxygen as the carbon dioxide helps to prevent the onset of apnoea and has an expectorant action (Baseh et al., 1941). While one cannot condemn the use of morphine in status asthma tic us too strongly, because of its central depressant action on a respiration already barely adequate, these patients are as a rule fatigued and apprehensive, and benefit from the safe sedation produced by phenobarbitone sodium, 3 gr. (0.2 g.) intramuscularly. Mucous plugging has been stressed throughout this paper, as it has apparently often contributed to the death of the patient. Potassium iodide renders sputum less viscid and thus easier to expectorate. It should therefore be given as soon as possible, in the form of Lugol's solution, 10 minims (0.6 ml.) three times a day. Cortisone and A.C.T.H. are accepted as powerful anti allergic agents and can be used in attacks resistant to the scheme of treatment outlined above. These drugs encourage fluid retention, however, and this should be borne in mind if there is any sign of cardiac failure. In the asthmatic patient with an infective sputum penicillin should be given in anticipation of bacteriological results.