Significant Differences In FEV1 Research Articles

Secondary Prevention of Asthma by the Use of Inhaled Fluticasone Propionate in Wheezy Infants (IFWIN): Double-Blind, Randomised, Controlled Study

Murray CS, Woodcock A, Langley SJ, Morris J, Custovic A; IFWIN Study Team. Lancet. 2006;368:754–762 PURPOSE OF THE STUDY. To determine if the early use of inhaled fluticasone propionate in wheezy infants helps to prevent loss of lung function and progression of asthma later in childhood. STUDY POPULATION. High-risk children (N = 1073) identified by having 1 atopic parent were followed prospectively until 2 wheezing episodes occurred or there was 1 wheezing episode longer than 1 month. Of these patients, 206 who met the inclusion criteria were randomly assigned: 104 to placebo and 102 to treatment. The median age was 1.2 years (range: 0.5–4.9 years). Eighty-six percent continued to be followed by their fifth birthday. METHODS. Children were excluded if they had wheeze caused by bronchiolitis, were preterm (<34 weeks’ gestation), had other chronic lung disease or chronic illness, had previous inhaled corticosteroid (ICS) use, or were unable to use the inhaler. The treatment group was started on fluticasone propionate 100 μg twice daily. Randomly assigned patients were followed by monthly telephone calls for the first 3 months, if controlled, and then every 3 months until their fifth birthday. If symptoms were not under control by 3 months, then open-label fluticasone propionate 100 μg was added. Treatment was adjusted to the minimum necessary to control symptoms. Participants were allowed to use β agonists as needed. Parents were asked to keep daily diaries of symptom scores, reliever use, and unscheduled visits. At the age of 5, specific airway resistance (sRAW), forced expiratory volume in 1 second (FEV1), airway reactivity, and postbronchodilator lung function were measured and compared. RESULTS. There was no significant difference between those in the treatment group versus placebo in the proportion of children with current wheeze, physician-diagnosed asthma, use of asthma medication, or current wheeze, even when factoring the addition of those participants who added open-label medication. There was also no significant difference in FEV1 (baseline or postbronchodilator), sRAW, or airway reactivity at 5 years of age in these groups. The 2 groups were similar in the number of children who required, and in the length of time to adding, open-label drug. Symptom scores, use of reliever medication, and unscheduled visits to the family doctor were similar until the third month, when children in the treatment group had lower median daily symptom scores, a trend toward less reliever medication, and significantly fewer visits than those in the placebo group. In the 2 open-label drug groups, there was a greater risk of current wheeze, current use of asthma medications, and current wheeze with asthma medications compared with those in the placebo group, although there was no difference in baseline or postbronchodilator FEV1. However, there was a significantly higher sRAW in the treated groups, which represented decreased lung function. CONCLUSIONS. The use of ICS in young children at risk for asthma with the earliest sign of recurrent wheezing had no significant effect on the natural history of wheezing, lung function, or airway reactivity by 5 years of age and only showed a small improvement on symptom scores and unscheduled physician visits after the third month of the study. Higher postbronchodilator sRAW showing reduced lung function was seen in children in the treated group compared with those in the placebo group. REVIEWER COMMENTS. Evidence for the efficacy of ICS in infants and very young children remains unclear. It has been suggested that early use of ICS could be detrimental to the lung development on the basis of the sRAW scores of ICS-treated patients. However, children in both the treatment and placebo groups required the addition of fluticasone equally, which suggests that perhaps those in the treatment group had worse disease. Prestudy lung function was not tested, and individual atopic status was not assessed to determine if these 2 groups were truly equivalent. Studies are needed to determine if atopy is a confounding factor and whether controlling for allergen exposure in addition to ICS has an effect on asthma outcomes. This study and other similar studies suggest that ICS can improve asthma symptoms, but early use does not modify the disease.

Methacholine dry powder inhaler as a new tool for bronchial challenge test

Background The methacholine (MCH) challenge test is performed to detect bronchial hyperresponsiveness in subjects suffering from asthma. It is conducted by inhaling spasmogen substances at increasing doses and measuring FEV1-PD20 variation following the bronchoconstriction evoked. Aim This paper describes a new method for MCH challenge test using pre-metered respirable powders of MCH at different doses for facilitating test execution. The availability of a series of pre-metered doses gives higher control over aerosolized dose and fine particle fraction (respirable dose), improving the accuracy and repeatability of the test. Dosimetric tests with MCH solution and pre-dosed powder challenge tests were clinically compared. Methods and materials The inhalation powders were prepared by spray drying of solutions of methacholine, mannitol and hydroxypropylmethylcellulose in which different concentrations of MCH were included. The methacholine powders prepared were carefully characterized in terms of aerodynamic properties. Results Inhalation powders containing methacholine from 12.5 to 200 μg per metered dose, having a fine particle fraction between 40 and 60%, were prepared using mannitol and cellulose polymer. Eighteen subjects (12 hyperresponsive and six normal) were subjected to both the MCH solution and powder tests in random sequence. No significant differences in FEV1 and PD20 values were found between the challenge tests performed with liquid and powder formulations of methacholine. Conclusions Powders of MCH having high respirability of the delivered doses can be prepared by spray drying. They allow for the performance of a challenge test using a dry powder inhaler. The powder dose series can be an alternative to the current dosimetric test with MCH solutions.

Impact of obesity on ventilatory function

Although obesity was found to be associated with severe impairment of ventilation, most of the study population has been morbidly obese adults. We aimed to explore the effects of mild obesity on ventilatory function in the pediatric age group. In a cross-sectional controlled study, 80 patients (M/F: 35/45), who were evaluated in our outpatient clinic with the complaint of excess body weight, with no history of asthma or other atopic diseases were studied and compared to a control group of 50 normal weight children controlled for age and sex. The mean age of patients was 9.7+/-2.5 years (7 to 15 years). Anthropometric measurements and spirometry were performed in all subjects. Forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were used as measures of ventilatory function. There were no significant differences in FEV1%, FVC% and FEV1%/FVC% by study group (p > 0.05). Only three patients had obstructive abnormalities documented on their pulmonary function tests (two had moderately severe and one had mild obstructive abnormalities). No correlation was observed between pulmonary function parameters and anthropometric measurements. These data demonstrate that pulmonary function test parameters of the mildly obese children were similar to those of the normal weight children. Anthropometric measurements had no significant effect on spirometric measurements in children as they did on adults.

Validation of a guideline-based composite outcome assessment tool for asthma control

BackgroundA global definition of asthma control does not currently exist. The purpose of this study was to validate two new guideline-based composite measures of asthma control, defined as totally controlled (TC) asthma and well controlled (WC) asthma.MethodsWe used data from 3416 patients randomised and treated in the multi-centre Gaining Optimal Asthma controL (GOAL) study. The criteria comprising the asthma control measures were based on Global Initiative for Asthma/National Institutes of Health guidelines. This validation study examined the measurement properties of the asthma control measures using data from run-in, baseline, 12 and 52 weeks. Forced expiratory volume in 1 second (FEV1) and the Asthma Quality of Life Questionnaire (AQLQ) were used as the reference criteria in the validation analysis.ResultsBoth measures had good discriminative ability showing significant differences in FEV1 and AQLQ scores between control classification both cross-sectionally and longitudinally (p < 0.001). Overall both of the composite measures accounted for more of the variance in FEV1 after 52 weeks than the individual components of each asthma control measure. Both of the reference criteria were independently related to each asthma control measure (p < 0.0001). The measures also had good predictive validity showing significant differences in FEV1 and AQLQ scores at 52 weeks by control classification at 12 weeks (p < 0.0001).ConclusionThe guideline-based composite asthma control measures of WC asthma and TC asthma have good psychometric properties and are both valid functional indices of disease control in asthma.

Effect of montelukast on peripheral airflow obstruction in children with asthma

Montelukast is a widely used controller agent in childhood asthma. It is modestly effective in reducing symptoms, decreasing the need for rescue albuterol, and improving forced expiratory volume in 1 second (FEV1). To determine whether montelukast therapy improves peripheral airway obstruction as measured by lung volumes, air trapping, airway resistance (Raw), and specific conductance (Sgaw). Twenty-one children aged 9 to 18 years with mild-to-moderate asthma were randomized into a double-blind, placebo-controlled study to receive montelukast (5 or 10 mg) or matching placebo daily for 8 weeks. Symptoms and albuterol use were recorded twice daily, and exhaled nitric oxide measurement, forced oscillometry, spirometry, and body box plethysmography (before and after beta-agonist use) were performed at randomization and at 2, 4, 6, and 8 weeks. Circulating eosinophil counts and serum eosinophil cationic protein (ECP) levels were obtained at randomization and at 8 weeks. Montelukast-treated patients had lower residual volume (P = .05), residual volume-total lung capacity ratio (P = .04), Raw (P = .02), Sgaw (P = .03), and serum ECP levels (P = .02) at 8 weeks compared with those treated with placebo. There was a trend toward reduced daytime and nighttime albuterol use, although the difference did not reach statistical significance. There were no significant differences in FEV1, FEV1-forced vital capacity ratio, exhaled nitric oxide levels, or daytime and nighttime symptom scores between the 2 groups. Montelukast therapy was associated with less air trapping, hyperinflation, and Raw and better Sgaw compared with placebo. Lower serum ECP levels, a surrogate measure of airway inflammation, were associated with improvements in lung function.

Psychological interventions for adults with asthma

Many people have asthma, and for some their symptoms may be triggered by psychological factors. In addition compliance with medical therapy may have a psychological dimension. Therefore, psychological interventions aim to reduce the burden of symptoms and improve management of the disease. To assess the effectiveness of psychological interventions for adults with asthma. The Cochrane Airways Group Specialised Register and PsycINFO were searched with pre-defined terms up until August 2005. Randomised controlled trials published in any language assessing the effects of a psychological intervention compared with a form of control in adult participants were included in the review. Two reviewers assessed the relevance of abstracts identified by electronic searching and retrieved agreed studies for further scrutiny. The studies that met the inclusion criteria were assembled and data extracted. Fourteen studies, involving 617 particpants, were included in the review, however study quality was poor and sample sizes were frequently small. However, some pooled effects were analysed. The use of 'as needed' medications was reduced in two studies, (47 patients), by relaxation therapy (OR 4.47, CI 1.22 to 16.44). There was no significant difference in FEV1 for relaxation therapy in four studies of 150 patients, (SMD -0.01, CI -0.41 to 0.40). Quality of life, measured using the Asthma Quality of Life Questionnaire in two studies, (48 patients), showed a positive effect following CBT (WMD 0.71, CI 0.23 to 1.19). Peak Expiratory Flow outcome data in two studies, (51 patients), indicated a significant difference in favour of bio-feedback therapy (SMD 0.66, CI 0.09 to 1.23). The remainder of the findings between studies were conflicting. This may have been due to the different types of interventions used and the deficiencies in trial design. This review was unable to draw firm conclusions for the role of psychological interventions in asthma due to the absence of an adequate evidence base. Larger, well-conducted and reported randomised trials are required in this area, in order to determine the effects of these techniques in the treatment of asthma in adults.

THE EXPOSURE OF TOLUENE AND RESPIRATORY PROBLEMS AMONG AUTOMOTIVE INDUSTRY WORKERS IN SELANGOR

ISEE-439 Aim: A cross sectional study was carried to determine the association between toluene in air and urinary hippuric acid (toluene metabolite), and pulmonary functions and respiratory symptoms among exposed workers in an automotive industry in Selangor. Methods: Workers in the paint shop were selected as the exposed group (N = 66) and a group of administrative workers (N = 42) was the control group. Respiratory symptoms were determined using a modified American Thoracic Society's questionnaire. Individual workers' breathing zones were sampled for toluene at the beginning and before the end of the work shift. Toluene was analyzed using gas chromatography. Measurements of pulmonary function were carried out with a spirometer. Urine samples were collected at the end of the work shift. Urine hippuric acid levels were analyzed by high performance liquid chromatography. Results: Respiratory symptoms most commonly experienced by the respondents were cough with phlegm (70.97 %); the least common symptom was shortness of breath (12.90 %). The prevalence of respiratory symptoms was significantly higher among the exposed group [cough (p< 0.001); cough with phlegm (p<0.001); chest tightness (p=0.003)]. The mean air toluene concentration was 1.44 ppm (SD = 4.47). A significant association was found between air toluene levels and chest tightness (χ2 =4.364, p=“0.037”). The exposed group had a significantly higher prevalence of abnormal FEV1% predicted, FVC% predicted and FEV1/FVC% predicted, than the comparative group. There were significant differences in the FVC% predicted (p=0.015), FEV1% predicted (p<0.001) and FEV1/FVC% predicted (p<0.001), between the two groups. ANCOVA analysis showed a significant difference in FEV1 (p<0.001), FEV1% predicted (p<0.001) and FEV1/FVC% predicted (p<0.001) between the two study groups, after adjusting for age, work duration, body mass index and smoking habits. The mean urinary hippuric acid concentration was 0.24 μg/g creatinine (SD = 1.40 μg/g creatinine). There was no significant correlation between urinary hippuric acid and any of the respiratory symptoms, lung function outcomes, or the air toluene levels. Multiple linear regression analysis showed that no variable significantly influenced the lung function tests and urinary hippuric acid concentrations. Conclusion: Exposure to organic solvents has significant chronic health effects, as indicated by the higher prevalence of respiratory symptoms and the reduction in lung functions, among the exposed group. The air toluene and urinary hippuric acid levels were not associated with the lung function results. Therefore, chemical compounds in the solvents, which have not been identified in this study, may have been associated with the respiratory problems.

Oral corticosteroids for stable chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a common chronic lung disorder, usually related to cigarette smoking, representing a major and increasing cause of morbidity and mortality. It is defined "as a disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases". The use of corticosteroids for their anti-inflammatory effects has been suggested. To assess the effects of oral corticosteroids on the health status of patients with stable COPD. Searches of the Cochrane Airways Group Specialised Register and MEDLINE were carried out in December 2003 and 2004. Review articles and bibliographies were searched. Randomised controlled prospective studies in adults with stable COPD ( post-bronchodilator FEV1 <80% of predicted, FEV1/FVC <70%) and a history of smoking, excluding known asthmatics, in which oral steroid use was compared with placebo and use of co-interventions was matched in both groups. Data was extracted independently by two reviewers. All trials were combined using Review Manager (version 4.2.7). From 459 titles 24 studies met the inclusion criteria. Treatment lasted three weeks or less in 19 studies, high dose oral steroid was used in 21 studies and subjects had moderate or severe COPD in 15 studies. There was a significant difference in FEV1 after two weeks treatment, WMD 53.30 ml; 95% confidence interval 22.21 to 84.39 favouring oral steroid use compared to placebo when 14 studies with available data (n=396) were combined, with no significant heterogeneity. There was a significant increase in odds for individual patient FEV1 response greater than 20% from baseline with high dose oral steroid treatment compared to placebo, OR 2.71; 95% CI 1.84 to 4.01 (9 studies) . It would be necessary to treat 7 patients (95% CI 5 to 12) with oral corticosteroids to achieve one extra case of increasing FEV1 by more than 20%, with a placebo group risk of 0.13. All differences in health-related quality of life were less than the minimum clinically important difference. There were small statistically significant advantages for functional capacity and respiratory symptom of wheeze with oral steroid treatment but no significant difference in risk of withdrawal from study due to an exacerbation or rate of serious exacerbations over 2 years with low dose oral steroid treatment. There was an increased risk of adverse effects, including increased blood glucose, adrenal suppression and reduced serum osteocalcin. There is no evidence to support the long-term use of oral steroids at doses less than 10-15 mg prednisolone though some evidence that higher doses (>/= 30 mg prednisolone) improve lung function over a short period. Potentially harmful adverse effects e.g.. diabetes, hypertension, osteoporosis would prevent recommending long-term use at these high doses in most patients.

Treatment of asthma at asthma-relieving earpoint and its influence on FEV1 and PEF

Purpose: To investigate the treatment of asthma at asthma-relieving earpoint and its influence on FEV1 and PEF. Method: One hundred and seventy-eight patients exactly diagnosed with bronchial asthma were selected and averagely divided, according to a simple random number table, into an asthma-relieving earpoint treatment group (observation group) and a body acupuncture treatment group (control group). Results: The effective rate was 90.0% in the observation group and 91.0% in the control group. A comparison of the curative effects between the two groups showedP>0.05. In the observation group there were significant differences in FEV1 and PEF between pretreatment and posttreatment (P<0.05 andP<0.01, respectively). Conclusion: Asthma-relieving earpoint is markedly effective in treating asthma and has a certain influence on lung function.

Effect of single and double strap backpacks on lung function

Carrying heavy and moderate military loads in backpacks or as body armour compresses the chest, causing a change in lung function that is typical of a restrictive ventilatory impairment. It is not known if a lighter backpack load of only 6 kg, such as is typical of loads carried by students, will have a similar effect on lung function. There have been no studies examining whether backpacks of different strapping styles have an effect on lung function. Several designs of student backpack have recently been introduced to the market. One of the most popular is a single-strap backpack. This study examined Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), FEV1.FVC − 1% and Peak Expiratory Flow (PEF) in 13 participants (4 males, 9 females) wearing each of two 6 kg backpacks, one with two shoulder straps (a Double Strap Backpack (DSB)) and the other with a single strap (a Single Strap Backpack (SSB)) worn across the shoulder and chest. In comparison with the control of no pack (N), SSB significantly reduced FVC (by 3.94%, p = 0.006) but there were no significant differences in FEV1, FEV1. FVC − 1% and PEF. The DSB also significantly reduced FVC (by 1.97%, p = 0.034) but no significant differences were found in FEV1, FEV1. FVC − 1% and PEF measures. In comparison with DSB, the SSB was associated with a significantly lower FVC (by 2.05%, p = 0.049) and FEV1 (by 1.88%, p = 0.029) but there were no significant changes in FEV1. FVC − 1% and PEF. It is concluded that a backpack load of 6 kg could produce a mild restrictive type of ventilatory impairment in lung function. This effect was greater for a single cross-chest strap than for a more conventional double strap harness.

The potential for bronchoscopic lung volume reduction using bronchial prostheses. A pilot study

The potential for bronchoscopic lung volume reduction using bronchial prostheses. A pilot study

To clip or not to clip? Noseclips for spirometry.

The use of noseclips for open-circuit spirometry is sporadic, despite guidelines encouraging their use. The authors aimed to evaluate whether noseclips significantly affected measurements of forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) in children attending a tertiary, paediatric respiratory centre. Children attending the asthma and cystic fibrosis (CF) clinics were asked to perform two sets of spirometry, one with and one without noseclips in random order, 20-min apart. Paired data was obtained on 62 patients (32 asthma, 30 CF) with a median age of 11.4 yrs (range 7.2-17.2 yrs). There were no systematic differences in FEV1 or FVC measured with and without noseclips, although seven children (11%) had clinically significant differences in FEV1 of >190 mL. There is no clear advantage to wearing noseclips when performing open-circuit spirometry. Individuals should be assessed to ascertain their optimal technique, which should then be used consistently in clinical practice. Noseclips should probably be retained for research protocols.

Effects of hypertonic saline, alternate day and daily rhDNase on healthcare use, costs and outcomes in children with cystic fibrosis

Background: Daily recombinant human deoxyribonuclease (rhDNase) is an established but expensive treatment in cystic fibrosis (CF). An alternative lower cost therapy is hypertonic saline (HS), which has been shown to...

Low-dose levalbuterol in children with asthma: Safety and efficacy in comparison with placebo and racemic albuterol

Background: Racemic albuterol (RAC) is an equal mixture of (R)-albuterol and (S)-albuterol. Only the (R)-isomer, levalbuterol (LEV), is therapeutically active. Lower doses of LEV, devoid of (S)-albuterol, have demonstrated efficacy comparable to that of higher doses of the (R)-isomer administered as a component of RAC. Objective: The purpose of this study was to determine whether LEV results in improved safety and efficacy in children. Methods: Asthmatic children aged 4 to 11 years (n = 338; FEV1, 40% to 85% of predicted) participated in this multicenter, randomized, double-blinded study and received 21 days of 3-times-a-day treatment with nebulized LEV (0.31 or 0.63 mg), RAC (1.25 or 2.5 mg), or placebo. The primary endpoint was FEV1 (peak percent change). Adverse events, clinical laboratory test results, vital signs, and electrocardiograms were evaluated for safety. Results: All active treatments significantly improved the primary endpoint in comparison with placebo (P < .001). Significant differences in FEV1 were noted immediately after nebulization (median change, 2.0%, 19.0%, 18.1%, 12.4%, and 15.6% for placebo, LEV 0.31 and 0.63, RAC 1.25 and 2.5 mg, respectively; P < .05 vs placebo; P < .05 for LEV 0.31 and 0.63 vs RAC 1.25 mg). LEV 0.31 mg was the only treatment not different from placebo for changes in ventricular heart rate, QTc interval, and glucose (P > .05). All active treatments decreased serum potassium (range, –0.3 to –0.6; P < .002 vs placebo), and RAC 2.5 mg caused the greatest change (P < .005 vs other actives). In a patient subset with severe asthma, a dose-response relationship was observed for levalbuterol, indicating that higher doses were more effective. Conclusion: LEV was clinically comparable to 4- to 8-fold higher doses of RAC, and it demonstrated a more favorable safety profile. LEV 0.31 mg should be used as the starting dose in 4-11 year old children with mild to moderate persistent asthma. Patients with severe disease might benefit from higher doses. (J Allergy Clin Immunol 2001;108:938-45.)

The effect of shoulder-girdle loading by a school bag on lung volumes in Chinese primary school children.

Heavy loading of the spine may induce musculoskeletal problems in children. Local surveys reported frequent overloading of school bags carried by primary school children. The effect of an overweight school bag on the child's lung function has not been reported. To investigate the effect of shoulder-girdle loading on forced expiratory lung volumes in primary school children and to compare this effect with that of an assumed kyphotic posture. Forty-three primary school children, mean age 9.6 years underwent spirometry lung-function measurements, while adopting the following five conditions in random order: free standing; kyphotic standing; standing wearing a backpack weighing 10%, 20% and 30% of their body weight. Forced expiratory volume in the first second (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEF). There were no significant differences in FEV1 and FVC between free standing and the 10% body weight load. However, both FEV1 and FVC decreased significantly when the student adopted the kyphotic posture and when the load in the backpack was increased to 20% and 30% of body weight. This study demonstrates a restrictive effect on lung volumes when a school-bag load is heavier than 10% of a child's body weight. Our results also confirm the detrimental effect of a kyphotic posture on pulmonary mechanics and the necessity for health-care professionals to advocate proper postural advice to school children, teachers and parents.

Efficacy of HFA-beclomethasone dipropionate extra-fine aerosol (800 μ g day−1) versus HFA-fluticasone propionate (1000 μ g day−1) in patients with asthma

Hydrofluoroalkane-134a beclomethasone dipropionate (HFA-BDP) extra-fine aerosol and HFA-fluticasone propionate (HFA-FP) are chlorofluorocarbon-free inhalers.We conducted an 8-week, open study to demonstrate the equivalence of HFA-BDP (800 μ g day−1) and HFA-FP (1000 μ g day−1) in moderate to severe asthma. Symptomatic patients on 500–1000 μ g day−1CFC-BDP (or equivalent) and short-acting β -agonist, were randomized to HFA-BDP (n=101) or HFA-FP (n=97) after 7–14 (±2) day run-in.In the intent-to-treat (ITT) population (n=198), both treatments provided clinically and statistically significant improvements in asthma control, with increases in peak expiratory flow in the morning (AM PEF) and asthma symptoms (within treatment analysis P<0·05). Mean (SE) change in AM PEF from baseline at week 8 was equivalent (defined as 90% CI for the mean difference between treatments within ±25 l min−1) in the two groups: 29·59 (5·19) 1 min−1for HFA-BDP vs. 17·3 (5·45) 1 min−1for HFA-FP (90% CI−0·02, 24·91). For the per-protocol population (n=121), the mean (SE) change in AM PEF from baseline was not equivalent; AM PEF improved to a significantly greater extent in the HFA-BDP group than HFA-FP group [34·84 (7·08) vs. 20·63 (7·32) 1 min−1P<0·01; 90% CI; 2·66, 31·10]. At week 8 in the ITT population, there were no statistically significant differences in FEV1, β -agonist use, asthma symptom/sleep disturbance scores, or percentage of days without asthma symptoms/sleep disturbance. There was a significantly greater reduction from baseline in mean eosinophil count for HFA-BDP compared with HFA-FP at weeks 3 and 8 (P<0·01), and eosinophil cationic protein value at week 8 (P<0·01). Both treatments were well tolerated and there were no statistically significant differences in urinary cortisol creatinine parameters.In conclusion, this study showed that, in patients with moderate-to-severe symptomatic asthma, HFA-BDP extra-fine aerosol 800 μ g−1was at least as effective and equally well tolerated as 1000 μ g day−1HFA-FP.

Acoustic parameters of voluntary cough in healthy non-smoking subjects.

The aim of this study was to explore cough in healthy subjects. We studied 234 coughs generated by 24 (12 males) healthy non-smokers (forced expiratory volume in 1 s (FEV1) 103+/-8% of predicted), who had no significant differences in FEV1 and age between males and females. For each subject, several bouts of voluntary coughing were recorded using a personal computer with an A/D converter (sampling rate 10 kHz, 8 bit resolution) and the first and second coughs of each bout were analysed using short-time Fast Fourier Transformation. For each cough we studied the three phases that are produced. In particular, we studied the duration of the three parts, loudest frequency in the first part, lowest and highest frequencies, number of continuous frequencies and lowest and highest continuous frequencies in the second part, and the loudest frequency of the third part if present. We found significant differences between males and females in length of the first part (41.4+/-14 vs 44.7+/-10.4 msec, P = 0.04), loudest frequency of the first part (362+/-145 vs 449+/-145 Hz), lowest frequencies (282+/-100 vs 348+/-135 Hz) and highest continuous frequencies (3877+/-571 vs 4147+/-362 Hz; P < 0.001) of the second part. An interesting finding was that healthy males and females had the same number of continuous frequencies. Different frequencies are probably a consequence of anatomical differences in airway geometry involved in the cough. In cough frequency spectrum studies the differences between the two sexes should be taken into account to reduce the variability of the results.

Additive Effects of Prednisolone and Beclomethasone Dipropionate in Patients with Stable Chronic Obstructive Pulmonary Disease

It remains unclear whether inhaled corticosteroids can produce the maximum benefits of corticosteroids in patients with chronic obstructive pulmonary disease (COPD). To assess the additive effects of 30 mg/day prednisolone to high-dose, inhaled beclomethasone dipropionate (BDP), we conducted a randomised double-blind, placebo-controlled cross-over trial. The study population consisted of 21 men with stable COPD. The mean age of the patients was 69.1 ± 6.8 years, and FEV1was 0.86 ± 0.28 l. Seventeen out of the 21 patients (81%) were considered susceptible to steroids in a previous trial (FEV1increased at least 15% from baseline after receiving 14 days of 30 mg/day prednisolone). All of the patients had been on 1600 μg/day BDP for more than 3 months. Spirometry was performed before the entry, and at the end of 3-week placebo and prednisolone periods. The peak expiratory flow (PEF), symptoms, and Guyatt's Chronic Respiratory Disease Questionnaire (CRQ) as a disease specific health-related quality of life over the last seven days of each period were also evaluated. Although a marginal increase in PEF was found during the prednisolone period, no significant differences in FEV1, FVC, symptoms or CRQ scores were observed between the two treatment periods. We conclude that the therapeutic effects of steroid therapy may be achieved by the long-term use of high-dose, inhaled corticosteroid in some patients with stable COPD.

Elective versus symptomatic antibiotic treatment in cystic fibrosis patients with chronic Pseudomonasinfection of the lungs

BACKGROUNDA previous retrospective study suggested that a policy of regular anti-pseudomonal antibiotic treatment improved pulmonary function and increased survival in patients with cystic fibrosis chronically infected with Pseudomonas species. The...

Rapid Reversibility of the Allergen-Induced Pulmonary Late-PhaseReaction by an Intravenous β2-Agonist

Peebles R Jr, Permutt S, Togias AJ Appl Physiol.84199815001505To determine the degree to which β2-adrenergic receptor agonists can reverse the allergen-induced late reduction in lung function.Seven allergic subjects with mild asthma.In phase I of the study, terbutaline was administered as an initial bolus followed by continuous intravenous infusion over 45 minutes to determine the maximal attainable bronchodilation at baseline. In phase II, the subjects underwent an allergen inhalation (ragweed) challenge until forced expiratory volume in 1 second (FEV1) declined by at least 20%. Seven hours later, subjects were randomized and crossed over to receive terbutaline or a vehicle intravenous infusion identical to the phase I infusion protocol. Forced expiratory spirometry was performed at baseline and every hour after allergen-inhalation challenge. Spirometry was performed before and every 5 minutes through terbutaline (phase II and I) and placebo infusion (phase II) as well.At baseline, there was no significant difference in FEV1 or forced vital capacity (FVC) between phase I and phase II. In phase I, terbutaline infusion led to significant improvement in FEV1compared with preinfusion value (P < .03). After ragweed bronchoprovocation FEV1 decreased <85% at any single timepoint between hour 4 and 7 postallergen inhalation. On the day placebo was infused 7 hours after allergen inhalation, FEV1 values did not change significantly compared with the preinfusion value (P > .2). In contrast, on the day terbutaline was infused, FEV1 was significantly higher than preinfusion (P < .02). The overall pattern of FVC was the same as for FEV1. The kinetic curves for bronchodilator response to terbutaline infusion in phase I and in phase II were superimposable, indicating that the terbutaline induced bronchodilation was driven by the same pharmacologic mechanism.The late reduction in lung function caused by allergen inhalation challenge in asthmatic subjects is rapidly and almost completely reversible by an intravenous β2-adrenoreceptor agonist.Most previous studies have demonstrated that inhaled β2-adrenoreceptor agonists are only partially effective in reversing allergen-inhaled late phase airway obstruction. Interestingly, the ability to reverse this type of airway obstruction appears to be significantly enhanced using an intravenous route for drug administration. These observations challenge the current dogma that the airway obstruction observed 4 to 8 hours after allergen challenge is mostly related to airway edema, inflammation, and mucus secretion as opposed to bronchial smooth muscle spasm. A third arm of the study in which equivalent doses of β-agonist were given by aerosol would have been helpful in determining what role drug delivery may have contributed to the observed results.