Showing papers by "Pierre Ernst published in 1992"
TL;DR: The use ofβ-agonists administered by a metered-dose inhaler was associated with an increased risk of death from asthma and the regular use of β2-agonist bronchodilators.
Abstract: Background. Morbidity and mortality from asthma appear to be increasing, and it has been suggested that medications used to treat asthma are contributing to this trend. We investigated a possible association between death or near death from asthma and the regular use of β2-agonist bronchodilators. Methods. Using linked health insurance data bases from Saskatchewan, Canada, we conducted a matched case–control study of subjects drawn from a cohort of 12,301 patients for whom asthma medications had been prescribed between 1978 and 1987. We matched 129 case patients who had fatal or near-fatal asthma with 655 controls (who had received medications for asthma but had not had fatal or near-fatal events) with respect to region of residence, age, receipt of social assistance, and previous hospitalization for asthma. Results. The use of β-agonists administered by a metered-dose inhaler was associated with an increased risk of death from asthma (odds ratio, 2.6 per canister per month; 95 percent confidence...
1,148 citations
TL;DR: Data support recent guidelines from several countries that recommend the use of inhaled corticosteroids in moderate and severe asthma.
Abstract: Objective. —To examine the relationship between patterns of use of inhaled beclomethasone dipropionate and the risk of fatal and near-fatal asthma. Design. —Nested case-control analysis of a historical cohort; a further analysis. Setting. —The 12 301 residents of Saskatchewan aged 5 to 54 years who were dispensed 10 or more asthma drugs from 1978 to 1987. Patients. —The 129 persons who experienced asthma death (n=44) and near-death (n=85) and their 655 controls matched as to age and date of entry into the cohort, with the additional matching criteria of at least one hospitalization for asthma in the prior 2 years, region of residence, and having received social assistance. Main Outcome. —Life-threatening attacks of asthma defined as death due to asthma or the occurrence of hypercarbia, intubation, and mechanical ventilation during an acute attack of asthma. Results. —After accounting for the risk associated with use of other medications and adjustment for markers of risk of adverse events related to asthma, subjects who had been dispensed, on average, one or more metered-dose inhalers of beclomethasone per month over a 1-year period had a significantly lower risk of fatal and near-fatal asthma (odds ratio, 0.1; 95% confidence interval, 0.02 to 0.6). Conclusion.—These data support recent guidelines from several countries that recommend the use of inhaled corticosteroids in moderate and severe asthma. ( JAMA . 1992;268:3462-3464)
283 citations
TL;DR: NPV as used in this study is difficult to apply and ineffective when used with the aim of resting the respiratory muscles in patients with stable COPD.
120 citations
TL;DR: The gathering evidence that test failure may be of itself an indicator of impaired respiratory health, and its association with bronchial hyperresponsiveness to methacholine in men suggests that in them test failure is related to airway lability, but in women the relationship to smoking suggests an irritative mechanism.
Abstract: Spirometric test failure has been defined as failure by a subject to meet the acceptability and/or reproducibility criteria laid down by the American Thoracic Society for measurements derived from forced expiratory maneuvers The prevalence and determinants of spirometric test failure were examined in 416 men and women aged 20 to 45 yr working in an office environment In this study population, 115% (28 men and 20 women) exhibited test failure for forced expiratory volume in one second (FEV1) The main determinant of test failure in men was bronchial hyperresponsiveness to methacholine challenge (odds ratio 67; confidence interval 17, 271) and in women being a current smoker (odds ratio 402; confidence interval 113, 1433) There was also a relationship to eczema in both men and women, but not at a statistically significant level When FEV1 variability was defined as the difference (in milliliters) between the two best FEV1 values and the results of men and women combined for analysis, significant p
62 citations
TL;DR: It is concluded that double-lung transplantation is an acceptable modality for the treatment of cystic fibrosis patients with end-stage lung disease and may be a better alternative to heart-l Lung transplantation considering the paucity of thoracic organ donors.
59 citations
TL;DR: It would be foolish to ignore Tudor Hart's authoritative paper on the underdiagnosis of asthma, but it must reiterate that the study concerned episodes and not prevalence, and his comments are inappropriate.
Abstract: Practitioners, they are in a better position than us to validate or reject such a conjecture. Our information is that no such effect is evident in the figures. As for the third hypothesis, which they implicitly attribute to us, our version was that \"open cast coal mining increases episodes of asthma.\" To distinguish between open cast coal mining and coal dust is crucial for further work. Finally, though it would be foolish to ignore Tudor Hart's authoritative paper (and others he quotes) on the underdiagnosis of asthma, we must reiterate that our study concerned episodes and not prevalence. His comments are therefore inappropriate.
7 citations