European journal of respiratory diseases 

About: European journal of respiratory diseases is an academic journal. The journal publishes majorly in the area(s): Asthma & Respiratory disease. It has an ISSN identifier of 0106-4339. Over the lifetime, 686 publications have been published receiving 13095 citations.

Rate of decline of lung function in subjects with asthma.

Abstract: Retrospective and prospective questionnaire and lung function data, collected during seven population health surveys over 18 years in Busselton, Western Australia, have been analysed for 92 subjects with asthma and 186 normal subjects. Subjects who had a minimum of four observations over an 18-year period were selected; the age range at first study was 22-69 years. Individual regression analyses of forced expiratory volume in one second (FEV1), adjusted for height, on age were used in analyses. Subjects with asthma had a greater rate of decline in FEV1 (p less than 0.01) and a lower baseline lung function (p less than 0.001). The mean loss of FEV1 in males of 1.7 m height was 50 ml/year in nonsmokers with asthma compared with 35 ml/year in the normal subjects. The effect of asthma was variable and not all subjects with asthma had steep rates of decline. There were insufficient numbers of smokers with asthma to draw conclusions about an effect of cigarette smoking additional to the effect of asthma. No relationship was found between rate of decline of FEV1 and age or atopic status. In subjects with asthma, bronchial hyperresponsiveness, which was measured at the end of the study, accounted for 9% of the variation in rate of decline of FEV1 and airflow limitation, measured by FEV1 FVC, accounted for 10%. Further studies are needed to determine whether the steep rates of decline found in subjects with asthma are preventable.

Sensitivity to heat and water loss at rest and during exercise in asthmatic patients.

Abstract: We investigated the respiratory heat and water loss in 24 asthmatic patients who performed bicycle exercise while inspiring air conditioned to varying temperatures and water contents. Measurements of peak expiratory flow and forced expiratory volume in 1 s were made at rest, during and after exercise to determine changes in airways resistance. Respiratory heat and water loss were measured using rapid thermistors and a mass spectrometer to measure inspired and expired temperature and water vapour pressure. Exercise-induced asthma (EIA) was enhanced as the inspired water content of the air was reduced. However, there was a wide variation in sensitivity to the loss of heat and water between individual patients. This variability could not be accounted for by differences in body size. When patients inspired air conditioned to body temperature and fully saturated with water vapour, EIA was significantly reduced; however, half the patients still had an attack of asthma following exercise which had induced no significant loss of heat or water. It is suggested that the bronchoconstriction induced by water loss from the airways during exercise may be due to a change in osmolarity in the respiratory tract fluid.

How should a pressurized beta-adrenergic bronchodilator be inhaled?

Abstract: Although the manufacturers of pressurized aerosol bronchodilators issue instructions for using the inhalers, little or no experimental verification exists. Furthermore, the instructions often fail to take into account known facts about aerosol deposition. We have reviewed the evidence for the most effective mode or modes of inhalation of pressurized aerosol bronchodilators, some of which has arisen from experiments performed in our laboratory. In order to achieve a maximal effect following inhalation of terbutaline sulphate bronchodilator aerosol (Bricanyl, Astra Pharmaceuticals), the canister should be actuated during a slow (25 l min-1), deep inhalation and breath held subsequently for 10 s. Bronchodilatation may be reduced if aerosol is inhaled rapidly (80 l min-1) or if breath is held for 4 s. We have considered the applicability of these simple rules to other types of bronchodilator and to all patients, irrespective of their diagnosis or degree of airway obstruction. The lung volume at which aerosol is released into the airstream, the importance of coordinating inhalation with aerosol actuation, and the relative merits of "open" and "closed" mouth inhalation techniques are also discussed.

Oral acetylcysteine reduces exacerbation rate in chronic bronchitis: report of a trial organized by the Swedish Society for Pulmonary Diseases

Abstract: This multicentre trial was undertaken to confirm previous results indicating that long-term treatment with oral acetylcysteine reduces the exacerbation rate in patients with chronic bronchitis. Two hundred and eighty-five patients, smokers or ex-smokers, with chronic bronchitis started a pre-trial placebo-period of 1 month. After this run-in period 259 patients were included in the trial and randomized into two parallel groups. The patients were treated in a double-blind way either with acetylcysteine 200 mg b.i.d. or placebo b.i.d. for 6 months. The trial was completed by 98 patients in the acetylcysteine group and by 105 patients in the placebo group. Initially, there were no significant differences between the groups. Twice weekly, the patients filled in a diary card concerning symptoms. The number of exacerbations was assessed from these cards and at visits 2, 4 and 6 months after institution of therapy. The exacerbation rate was significantly lower in the acetylcysteine group in which 40% of the patients remained free from exacerbations compared to 19% in the placebo group. Sick-leave due to acute exacerbation was significantly less common in the acetylcysteine group. The drug was well tolerated.

Improving the ketchup bottle method with positive expiratory pressure, PEP, in cystic fibrosis.

Abstract: We studied the acute effects of 4 different chest physical therapy regimens using a randomised cross-over design in 14 patients with cystic fibrosis. Treatment A consisted of postural drainage, percussion and vibration; treatment B of postural drainage and periodic application of a face mask with positive expiratory pressure (PEP); treatment C of PEP in the sitting position; treatment D of the forced expiration technique in the sitting position. In terms of sputum expectorated, treatments B and C were superior to treatment D and especially to treatment A (p less than 0.05). Skin oxygen tension, PSO2 was monitored continuously during and for 35 min after treatment. A substantial and prolonged decay in PSO2 was observed during treatment A, quite different from other patterns seen. During and even following treatment C, an increase in PSO2 was noted. PEP was well accepted by the patients, who preferred treatment C, and we suggest it is incorporated in chest physical therapy regimens if the therapeutic objective is to increase expectoration.