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Latest & greatest articles for asthma
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on 5 consecutive nights to a further group of 8 asthmatic subjects significantly reduced the early morning fall in FEV1 from 28.7 (6.5)% after placebo to 19 (4.2)% after 0.25 mg and 14.9 (6.5)% after 0.5 mg. Potassium-channel activators may be useful in the treatment of asthma, especially for nocturnal symptoms. (...) Attenuation of nocturnal asthma by cromakalim. In a randomised, double-blind, crossover study, single oral doses of cromakalim, a potassium-channel activator, or placebo were given to 23 patients with nocturnal asthma. There was a significant reduction (p less than 0.005) in the early morning fall in forced expiratory volume in 1 s (FEV1) after 0.5 mg cromakalim (fall 9.8% [SEM 3.2%]) compared with placebo (18.5 [2.8]%). In a repeat dosing study, administration of 0.25 mg and 0.5 mg cromakalim
Protection against allergen-induced asthma by salmeterol. The effects of the long-acting beta 2-agonist salmeterol on early and late phase airways events provoked by inhaled allergen were assessed in a group of atopic asthmatic patients. In a placebo-controlled study, salmeterol 50 micrograms inhaled before allergen challenge ablated both the early and late phase of allergen-induced bronchoconstriction over a 34 h time period. Salmeterol also completely inhibited the allergen-induced rise (...) in non-specific bronchial responsiveness over the same time period. These effects were shown to be unrelated to prolonged bronchodilatation or functional antagonism. These data suggest novel actions for topically active long-acting beta 2-agonists in asthma that extend beyond their protective action on airways smooth muscle.
Regular inhaled beta-agonist treatment in bronchial asthma. 89 subjects with stable asthma took part in a double-blind, placebo-controlled, randomized, crossover study of the effects of regular versus on-demand inhaled bronchodilator therapy. The subjects inhaled fenoterol or placebo by a dry powder delivery system for 24 weeks. Control of asthma was judged by daily morning and evening peak expiratory flow rates, symptom diaries, use of additional inhaled bronchodilator, and requirement (...) for short courses of prednisone. Of 64 subjects who completed the trial, 57 showed a clear difference in degree of control of asthma between the fenoterol and placebo periods: in 17 (30% [95% confidence interval 18.4-43.4%]) asthma was better controlled during regular inhaled bronchodilator treatment, whereas in 40 (70% [56.6-81.6%]) control was better during placebo treatment with bronchodilator for symptom relief only. Mean airway responsiveness to methacholine increased slightly during the fenoterol
1990LancetControlled trial quality: predicted high
Bronchodilator, cardiovascular, and hypokalaemic effects of fenoterol, salbutamol, and terbutaline in asthma. The airway response and cardiovascular and hypokalaemic effects of fenoterol, salbutamol, and terbutaline given in multiples of standard doses from metered-dose inhalers were studied in ten patients with mild asthma. In a double-blind, crossover, placebo-controlled study the subjects received 2, 6, and 18 puffs of each drug with intervals of 90 min, and forced expiratory volume in 1 s
Salmeterol in nocturnal asthma: a double blind, placebo controlled trial of a long acting inhaled beta 2 agonist. To determine whether inhaled salmeterol, a new long acting inhaled beta adrenergic agonist, reduces nocturnal bronchoconstriction and improves sleep quality in patients with nocturnal asthma.Randomised, double blind, placebo controlled crossover study.Hospital outpatient clinics in Edinburgh.Twenty clinically stable patients (13 women, seven men) with nocturnal asthma, median age 39 (...) (range 18-60) years.Salmeterol 50 micrograms and 100 micrograms and placebo taken each morning and evening by metered dose inhaler. Rescue salbutamol inhalers were provided throughout the run in and study periods.Improvement in nocturnal asthma as measured by peak expiratory flow rates and change in sleep quality as measured by electroencephalography.Salmeterol improved the lowest overnight peak flow rate at both 50 micrograms (difference in median values (95% confidence interval for difference
Evaluation of peak flow and symptoms only self management plans for control of asthma in general practice. To compare a peak flow self management plan for asthma with a symptoms only plan.Randomisation to one of the self management plans and follow up for a year.Four partner, rural training practice in Norfolk.115 Patients (46 children and 69 adults) with asthma who were having prophylactic treatment for asthma and attending a nurse run asthma clinic.The number of doctor consultations, courses (...) action to take when their asthma deteriorates is the key to effective management of asthma. Simply prescribing peak flow meters without a system of self management and regular review will be unlikely to improve patient care.
The effects of a 5-lipoxygenase inhibitor on asthma induced by cold, dry air. The enzyme 5-lipoxygenase catalyzes the metabolism of arachidonic acid to form products that have been implicated in the airway obstruction of asthma. We hypothesized that if products of the 5-lipoxygenase pathway are important in mediating this obstruction, then prevention of their formation should decrease the severity of an induced asthmatic response.In a randomized, double-blind, placebo-controlled, crossover (...) study, we examined the effect of A-64077, a 5-lipoxygenase inhibitor, on the bronchoconstriction induced by hyperventilation of cold, dry air in 13 patients with asthma. The completeness of 5-lipoxygenase inhibition was confirmed by examining the profile of eicosanoids produced in whole blood ex vivo after activation with the calcium ionophore A-23187.A-64077 decreased the mean (+/- SEM) ionophore-induced synthesis of leukotriene B4, a 5-lipoxygenase product, by 74 percent (from 265.3 +/- 30.3
Adrenaline and nocturnal asthma. To determine whether the nocturnal fall in plasma adrenaline is a cause of nocturnal asthma.Double blind placebo controlled cross-over study. In the first experiment the nocturnal fall in plasma adrenaline at 4 am was corrected in 10 asthmatic subjects with an infusion of adrenaline after parasympathetic blockade with 30 micrograms/kg intravenous atropine. In the second experiment 11 asthmatic subjects showing similar variations in peak expiratory flow rate had (...) adrenaline is not a cause of nocturnal asthma.
Trichophyton asthma: sensitisation of bronchi and upper airways to dermatophyte antigen. 12 adult patients with perennial asthma and chronic skin infection were found to have immediate hypersensitivity to Trichophyton spp. 10 patients were tested by bronchial provocation and gave immediate bronchial reactions to an extract of T tonsurans. Double-blind, placebo-controlled nasal challenge of 8 patients demonstrated that the upper airways of these patients were also sensitive to this dermatophyte (...) antigen. In addition to perennial asthma most of the patients had persistent eosinophilia and chronic rhinosinusitis. The results suggest that absorption of fungal antigen can give rise to IgE antibody production, sensitisation of the airways, and symptomatic asthma and rhinosinusitis. Several patients had many of the features of late onset or "intrinsic" asthma.
. We studied 11 subjects with mild allergic asthma, who had both early and late asthmatic responses to a specific inhaled allergen in a preliminary challenge. After placebo administration, the maximal changes (mean +/- SE) from base line in the forced expiratory volume in one second (FEV1) and specific airway resistance were, respectively, a decrease of 35 +/- 4 percent and an increase of 288 +/- 56 percent between 0 and 60 minutes after inhalation of the allergen (early response) and a decrease (...) Protective effect of inhaled furosemide on allergen-induced early and late asthmatic reactions. The movement of ions and water across the membranes of bronchial cells is part of the control of the bronchial obstructive response to physical stimuli. In a double-blind, randomized, crossover study, we compared the effect of an aerosol of the loop diuretic furosemide with that of a placebo on the early (within 60 minutes) and late (4 to 12 hours) asthmatic responses to a specific inhaled allergen
Intravenous magnesium sulfate for the treatment of acute asthma in the emergency department. Conventional nebulized beta-agonist therapy has met with disappointing results in an increasing number of moderate to severe asthmatics who may be characterized as "poor responders." Thirty-eight patients suffering from acute exacerbations of moderate to severe asthma were treated in an emergency department with an intravenous infusion of saline placebo or 1.2 g of magnesium sulfate after conventional (...) ). Intravenous magnesium sulfate may represent a beneficial adjunct therapy in patients with moderate to severe asthma who show little improvement with beta-agonists.
Effect of peak flow information on patterns of self-care in adult asthma. Self-care is an important issue in the management of adults with asthma. Little is known about the specific strategies used by people with asthma to control symptoms and abort asthma attacks. The purpose of this study was to identify self-care strategies used to control asthma symptoms and to determine the effect of peak expiratory flow rate (PEFR) information on selection of self-care strategies. Thirty adult subjects (...) with asthma were randomly assigned to either a control or an experimental group; 28 completed the study. All subjects recorded episodes of dyspnea, wheezing, and chest tightness and self-care actions in an asthma symptom diary. The experimental group recorded PEFR at the beginning and end of each symptom episode. Reported strategies were categorized into problem-focused, emotion-focused, or mixed self-care strategies. The experimental group, with access to PEFR information, used medication significantly
Ambulatory pH monitoring of gastro-oesophageal reflux in "morning dipper" asthmatics. A causal relation between gastro-oesophageal reflux and nocturnal asthma has been postulated. Forty four adult asthmatics underwent ambulatory monitoring of their oesophageal pH over 24 hours to find out if there was such a relation. Of these 21 showed significant "morning dipping" in which the peak expiratory flow falls during the night. Asthmatics with morning dipping had a history of nocturnal wheeze (...) and a higher incidence of reflux symptoms, but measurement of oesophageal pH showed no significant difference in the amount or pattern of reflux when compared with "non-dippers." Overall, 15 asthmatics had gastro-oesophageal reflux, and these participated in a randomised, double blind crossover trial of ranitidine versus placebo. No significant difference was found in the peak expiratory flow rates or subjective evaluation of well being of the patients.
Intravenous beta agonist in severe acute asthma. To determine whether salbutamol is more effective in treating severe asthma when given intravenously or by inhalation.Randomised trial of short term response to intravenous versus nebulised salbutamol in acute severe asthma.District general hospital (secondary care centre).76 patients aged 16-70 admitted to hospital with acute severe asthma (peak expiratory flow rate less than 50% of predicted) during study period. Five withdrawn because (...) intravenous group; non-response caused three withdrawals from nebuliser group.Intravenous salbutamol is more effective than nebulised salbutamol in acute severe asthma but may have unacceptable cardiovascular effects.
Controlled trial of budesonide given by the nebuhaler in preschool children with asthma. To determine whether the inhaled corticosteroid budesonide, given by a Nebuhaler spacing device, was effective in prophylaxis of asthma in preschool children.Double blind, placebo controlled, random order crossover trial with two week practice run in period.Outpatient clinic referrals in secondary referral centre.39 children aged 2-6 years selected for the following: able to use Nebuhaler; parents able (...) to complete record card; poorly controlled asthma (defined); not already on systemic or inhaled steroids. Eleven withdrew for various reasons not connected with intolerance to budesonide. Age, sex, other atopies, and symptoms during run in period were similar in the 28 children who completed the trial and in the 11 who withdrew.Budesonide 200 micrograms or placebo (both one puff) given twice daily during 6-week treatment or control periods, using Nebuhaler after prior training. Three week "washout
Comparison of effects of a self management booklet and audiocassette for patients with asthma. The effects on self management of asthma of a specially prepared book and audiocassette tape with similar contents were observed in a controlled study of 177 patients with asthma in general practice. After a run in period of six months patients were randomly given the book, the tape, both the book and tape, or neither. Patients' knowledge of the use of drugs, perceptions of their disability, skill (...) groups given the material considered that their disability was reduced. There were no other significant changes. Patients given both the book and the tape preferred the book. Patients with asthma can obtain useful information from such material. The paradoxical result whereby patients learnt more from the tape but preferred the book suggests that a distinction can be made between information that patients need, which may be acquired better from an audiocassette, and information that they want, which
Methotrexate in the treatment of corticosteroid-dependent asthma. A double-blind crossover study. To test our previous observation that methotrexate reduces corticosteroid requirements of patients with severe asthma, we studied 14 patients with corticosteroid-dependent bronchial asthma in a 24-week randomized double-blind crossover trial comparing a low dosage of methotrexate (15 mg per week) with placebo. At base line the mean dosage of prednisone was 173.5 mg per week (range, 70 to 420 (...) patients and an evanescent rash in one patient. Nine patients are still receiving methotrexate 3 to 10 months after the study's conclusion. The dosages of steroids have been further reduced in each of these patients, and prednisone has been discontinued in four. We conclude from this preliminary study that the use of methotrexate allows a significant reduction in the use of corticosteroids in patients with severe asthma without deterioration of pulmonary function.
Attenuation of exercise-induced asthma by acupuncture. A prospective randomised single-blind study of the effects of real and sham acupuncture on exercise-induced asthma was conducted in nineteen children. Forced expiratory flow in 1st second (FEV1), forced vital capacity (FVC), and peak expiratory flow rate (PEFR) were measured throughout acupuncture and after treadmill exercise. Neither real nor sham acupuncture affected the basal bronchomotor tone but both, when applied 20 min before (...) exercise, attenuated exercise induced asthma: mean maximum percentage falls in FEV1, FVC, and PEFR were 44.4%, 33.3%, and 49.5% without acupuncture; 23.8%, 15.8%, and 25.9% after real acupuncture; and 32.6%, 26.1%, and 34.3% after sham acupuncture. Real acupuncture provided better protection against exercise-induced asthma than did sham acupuncture (p less than 0.05).
Effect of a single oral dose of prednisolone in acute childhood asthma. 140 children of 184 with acute asthma entered a randomised double-blind trial of oral prednisolone (n = 67) compared with placebo (n = 73) administered soon after admission. The dose of prednisolone was 30 mg in children under 5, otherwise 60 mg. All children also received salbutamol. All had moderate or severe dyspnoea. Initial evaluation was similar for both groups. On reassessment after a few hours 20 children (...) in the prednisolone group were fit for discharge compared with only 2 in the placebo group. There were no early reattendances. Children remaining in hospital had a shorter median duration of stay and were less likely to require further steroid therapy if they had initially received prednisolone. In acute asthma the prompt use of a single dose of oral prednisolone can reduce morbidity and the need for hospital care.
[Air purifiers in the treatment of asthma in adults]. 3698871 1986 06 02 2006 11 15 0012-7183 102 5 1986 Duodecim; laaketieteellinen aikakauskirja Duodecim [Air purifiers in the treatment of asthma in adults]. 313-9 Vilkka V V Haahtela T T Mönkäre S S Kuusisto P P Tukiainen P P fin Clinical Trial English Abstract Journal Article Randomized Controlled Trial Ilmanpuhdistimet aikuisten astman hoidossa. Finland Duodecim 0373207 0012-7183 IM Adolescent Adult Aged Air Pollution prevention & control (...) Asthma prevention & control Child Child, Preschool Electronics Female Filtration Humans Male Methods Middle Aged 1986 1 1 1986 1 1 0 1 1986 1 1 0 0 ppublish 3698871