Tobramycin solution for inhalation reduces sputum Pseudomonas aeruginosa density in bronchiectasis.

We conducted a placebo-controlled, double-blind, randomized study to evaluate the microbiological efficacy and safety of inhaled tobramycin for treatment of patients with bronchiectasis and Pseudomonas aeruginosa. Patients were randomly assigned to receive either tobramycin solution for inhalation (TSI) (n = 37) or placebo (n = 37), which was self-administered twice daily for 4 wk and followed by 2-wk off-drug. At Week 4, the TSI group had a mean decrease in P. aeruginosa density of 4.54 log(10) colony-forming units (cfu)/g sputum compared with no change in the placebo group (p < 0.01). At Week 6, P. aeruginosa was eradicated in 35% of TSI patients but was detected in all placebo patients. Investigators indicated that 62% of TSI patients showed an improved medical condition compared with 38% of placebo patients (odds ratio = 2.7, 95% confidence interval [CI] 1.1 to 6.9). Tobramycin-resistant P. aeruginosa strains developed in 11% of TSI patients and 3% of placebo patients (p = 0.36). The mean percent change in FEV(1) percent predicted from Week 0 to Week 4 was similar for the TSI and placebo groups (p = 0.41). More TSI-treated patients than placebo patients reported increased cough, dyspnea, wheezing, and noncardiac chest pain, but the symptoms did not limit therapy. Additional study is warranted to further evaluate TSI in bronchiectasis patients.

Ninety-day follow-up of patients in the emergency department with chest pain who undergo initial single-photon emission computed tomographic perfusion scintigraphy with technetium 99m-labeled sestamibi.

BACKGROUND: Patients in the emergency department with typical chest pain and a normal or nondiagnostic electrocardiogram have a 10% to 20% risk of nonfatal myocardial infarction. These patients can be stratified into groups of very low and very high risk for inpatient adverse cardiac events on the basis of initial 99mTc-labeled sestamibi single-photon emission computed tomographic (SPECT) perfusion imaging performed during symptoms. However, the intermediate or posthospital discharge prognosis of such patients has not been reported. METHODS AND RESULTS: Patients (n = 150) with typical chest pain (based on a semiquantitative chest pain questionnaire) and a normal or nondiagnostic electrocardiogram underwent injection of 15 to 45 mCi 99mTc-labeled sestamibi injected during symptoms. Ninety-day follow-up history (telephone questionnaire and review of medical records) was obtained in 140 patients, and follow-up electrocardiography was performed in 72 patients. Cardiac events (death, nonfatal myocardial infarction, thrombolysis, percutaneous transluminal coronary angioplasty, or coronary artery bypass grafting) occurred before hospital discharge in 33 patients (18%), and these patients were excluded from further analysis. At follow-up, two (8%) of 25 patients with an abnormal initial scintigram and none of 87 patients with a normal scan had cardiac events (p = 0.008). CONCLUSIONS: In patients with typical angina and a normal or nondiagnostic electrocardiogram, initial SPECT scintigraphy allows early accurate risk stratification. The previously observed excellent inpatient prognosis of patients with a normal scintigram appears to extend for at least 90 days of follow-up. These observations may provide a rational basis for safe and cost-effective outpatient evaluation of selected patients in the emergency department with typical angina, a normal or nondiagnostic electrocardiogram, and a normal initial 99mTc-labeled SPECT perfusion scintigram performed during symptoms.

Effect of age on bronchodilator response.

STUDY OBJECTIVE: Our objective was to compare the differential effects of age and drug type on bronchodilator response. DESIGN: The design was an unblinded, randomized crossover study. SETTING: An ambulatory pulmonary drug study unit was the setting. PATIENTS: Nineteen young (18 to 25 yr) and 17 elderly (greater than 65 yr) stable asthmatic subjects were studied. INTERVENTIONS AND MEASUREMENTS: Albuterol or ipratropium was given on two separate mornings using an MDI with extender. Subjects inhaled two puffs initially and then one puff every 30 min to a total of six puffs. Pulmonary function, blood pressure, and pulse were measured at baseline and every 30 min for 3 h. RESULTS: All subjects had a greater than 15 percent increase in FEV1 with one or both drugs. More patients responded to albuterol than to ipratropium in both age groups. The maximum percentage of change from baseline was greater (p less than 0.05) with albuterol (mean, 40.1 percent in young and 60.5 percent in old) than with ipratropium (21.2 percent in young; 31.2 percent in old) in both groups. These differences remain significant after correction for baseline differences using area-under-the-curve analysis of the percent of maximum improvement; however, the differences between age groups for the same drug were not statistically significant by either index of change. There were also no differences between drugs or between age groups for time (or number of puffs) to reach maximum improvement (mean, 2.0 to 2.2 h for albuterol and 1.6 to 1.7 h for ipratropium). The changes in FVC and FEF25-75% were similar to FEV1. Changes in blood pressure and pulse were not significant. Three subjects stopped therapy with albuterol with side effects. CONCLUSIONS: Both drugs are effective bronchodilators in young and old asthmatic subjects, but albuterol results in a greater magnitude of response in both age groups. Age is not a predictor of response to either drug.

Effects of topical betaxolol, timolol, and placebo on pulmonary function in asthmatic bronchitis.

To evaluate the effects of two beta-adrenergic blocking agents on cardiopulmonary function, we investigated two topical ophthalmologic preparations, betaxolol 1% and timolol 0.5%, in nine patients (eight men and one woman, ranging in age from 25 to 69 years) with reactive airway disease. The randomized, double-masked, crossover study used placebo eyedrops as the control, and each drug was tested on separate days. Spirometric measurements, respiratory rate, pulse rate, and blood pressure were observed at frequent intervals for four hours after the test solutions were instilled. At the end of the test, an inhaled beta-adrenergic stimulant (isoproterenol) was administered, and the measurements were repeated. Timolol produced a significant decrease in airflow, measured by forced expiratory volume in one second (FEV1) and the ratio of FEV1 to vital capacity at each observation time beyond 15 minutes. Betaxolol and placebo eyedrops produced no significant change from control values. These results suggested that timolol can adversely affect patients with reactive airway disease. Betaxolol eyedrops, conversely, caused no decrease in airflow in the same patients with proven airway disease.