[Interferon-alpha as treatment option in severe persistent uncontrolled bronchial asthma: an open label study]. / Interferon-alpha als Therapieoption bei der Behandlung des schwergradig persistierenden, unkontrollierten Asthma bronchiale: Eine offene Studie.

BACKGROUND: The purpose of this study was to evaluate the long-term safety and therapeutic effects of IFN-alpha in patients with severe persistent uncontrolled asthma on long-term oral glucocorticoid (GC) treatment. PATIENTS AND METHODS: The study included 16 patients (2 male, 14 female; age 39 years [range: 24 - 63]) with severe persistent asthma. Diagnosis and severity classification of asthma were established according to the guidelines of the "Deutsche Atemwegsliga". Eight patients stopped the therapy within 7 months due to side effects (n = 3), costs not covered by health insurance (n = 2), non-compliance (n = 2), and change of residence (n = 1). 8 patients (8 female, age 49 years [range: 35 - 68], duration of disease 16 years [range: 5 - 24]) were treated for at least 12 months with IFN-alpha (9 microg) 3 times/week. All patients were on oral glucocorticoids (GCs) for more than 5 years (average dose 17.5 [range: 5.0 - 64.0] mg/d). Clinical signs, lung function, need for reliever medication, number of emergency visits and hospitalisations and diary were assessed prior to and after 12 months of treatment. Data are given as percent of normal or median [range]. RESULTS: IFN-alpha improved lung function after 12 months: FEV1 64 vs. 75 %; FEV1/IVC 76 vs. 89 %; RV 153 % vs. 129 %; Rtot 193 vs. 111 % and morning PEF by 50 - 190 L/min. IFN-alpha also significantly reduced the use of reliever medication (10 [2 - 20] vs. 1 [0 - 3] puffs/d), nocturnal awakening (11 [4 - 30] vs. 1 [0 - 5]/month), emergency visits (7 [2 - 15] vs. 0 [0 - 5]/month) and hospitalisations (4 [1 - 8] vs. 0 [0 - 5]/year). In 5 patients the asthma attacks and nightly disturbances disappeared completely. The improvements were achieved despite a tapering of the oral GCs in all patients from 17.5 (5.0 - 64.0) to 2 (0 - 16) mg/d. In 5 patients GC treatment could be discontinued. The number of blood eosinophils decreased from 0.46 to 0.28 Gpt/L. Adverse events were transient and usually decreased within 3 to 4 weeks. Two patients developed an autoimmune thyreoiditis. CONCLUSION: In severe persistent, uncontrolled, and GC-dependent asthma, treatment with IFN-alpha leads to sustained clinical improvement and allows the reduction or discontinuation of oral GCs. Severe side effects may occur in isolated cases.

[Changes in specific airway resistance after powder inhalation of formoterol or salmeterol in moderate bronchial asthma]. / Anderung des spezifischen Atemwegswiderstandes (sRaw) nach Pulverinhalation von Formoterol oder Salmeterol bei mittelschwerem Asthma bronchiale.

Formoterol and salmeterol are two long acting beta 2 agonists available for the treatment of asthma which show differences in onset of action. In a multicentre parallel group study, patients with moderate asthma were investigated by measuring the specific airway resistance (sRaw), a more sensitive parameter than FEV1. A total of 99 patients were randomised for open treatment with either 12 micrograms formoterol delivered via Turbohaler or 50 micrograms salmeterol via Diskus. The patients were between 18 and 66 years of age, had a medium FEV1 of 68.8% (+/- 17.8%) predicted and showed a medium reversibility of 28.8% (+/- 16.5%). The patients response to one inhalation of the study drug was investigated by sRaw measurements 2, 5, 10, 20 and 60 minutes after inhalation of the formulation. Additionally, FEV1 was measured. The results show a significant decrease in specific airway resistance of 29% within the first two minutes in patients who had received 12 micrograms formoterol via Turbohaler. However, patients on salmeterol showed no change (sRaw +/- 1%). This difference is statistically highly significant (p < 0.0001). Furthermore, in 49% of the patients treated with salmeterol an increase in sRaw was seen immediately after inhalation of the drug. This increase was +16.4% in an average of 2 minutes after inhalation. One hour after inhalation the differences between the groups were small and not significant neither between formoterol and salmeterol-treated patients nor within the salmeterol group. In the following week patients were treated with 12 micrograms formoterol Turbohaler b.i.d. or 50 micrograms salmeterol Diskus b.i.d., respectively. A further sRaw measurement was performed 11 +/- 1 hours after the last inhalation of the drug. The results for sRaw and FEV1 show no differences between both study drugs indicating a similar duration of action for both formoterol Turbohaler and Salmeterol Diskus in moderate asthma. No serious adverse events were reported. The adverse event profile observed in both study groups was comparable. Thus, this study shows once again that formoterol delivered via Turbohaler has a more rapid onset of bronchodilating action compared with salmeterol Diskus. Furthermore the inhalation of salmeterol via Diskus in one-half of the patients led to an increase in specific airway resistance within the first minutes after inhalation. It is worth discussing whether an unspecific reaction to the relatively large lactose particles which are components of the salmeterol Diskus formulation are responsible for this observation.

[Value of mechanocardiographic parameters in comparison to radiocardiography in cardiologic diagnosis and therapy control]. / Wertigkeit mechanokardiographischer Parameter in Vergleich zur Radiokardiographie in der kardiologischen Diagnostik und Therapiekontrolle.

Two noninvasive methods for diagnosing cardiac function, the determination of systolic time intervals (STI) and radiocardiography-cyclography (RCG), were investigated in parallel on two study groups - patients with healthy heart and patients with myocardial insufficiency - before and after glycoside treatment with regard to their diagnostic validity by inter- and intraindividual comparison. The STI in patients with myocardial insufficiency clearly deviated from the values found in normals, but reached, however, the limit of significance only for the equalized pre-ejection period (PEP) and the quotient according to Weissler (PEP/LVET). A reliable quantitative conclusion about cardiac function by interindividual comparison with the help of STI, therefore, does not seem possible. The intraindividual comparison (before and during glycoside treatment) reveals statistically significant alterations in STI. In patients with myocardial insufficiency, the radiocardiographic findings in part exhibit considerable deviations from the expected values and those of other authors. Methodological and pathophysiological causes of these deviations are discussed. Taking into consideration methodological factors of influence (body position etc.), RCG yields quantitatively significant conclusions about the functional condition of the normal and insufficient heart and is, therefore, in its diagnostic valency superior to the determination of STI.

[The current problem of euthanasia -- a discussion]. / Aktuelle Probleme der Euthanasie-Diskussion.

New conditions and possibilities of medical treatment demand a more intensive discussion of the problems of the patient with heavy illness and of the dying patient. After a short representation of the notion of euthanasia the individual forms of dying help with their ethical consequences are discussed. Propositions are made for a further elaboration of these problems.

[Effects of menopause, pregnancies, breast feeding and hormonal contraceptives on the course of rheumatoid arthritis]. / Beeinflussung durch Klimakterium, Schwangerschaften, Stillperioden und Ovulationshemmer.

PIP: Of 763 patients who were treated for rheumatoid arthritis (RA), 219 went through menopause, 114 were pregnant, 92 breast-fed children, and 29 used oral contraceptives. Of the 219 menopausal women, 5% experienced an improvement and 46.1% an adverse effect on the RA. It was found that those who experienced improvement during menopause more often had had RA for longer periods and tended to have developed RA before the 45th year of age. 59 patients first developed RA during the menopause, and a general adverse effect of menopause on RA was observed. Increased seronegativity and a reduction in rheumafactor levels were observed in this group, as well as a significantly higher BSG level. In the group which developed RA during menopause, increases in morphological stage II, in grade I of functional inefficiency, and in grip strength and the BFT were observed. There was also a significant increase in the incidence of long arthralgic periods before developing RA during menopause. The relationship between RA during menopause and various other factors, e.g. occupation, weight, prior therapy, is also discussed. Among the 114 pregnant patients, 42 reported a positive effect and 30 an adverse effect on RA. Among the 92 patients who breast-fed their children, 25 reported an adverse effect and 19 reported improvement of RA. Patients who had had RA for longer periods more often reported improvement during pregnancy and breast feeding. Adverse effects of pregnancy on RA usually continued during the breast feeding period. Of the 29 patients who had used oral contraceptives, 5 reported a positive effect on RA.^ieng