The efficacy of inhaled beclomethasone in chronic obstructive airway disease.

The objective of this study was to examine the effectiveness of inhaled beclomethasone in the treatment of stable chronic obstructive airway disease (COAD). Eight patients completed a randomized, double-blind, placebo-controlled, crossover trial of inhaled beclomethasone and oral prednisone. Each patient received 3 treatment regimens given for 14 days: inhaled beclomethasone, prednisone, and placebo. There were no statistically significant differences in pulmonary function tests, oxygen cost diagram, or 12-minute walking distance test among the regimens. The only improvement in arterial blood gasses was partial pressure of oxygen, which was negligibly increased during prednisone treatment compared with beclomethasone and with placebo (p less than 0.05). Evaluation of 95% confidence intervals indicated that clinically significant mean differences were unlikely with either beclomethasone or prednisone. Larger studies are required to determine if a responsive subgroup exists, and to determine if this form of therapy has a role in treatment of COAD.

Nontuberculous mycobacterial lung disease. Substantiation of a less aggressive approach.

A nonsurgical, less aggressive, less toxic chemotherapeutic protocol for the management of nontuberculous mycobacterial (NTB) pulmonary infections has been uniformly applied to patients in our institution between 1972 and 1985. Forty-three nonimmunocompromised patients with active lung disease caused by Mycobacterium avium-intracellulare (MAI) (n = 26), M kansasii (n = 16), and M xenopi (n = 1) were identified retrospectively. Eighteen MAI patients were treated with three or four antituberculosis agents resulting in sputum conversion and clinical improvement in 12 (67 percent). Additionally, 11 out of 16 (69 percent) patients completing therapy or still undergoing therapy for persistent MAI disease, achieved sputum conversion and clinical improvement after prolonged therapy (3.6 +/- 0.5 years [SEM]). When M kansasii was identified as the etiologic agent, all patients were treated with four or fewer antituberculosis agents and 14 out of 16 patients (88 percent) achieved sputum conversion and clinical improvement throughout the follow-up period. We conclude that the use of three or four chemotherapeutic agents in the treatment of NTM lung disease provides an excellent probability of successful outcome even in MAI infections.

Role of interleukin-2 release by lung T-cells in active pulmonary sarcoidosis.

Using a human T-cell line sensitive to interleukin-2 (IL-2), we evaluated supernatants of unstimulated, purified lung T-lymphocytes from patients with sarcoidosis and high-intensity alveolitis (active disease), patients with sarcoidosis and low-intensity alveolitis (inactive disease), patients with idiopathic pulmonary fibrosis, and normal volunteers for the presence of IL-2. After 24 h in culture, supernatants of lung T-cells from patients with sarcoidosis and high-intensity alveolitis contained significantly greater amounts of IL-2 than did supernatants of lung T-cells from the other 3 groups, which we used as controls (p less than 0.001 for each comparison). The IL-2 present in supernatants of lung T-cells had a molecular weight of approximately 15,000 daltons and the supernatants that contained IL-2 significantly (p less than 0.01) increased in vitro immunoglobulin production by T-cell-depleted normal mononuclear cell suspensions stimulated with pokeweed mitogen. These studies suggest that the release of IL-2 by lung T-cells may explain in part the local proliferation of T-cells and hypergammaglobulinemia that are characteristic of pulmonary sarcoidosis.

The response to atropine sulfate given by aerosol and intramuscular routes to patients undergoing fiberoptic bronchoscopy.

Two groups of 11 patients each were studied in their responses to intramuscular (IM) or aerosolized atropine sulfate, given in preparation for fiberoptic bronchoscopy. The patients in group 1 received 1.0 mg of atropine IM, and those in group 2 were given a prepared solution of atropine in saline (5 mg/ml) at a dosage of 0.1 mg/kg by nebulization (IPPB). Statistical analysis of the FVC, FEV1, FEF25-75%, and FEFmax showed excellent protective bronchodilatory effects of both IM and aerosolized atropine. In fact, the beneficial result was more prolonged when the drug was administered by inhalation. One possible factor to consider, however, is that atropine given by the aerosol route did not inhibit the vasovagal response in three of the 11 patients. Another factor to take into account is that atropine by IM injection is quicker to administer, more convenient, and requires less instrumentation than atropine given by aerosol.

A severe, stable obstructive defect in the airways in primary pulmonary histiocytosis X.

An adult with biopsy-proven primary pulmonary histiocytosis X was followed-up over a period of 8 1/2 years. A severe obstructive defect was manifested by severely reduced rates of flow, a fall in the forced vital capacity from 2.6 L to 1.4 L, and a total lung capacity greater than 100 percent of the predicted normal value on three occasions. The patient has survived two episodes of respiratory failure. Her severe interstitial process may explain the development of obstruction of the airways.

Tuberculosis in the intensive care unit.

The overwhelming majority of patients infected with tuberculosis may be very adequately treated without hospitalization on an out-patient basis. Until tuberculosis is completely eradicated, however, some patients with extensive disease will require hospitalization for diagnosis and the institution of appropriate chemotherapy. A minority of these who are desperately ill and require admission to an intensive care unit may still recover by the prompt diagnosis of the illness, appropriate supportive care, and the rapid institution of appropriate antituberculous chemotherapy.