ABSTRACT
We evaluated the response of 15 male patients with severe chronic obstructive pulmonary disease (COPD) to sequential inhalations of an anticholinergic agent, ipratropium bromide 0.25 mg (IB) and a B2 adrenergic agonist, terbutalin 2.5 mg (TER), in a double-blind crossover study. We found no statistically significant difference in the bronchodilatory response between the two agents when comparing the change in forced vital capacity and forced expiratory volume in 1 sec. The subsequent effect of the sequential inhalation demonstrated some additional bronchodilatory response when IB was given after TER, but not when TER was given after IB. However, the end result after the two protocols was not statistically different. The results indicate that in COPD patients the two agents are equipotent. However, in order to prescribe the best treatment schedule for each patient, it is still necessary to evaluate how each individual patient responds to each of the agents. Sequential inhalation may be beneficial in some patients.
Subject(s)
Adrenergic beta-Agonists/therapeutic use , Lung Diseases, Obstructive/drug therapy , Parasympatholytics/therapeutic use , Adrenergic beta-Agonists/administration & dosage , Aged , Double-Blind Method , Forced Expiratory Volume , Humans , Ipratropium/administration & dosage , Ipratropium/therapeutic use , Lung Diseases, Obstructive/physiopathology , Male , Middle Aged , Parasympatholytics/administration & dosage , Terbutaline/administration & dosage , Terbutaline/therapeutic use , Vital CapacityABSTRACT
The effect of 2 weeks oral digoxin administration on respiratory muscle performance (RMP) in 14 patients with chronic obstructive lung disease (COPD) was investigated in a randomized double-blind placebo-controlled cross-over study. All patients were ambulatory with severe air flow obstruction. FEV1/FVC was 0.44 +/- (SD) 0.11, FEV1 was 0.88 +/- (SD) 0.35 liter/s RMP was assessed by measuring maximal inspiratory pressure (PImax), maximal expiratory pressure (PEmax), and maximal voluntary ventilation. Although these parameters were significantly reduced in the COPD patients, 2 weeks of digoxin administration (with serum levels in the therapeutic range) did not alter any parameter of RMP or spirometry. We conclude that digoxin has no effect on RMP or spirometry in ambulatory patients with severe COPD.
Subject(s)
Digoxin/pharmacology , Lung Diseases, Obstructive/physiopathology , Respiratory Muscles/physiopathology , Adult , Aged , Digoxin/therapeutic use , Double-Blind Method , Humans , Lung Diseases, Obstructive/drug therapy , Male , Middle Aged , Respiratory Mechanics/drug effects , Respiratory Muscles/drug effectsABSTRACT
We describe 3 patients who developed extreme hypermagnesemia due to ingestion of water of the Dead Sea, which would have been fatal were it not for the protective effects of the accompanying hypercalcemia. We emphasize the clinical features of this condition and the importance and effectiveness of early hemodialysis as the main modality of treatment.
Subject(s)
Magnesium/blood , Seawater/adverse effects , Aged , Female , Humans , Hypercalcemia/blood , Hypercalcemia/etiology , Immersion , Male , Middle Aged , Oceans and Seas , Renal DialysisABSTRACT
A 54-year-old man, treated with amiodarone, developed thyrotoxicosis. When rechallenged with the same drug 6 months later, he developed hypothyroidism. The therapeutic implications of this clinical sequence are discussed.
