Relationship of daytime asthma symptom frequency to morning peak expiratory flow.

Since management plans based on peak flow measurements are increasingly used, the relationship between peak flow rate and ensuing symptom frequency is of particular interest to the treatment of asthma. The objective of this study was to examine to what extent morning peak flow was related to symptom frequency during the day. In 168 out of 307 randomly selected adult asthmatics from a general practice population, adequate recordings of morning peak flow (amPF) and symptom frequency during the day (DSF) were obtained for 28 days. In each individual, the relationship between these two variables was studied and the mean values of these two variables over 28 days were calculated. The relationship between the means of the variables was also examined for the group as a whole. In individuals, the correlation between amPF and DSF varied widely; only 16% of patients had a good relationship (Pearson r = -1 to -0.5). For the whole group, the relationship between mean amPF and mean DSF best fitted a curvilinear model (r = -0.6). This was unaffected by age, sex or the use of inhaled steroids. For the majority of asthmatics, morning peak flow may be an unreliable predictor of expected symptoms during that day. Reliance on peak flow measurement as a tool enabling asthmatics to manage their asthma on a daily basis needs to be reconsidered.

Using information from asthma patients: a trial of information feedback in primary care.

OBJECTIVE: To test the effects of feedback of information about patients' asthma to primary care teams. DESIGN: Patients' reports of morbidity, use of health services, and drug use on questionnaire was given to primary care teams. Randomised controlled trial with general practices as the subject of the intervention was used to test effectiveness of supplying information. SETTING: Primary care in district health authority, London. SUBJECTS: 23 general practices, each of which notified at least 20 asthmatic patients aged 15-60 years for each principal. Practices were randomly allocated to an invention group (receiving feedback of information on control of asthma) or a control group (no feedback). INTERVENTION: Information on cards inserted in patients' medical records; booklet copies of information for team members; formal presentation to primary care teams; poster displays of data on patients in each practice. MAIN OUTCOME MEASURES: Type and frequency of asthma symptoms, use of health services, use of asthma drugs. RESULTS: Reported morbidity at entry to the study was substantial: 45% (818) patients reported breathlessness at least once a week. Less than half these patients were using inhaled steroids regularly. Intervention and control groups did not differ in practice or patient characteristics on entry to the study. In spite of the potential for improvement no differences were observed between the two practice groups at the end of the study--for example, breathlessness at least once a week in last six months was experienced by 36% in intervention group v 35% in control group (t = -0.27, P < 0.79); surgery attendance in last six months by 48% v 48% (t = -0.05, P < 0.96); regular use of inhaled steroids by 60% v 58% (t = 0.51, P < 0.62). CONCLUSION: Feedback to general practitioners of information about patients' asthma does not on its own lead to change in the outcome of clinical care.

Phosmet for the systemic control of pig mange in growing pigs.

A study of the effect of Sarcoptes scabiei var. suis on the performance of growing pigs under commercial conditions is described. Mange was endemic on the farm. Phosmet treatment controlled mange in growing pigs and resulted in a 12% increase in average daily liveweight gain over untreated mange-infected controls.

Efficacy of clavulanate-potentiated amoxycillin in experimental and clinical skin infections.

The efficacy of clavulanate-potentiated amoxycillin was compared with amoxycillin alone in experimental staphylococcal infection in dogs and in a controlled trial in clinical cases of skin infection in dogs and cats. The experimental infection was produced by subdermal inoculation with beta-lactamase producing (amoxycillin resistant) staphylococci absorbed in cotton dust. This produced discrete, localised lesions with no systemic involvement. In a cross over study, six animals were randomly allocated to treatment with either amoxycillin alone (10 mg/kg, dosed twice daily) or a formulation of clavulanate-potentiated amoxycillin (12.5 mg/kg, of a 1:4 ratio, dosed twice daily). The lesions of the animals treated with clavulanate-potentiated amoxycillin resolved more quickly than those treated with amoxycillin alone. The difference was significant (P less than 0.05) for both lesion diameter and inflammation score after day 6 of treatment. A trial was carried out in clinical cases of skin disease which were randomly allocated to twice daily treatment with either amoxycillin alone (10 or 20 mg/kg), or with clavulanate-potentiated amoxycillin (12.5 or 25 mg/kg of a 1:4 ratio). The required duration of treatment was shorter (P less than 0.5) for the potentiated amoxycillin treatments, and the success rate (judged by cure or substantial improvement) was higher (P less than 0.05) for this group, especially (P less than 0.01) where amoxycillin resistant organisms were isolated. It was concluded that clavulanate-potentiated amoxycillin was an effective treatment of skin infections both under experimental and clinical conditions.