Dexamethasone-isonicotinate aerosol in the long-term treatment of steroid-dependent asthmatic children.

Dexamethasone-isonicotinate aerosol (DIA) was administered to twenty-nine steroid-dependent children with chronic perennial asthma, in an open trial during one year. An attempt was made to withdraw systemic corticosteroid therapy. As judged by clinical results, inhaled dexamethasone-isonicotinate controlled the asthma quite as well as did previous therapy. Oral corticosteroids were withdrawn in 27 patients, and the dosage considerably reduced in another two. Cushingoid features subsided. There was a statistically significant improvement in most pulmonary function parameters (airway obstruction and lung hyperinflation were reduced towards normal). Reduction of systemic steroid dosage resulted in the appearance of previously suppressed manifestations such as hay fever, eczema, and nasal polyps. There was no increased tendency to the occurrence of respiratory tract infection; routine examination showed Candida albicans in about 37% cultures.

Relationships of carbon dioxide retention to ventilatory impairment and hypoxemia in chronic obstructive lung disease.

In a group of 80 male patients (average age 52.5 years) with severe obstructive ventilatory impairment (FEV1.0 less than 40% of predicted) due to chronic bronchitis and/or emphysema, the blood carbon dioxide tension measured at rest, in a stable clinical status, was confronted to the spirometric variables and the oxygen tension. PaCO2 (range 31--60 mm Hg) was loosely related to the VC (r = -0.28) and the FEV (r = -0.30, both p less than 0.05) and strongly related to the PaO2 (r = 0.60; p less than 0.001). When patients were classified as bronchitic or emphysematous according to clinical, roentgenologic and biological criteria, the correlations above were found to be higher for bronchitics. In patients with chronic bronchitis with severe obstruction a very good estimation of PaCO2 is possible from PaO2: PaCO2 = 75.8-0.44 PaO2 (SEE 0.4 MM Hg).

Dexamethasone isonicotinate aerosol therapy in patients with chronic bronchial asthma.

Dexamethasone isonicotinate aerosols were used for the management of 106 patients (33 men, 73 women) with bronchial asthma (mean age 32.7 years); 62 of the patients were steroid-dependent (maintenance dose 1 to 25 mg prednisone/day for 0.5 to 11 years) at the start of the study. A diary of symptoms (including consumption of antiasthmatic drugs) was kept; physical examination and measurement of pulmonary function (peak flow rate, forced expiratory volume in one second) were performed during a one-to-four week control period, as well as at various intervals (up to 14 months) after the start of corticosteroid aerosol therapy. Clinical subjective and objective improvement was accompanied by a significant increase in ventilatory function indices (e.g. the FEV1.0 rose from a control average of 55.5% of predicted to 72% after 4 weeks and 85% after 12 months). The antiasthmatic drug consumption decreased markedly. Administration of systemic steroids could be withdrawn in 49 of the 62 steroid-dependent patients (79%); in the remaining 13 the dose was only lowered. The side-effects were minor (hoarseness of the voice, oropharyngeal candidosis), and limited to a few cases. It is concluded that bronchial asthma can be successfully controlled in four fifths of the patients by very low doses of dexamethasone isonicotinate aerosols, with practically no systemic effects.

Hypoxemia in chronic bronchitis and pulmonary emphysema.

The measurement of arterial blood oxygen tension (PaO2) in 54 patients with chronic nonspecific lung disease with a FEV1.0 of 1.51 or less, in a stable clinical state, at rest, indicated subnormal results to be more frequent among "bronchitics" (79 per cent with hypoxemia) than than among "emphysematous" patients (63 per cent with hypoxemia). The patients were classified according to a mixed clinical-roentgenologic-biological "score" (Nash et al., 1965). A significant correlation was found between PaO2 and the "emphysema score" (r=0.36; p less than 0.01). The average PaO2 was significantly (p less than 0.02) lower in "bronchitics" (65.5 +/- 8.8 mmHg; n = 14) as compared to the "emphysema" group (71.8 +/- 5.7; n = 19), in agreement with the data of the literature.

Ventilatory impairment and hypoxemia in chronic non-specific lung disease.

The relation between arterial oxygen tension at rest (Pao2) and ventilatory performance (VC and FEV1.0) was studied (198 determinations) in a group of 156 patients (11 females) aged 31 to 76 (mean 52.1) years, with chronic non-specific lung disease (asthmatics non included). The average results were 72.7 mmHg for Pao2, 2.87 1 for VC, 1.32 1 for FEV1.0 and 44.9 % for the FEV1.0/VC ratio. Ninety per cent of the patients had ventilatory impairment (FEV1.0 less than 81 % predicted) and 2/3 had hypoxemia (Pao2 less than 75 mmHg). The Pao2 - spirometric variables linear correlation coefficients were of medium value (0.35 to 0.51), but highly significant due to the large number of observations. The correlation was high in patients with severe ventilatory defect (FEV1.0 less than 40% pred.), weak in those with moderate (FEV1.0 41-60 % pred.) and absent in those with minor or absent ventilatory impairment. In respect to the clinical type of obstructive disease, Pao2 and FEV1.0 showed a high correlation (r=0.69) in "bronchitics", a looser one (r=0.45) in "intermediate" patients, and no correlation for "emphysema" patients. The regression equation relating Pao2 and FEV1.0 (Pao2=64.4 + 5.9 X litres) had too high a standard error of estimate (20 % of the mean) to be of practical value.

Arterial carbon dioxide tension and dyspnea in chronic bronchitis and pulmonary emphysema.

The severity of dyspnea (MRC scale) was confronted to the blood carbon dioxide tension (PaCO2) in 45 patients with chronic nonspecific lung disease having moderate or severe airway obstruction (FEV1.0 of less than 1.5 liters). The patients were classified as "bronchitic", "emphysematous" and "intermediate" using a 10- criterion (clinical, roentgenologic and biological) "emphysema score". No correlation between dyspnea grade and PaCO2 was found in "bronchitic" and "intermediate" patients; in the "emphysematous" subgroup PaCO2 tended to rise as dyspnea was more severe, but the linear correlation coefficient (r= +0.37) did not reach the significance threshold, which is high (0.468) for such a limited number of observations.

[Clinico-functional correlations in chronic obstructive bronchopneumopathy: dyspnea and arterial oxygenation]. / Corelatii clinico-functionale in bronhopneumopatia cronica obstructiva: dispnee si oxigenare arteriala

The severity of dyspnoea was confronted to the value of the partial pressure of arterial oxygen at rest in a group of 51 patients with chronic non-specific pneumopathy associated to medium or severe ventilatory obstruction (VEMS under 1,5 I). The patients have been classified as "predominantly bronchitic" or "predominantly emphysematous" on the basis of clinical, radiological and biological criteria. In the group as a whole there was no relation between the partial pressure of arterial oxygen and the severity of the dyspnoea. The analysis of sub-groups evidenced a tendency to decrease of the oxygen pressure with accentuation of dyspnoea in the "bronchitis" group, although the coefficient value of this inverse correlation did not reach the treshold of statistical significance (r = -0,46; p greater than 0,05).

Breathlessness and blood oxygen tension in patients with chronic bronchitis and emphysema.

The dyspnea grade (MRC scale) was confronted with the arterial oxygen tension (PaO2) measured at rest in a group of 51 patients with chronic obstructive lung disease with moderate or severe impairment of ventilatory function (FEV 1.0 less than 1.5 1). For the group as a whole no correlation was found, but in the "bronchitic" subgroup (clinical-roentgenologic and biologic criteria) a tendency of PaO2 to decrease with the increase in dyspnea severity was apparent. The linear correlation coefficient did not attain the significance threshold owing to the limited number of observations (r = 0.46; p greater than 0.05).

Transfer factor for the lung, airway obstruction and hyperinflation in chronic bronchitis and emphysema.

The interrelationships of breath holding lung transfer factor (TCO) and transfer coefficient (KCO) with ventilatory obstruction (FEV1.0) and FEV1.0/VC) and hyperinflation (RV and RV/TLC) were studied in 37 patients with chronic nonspecific lung disease with a FEV1.0 of 1.5 litre or less classified as "bronchitic", "emphysematous" or "intermediate" according to Nash, Briscoe and Cournand (1965). No relationships could be found between TCO and airway obstruction or hyperinflation. KCO tended to decrease as RV increased (r=-0.26) and was weakly related to the FEV1.0/VC ratio in "intermediate" (r=0.34) and "emphysema" (r=0.29) patients but these relationships were nonsignificant.

Smoking and blood oxygen tension in healthy middle-aged males.

The blood oxygen tension (PaO2) was measured using a Clark-type microelectrode on 'arterialised' capillary blood samples obtained from 74 sitting subjects; these were asymptomatic and spirographically normal men aged 42-63 (average 53.7) years. The mean PaO2 of smokers (83.8+/-6.0 mm Hg) was slightly, non-significantly lower as compared to non-smokers (85.5+/-4.9 mm Hg). The trend towards lower mean values with increase in current cigarette consumption or amount smoked in life did not result in significant differences between smoker sub-groups. The lower normal limit for the whole group was 73.3 and the average PaO2 85.3 mm Hg. Though no significant influence of tobacco use could be demonstrated, the histogram of specific subjects shows a bi-modal distribution in smokers, suggesting the existence of a sub-group (about one third of the smokers) who tend to have lower PaO2s, possibly as a consequence of sub-clinical 'small airway disease'.

Coronary heart disease and its risk factors in a group of 5,000 middle aged men in urban environment.

The results obtained at entry in the subjects included in a pilot study (Institute of Internal Medicine, Bucharest) for the detection and prevention of coronary heart disease and hypertension, are presented. These data are the prevalences of the risk factors of coronary heart disease (high serum cholesterol, hypertension, smoking, overweight, diabetes, nonspecific minor ECG signs, family history), as well as the prevalences of the various forms of coronary heart disease. The study of the frequency distribution of biologic parameters likely to become risk factors showed that in middle aged subjects the upper limit of the normal should be lowered from the 95th percentile to the 76th one.

New devices: the McDermott spirometer.

The assessment of a new bellows spirometer against a water spirograph showed: slight alinearity, minimal overestimation of FVC (1.7%) and underestimation of FEV 1-0 (2.9%) as well as of the ratio FEV 1-0/FVC (4.8%). The main advantages of the instrument are: lightness, easy operation, ruggedness and low cost; it seems mainly indicated for use in large scale field surveys.

Smoking habits in Romania.

The main aspects and consequences of tobacco use resulting from a series of field surveys in Romania are reviewed. The proportion of smokers in middle-aged adults is about 10 per cent for women and 40 to 50 per cent for men. Cigarettes are practically the only form of tobacco consumed--cigars are very rarely smoked and pipe-smoking accounts for less than 1 per cent of tobacco use. Less than 10 per cent of smokers use more than 25 cigarettes a day. Age at starting to smoke is low, with a quarter of smokers taking up the habit by the age of 15. Ninety per cent of the smokers admit to inhaling, and about half the men and nearly all the women smoke filter cigarettes.

Prevalence of respiratory symptoms in towns with different air pollution.

An epidemiologic study was carried out for the estimation of air pollution as a risk factor for chronic obstructive lung disease. The whole male population aged 40 to 60 years was investigated in a polluted and a non-polluted control town. The subjects with occupational exposure to dusts, gases and irritant vapours were discarded from the study. The prevalence of respiratory symptoms and of chronic bronchitis in the polluted town was twice that in the control (non-polluted) one. These results are discussed in the light of some previous investigations of the authors and of the available data in the literature.