A trial of tiaramide in asthma.

Tiaramide hydrochloride is a new non-steroidal anti-inflammatory agent previously shown to inhibit allergic responses both in vitro and in vivo. Clinical studies in asthmatic adults and children have also shown benefit. We report a double blind cross-over study in 35 adult asthmatic patients comparing oral tiaramide 200 mg four times daily with oral salbutamol 4 mg four times daily and placebo. Symptoms and bronchodilator inhaler usage were recorded in diary cards and morning and evening peak expiratory flow rates were also monitored. Both tiaramide and salbutamol had a significant therapeutic effect compared with placebo. More patients preferred tiaramide than salbutamol and there were fewer side effects during treatment with tiaramide. Tiaramide may be a useful oral therapy in asthma particularly for those patients intolerant of oral beta-adrenergic agonists.

Archie: the use of a microcomputer in an allergy clinic.

In an attempt to improve the efficiency and quality of allergy history taking we surveyed the practice of 57 allergy clinics in the UK. After studying their methods we developed a computer program based on a relatively inexpensive (pounds 2500) microcomputer system to obtain a detailed history from patients suffering from asthma or rhinitis. The program automatically suggests appropriate allergy tests depending on the answers given to the questions. Details of the history and the results of tests are collated and printed in a form suitable for storing in the patient's records, and are filed on magnetic disk for subsequent analysis. Computer interrogation was accepted and enjoyed by patients.

A new nasal oxygen mask.

Recent interest in the benefits of long-term oxygen therapy for patients with chronic airflow obstruction and hypoxaemia should lead to an increased use of nasal prongs for prolonged (15 hours/day) oxygen administration. Because some patients find nasal prongs uncomfortable and since they may slip out of position during use, we have devised a new nasal oxygen mask and compared both its performance and comfort with conventional nasal prongs. Changes in end-tidal oxygen concentration were measured after administering oxygen at 2 litres/min through each device for 10 minutes in 15 normal subjects and for 1 hour in patients with chronic airflow obstruction and hypoxaemia. Although the prongs produced larger increases in end-tidal oxygen concentration in normal subjects, there were no significant differences between the two devices in the patients. There was also no difference in the improvement in arteriolized capillary oxygen tensions (mask 3.5 kPa; prongs 4.0 kPa). In a separate study of prolonged (22 hours) use there was no difference in reported comfort. The new mask is a useful alternative to conventional nasal prongs.

The use of a micro-computer system in a lung function testing laboratory.

This report describes the use of a relatively inexpensive micro-computer, floppy disk drive and printer, now costing about 2000 pounds, in a routine lung function testing laboratory in a district general hospital. The computer calculates and types the results of lung function tests and calculates normal values and percentages. In addition it automatically generates a typed commentary on the results, files the current results on the disk and searches and tabulates previous results. The computer can produce lists of patients with particular characteristics and can also be used for other purposes.

A controlled trial of ketotifen in exercise-induced asthma.

We studied 17 patients in a double-blind controlled trial to see if ketotifen, a new oral mast-cell stabilizing agent, would protect against bronchoconstriction induced by exercise on a treadmill. In addition eight of the patients also completed exercise tests without previous medication and again after inhalation of disodium cromoglycate (DSCG). The greatest amount of bronchoconstriction was caused by exercise without preliminary treatment. There was less bronchoconstriction after ketotifen, but this was no better than a placebo. DSCG provided significant protection. We were unable to confirm previous reports that ketotifen is as effective as DSCG in preventing exercise-induced asthma.

Multipurpose intensive care unit in a district general hospital.

The advantages of a four-bedded purpose-built general intensive care unit in a district general hospital are described. In addition to 1,447 inpatients treated between January 1968 and December 1971 the unit was used to conduct outpatient investigations. This has filled an important gap in conventional arrangements, and is practical and economical. The unit has proved to have advantages, not only for seriously ill patients but also has benefited the hospital in other ways. It has been of material assistance in recruiting and training nursing and medical staff and has been welcomed and supported by patients and their relatives. It has also attracted practical support from voluntary organizations whose generosity has enabled much additional equipment to be purchased.

Fibrinolytic response of diabetics and non-diabetics to adrenaline.

The fibrinolytic response of 30 diabetic patients and 35 non-diabetics to 0.5 mg. subcutaneous adrenaline was measured, using the dilute clot lysis test. With the exception of two patients out of six who were taking phenformin, who had a depressed response, the diabetics showed a similar increase in fibrinolytic activity to the non-diabetics. The diabetics in this series did not tend to have longer spontaneous lysis times than the non-diabetics, although this type of comparison may not be valid.