Domiciliary liquid oxygen versus concentrator treatment in chronic hypoxaemia: a cost-utility analysis.

Whether long-term oxygen therapy (LTOT) improves quality of life in chronic hypoxaemia has been questioned. LTOT with an oxygen concentrator (C/C) and gas cylinders for ambulation is considered cumbersome compared to mobile liquid oxygen equipment (L). The hypothesis for this study was that LTOT with liquid oxygen treatment (L) improves patients' health-related quality of life, but that it is also more expensive compared to concentrator (C/C) treatment. A prospective, randomized multicentre trial comparing C/C with L for LTOT was conducted during a six-month period. Fifty-one patients (29 on L and 22 on C/C) with chronic hypoxaemia, regularly active outside the home, participated in the study initially. Costs for oxygen were obtained from the pharmacies. Patient diaries and telephone contacts with members of the healthcare sector were used to estimate costs. Health-related quality of life was measured by the Sickness Impact Profile (SIP) and the EuroQol, instruments at the start and after 6 months. The average total cost per patient for group C/C for the six-month period was US$1,310, and for group L it was US$4,950. Health-related quality of life measured by the SIP instrument showed significant differences in favour of group L in the categories/dimensions of physical function, body care, ambulation, social interaction and total SIP score. In conclusion, liquid-oxygen treatment was more expensive compared to concentrator treatment. However, treatment effects showed that liquid oxygen had a better impact on quality of life.

Pleural disease during treatment with bromocriptine in patients previously exposed to asbestos.

Bromocriptine, which is used in the treatment of Parkinson's disease, can cause adverse pleuropulmonary reactions. Exposure to asbestos can result in similar lesions. Fifteen patients with former exposure to asbestos, who developed pleural fibrosis after treatment with bromocriptine, were observed independently in Sweden (11 patients) and Australia (four patients). The patients complained of malaise, often associated with weight loss, dyspnoea, and a disturbing cough. Laboratory values included increased erythrocyte sedimentation rate and a low haemoglobin level. Lung function tests showed a restrictive lung function defect. Chest radiographs showed bilateral pleural fibrosis, with small amounts of fluid in some cases. Soon after bromocriptine was withdrawn, the patients improved clinically, and the laboratory values returned to normal. However, in most cases, pleural fibrosis and a restrictive lung function defect persisted to some extent. In conclusion, in patients who develop pleuropulmonary fibrosis whilst being treated with bromocriptine, former exposure to asbestos should be investigated. Conversely, when pleural changes develop in a patient on bromocriptine and with prior exposure to asbestos, the possible causative role of the drug should be discussed. Special follow-up may be indicated when bromocriptine is planned in a patient with previous asbestos exposure, and if symptoms or signs of pleural fibrosis develop, bromocriptine withdrawal should be considered.

Effect of protriptyline, 10 mg daily, on chronic hypoxaemia in chronic obstructive pulmonary disease.

A daily dose of 20 mg of protriptyline can improve daytime arterial blood gas tensions in chronic obstructive pulmonary disease (COPD). Its usefulness is limited by anticholinergic side-effects. This study examined whether a daily dose of 10 mg of protriptyline improved daytime arterial oxygen tension (PaO2) and quality of life in patients with stable mild or moderate hypoxaemia caused by COPD. Twenty six patients were randomized to receive protriptyline or placebo in a double-blind parallel-group trial for 12 weeks, following a run-in period of 4 weeks, in order to assess the stability of hypoxaemia. Patients with a change in PaO2 of > 0.7 kPa during the run-in were excluded. Spirometry, quality of life and dyspnoea score were measured at randomization and after 12 weeks, whilst arterial blood gas tensions were also measured 2 and 6 weeks after randomization. No improvement in arterial blood gas tensions, spirometry values, dyspnoea score, or quality of life was found in either the protriptyline or the placebo group. The majority of patients receiving protriptyline experienced anticholinergic side-effects, which necessitated the withdrawal of the drug in one patient. We conclude that there was no evidence that a daily dose of 10 mg of protriptyline had a significant effect on daytime arterial oxygen tension in stable mild and moderate hypoxaemia caused by COPD. Despite the low dose, anticholinergic side-effects occurred in most patients.

Differences in utilisation of asthma drugs between two neighbouring Swedish provinces: relation to prevalence of obstructive airway disease.

BACKGROUND: Considerable variation exists in the use of antiasthmatic drugs in different counties in Sweden. The reasons for this variation are unknown. A study was performed to determine if there is an association between sales of antiasthmatic drugs and the prevalence of obstructive airway diseases in two adjoining Swedish counties. METHOD: The prevalence of asthma-associated symptoms in the county of Jämtland where there is high drug use, and the county of Gävleborg where it is lower, was assessed in 1990 by a postal questionnaire answered by 11,300 subjects. Three age groups were included: all 16 year olds, 13% of those aged 30-39 years, and 13% of 60-69 year olds. A total of 2100 subjects reporting airway symptoms in a questionnaire and 450 asymptomatic controls were further investigated at an interview with lung function tests and, in 500 cases, with a methacholine challenge. Asthma was diagnosed in subjects reporting a typical history or repeated episodes of dyspnoea and wheezing, or dry cough combined with reversibility in FEV1, variability in peak expiratory flow, or a PC20 value of < or = 4 mg/ml. RESULTS: The prevalence of current asthma was close to 8% in all age groups in Jämtland and significantly lower (close to 6%) in all age groups in the warmer, more industrialised and more densely populated county of Gävleborg. A gender difference with a higher prevalence in women was found in Gävleborg but not in Jämtland. There was no significant difference in the use of inhaled beta 2 stimulants among subjects with asthma in the two counties. Inhaled steroids were used more often in Jämtland. However, they were used regularly by fewer than 10% of asthmatic subjects in the two younger age groups. CONCLUSION: The differences in the use of antiasthmatic drugs in these two counties reflect a difference in the prevalence of obstructive airway disease.

Differences in utilization of asthma drugs between two neighbouring Swedish provinces: relation to symptom reporting.

Utilization of anti-asthma drugs is rapidly increasing and varies markedly between counties in Sweden. In 1989, the sales in the county of Gävleborg were less than 60% of those in neighbouring Jämtland. In order to study the possible reasons for--and effects of--this difference, an epidemiological survey was started in 1989, the first part of which is reported here. A questionnaire was sent to all 16 yr olds, and to a random sample of 30-39 and 60-69 yr olds, in the two counties. A total of 12,500 questionnaires were distributed. Overall response rate was 90%. A total of 7.2% in Jämtland and 5.8% in Gävleborg (p < 0.01) reported that they had had asthma at some time. A similar significant difference between the counties was also present in response to questions on attacks of shortness of breath, wheezing and self-reported diagnosis of asthma, as well as on use of anti-asthma drugs. There were no statistically significant differences between the counties in positive answers to questions concerning history and symptoms of chronic bronchitis; approximately 5% in the oldest age group. The findings support earlier results indicating a high asthma prevalence in northern Sweden. Contrary to reports from other countries, the prevalence was higher in the colder and less urbanised of the two provinces. We conclude that the differences in drug sales between the counties reflect a difference in prevalence of asthmatic symptoms.

Bronchoalveolar lavage is better than gastric lavage in the diagnosis of pulmonary tuberculosis.

Bronchoalveolar lavage was performed in 62/63 patients with suspected pulmonary tuberculosis and gastric lavage in 60 of the 63. Mycobacteria could be cultured from 14 of the patients. Cultures on bronchoalveolar lavage were positive in 13 of them, while gastric lavage was positive in only 7. Our conclusion is that bronchoalveolar lavage should be performed instead of gastric lavage when pulmonary tuberculosis is suspected.