Effects of terbutaline and budesonide on sputum cells and bronchial hyperresponsiveness in asthma.

Previous studies have shown that the regular administration of short acting beta-agonists can be associated with adverse effects on airway caliber and bronchial hyperresponsiveness (BHR) and that this may occur through a proinflammatory mechanism. The aim was to explore possible adverse effects of high-dose beta-agonist therapy and to assess any adverse interaction with corticosteroids. We undertook a randomized, crossover study to investigate the effects of 6 wk of treatment with regular terbutaline (1 mg four times a day), regular budesonide (400 microg twice a day), combined treatment, and placebo in subjects with mild to moderate asthma. Major endpoints were PD(15) saline, PD(20) methacholine, and induced sputum differential cell counts. Thirty-four subjects were randomized and 28 completed the study. PD(15) saline decreased on terbutaline alone compared with placebo treatment and on combined treatment compared with budesonide alone (mean fold decrease of 0.57 [95% CI = 0.36, 0.90] and 0.65 [95% CI = 0.43, 0.97], respectively). PD(20) methacholine was not affected by the use of terbutaline either alone or in combination with budesonide. The percentage of eosinophils in induced sputum increased during terbutaline treatment alone compared with placebo (median 8.3% versus 4.4%, p = 0.049). The addition of terbutaline to budesonide did not affect the percentage of eosinophils compared with budesonide treatment alone. These findings support the hypothesis that short-acting beta-agonists have a permissive effect on airway inflammation and that when used in high dose there may be an unfavorable interaction with inhaled corticosteroids.

Nursing activities and acute confusional states in elderly hip-fractured patients.

Confusion in 91 hospitalized patients over 60 years of age who had sustained hip fracture and undergone subsequent surgical repair was examined in seven hospitals in five states. The relationship of nursing activities, patient, surgical, and environmental variables to the extent of confusion apparent in the sample was explored. Data were gathered by record review, patient testing, observation, and interview. Patient testing and interview were carried out on the first, third, and fifth postoperative days; the patient's caregiver on those days was also interviewed. The major dependent variables used in multiple regression analysis were memory (immediate and recent), observed behavior, and patient's self-report of mental clarity. Results showed that the most consistent predictors of postoperative confusion were the presence of confusion on admission to the hospital or confusion during the preoperative period. Greater postoperative mobility and freedom from urinary problems resulted in less confusion. Being male and of increased age were risk factors. The presence of timepieces and patients' use of television were associated with higher levels of mental clarity. Patients in private rooms tended to do better on memory testing than patients in rooms shared with others. Nursing personnel's major action in response to patient confusion was that of conscious attention to orientation, explanation, or reassurance. Use of restraints was relatively frequent.