Asthma quality of life in a Southern practice: towards a new paradigm.

BACKGROUND: Quality of life (QOL) surveys are increasingly recognized as part of state-of-the-art asthma assessment. Disease-specific surveys quantitate total QOL and subscale domains which, along with changes in these measures, suggest asthma severity and effects of intervention. OBJECTIVES: This study was conducted to (1) compare regional variation in QOL and change in QOL in an allergy practice in the South and (2) to examine if one or a set of questions relating to asthma severity could estimate QOL thereby obviating the need for a complete survey. METHODS: Fifty-eight patients were administered an asthma specific quality of life (AQOL) questionnaire, the Marks et al Asthma Quality of Life survey, at baseline and surveyed in follow-up at 1 and 6 months. Additional questions were asked concerning bronchodilator use in a day and 1 week, missed work/school days, nocturnal wakening in 1 week due to asthma, emergency room visits in the previous month, and past hospitalizations in the last year. Spirometry was performed at each visit. RESULTS: Baseline AQOL is significantly (P < .05) related individually to nocturnal wakening, bronchodilator use in a day, work or school days missed, and hospitalization during the past year. A model combining these factors explains 49% of the variance, r2 = .49. The AQOL score between baseline and the first month shows a significant improvement (P < .0001) and this improvement is related (P = .002) to the reduction in nocturnal wakenings during that same time period. CONCLUSIONS: Specialty care intervention affected QOL similarly in the Southern practice compared with other regions/countries. Nocturnal wakening, bronchodilator use in a day, workdays missed, and hospitalization in the past year were all significantly correlated with AQOL. Number of nocturnal wakenings and bronchodilator use in a day may not only stratify asthma severity, they roughly stratify AQOL. The wide scatter of AQOL scores for a given indicator of asthma severity makes a limited combination of questions an indicator but not yet a reliable predictor of AQOL.

Floating patterns of metered dose inhalers.

As long as metered dose inhalers have existed, patients have sought a reliable method to determine if a given canister was still potent. Concerning beta agonists, the answer to this question may be lifesaving. Issues of compliance have made dating canisters or counting doses impractical. Likewise, previous claims of floating characteristics are unreliable. In tap water, we float-tested 13 commonly used inhalers three times each, observing variations as they were incrementally actuated, emptying their contents. One essential pattern was observed. Almost all prescription-size canisters sink when full; all float by the time one-third of their contents is gone. Orientation of prescription-size canisters changes in a distinct pattern especially near 90% depletion. Sample-size canisters showed some variance. Results suggest that the pharmaceutical industry should include individual floating characteristics as part of the package insert as they provide a reproducible means of gauging contents.

Anaphylaxis. A review of 266 cases.

BACKGROUND: A presentation of findings from a large population of anaphylaxis cases. METHODS: Retrospective chart review and follow-up questionnaire provided data on 266 subjects (113 males and 153 females) aged 12 to 75 years (mean age, 38 years) who were referred to a university-affiliated private allergy-immunology practice in Memphis, Tenn, for evaluation and management of anaphylaxis from January 1978 through March 1992. RESULTS: Of 266 subjects, 162 (61%) had three or more anaphylactic episodes, 41 (15%) had two episodes, and 63 (24%) had one episode. Atopy was present in 98 individuals (37%). Physicians thought foods, spices, and food additives caused anaphylaxis in 89 individuals (34%); crustaceans and peanut accounted for about half of these cases. Medications were thought to have caused the anaphylactic episodes in 52 individuals (20%); nonsteroidal anti-inflammatory drugs in about half of these cases. Other probable causes included exercise (n = 19), latex (n = 2), hormonal changes (n = 2), and insect bites (n = 4). A suspected cause could not be determined in 98 individuals (37%). These subjects were diagnosed as having idiopathic anaphylaxis. Of the 266 subjects, 102 responded to a follow-up survey; 68 (67%) of the 102 were thought to have identifiable causes of anaphylaxis (32 of whom [47%] failed to carry epinephrine syringes for self-administration despite instructions to do so). In contrast, of 34 subjects with idiopathic anaphylaxis who responded to the survey, only three (9%) did not carry epinephrine. CONCLUSIONS: (1) Atopy is common in subjects who experience anaphylaxis, regardless of its origin; (2) crustaceans and nonsteroidal anti-inflammatory drugs are the most common food and medication groups, respectively, thought to cause anaphylaxis; (3) causative agents can be identified for two thirds of the subjects, and recurrent attacks are the rule; and (4) subjects with idiopathic anaphylaxis are more likely to carry epinephrine for self-administration than those with identifiable causes.

Pneumocystis carinii antigenemia in acquired immunodeficiency syndrome.

The present study was conducted to determine the prevalence and significance of Pneumocystis carinii antigenemia in patients with acquired immunodeficiency syndrome (AIDS) and clinically or invasively diagnosed P. carinii pneumonitis. Single serum specimens from 20 AIDS patients invasively examined for P. carinii organisms and 106 AIDS patients with a clinical diagnosis only of P. carinii pneumonitis were blindly tested for P. carinii antigenemia by a counterimmunoelectrophoresis assay. In the 20 specimen-documented cases, the antigen test demonstrated a sensitivity of 75% and a specificity of 90%. The positive predictive value of the test was 90%, while the negative predictive value was 70%. In AIDS patients with specimen-documented P. carinii pneumonitis, the prevalence of P. carinii antigenemia coincided almost exactly with the prevalence of positive invasively obtained specimens (60 and 59%, respectively). In patients with a clinical diagnosis only of P. carinii pneumonitis, half as many (30%) were found to exhibit antigenemia. Sequential P. carinii antigen titers determined by a new latex agglutination technique on three AIDS patients with specimen-documented P. carinii pneumonitis demonstrated the influence of specific therapy upon P. carinii antigenemia and its potential prognostic application.

Developmental arrest of mouse tooth germs in vitro by 6-diazo-5-oxonorleucine (DON).

Molars and incisors were excised from the mandibles of 15-day-old mouse embryos and explanted to agar-solidified Eagle's basal medium with 10% fetal calf serum and to medium containing 6-diazo-5-oxonorleucine (DON), a glutamine analog which inhibits glycoprotein and glycosaminoglycan synthesis. The concentration of DON ranged from 5-100 microgram/ml; the lowest dose at which consistent results were obtained was 75 microgram/ml. At the end of a 4-day culture period, controls displayed characteristic incisiform or molariform morphologies and possessed odontoblasts and preameloblasts. The growth and development of DON-treated germs, however, was arrested and such germs remained morphologically and histologically similar to the developmental state attained at the time of explantation. DON-treated germs also contained less abundant Alcian blue staining material than controls. Development arrest by DON was prevented by addition of glutamine but not by glucosamine or the purine analog amino imidazol carboximine. Suppressed germs resumed normal development when removed from medium containing 75 microgram/ml of DON to control medium. These results suggest that glycoprotein or glycosaminoglycans play a role in epithelial-mesenchymal inductive interactions.