ABSTRACT
BACKGROUND: Nonspecific bronchial provocation tests may be simplified by the use of hand-held devices to deliver methacholine. OBJECTIVE: To study the feasibility of using a metered-dose inhaler (MDI) to administer methacholine in bronchial provocation tests, and the ability of such a device to diagnose bronchial hyperresponsiveness (BHR) accurately. METHODS: In an open randomized crossover pilot study, we compared the provocative dose that induces a 20% fall in FEV1 (PD20 FEV1) obtained with the methacholine MDI with that obtained using a conventional nebulizer in 20 hyperresponsive and 20 nonhyperresponsive subjects. The MDI delivers 400 doses of 100 microg of methacholine, and was used via a spacer. Bronchial hyperresponsiveness (BHR) was defined as a PD20 FEV1 <2,000 microg with the conventional test using the nebulizer. The tests were performed in each subject in a randomized order, 1 to 7 days apart. RESULTS: Of the subjects who had a nebulizer PD20 FEV1 <2,000 microg, all but one had an MDI PD20 FEV1 <800 microg. When 800 microg was taken as the threshold for the diagnosis of BHR with the MDI test, the accuracy of this test to diagnose BHR was 97.5%, and the two tests were highly concordant for the diagnosis of BHR (Pearson chi2, 36.19; p<0.0001). CONCLUSION: A hand-held device may be suitable for delivery of methacholine during bronchial provocation tests, if these results are confirmed in large samples.
Subject(s)
Bronchial Provocation Tests/instrumentation , Methacholine Chloride/administration & dosage , Adult , Bronchial Hyperreactivity/diagnosis , Cross-Over Studies , Female , Humans , Male , Nebulizers and Vaporizers , Pilot ProjectsABSTRACT
Cyclosporine had been used to treat steroid resistant rejection episodes in 24 living related donor kidney transplants. The rejection episodes as well as their response to cyclosporine were documented by graft biopsies and/or fine needle aspiration cytology. Ten similar patients suffering from steroid resistant rejection episodes were not given cyclosporine. These cases were evaluated and their outcome was compared to those who received cyclosporine therapy. In the 24 cases who received cyclosporine, there was complete reversal of the rejection episodes in 11, partial reversal in 6, arrest of the rejection crisis in 4 and failure in 3. In all the 10 cases without cyclosporine therapy the grafts were found to be lost. It was concluded that cyclosporine can cure established rejection episodes even when severe and steroid resistant.
