Clinical efficacy of azithromycin in lower respiratory tract infections.

A total of 51 patients with acute exacerbation of chronic bronchitis and pneumonia were enrolled: 27 treated with azithromycin (500 mg once a day for 3 days), and 24 with roxithromycin (150 mg every 12 hours for 7 days). The two regimens were equally effective, with clinical cure in 80% and 72% of patients respectively. Bacteriological eradication on day 19-23 was obtained in 7/11 cases (64%) and in 6/13 cases (46%) in the two groups, respectively. No side effects occurred in patients treated with azithromycin, while they occurred in the roxithromycin group (2 vomiting and 1 gastritis). Clinical and bacteriological efficacy, excellent tolerability, simplified dosage (single daily dose) and short-course (3 days) therapeutic regimen make azithromycin, in our experience, efficacious for the treatment of acute exacerbation of chronic bronchitis and community-acquired pneumonia.

Legionellosis associated with artesian well excavation.

In October 1990 pneumonia due to Legionella pneumophila was diagnosed in two employees working in the area of Apulia, southern Italy, where artesian wells were in construction. Although the exposure to excavation has been associated with Legionnaires' disease, in our investigation the illness occurred only in those employees who were present when the water emerged from the ground under high pressure. On the basis of this report, water appears as the most likely reservoir of the organism and the main route of infection.

Pollinex Parietaria (Bencard Parietaria), a new allergoid for treatment of patients sensitive to Parietaria pollen.

Two matching groups each of eleven patients suffering from allergy to Parietaria pollen were treated either with tyrosine-adsorbed glutaraldehyde-modified extract of Parietaria judaica pollen (Bencard Parietaria/Pollinex Parietaria) or with alum-adsorbed pyridine-extract (Alavac). The side effects of therapy were similar in both groups and were mostly local in nature. Nasal symptoms were significantly less at the end of treatment in the group of patients treated with Pollinex. P. judaica-specific IgG levels were significantly higher in patients following treatment with Pollinex. The majority of patients in both groups showed reduced nasal and/or skin sensitivity following therapy as measured by provocation testing. The results indicate that Pollinex Parietaria is an effective vaccine for the treatment of immediate hypersensitivity to Parietaria pollen.

Airway hyperreactivity and menstrual cycle in asthmatic patients.

Healthy women and infertile asthmatic patients do not show any change in IgE, circulating eosinophils, sensitivity to metacholine, lung volumes. Allergic asthmatic patients tested in periods without allergen load and drug intake showed contrasting cycle related changes in aspecific hyperreactivity. Such changes are not directly related to hormonal levels. Circulating mediators are likely to explain observed pathways.

[Asthma improved by acetylsalicylic acid]. / Asthme amélioré avec l'acide acétylsalicilique.

It is known that in some asthmatic subjects the administration of acetylsalicylic acid (ASA) and non-steroid anti-inflammatory drugs (NSAID) results in bronchodilatation. We have administered 750 mg of ASA intravenously to 100 asthmatic patients who were without history of ASA intolerance. Functional assessment (FEV) was performed under basal conditions and after 5, 10, 15, 30, 60, 90, 120, 150 and 180 minutes after the administration of ASA. 64 patients had no functional variations, 14 showed a percentage variation of less than 20% in FEV and 14 had a doubtful bronchodilatation (FEV 15-20%). The test was repeated after an interval of 1 week in those patients who showed an increase of 20% in FEV and only 2 confirmed the bronchodilatation. The pathogenesis of asthma that is improved by ASA is not entirely clear, but it is an extremely interesting model for study of the role of different mediators in the asthma syndrome.

Ambroxol for the prevention of chronic bronchitis exacerbations: long-term multicenter trial. Protective effect of ambroxol against winter semester exacerbations: a double-blind study versus placebo.

In a 6-month, double-blind multicenter trial conducted over the winter, the effects of daily administration of ambroxol retard (75 mg) were compared with those of placebo in preventing exacerbations and improving symptoms and clinical signs in chronic bronchitis patients. The trial was completed by 110 patients in the ambroxol group and by 104 in the placebo group. Initially, there were no significant differences between the groups. By the end of the 2nd month of treatment, 67.2% of the ambroxol group had had no exacerbations compared to 50.4% in the placebo group. At the end of the 6-month trial, 45.5% of the treatment group had had no exacerbations, compared to only 14.4% of the control group. These differences were statistically significant. Patients in the treatment group lost significantly fewer days through illness (442) and had fewer days when they needed antibiotic therapy (371) compared to the placebo group patients (837 and 781). Ambroxol also produced statistically significant symptomatic improvement, measured as difficulty in expectoration, coughing, presence of dyspnea and the auscultatory signs as compared to controls. Since ambroxol was well tolerated and compliance was good, it appears like a drug of choice for pharmacological prophylaxis of chronic bronchitis.

Effects of aztreonam and netilmicin upon alveolar macrophage function.

Both aztreonam and netilmicin showed no toxic effect on alveolar macrophage function when administered at varying concentrations. Killing ability was unchanged as well. The increase of enzyme delivery, assessed at varying concentrations, was very limited and of no relevance in the pathogenesis of possible tissue damage. It can be explained on the basis of a change in the permeability of membranes or to output during phagocytosis. In cultures containing either antibiotic under similar conditions we did not note any substantial differences. The concentrations tested can be used safely in the therapy of infections due to most gram-negative bacteria.

Protective effect of Duovent on bronchospasm induced by carbachol in comparison with each of its components.

The protective effect on bronchospasm, induced by carbachol, of 2 puffs of fenoterol (200 micrograms), ipratropium bromide (80 micrograms) and Duovent (200 micrograms fenoterol + 80 micrograms ipratropium bromide) was compared in a group of 12 asthmatic patients. The double-blind study was always performed at the same time of day, 2 and 5 h after premedication, on 4 consecutive days. After the 1st day, when placebo was given, the drugs were administered randomly. As regards PD20 FEV1 (dose of carbachol necessary to determine a 20% decrease in FEV1), Duovent was found to be the most active drug. A very clear difference was seen 2 h later, not only compared to fenoterol (PD20 placebo, means +/- SD: 90.8 +/- 93.2 micrograms; PD20 Duovent: 1,876.5 +/- 1,103.5 micrograms; PD20 fenoterol: 324.3 +/- 220.7 micrograms) but also with ipratropium bromide (PD20: 1,215.8 +/- 950 micrograms). After 5 h, the three treatments maintained a significant action, but the efficacy of Duovent, while significantly greater than that of fenoterol, was very similar to that of ipratropium (PD20 placebo: 78.4 +/- 92.6 micrograms; PD20 fenoterol: 134.6 +/- 138.2 micrograms; PD20 ipratropium bromide: 295.4 +/- 337 micrograms; PD20 Duovent: 286.7 +/- 181.2 micrograms).

Lysozyme activity in bronchial and broncho-alveolar fluids.

Patients affected by different diseases were submitted to bronchial and bronchoalveolar lavage, performed by fiberoptic bronchoscopy under xylocaine anesthesia. Bronchial lavage levels of lysozyme are very high and depend on the secretory rate of the mucosa, although further amounts can be derived from bronchial washings during inflammatory processes by neutrophils. Broncho-alveolar levels are mainly a function of macrophage secretion and dosages may provide an insight to the dynamic behaviour of macrophages in their response to foreign stimuli. Alveoli and blood levels reach an equilibrium, as assessed by mixed venous and arterial blood samples. Administration of exogenous lysozyme is able to increase bronchial IgA and sIGA. Serum immunoglobulins are higher as well, because of the polyclonal stimulation of the lymphocytes. Antiinflammatory properties and modulation of PMN arrival to inflammatory sites play a role in diminishing the enzymatic load to the lung and bronchi.

Asthma relieved by acetylsalicylic acid and nonsteroid anti-inflammatory drugs.

The authors report 2 typical asthmatic cases in whom the administration of acetylsalicylic acid (ASA) and nonsteroid anti-inflammatory drugs (NSAID) resulted in bronchodilatation. 500 mg of ASA were administered intravenously to 1 patient and the other was treated with ASA, indomethacin, noramidopyrine intravenously and acetaminophen orally during a bronchospastic attack. FEV1 and SRAW were measured before and after drug administration. The test was repeated with placebo (physiological saline). FEV1 increased rapidly after ASA and NSAID administration. Although the pathogenesis of asthma reversed by aspirin is not entirely clear, the authors suggest an alteration of sensitivity of the cyclo-oxygenase enzyme due to the inhibitory action of ASA and NSAID.

Functional assessment of airways bronchoconstriction with nebulized acetyl salicylic acid.

The aim of our study was to verify the functional modifications affecting central and peripheral airways during bronchoconstriction induced by aerosolized aspirin, so as to better understand the pathophysiologic mechanisms of the asthmatic crises in A.S.A. sensitive patients. The preliminary results were presented of a study carried out o 12 asthmatic A.S.A. sensitive patients, 7 of whom were females and 5 males, between the ages of 22 and 57 years. A.S.A. sensitivity was found in their medical history, in some cases, it had been confirmed by oral A.S.A. challenge. Among these patients, 6 were also affected by nasal polyposis. The method used was recently described by Bianco et al. although slightly modified by us: a fresh aqueous solution (18%) of A.S.A. -L is diluted 1:3 in saline; 4 ml of this solution is transferred to a glass nebulizer activated by a small compressor. The patients underwent treatment for 60 sec, during which a dose of approximately 1,8 mg of A.S.A. was inhaled, corresponding to about 40 mg of aspirin taken orally. In comparison with the reactions induced by oral challenge, those obtained with this treatment are easier, faster and confined only to the respiratory system. Before giving A.S.A. to the patients, control tests using saline aerosol were done. The functional assessment was performed under basal conditions, and 1, 15, 30, 60, 90 and 120 minutes following administration of A.S.A. since bronchoconstriction caused by nebulized A.S.A. usually reaches peak values between the 60th and 90th min. after which it gradually decreases over the following two hours. Our results show that, though A.S.A. induced bronchoconstriction prevails at large airways, it also influences the distal tracts of the tracheobronchial tree, since both SRAW, FEV1 and Vmax50C are modified at the same time.