Efficacy of HFA-beclomethasone dipropionate extra-fine aerosol (800 microg day(-1)) versus HFA-fluticasone propionate (1000 microg day(-1)) in patients with asthma.

Hydrofluoroalkane-134a beclomethasone dipropionate (HFA-BDP) extra-fine aerosol and HFA-fluticasone propionate (HFA-FP) are chlorofluorocarbon-free inhalers. We conducted an 8-week, open study to demonstrate the equivalence of HFA-BDP (800 microg day(-1)) and HFA-FP (1000 microg day(-1)) in moderate to severe asthma. Symptomatic patients on 500-1000 microg day(-1) CFC-BDP (or equivalent) and short-acting beta-agonist, were randomized to HFA-BDP (n = 101) or HFA-FP (n = 97) after 7-14 (+/-2) day run-in. In the intent-to-treat (ITT) population (n = 198), both treatments provided clinically and statistically significant improvements in asthma control, with increases in peak expiratory flow in the morning (AM PEF) and asthma symptoms (within treatment analysis P<0.05). Mean (SE) change in AM PEF from baseline at week 8 was equivalent (defined as 90% CI for the mean difference between treatments within +/-25 l min(-1)) in the two groups: 29.59 (5.19) l min(-1) for HFA-BDP vs. 17.3 (5.45) l min(-1) for HFA-FP (90% CI-0.02, 24.91). For the perprotocol population (n = 121), the mean (SE) change in AM PEF from baseline was not equivalent; AM PEF improved to a significantly greater extent in the HFA-BDP group than HFA-FP group [34.84 (7.08) vs. 20.63 (7.32) l min(-1) P<0.01; 90% CI; 2.66, 31.10]. At week 8 in the ITT population, there were no statistically significant differences in FEV1, beta-agonist use, asthma symptom/sleep disturbance scores, or percentage of days without asthma symptoms/sleep disturbance. There was a significantly greater reduction from baseline in mean eosinophil count for HFA-BDP compared with HFA-FP at weeks 3 and 8 (P<0.01), and eosinophil cationic protein value at week 8 (P<0.01). Both treatments were well tolerated and there were no statistically significant differences in urinary cortisol creatinine parameters. In conclusion, this study showed that, in patients with moderate-to-severe symptomatic asthma, HFA-BDP extra-fine aerosol 800 microg(-1) was at least as effective and equally well tolerated as 1000 microg day(-1) HFA-FP.

[Bronchiectases; clinical aspects, diagnosis and treatment]. / Bronchiëctasieën; kliniek, diagnostiek en behandeling.

Localised bronchiectasis was diagnosed in three immigrants, a male aged 16 and two females aged 45 and 20 years old. The symptoms were productive coughing (purulent discharge) and (or) haemoptysis. All recovered after surgical resection of the diseased lung parts. With the growing population of immigrants in the Netherlands it is of great importance to consider the presence of localised bronchiectasis in patients from this population who present with a persistent or recurrent bronchopneumonia.

[Bronchospasm, apnea and heart arrest following dipyridamole perfusion scintigraphy]. / Bronchospasme, apnoe en hartstilstand na een dipyridamol-perfusiescintigrafie.

The occurrence of fatal respiratory insufficiency following dipyridamole-thallium imaging is described. The patient, a 67-year-old man, had a history of chronic obstructive lung disease. Since patients with a history of chronic obstructive lung disease have an increased risk of developing bronchospasm after dipyridamole infusion, it is advised to be cautious in performing dipyridamole-thallium imaging in these patients. Dobutamine may be an acceptable alternative to dipyridamole in these patients.

Pulmonary hyalinizing granuloma.

A patient with pulmonary hyalinizing granuloma (PHG) is presented. PHG is a rare disease with very specific histological characteristics. Roentgenograms display multiple bilateral pulmonary nodules which may be cavitated. Evidence exists that the nodules are the result of an exaggerated chronic immune response. The course of the disease is generally favourable. PHG should be considered in patients showing multiple bilateral pulmonary nodules.