RESUMO
Eight asthmatic patients completed a 12-week, double-blind, placebo controlled study to assess the efficacy of ketotifen, 1 mg twice daily, in the inhibition of bronchoconstriction induced by isocapnic hyperventilation (IH). There was no significant difference in the degree of bronchoconstriction produced by IH after treatment with ketotifen or placebo.
Assuntos
Asma/tratamento farmacológico , Espasmo Brônquico/prevenção & controle , Hiperventilação/fisiopatologia , Cetotifeno/farmacologia , Adulto , Asma/complicações , Espasmo Brônquico/etiologia , Ensaios Clínicos como Assunto , Método Duplo-Cego , Feminino , Volume Expiratório Forçado , Humanos , Hiperventilação/complicações , Masculino , Distribuição AleatóriaRESUMO
A hospital self-admission service for asthmatic patients was started in December 1968. During a 15-year period, 195 asthmatic patients were responsible for 873 hospital self-admissions. During the last 3 years there were significantly more night admissions and shorter durations of asthma attacks prior to admission than during the first 3 years. Assisted ventilation was necessary on 36 occasions (4%), but one patient was responsible for 28 of these episodes. There were three hospital deaths. One patient died from a tension pneumothorax as mechanical ventilation was being started, and two patients were not actively resuscitated because of irreversible airways obstruction and ischaemic heart disease. There were six deaths outside hospital, one from myocardial infarction, four from asthma; one young female died on a holiday trip. The hospital death rate for patients admitted via this service is 0.34% (0.1% if the two patients who were electively not resuscitated are excluded). This low mortality rate suggests that this self-admission service saves lives. There are no costs and this service gives confidence to patients and general practitioners.
Assuntos
Asma/terapia , Serviços Médicos de Emergência/organização & administração , Admissão do Paciente , Adolescente , Adulto , Idoso , Asma/mortalidade , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Respiração Artificial , Escócia , Autocuidado , Transporte de PacientesRESUMO
Between 1971 and 1978, 140 cases of small cell anaplastic carcinoma of the bronchus were registered by a group of chest physicians in north Edinburgh. Sixty-five of these patients received specific treatment either with radiotherapy or cyclophosphamide and 75 patients were given treatment for symptoms only. Between 1979 and 1981 83 patients referred to the same physicians and pathologists were treated with combination chemotherapy (methotrexate, cyclophosphamide and CCNU) for 12 weeks. Overall median survival in the 1971 to 1978 group was two months with the actively-treated patients surviving for five months vs. less than one month for treatment of symptoms only. For the 83 patients treated with combination chemotherapy, median survival was nine months with 33 per cent alive at one year and 13 per cent at two years. Positive factors associated with prolonged survival included performance status at presentation and response to chemotherapy. This study demonstrates that the prognosis for the majority of patients with small cell carcinoma of the bronchus has improved significantly with the introduction of combination chemotherapy.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Adulto , Idoso , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma de Células Pequenas/mortalidade , Ensaios Clínicos como Assunto , Ciclofosfamida/administração & dosagem , Feminino , Humanos , Lomustina/administração & dosagem , Neoplasias Pulmonares/mortalidade , Masculino , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Prognóstico , Estudos ProspectivosRESUMO
A 14-year-old previously fit schoolboy was admitted with staphylococcal pneumonia secondary to influenza A infection. His condition deteriorated as he developed adult respiratory distress syndrome (ARDS); during a stormy recovery exceptionally high doses of benzodiazepines and opiates were given in order to suppress voluntary breathing during a successful period of assisted ventilation. It is possible that benzodiazepine-opiate antagonism developed. Subsequent studies in laboratory mice indicate that the respiratory depressant effects of morphine can be antagonized by prior treatment with lorazepam.
Assuntos
Ansiolíticos/farmacologia , Cuidados Críticos , Morfina/antagonistas & inibidores , Adolescente , Animais , Ansiolíticos/uso terapêutico , Interações Medicamentosas , Heroína/antagonistas & inibidores , Humanos , Lorazepam/farmacologia , Lorazepam/uso terapêutico , Masculino , Camundongos , Morfina/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Síndrome do Desconforto Respiratório/induzido quimicamenteRESUMO
A comparative study of the clinical response to salbutamol nebulized by an Inspiron Mini-Neb using flow rates of 4 and 8 litres/min is described. Forty patients with chronic asthma were given doses of approximately 1 mg and 5 mg of salbutamol using flow rates of either 4 or 8 litres/min. The two flow rates and the two dosages produced similar increases in FEV1 and FVC and similar changes in pulse rate. These results demonstrate that flow rates of 4 litres/min, such as can be produced by a domestic oxygen cylinder, and doses of 1 mg salbutamol are effective in the treatment of patients with chronic reversible airflow obstruction. While we do not advocate the general use of oxygen cylinders to drive nebulizers, our study shows that this form of administration produces a bronchodilator response similar to that using a flow rate of 8 litres/min.
