Different prevalence and degree of nonspecific bronchial hyperreactivity between seasonal and perennial rhinitis.

From the patients observed at our respiratory allergology service, we selected patients with rhinitis only, without any past or present respiratory symptoms, for our study. All these patients had normal pulmonary function, were administered carbachol or methacholine bronchial challenges, and had one or more skin reactions to perennial or seasonal allergens. Patients were allocated to three groups: group A, patients with seasonal rhinitis who were administered nonspecific challenges out of season; group B, patients with seasonal rhinitis tested during the season; and group C, patients with perennial rhinitis. The three groups were divided into subgroups according to the duration in years of rhinitis and to the degree of nonspecific bronchial responsiveness. The distribution into four groups of reactivity, arbitrarily defined as normal and mildly, moderately, and severely increased reactivity, was as follows: group A, 124, 21, 30, 22; group B, 75, 15, 7, and 21: and group C, 69, 17, 39, and 72, respectively. The patients of group C (perennial rhinitis) demonstrated a distribution significantly (p less than 0.001) different from subjects with seasonal rhinitis, both group A and group B. Our results are consistent with the hypothesis that perennial rhinitis is much more important than seasonal rhinitis as a risk factor for developing nonspecific bronchial hyperresponsiveness.

Effect of inhaled frusemide on the early response to antigen and subsequent change in airway reactivity in atopic patients.

The purpose of this study was to investigate whether inhaled frusemide was able to inhibit the increase in nonspecific bronchial reactivity that occurs after the early response to allergen exposure in subjects with allergic rhinitis or asthma (or both). Ten symptom free patients initially underwent a challenge with methacholine, to determine the dose of methacholine that caused a 15% fall in FEV1 (PD15 FEV1 meth) and a challenge with a specific allergen, to determine the concentration of allergen that caused a fall in FEV1 of at least 15%. On two further occasions they inhaled allergen concentration that had caused the greater than or equal to 15% fall in FEV1 preceded by inhaled frusemide (40 mg frusemide in 4 ml buffered saline) or placebo (4 ml of diluent solution), according to a randomised, double blind, crossover design. All allergen studies were separated by at least seven days. A methacholine challenge was performed two hours after the allergen challenge, a time when the early response to allergen had completely resolved. Frusemide inhibited the early response to antigen, causing mean (95% confidence interval) protection of 87.6% (96-80%) for the maximum fall in FEV1. The increase in non-specific airway reactivity that occurred after antigen when this was preceded by placebo was reduced by frusemide. The mean (95% CI) difference in PD15 values between the placebo and the frusemide days was 1.73 (2.30-1.16) doubling doses of methacholine. These results confirm that frusemide is highly effective in preventing the early response to allergen, and show that it inhibits the increase in reactivity to methacholine that follows the early response.

Effect of nisoldipine (BAY k 5552) on methacholine-induced bronchoconstriction in patients with nonspecific bronchial hyperreactivity.

The purpose of this study was to determine whether a new calcium antagonist, nisoldipine (BAY k5552), exerted protection against methacholine-induced bronchoconstriction in subjects with hyperreactive airways. Twelve symptomless rhinitic and/or asthmatic patients with previously demonstrated bronchial hyperreactivity to methacholine were treated with placebo or nisoldipine (10 mg) according to a randomized, double-blind, crossover, placebo-controlled study design. Airway reactivity was examined through changes in response to methacholine challenge three hours after drug or placebo administration. Nisoldipine, in comparison to placebo, produced a weak but significant rise of provocative dose of methacholine responsible for a 15% fall in FEV1 (P less than .01). The data suggest that a single dose of 10 mg of nisoldipine is able partially to counteract methacholine-induced bronchoconstriction in atopic subjects with nonspecific airway hyperresponsiveness.

Famotidine effects on theophylline pharmacokinetics in subjects affected by COPD. Comparison with cimetidine and placebo.

The effect of a new H2-antagonist, famotidine, on theophylline pharmacokinetics was compared with placebo and cimetidine in 26 patients affected by COPD. Cimetidine, placebo, and famotidine were administered, four days each drug at random, to all the subjects. Results suggest that famotidine, contrary to cimetidine, does not influence theophylline metabolism in man.

Non-Hodgkin's lymphoma primarily involving the bronchial tree.

Among extranodal localizations, the bronchial one is very unusual, especially as primary involvement. The authors present 2 cases of non-Hodgkin's lymphoma (NHL) admitted to the hospital because of thoracic abnormalities. Chest x-ray revealed lobar atelectasis. Fiberoptic bronchoscopic findings agreed with the diagnosis of unresectable bronchogenic tumor in both cases. Histologic examination of biopsy specimens was nonrevealing in the first patient, and suggested small cell lung cancer in the second one. Further histologic and immunohistochemical examinations excluded bronchial tumors (particularly small cell bronchogenic carcinoma) and led to the diagnosis of lymphocytic lymphoma in one case and centroblastic lymphoma in the other. In the differential diagnosis of bronchogenic tumors, it is necessary to keep in mind the hypothesis of lymphomatous involvement of the bronchial wall, although it rarely occurs.

Procaterol metered aerosol in patients with chronic obstructive pulmonary disease.

The activity and tolerability of procaterol, a recently introduced beta 2-adrenergic drug, were evaluated in comparison with fenoterol and a placebo in a single blind, cross-over study, using a metered aerosol formulation. Twelve patients suffering from chronic obstructive pulmonary disease with reversible bronchial obstruction were enrolled. Before and 30, 120, 240, 360, 480 min after drug administration, forced vital capacity (FVC), forced expiratory volume at the first second, forced expiratory flow at 25-75% and 75-85% respectively of the FVC, thoracic gas volume and the specific airways conductance were calculated. Procaterol 20 mcg showed a significant bronchodilating activity as well as fenoterol 400 mcg. This activity was already significant within 30 min, achieved its maximum after two hours and lasted more than eight hours. Side-effects were complained of by 41% of patients treated with procaterol and by 50% treated with fenoterol; procaterol showed less cardiovascular effects than fenoterol.

Lomustine (CCNU)-induced pulmonary fibrosis.

A case of progressive pulmonary interstitial fibrosis following adjuvant lomustine (CCNU)-5-fluorouracil therapy for a colon carcinoma is reported. A close relationship between lomustine assumption and lung damage seems to emerge from the clinical, radiologic and histologic findings presented. On the basis of this experience and previous available data from literature, pulmonary toxicity must be regarded as a possible adverse effect of lomustine therapy.