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A K Webb

Publications and source records attributed to A K Webb.

At least 91 records · Page 5Linked to original sources
PubMed1995

The isolation and characterization of non-typeable Haemophilus influenzae from the sputum of adult cystic fibrosis patients.

The role of non-typeable Haemophilus influenzae in cystic fibrosis (CF) remains unclear. We wanted, therefore, to determine the presence and characteristics of non-typeable H. influenzae in sputum samples from patients with CF. In order to do this, we have assessed sputum samples from 55 consecutive clinically stable patients seen routinely at an adult CF out-patient clinic. Quantitative bacterial culture was performed using a selective media containing cefsoludin, and isolates were characterized by biotyping and outer membrane protein profile analysis. In 17 (30%) of these samples, non-typeable H. influenzae was isolated and was present in similar viable numbers (mean 7.7 x 10(8) colony-forming units (cfu).mL-1; SEM 3.1) to Pseudomonas aeruginosa (mean 8 x 10(8) cfu.mL-1: SEM 2.4). All non-typeable H. influenzae isolates recovered were beta-lactamase negative and sensitive to a range of antibiotics. Several biotypes and outer membrane protein profiles were observed, with no apparent association between these two phenotypic characteristics. The study showed that large numbers of non-typeable H. influenzae are often present in sputum from adult patients with CF. Further longitudinal studies of outer-membrane protein profile analysis are required to determine the dynamics of non-typeable H. influenzae colonization in individual patients and the clinical significance.

Adolescent↗
PubMed1995

The treatment of pulmonary infection in cystic fibrosis.

The survival of cystic fibrosis patients has improved through an aggressive, multidisciplinary approach to the therapy of pulmonary sepsis. Intravenous antibiotics play a major role in the care of cystic fibrosis patients, even though it is not possible to achieve persistent bacterial eradication due to the complex microbiology and pathology of these patients. The most important pathogen in older patients is Pseudomonas aeruginosa. The increasing incidence of Pseudomonas cepacia, strains of which can be highly resistant to many antibiotics, also represents an important challenge to the efficacy of antibiotic therapy. Choice of appropriate antimicrobial therapy is hampered by the fact that a single patient may harbour several different pseudomonas phenotypes with variable resistance patterns. Carbapenem antibiotics possess a wide range of activity against most Gram-negative and Gram-positive bacteria and are therefore a useful addition to the antimicrobial armamentarium available to the clinician. The new carbapenem meropenem is well tolerated at high doses by both children and adults. Results from a comparative trial against ceftazidime suggests that meropenem has a place in the management of cystic fibrosis.

Adult↗
PubMed1994

Treatment compliance in adults with cystic fibrosis.

BACKGROUND: The study comprised three interrelated aims: (1) to ascertain (a) patient compliance with physiotherapy, exercise, enzyme and vitamin regimens, (b) how compliance was perceived by patients, and (c) the reasons for poor compliance (2) to identify demographic and clinical variables associated with compliance; and (3) to determine how accurately patient compliance can be predicted by carers. METHODS: Demographic and medical history data were obtained from medical records and a patient questionnaire. The data obtained included age, sex, employment status, inpatient or outpatient status, frequency of contact with the clinic, age at diagnosis, and the number of years practising physiotherapy. Measures of clinical status, including FEV1 and FVC percentage predicted, Shwachman score, and 24 hour sputum weight were recorded before completion of the questionnaire. The questionnaire, administered by a psychologist, assessed the reported degree of patient compliance, their perception of compliance, and their reasons for poor compliance. RESULTS: Sixty patients participated in the study and 51/60 and 41/55 patients were considered compliant with enzyme and exercise therapies, respectively. Compliance was lower with physiotherapy (32/60) and vitamin treatment (21/45). Patients reporting immediate benefits following exercise and physiotherapy were more compliant than those reporting no improvement. The perception by patients that compliance was sufficient ("about right") was physiotherapy 67%, exercise 37%, enzymes 78%, and vitamins 9%. Compliance was not influenced by demographic details nor by severity of disease, although patients producing large amounts of sputum and receiving help with physiotherapy were more compliant with physiotherapy. The physiotherapist and physician judged correctly the degree of compliance with physiotherapy in 83% and 75% of cases, respectively, and with exercise in 68% and 67% of cases, respectively. CONCLUSIONS: The reported degree of compliance and reasons for poor compliance were treatment specific. Demographic and disease severity variables were not associated with compliance. Those involved in the care of patients with cystic fibrosis were able to predict patient compliance.

Adolescent↗
PubMed1993

Evidence for transmission of Pseudomonas cepacia by social contact in cystic fibrosis.

Pulmonary colonisation with Pseudomonas cepacia in patients with cystic fibrosis can be associated with increased morbidity and mortality. The modes of transmission of P cepacia are, however, unclear. We used selective media and phenotypic and genomic typing systems to investigate the acquisition of P cepacia by adults with cystic fibrosis. An analysis of isolates from 210 patients attending regional clinics in Edinburgh and Manchester between 1986 and 1992 showed that the main cause of increased isolations of P cepacia from 1989 was the emergence of an epidemic strain that had spread between patients in both clinics. Epidemiological evidence indicated that social contact was important in spread of the epidemic strain within and between clinics. We suggest that guidelines to limit the acquisition of P cepacia should not be restricted to patients in hospital, and that intimate or frequent social contact is associated with a high risk of cross-infection.

Adolescent↗
PubMed1993

The difficulties of treating infection in adults with cystic fibrosis.

The treatment of pulmonary infection in the adult with cystic fibrosis (CF) is palliative rather than curative. This review discusses the following management problems: infection with Pseudomonas aeruginosa and the associated strong self-damaging host responses; Pseudomonas cepacia; the underestimated role of viruses in causing progressive lung damage; and the difficulty of treating infection when complicated by medical problems, such as diabetes, haemoptysis, pneumothorax and pregnancy. Also considered, are the effect of poor compliance upon treatment and the expertise that is required to keep alive the preterminal patient actively listed for heart lung transplantation.

Cystic Fibrosis↗
PubMed1992

The benefits of exercise combined with physiotherapy in the treatment of adults with cystic fibrosis.

The impact of exercise, physiotherapy, and combinations of exercise and physiotherapy upon sputum expectoration were compared in 18 adults with cystic fibrosis. Any treatment which included physiotherapy either alone or in combination with exercise produced a significantly higher sputum weight during treatment time than did exercise alone (P < 0.01). This trend was true for both high (greater than 35 g in 24 h) and low (less than 35 g in 24 h) sputum producers (P < 0.05). There were no significant changes in FEV1 and FVC 30 min after any treatment. The treatment option preferred by patients to continue at home was exercise followed by physiotherapy (P < 0.001). Exercise alone was less productive than the other three modalities in clearing sputum (P < 0.001).

Adolescent↗
PubMed1992

Deficient nifedipine oxidation: a rare inherited trait associated with cystic fibrosis kindreds.

Previous studies have indicated that there is weak genetic linkage between the defective gene in cystic fibrosis (CFTR) and the gene encoding the nifedipine metabolizing enzyme P4503A4 which are both located on chromosome 7. To examine further this possible association, nifedipine metabolism was investigated in a group of 59 volunteers, and 17 adult cystic fibrosis patients and 37 of their relatives. In agreement with the majority of previous studies, the volunteer group showed a unimodal distribution of recoveries for the major metabolite M-II ranging from 33 to 78% excretion in 8 h. In the case of both the cystic fibrosis patients and their parents, the distribution of recoveries was shifted to the left with five out of 20 parents and three out of 11 unrelated cystic fibrosis patients showing recoveries below the range observed in the volunteer group. This poor metabolism appeared to be both reproducible and heritable and did not appear to be a consequence of mutations in the CFTR gene.

Adolescent↗
PubMed1991

Management problems of the adult with cystic fibrosis.

Aggressive palliative therapy which includes antibiotics, physiotherapy, exercise and adequate nutrition remain the basis for treatment and account for improved survival into adulthood. However, although mean actuarial survival into the third decade of life is to be expected in well organised cystic fibrosis centres, a plateau has probably been reached and we need innovative forms of treatment before we can expect further improvements. Indeed, as patients have matured into adulthood new clinical problems have arisen; diabetes is more common, liver disease can progress, and vasculitis may affect joints, skin and brain. Furthermore, social and psychological problems are magnified by patient realization of a deteriorating lethal disease. This article discusses the recommended provision of care for adults with cystic fibrosis, the management of medical and social problems, and finally, how the introduction of heart lung transplantation has affected patient management in the terminal phase of the disease.

Adult↗