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Biomedical subjects

B R O'Driscoll

Publications and source records attributed to B R O'Driscoll.

At least 19 recordsLinked to original sources
PubMed2006

The link between fungi and severe asthma: a summary of the evidence.

There is current evidence to demonstrate a close association between fungal sensitisation and asthma severity. Whether such an association is causal remains to be confirmed, but this is explored by means of a detailed literature review. There is evidence from two randomised controlled trials that, in the example of allergic bronchopulmonary aspergillosis (ABPA), treatment with systemic antifungal therapy can offer a therapeutic benefit to approximately 60% of patients. ABPA is only diagnosed if a combination of clinical and immunological criteria is achieved. It is not known whether such cases are a discrete clinical entity or part of a spectrum of the pulmonary allergic response to fungi or fungal products. This paper describes the epidemiological evidence that associates severity of asthma with fungi and discusses possible pathogenetic mechanisms. Many airborne fungi are involved, including species of Alternaria, Aspergillus, Cladosporium and Penicillium, and exposure may be indoors, outdoors or both. The potential for a therapeutic role of antifungal agents for patients with severe asthma and fungal sensitisation is also explored. Not only are many patients with severe asthma desperately disabled by their disease, but, in the UK alone, asthma accounts for 1,500 deaths per yr. The healthcare costs of these patients are enormous and any treatment option merits close scrutiny. Within this report, the case for the consideration of a new term related to this association is put forward. The current authors propose the term "severe asthma with fungal sensitisation". However, it is recognised that enhanced and precise definition of fungal sensitisation will require improvements in diagnostic testing.

Asthma↗
PubMed2002

Prospective, placebo-controlled trial of 5 vs 10 days of oral prednisolone in acute adult asthma.

BACKGROUND: The optimal duration of oral steroid treatment in the management of acute adult asthma is unclear. We prospectively studied the effect of 5 vs. 10 days of oral prednisolone in patients with acute asthma requiring hospital admission. METHODS: Each patient received 40 mg of enteric-coated prednisolone daily for 5 days, followed by 5 days of 40 mg prednisolone daily (n=24) or placebo (n=20). All were given their usual inhaled asthma therapy including inhaled corticosteroids. Patients kept PEF and symptom diaries for 21 days. RESULTS: For the 5-day treatment group mean (95% CI) early morning PEF was 6 (-47,+36) l/min lower to day 21 (P=0.78). There was no evidence of differences in other PEF measures (morning post-bronchodilator, evening or worst of day). One patient in each group had an exacerbation requiring further oral steroids during the 21-day observation period. Asthma symptom scores were worse in the 5-day group on days 6-21 but the significance of this finding was uncertain, as a difference had emerged by day 5 (prior to trial entry). CONCLUSIONS: It may be possible to reduce the standard steroid course to 5 days in acute adult asthma, provided all patients receive inhaled steroids and a personal asthma management plan.

Acute Disease↗
PubMed2001

Value and accuracy of cytology in addition to histology in the diagnosis of lung cancer at flexible bronchoscopy.

There is still disagreement as to the value and reliability of wash and brush cytology, in comparison with histology, for the diagnosis of malignancy at flexible bronchoscopy. The present study compares the yield and concordance of findings from the two modalities for visible tumours at flexible bronchoscopy. A single-centre study of 514 consecutive flexible bronchoscopy procedures, in which a lesion suspicious of cancer was seen and bronchial wash cytology, brush cytology and forceps biopsy samples were taken. All equivocal or suspicious results were taken as negative. An overall yield of 89.3% was achieved using a combination of all three tests. This was greater for endobronchial than submucosal (95% vs. 86%) tumours. Cytology alone diagnosed 17.7% of cases. Use of all three modalities allowed tumours to be differentiated between small and non-small cell types in all but 5/459 positive cases (98.9%). There were only 3/313 cases in which there was a difference in cell type (small cell vs. non-small cell) between the two modalities. We conclude that wash and brush cytology are valuable tools, in addition to forceps biopsy, at flexible bronchoscopy. All three tests should be performed routinely in cases of suspected malignancy.

Biopsy↗
PubMed1999

Systemic bioavailability and potency of high-dose inhaled corticosteroids: a comparison of four inhaler devices and three drugs in healthy adult volunteers.

OBJECTIVES: To compare the systemic bioavailability (assessed by cortisol suppression) of high-dose budesonide when given by four inhaler devices and orally. Also studied are the relative systemic potencies of three inhaled steroids (budesonide, fluticasone propionate, and beclomethasone dipropionate) when given by metered-dose inhaler (MDI) with a large volume spacer. DESIGN: Double-blind, crossover, placebo-controlled trial. PARTICIPANTS: Sixteen healthy, steroid-naive adult volunteers. METHODS: On separate occasions, each subjects took 4 mg of budesonide through the following devices: MDI alone, MDI with 750-mL. spacer, dry-powder inhaler and nebulizer; 4 mg of budesonide was also taken orally to assess the effects of GI absorption. For the drug comparison, each subject took 4 mg of budesonide, fluticasone, and beclomethasone, and 2 mg of budesonide and fluticasone by MDI and spacer. RESULTS: Greatest percent suppression (95% confidence interval) of 9:00 AM cortisol with budesonide was observed with MDI alone (73% [57 to 90]) and turbohaler (72% [58 to 86]) compared with MDI spacer (42% [22 to 64]) and oral administration (14% [+6- to -34]). Nebulized budesonide produced an insignificant rise in 9:00 AM cortisol level. The most suppressive drug (given by MDI spacer) was fluticasone at 4 mg (86% [82 to 91]) and at 2 mg (72% [59 to 85]). The least suppressive drug was budesonide at 4 mg (43% [22 to 64]) and at 2 mg (25% [3 to 47]). The effects of 4 mg of beclomethasone were intermediate (66% [49 to 82%]). CONCLUSIONS: The choice of delivery device for administration of budesonide can lead to important differences in systemic bioavailability. Fluticasone has greater systemic potency than budesonide or beclomethasone when given at microgram equivalent dosage. The systemic potency ratio of fluticasone propionate to budesonide in normal human volunteers in the present study is similar to the therapeutic potency ratio of the drug in asthmatic patients (approximately 2:1).

Administration, Oral↗
PubMed1996

A long-term study of symptoms, spirometry and survival amongst home nebulizer users.

Although home nebulizers are widely used to deliver bronchodilator medication to patients with asthma and chronic obstructive pulmonary disease (COPD), the long-term benefits and hazards are unknown. The present authors have previously reported a prospective 12-month study of home nebulizer use involving 49 patients (15 asthma, mean forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) 1.3/2.1 1; 34 COPD, mean FEV1/FVC 0.7/1.8 1). Thirty-two of these patients were treated with long-term domiciliary nebulized bronchodilator treatment, the other 17 patients chose metered dose inhaler (MDI) therapy. The present paper reports the progress of these patients over 5 yr. Five-year survival was similar in both groups (nebulizer users 56%, MDI users 53%). Most deaths were due to respiratory failure (14 deaths) or lung cancer (four deaths). Survival was determined mainly by FEV1 (R = 0.54, P = 0.0001) and age (R = -0.47, P = 0.0007). Laboratory lung function tests (16 nebulizer users) showed that FEV1 and FVC were still higher than pre-nebulizer baseline measurements after 36 months of nebulizer use, but PEFR had fallen by 7%. Twenty-one of 23 surviving nebulizer users completed a questionnaire after 36 months of treatment. All used their nebulizer at least once per day and 20 of 21 patients reported that they still obtained full benefit from each nebulized treatment. The morning peak flow response to nebulized treatment was the same at baseline and at 36 months (48 1 min-1). All patients remained breathless (mean subjective score 4.8 on seven-point scale) but the subjective response to nebulized treatment was unchanged at 36 months. Tachyphylaxis did not develop among 13 patients who underwent repeated reversibility studies using 200 micrograms of salbutamol at 6, 12 and 36 months. It is concluded that home nebulizer therapy is safe and effective for a small number of carefully selected patients with severe asthma or COPD, who have been evaluated by a rigorous home nebulizer assessment protocol prior to commencing home nebulizer therapy.

Adult↗
PubMed1995

Late carmustine lung fibrosis. Age at treatment may influence severity and survival.

Previously, we have reported in 1990 that 35% of carmustine treated patients (6 of 17) who survived childhood brain tumors died of pulmonary fibrosis between 2 and 13 years after treatment. In addition, 8 patients studied in 1989 (13 to 17 years post treatment), had physiologic and biopsy or radiologic evidence of pulmonary fibrosis. We now report 3 more years of follow-up on these patients. Between 1989 and 1992, two more patients have died of pulmonary fibrosis, giving an overall mortality of 47%. Of the eight patients who died of pulmonary fibrosis, the median age at treatment was 2.5 years, whereas the nine long-term survivors had a median age at treatment of 10 years. All five patients treated below the age of 5 years have died of lung fibrosis. Analysis by the standard survival curve method indicated that patients treated at an age less than 6 years were more likely to die than those treated at an age older than 7 years (p = 0.03). Of the nine survivors, seven were observed over 3 more years. There was a gradual decline in mean forced vital capacity from 55% predicted (range, 44 to 81) to 51% predicted (range, 41 to 72) and total lung capacity fell from 65% predicted (range, 51 to 89) to 57% predicted (range, 47 to 77).

Adolescent↗