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Biomedical subjects

C F Donner

Publications and source records attributed to C F Donner.

124 records · Page 7Linked to original sources
PubMed1989

Proposal of an easy method to improve routine sputum bacteriology.

The study of bacterial flora of the lower respiratory tract is very important for the diagnosis of pulmonary infections and proper therapy but it has to face important methodologic problems. The main problem is contamination of the sputum during its passage through the upper airways. The present study suggests an improved procedure aiming first of all at reducing the specimen contamination by upper airway bacteria by means of a preliminary mouth wash, and secondly at comparing qualitative and quantitative cultures of spit with those of sputum. In our study bronchial lavage aspirate (BLA) cultures were used as a control. Both definite (80 patients) and random (20 patients) sequence sampling procedures were considered to show the importance of a correct sequential specimen collection. Bacteria isolated in the sputum and/or in BLA but absent in the spit were considered the most probable responsible for an eventual pulmonary infection. On the contrary a germ found in the spit and eventually in the sputum but not in BLA was considered responsible for only an eventual inflammation of the upper respiratory tract. Doubtful cases were solved by comparing the different bacterial concentrations in the various samples. A preliminary mouth washing procedure decreased the mean concentration of contaminants in the sputum: 3.6 +/- 7.5 x 10E8 (E = exponent) versus 3.7 +/- 7.2 x 10E7 CFU/ml spit versus sputum (80 patients) p less than 0.001. On the contrary if sputum preceded spit (12 out of the 20 randomly treated subjects), bacterial counts were not significantly different (2.1 +/- 5.7 x 10E8 vs. 1.3 +/- 2.9 x 10E8 CFU/ml, respectively, p = NS). In the group of correctly treated patients (80 subjects) only infrequently oral contaminants were found in BLA (12.5%). The finding of bacteria in BLA but absent in spit and/or sputum was rare (4.8%) suggesting that, at least in chronic obstructive lung disease (COLD) patients, spit and sputum quantitative and qualitative cultures may be sufficient for a good microbiologic examination in almost all the cases.

Bacteria↗
PubMed1989

Relationship between the perception of breathlessness and inspiratory resistive loading: report on a clinical trial.

We investigated the relationship between the sensation of breathlessness and progressively higher resistive inspiratory loadings in nine normal subjects (31 +/- 17 yr; forced expiratory volume in one second (FEV1) = 105 +/- 9% of predicted) and in eighteen chronic obstructive pulmonary disease (COPD) patients (63 +/- 7 yr; FEV1 = 43 +/- 17% of predicted). The sensation of breathlessness correlated with mouth pressure both in normals (r = 0.94) and in COPD patients (r = 0.95), with a steeper slope in patients. On this basis we studied the effect of inspiratory muscle training on the sensation of breathlessness in sixteen COPD patients (63 +/- 8 yr; FEV1 = 52 +/- 19% of predicted). After a baseline assessment of lung function, MIP (maximal inspiratory pressure), inspiratory muscle endurance and the sensation of breathlessness (Borg scale) at different inspiratory loads, the patients were divided into two groups: the first was trained by means of resistive breathing, the second used a placebo device. At the end of the training, MIP increased more in the trained group (56 +/- 10 to 69 +/- 15 cmH2O; p less than 0.001) than in the placebo group (50 +/- 17 to 56 +/- 22 cmH2O; p = NS). The Borg score fell significantly at all the considered inspiratory loads in trained patients, but not in the placebo group. We conclude that the training with inspiratory resistances decreased the sensation of breathlessness via an increase in inspiratory muscle strength and endurance.

Adult↗
PubMed1989

A new perspective in pulmonary rehabilitation: anaerobic threshold as a discriminant in training.

Exercise training is a mainstay of many pulmonary rehabilitation programmes. However, the physiologic basis for improved exercise tolerance is unclear. We hypothesized that since endurance training is known to reduce blood lactate at levels of work above the anaerobic threshold (AT), minute ventilation (VE) would also be lower. This might be an important benefit for the ventilatory-limited patient. We studied 10 normal subjects who performed 15 min of exercise at each of 4 work rates before and after 8 weeks of training. The lowest work rate was chosen to be below the AT; training produced a minimal decrease in VE (2.5 l.min-1). For the highest work rate, training produced a 4 mEq.l-1 decrease in lactate and a 37 l.min-1 decrease in VE. End-exercise VE reduction was well correlated with lactate reduction (r = 0.69). Seven men with chronic obstructive pulmonary disease (COPD) have also been studied. Each performed an incremental exercise test and two constant work rate tests (one above and one below AT) before and after an 8 week training period. Though responses were more variable than in normal subjects, training produced a reduced ventilatory requirement for exercise when blood lactate was reduced.

Adult↗
PubMed1986

A new bronchodilating agent, procaterol, in preventing exercise-induced asthma.

The aim of the present study was to verify the effectiveness of procaterol, a recent and specific beta-2-adrenoceptor stimulant, in preventing exercise-induced asthma (EIA). Twelve asthmatic patients were selected aged 18.6 +/- 5.6 years with a positive response to EIA and a basal forced expiratory volume of the first second (FEV1) better than 80% of predicted. The patients underwent four bronchoprovocation challenges on four consecutive days. On the first day they performed an inclusion test, and, on the three subsequent days, they were submitted, to three identical standardized challenges according to a randomized design. Fifteen minutes before, procaterol (20 mcg), salbutamol (200 mcg) and a placebo were administered as metered aerosol. No pharmacological treatment was given for 24 h (48 h for antihistamines) before each challenge. The test was carried out running on treadmill (10% grade) for 7 min. Room temperature (20-25 degrees C) and relative humidity (40-55%) were maintained constant. At baseline, 15 min before, 5, 10, 15, 30 and 60 min after the exercise, lung function was assessed. Basal mean values of FEV1 were 94.7, 94.9, 90.7 and 91.5% of predicted for the inclusion and the three protected tests, respectively, without significant differences. The FEV1 mean values showed a mild bronchodilation 15 min after salbutamol (+13.2%, p less than 0.006) and procaterol (+8%, NS). At every considered time all indices showed a significant gap (p less than 0.01) between drugs and the placebo with no appreciable differences between procaterol and salbutamol.

Adolescent↗
PubMed1984

[Functional recovery in pulmonary tuberculosis].

At first Authors explain the stages of tubercular disease in which a programme of functional respiratory rehabilitation can be advised. Then they deal with the main aspects of rehabilitating treatment in some tubercular manifestations, as sero-fibrinous pleural effusion, tubercular empyema, parenchymal fibrosis and surgical reliquates. With regard to surgical reliquates, we mostly consider pulmonary resections and pleural skinning. At last Authors recall the indications to physical exercise training, that are constituted by some reliquates of tubercular pathology, and they resume the accomplishment modalities of such a programme in order to allow every patient wide possibilities of social reintroduction.

Breathing Exercises↗
PubMed1984

Sustained-release anhydrous theophylline in preventing exercise-induced asthma.

A number of drugs have been taken into consideration as to their efficacy in preventing exercise-induced asthma (EIA), which may be a reliable model for the investigation of bronchodilating agents. 15 asthmatic patients (mean age 21.1 +/- 10.7), EIA positive (free running test), were selected for a double-blind cross-over study of a sustained-release theophylline preparation against placebo. Patients underwent four subsequent bronchoprovocation tests by means of free running, at a 3-hours' interval, with a prior administration (3 h before the first test) of the drug at the dose of 7-8 mg/kg or the placebo. Lung function was tested (FEV1.0, FEF50, FEF25, sGaw) after the four induction tests as regards to the plasma concentrations of theophylline. After 6, 9 and 12 h, respectively, from administration of the drug, theophylline plasma levels between 7 and 9 micrograms/ml were found, which are to be considered more than satisfactory after an acute administration. A continuous protective activity has been noted against the exercise stress, with a significant difference between drug and placebo, for all lung function parameters with the obvious exception of the first one in which a satisfactory level of theophylline absorption was not reached. The finding of this new positive aspect of the drug investigated appears to be extremely interesting, particularly if added to the already well-known therapeutic activity, and to the fact that often other classes of drugs do not show a good correlation of protective action against EIA and prevention of spontaneous asthmatic attacks.

Adolescent↗
PubMedDate not supplied

[Sleep disordered breathing: a new risk factor for accidents].

An estimated 2%-4% of the working population could be affected by sleep disordered breathing, in particular by obstructive sleep apnea syndrome. The main symptom is excessive daytime sleepiness, caused by sleep interruptions induced by respiratory events. The level of sleepiness varies according to the severity and duration of the disease: from a slight decrease in vigilance to an almost total inability to keep alert for more than a few hours. In addition, there is an increase in cardiovascular risks and dysmetabolic disorders, which has a variable incidence in the affected population. Even less severe clinical conditions can lead to a reduction in the power of concentration, attention and working performance. The recent trend of research aims at verifying the association between risk factors and obstructive sleep apnea syndrome in order to identify those subjects at real risk, to determine the actual level of sleep-disordered breathing which should be treated and whether the less serious disturbances, so frequent in the general population, represent a real threat to health.

Accidents, Occupational↗
PubMedDate not supplied

Anti-IgE monoclonal antibody: a new approach to the treatment of allergic respiratory diseases.

The immunoglobulin E (IgE) antibody plays a central role in the allergic immune responses. The ability to reduce circulating IgE with a humanized monoclonal antibody (omalizumab) represents a new therapeutic approach for the treatment of IgE-mediated allergic diseases. The use of an anti-IgE antibody in the treatment of asthma was first suggested in preliminary studies in which omalizumab demonstrated efficacy in attenuating both the early- and late-phase bronchial responses to inhaled aeroallergens. Therapy with omalizumab has demonstrated both a significant beneficial effect on a number of measures and a favorable safety profile. It reduces the frequency of asthma exacerbations and the need for inhaled corticosteroids (ICSs), and improves asthma symptoms, lung function, and quality of life. The anti-IgE approach to asthma treatment has several potential advantages, such as the treatment of other concomitant atopic diseases (allergic conjunctivitis and rhinitis, atopic dermatitis, and food allergy) regardless of atopiC of allergic sensitization.

Antibodies, Anti-Idiotypic↗
PubMedDate not supplied

[Rehabilitation of the worker with bronchopneumopathy].

Epidemiological data show that chronic diseases of the respiratory apparatus have constantly increased over the last 20 years or so, often involving relatively young age classes. The increased survival rates due to chemotherapy also increase the importance of rehabilitation in such diseases. The officially accepted concept of a "global" rehabilitation is particularly significant in the case of patients of working age. The main rehabilitation procedures include chest physiotherapy, aerosol therapy, oxygen therapy (where selection criteria have been established and where there are new prospects related to long-term oxygen therapy), intermittent positive pressure breathing and physical retraining. Details on the methods of assessment and training and data concerning three groups of patients suffering from respectively chronic obstructive lung disease, silicosis and asbestosis, are given. The data show a general pattern of a decrease in ventilation (for an unchanged level of O2 uptake and CO2 output) and reflect a rise in muscular efficiency (exercising and respiratory) enabling the body to perform the same work load at a lower energy cost. The authors discuss the vocational rehabilitation of the patient with lung disease and illustrate the most useful procedures in the assessment of the subject, the environment and the place of work, including guidelines to achieve this. Rehabilitation treatment is also summarized into a number of stages, with the goals at different therapeutic levels and the ways to reach them.

Asbestosis↗