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Biomedical subjects

G Bowes

Publications and source records attributed to G Bowes.

At least 73 records · Page 4Linked to original sources
PubMed1993

Evaluation of a new ambulatory spirometer for measuring forced expiratory volume in one second and peak expiratory flow rate.

A new pocket-sized ambulatory spirometer (meter) that measures FEV1 and PEFR was evaluated. The meter determines flow rate (V) from the differential pressure (P1-P2) across a sharp-edged orifice (V alpha square root of[P1-P2]). Ten meters were evaluated for accuracy using a computerized syringe to deliver the 24 ATS-recommended waveforms and nine scaled versions of a single waveform (PW#24). Within-meter reproducibility of FEV1 and PEFR was evaluated in two meters by passing five versions of waveform PW#24 through each meter 10 times. Reliability in the ambulatory setting was assessed in six meters on several occasions over a 10-week period using five versions of waveform PW#24. Results show that the 10 meters conform to the ATS accuracy specifications for PEFR with one or less errors and marginally outside these limits for FEV1 with four errors. For the nine versions of PW#24, the 95% confidence intervals indicate that the meter is accurate to within +/- 5.5% or +/- 15 L/min for PEFR and +/- 3.5% or +/- 0.12 L for FEV1. The mean within-meter coefficient of variation was 1.24% for FEV1 and 0.35% for PEFR. There was no significant change in meter accuracy or performance over the 10-wk reliability study. We conclude that the meter is suitable for use as an ambulatory spirometer for measuring FEV1 and PEFR.

Altitude↗
PubMed1992

Pediatric asthma deaths in Victoria: the mild are at risk.

Previous reviews of pediatric asthma mortality have mostly been from hospital-based clinic populations and suggest that only those with severe asthma are most at risk. This report summarizes an investigation, by interviewer-administered questionnaire, into the circumstances surrounding the death in all patients aged 20 years or less who died from asthma in the State of Victoria over a 3 year period from May 1, 1986. During this period, 51 deaths due to asthma were reported. Thirty-three percent of these were judged to have a history of trivial or mild asthma, and 32% had no previous hospital admission for asthma. However, 36% were judged to have had severe asthma, 43% were taking regular inhaled beclomethasone or sodium cromoglycate, and 10% were taking regular oral steroids. Twenty-two percent had a previous admission to an ICU. Death occurred outside hospital in 40 (78%) subjects. In the final attack 63% had sudden onset and collapse within minutes, 12% were found dead, and 25% had acute progression of an established attack. The investigators assessed 39% of the deaths to have had potentially preventable elements. The preventable factors included: inadequate assessment or therapy of prior asthma (68%), poor compliance with therapy (53%), and delay in seeking help (47%). The majority of subjects in this survey could not be classified as "high risk." Therefore, clinicians should ensure that all young patients with asthma are aware of optimal maintenance management, can recognize deteriorating asthma, and follow a clear individualized crisis plan.

Adolescent↗
PubMed1992

The prevalence of asthma in Victorian adults.

To determine the prevalence of asthma in Victorian adults, we carried out a cross-sectional postal survey utilising a new screening questionnaire which gathered data on self reported respiratory symptoms, whether asthma had been diagnosed and, if so, how it had been treated. Questionnaires were returned by 2198 (72%) of 3095 adults selected randomly from the Victorian electoral roll, an adequate response rate. The reported prevalences of individual asthmatic symptoms in the last 12 months ranged from 8% for nocturnal wheeze to 22% for current wheeze. Thirteen per cent of respondents had ever had asthma, 7% had experienced an attack within the last 12 months and 6% were currently taking medication. The high prevalence of asthma revealed by our study has major implications for the planning of health services.

Adolescent↗
PubMed1992

Accuracy of asthma death statistics in Australia.

Asthma mortality statistics issued by the Australian Bureau of Statistics (ABS) were compared with clinical data from a survey of asthma mortality. Deaths in Victoria from May 1986 to April 1987 containing 'asthma' in Parts 1 or 2 of the death certificate (N = 405) were reviewed. For each subject, the cause of death attributed by the Victorian Asthma Mortality Survey was compared with the ABS cause of death, by age and sex of the subject. Information on 393 of the 405 deaths investigated by the Victorian Asthma Mortality Survey was analysed. The ABS estimate of the total number of asthma deaths in Victoria was 47 per cent higher than the estimate of the Victorian Asthma Mortality Survey. In subjects under 50 years of age the two estimates were within 10 per cent. The difference between the estimates increased with age at death for persons over 50 years old and was equivalent for males and females. If the assessment by the Victorian Asthma Mortality Survey of the number of deaths due to asthma is accepted as accurate, then the ABS estimate of asthma deaths was reliable for those under 50 years of age. In those who died at an older age, the ABS significantly overestimated the number of deaths due to asthma in Victoria.

Asthma↗
PubMed1992

Myopathy in severe asthma.

Myopathy complicating the therapy of severe asthma has been recently described in several case reports. Twenty-five consecutive patients admitted to the intensive care unit (ICU) at this hospital for mechanical ventilation for severe asthma were studied for the incidence of creatine kinase (CK) enzyme rise and for the development of clinical myopathy. Pharmacologic therapy was standardized, every patient receiving corticosteroids and aminophylline intravenously and salbutamol both nebulized and intravenously. Twenty-two patients received muscle relaxant therapy with vecuronium. In 19 of 25 (76%) of patients there was elevation of CK levels to a median of 1,575 U/L (range, 66 to 7,430) occurring 3.6 +/- 1.5 days after admission. In nine patients there was clinically detectable myopathy. The presence of either myopathy or CK enzyme rise was associated with a significant prolongation of ventilation time. Arterial blood gas measurements on admission to the ICU revealed a pH (mean +/- SD) of 7.07 +/- 0.21, a PaCO2 of 87.2 +/- 32.7, and a PaO2 (with a high FIO2) of 129 +/- 97 mm Hg; however, no correlation was found between the severity of initial metabolic disturbance and the subsequent development of myopathy. There was no association between the type of corticosteroid administered and the subsequent development of myopathy. Patients with myopathy had received a significantly higher total dose of vecuronium when compared with those who did not develop myopathy (p < 0.001, Kruskal Wallis test). We have therefore found a surprisingly high incidence of CK enzyme rise and myopathy in this group of mechanically ventilated patients with severe asthma.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation↗
PubMed1992

Risk factors for morbidity in mechanically ventilated patients with acute severe asthma.

Acute severe asthma is associated with significant morbidity and mortality. We retrospectively quantified hypotension, pulmonary barotrauma, and cardiac arrhythmias in all patients with severe asthma admitted to the intensive care unit (ICU) and prospectively evaluated the predictive value of a measurement of dynamic hyperinflation (DHI) in those patients who required mechanical ventilation. In the first study, 88 ICU admissions for severe asthma over 5 yr (73 patients, 40 +/- 18 yr, 36 men, 37 women) were evaluated. Fifty-one admissions were mechanically ventilated, 29 were not, and 8 previously ventilated patients remained briefly intubated but were not ventilated in the ICU. Hypotension (18/88, 20%), pulmonary barotrauma (12/88, 14%), and arrhythmias (9/88, 10%) were entirely confined to patients who had been mechanically ventilated. There were no significant differences in ventilatory parameters, airway pressures, or blood gases between mechanically ventilated patients with and without complications. Two patients with previous severe hypoxic cerebral damage died from this complication after ICU discharge. In the second study, the end-inspiratory lung volume (VEI) (1) was compared with standard ventilatory parameters in 22 patients. There were no ICU deaths, but high incidences of pulmonary barotrauma (27%) and hypotension (41%) were found. Both minute ventilation (VE and VEI) were significantly higher in patients who developed complications (VE 13.7 +/- 3.0 versus 11.2 +/- 2.5 L/min, VEI 26.1 +/- 4.7 versus 20.0 +/- 7.4 ml/kg, p less than 0.05) but only VEI had a threshold value significantly predictive of complications. For VEI less than 1.4 L, 0/5 (0%) patients had complications; for VEI greater than or equal to 1.4 L, 11/17 (65%) had complications (p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1992

Use of a measurement of pulmonary hyperinflation to control the level of mechanical ventilation in patients with acute severe asthma.

Mechanical ventilation causes significant morbidity and mortality in patients with severe asthma. Hypoventilation may reduce this morbidity and mortality, but indicators to guide the degree of hypoventilation are unclear. We used a measure of pulmonary hyperinflation to assess the degree of airflow obstruction and to guide the extent and duration of hypoventilation. Ten patients who required mechanical ventilation for acute severe asthma were studied. All were sedated, paralyzed, and given an initial minute ventilation (VE) of 200 ml/kg/min. End-inspiratory lung volume (VEI) above FRC was measured from the total exhaled gas volume during 40 to 60 s of apnea. VEI was used to regulate VE to a safe level (VEsafe), irrespective of PaCO2, by reducing the rate when VEI was > 20 ml/kg and increasing it when VEI was < 20 ml/kg. Each patient was weaned when VEsafe resulted in PaCO2 < or = 40 mm Hg (the weaning point). FRC was measured computer analysis of anterior and lateral chest radiographs taken at the end of apnea. Using the weaning point criterion, 2 patients (PaCO2 < 40 mm Hg) were weaned shortly after arrival. The remaining eight (initial PaCO2, 63 +/- 17 mm Hg) continued hypoventilation until the weaning point was reached (30 +/- 29 h). The weaning point was reached by the VE required for PaCO2 40 mm Hg decreasing concurrent with the VEsafe increasing. All but 1 patient were successfully weaned within 24 h of the weaning point.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1991

The role of phosphoenolpyruvate carboxykinase in a marine macroalga with C4-like photosynthetic characteristics.

Udotea flabellum is a marine, macroscopic green alga with C4-like photosynthetic characteristics, including little O2 inhibition of photosynthesis, a low CO2 compensation point, and minimal photorespiration; but it lacks anatomical features analogous to the Kranz compartmentation of C4 plants, and phosphoenolpyruvate carboxylase [PEPC; orthophosphate:oxaloacetate carboxy-lyase (phosphorylating), EC 4.1.1.31] activity is negligible. Phosphoenolpyruvate carboxykinase (PEPCK) activity (carboxylating) in Udotea extracts was equivalent to that of ribulose-bisphosphate carboxylase [Rubisco; 3-phospho-D-glycerate carboxy-lyase (dimerizing), EC 4.1.1.39]. When PEPCK activity was inhibited in vivo with 3-mercaptopicolinic acid (MPA), thallus photosynthesis decreased by 70% and became sensitive to O2. Codium decorticatum, a related species that lacks C4-like photosynthetic features and PEPCK activity, showed no increase in O2 inhibition upon exposure to MPA. Rubisco and PEPC activities in Udotea were not inhibited by MPA. Labeling of the early photosynthetic products malate and aspartate was reduced 66% by MPA, while intermediates of the photorespiratory carbon oxidation cycle showed a 3-fold increase. Udotea evolved O2 in the light in the absence of inorganic carbon, suggesting it had an endogenous carbon source for photosynthesis. Exogenous malate stimulated this process, while MPA inhibited it. PEPCK was not involved in Crassulacean acid metabolism or dark CO2 fixation. These MPA studies establish a direct link between PEPCK activity and the low O2 inhibition of photosynthesis and low photorespiration in Udotea. The data are consistent with carboxylation by a cytosolic PEPCK providing a C4 acid, such as malate, to the chloroplast for decarboxylation to elevate the CO2 concentration at the Rubisco fixation site. Udotea is to date the most primitive plant with a C4-like form of photosynthesis.

Journal Article↗
PubMed1991

Dosage adjustment and clinical outcomes of long-term use of high-dose tobramycin in adult cystic fibrosis patients.

A two-phase study was undertaken designed to investigate the impact of computer-aided drug monitoring on tobramycin concentrations and clinical outcomes in adult patients with cystic fibrosis. In phase one, a baseline (historical control) study of drug use patterns was performed. During the second phase, patients admitted for intravenous treatment with tobramycin for acute exacerbations of pseudomonal pulmonary infections were randomly allocated to one of two schedules. Group A patients had tobramycin dosage regimens decided by clinicians based on pre-existing protocols using serum tobramycin assay data determined three times weekly. Group B patients had dosage regimens determined by a computerized pharmacokinetic predictive program using both population-based pharmacokinetic parameter estimation and fitting of serum concentration-time data using Bayesian regression. The agreed therapeutic target was a peak serum tobramycin concentration of 8-10 mg/L and a trough concentration of 1-2 mg/L. There was a major difference between the two groups comparing the number of paired trough and peak concentrations within the target concentration ranges (group A-14%; group B-34.7%, chi 2 test, P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Atrial natriuretic factor during hypoxia and mild exercise.

The effect of hypoxia on plasma atrial natriuretic factor (ANF), plasma renin activity (PRA), and plasma aldosterone concentration (PAC) was evaluated during 2 h of treadmill exercise at 2 km/h, 0 grade at sea level. Six male subjects exercised on 2 separate days during normoxia (21% O2) and hypoxia (13.3 +/- 0.3% O2). No significant changes in ANF or PRA occurred during either normoxic or hypoxic exercise. However, PAC fell significantly during normoxic exercise (17.5 +/- 3.6 vs. 12.7 +/- 2.6 ng/dl, p less than 0.05) but not during hypoxic exercise. Serum potassium concentration fell during hypoxic exercise (5.0 +/- 0.1 vs. 4.4 +/- 0.1 mmol/l, p less than 0.05) along with bicarbonate (27.8 +/- 0.7 vs. 25.8 +/- 0.6 mmol/l, p less than 0.01). Between normoxic and hypoxic studies there was a significantly higher heart rate during hypoxic exercise (78 +/- 5 vs. 90 +/- 6 b/min, p less than 0.01). The major conclusion of this study is that hypoxia resulting in arterial oxygen saturations of 81 +/- 0.7% does not affect plasma atrial natriuretic factor levels during mild exercise in normal male subjects.

Adult↗
PubMed1991

Is it asthma?

A patient assessment with history, physical examination and simple tests of air flow limitation will usually allow the primary care physician to make the correct diagnosis and to commence treatment. Nevertheless, the diagnosis of asthma is not always easy and the author discusses approaches to adults if the diagnosis of asthma is uncertain.

Adult↗
PubMed1990

Use of antiasthmatic drugs in Australia.

Bronchodilator prescription and sales data for Australia from 1975 to 1986 were analysed. Inhaled beta-agonists were the most commonly prescribed antiasthmatic agents in 1986, followed by sustained-release theophylline and inhaled corticosteroids. Marked increases in prescription sales of these three drug groups over the period were noted. We estimate that non-prescription sales of salbutamol inhalers increased by 410% between 1980 and 1986 (P less than 0.01). Prescribing rates by general practitioners for beta-agonists, sustained-release theophylline and inhaled corticosteroids increased from 1979 to 1986. Prescribing rates of beta-agonists were highest for persons aged 1-11 years and 55 years and over, and increased markedly for children aged 1-11 years over the period. For sustained-release theophylline, prescribing rates were highest for persons 55 years and over. The difficulties in postulating possible relationships between prescribing trends and asthma mortality are discussed.

Administration, Inhalation↗