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Biomedical subjects

G M Cochrane

Publications and source records attributed to G M Cochrane.

At least 55 records · Page 3Linked to original sources
PubMed1990

Plasma concentrations of salbutamol in acute severe asthmatics.

We studied prospectively 11 asthmatic patients presenting to the Accident and Emergency department with acute asthma. (Four patients reported historically that they were taking some form of oral salbutamol as part of their maintenance therapy.) Standard cardiovascular and respiratory parameters and plasma salbutamol concentrations were measured before and one hour after treatment with five milligrams of nebulised salbutamol. The median plasma salbutamol concentration before treatment was below the level of detection of the assay (less than 3 micrograms.l-1) with a range from less than 3 micrograms.l-1 to 34.6 micrograms.l-1. One hour post treatment the median plasma salbutamol concentration was 7.4 micrograms.l-1 (range less than 3.0 micrograms.l-1 to 56.0 micrograms.l-1) p less than 0.05. (Wilcoxons test). Correlations were investigated between the measured pretreatment physiological variables and pre-treatment plasma salbutamol concentrations. None were found to be significant. Similar analysis of the measured post-treatment physiological variables and post-treatment plasma salbutamol concentrations again revealed no significant correlations. However, a significant negative correlation was noted between the change in plasma salbutamol concentration with treatment and the change in respiratory rate (Rs = -0.56, p = 0.04). If asthmatics do indeed use high doses of inhaled beta-2-agonists (salbutamol) in an attempt to abort an acute attack (as many clinicians suspect), little, if any, of the drug appears to reach the systemic circulation. In this study the administration of five milligrams of nebulised salbutamol to acute asthmatics did not produce excessive increases in plasma salbutamol concentration, even in those patients taking oral salbutamol as part of their maintenance therapy.

Acute Disease↗
PubMed1989

Does urinary salbutamol reflect compliance with the aerosol regimen in patients with asthma?

Compliance with inhaled beta agonist therapy in a group of asthmatic patients in general practice has been monitored using a high performance thin layer chromatographic assay of salbutamol in urine. Urine salbutamol levels were lower than expected in five of 51 patients and much higher than expected in a further 11 patients. These results suggest the assay may be clinically useful for monitoring compliance of asthmatic patients with inhaled salbutamol.

Aerosols↗
PubMed1989

Management of asthma in general practice.

An audit of the management of asthma in two large general practices has been undertaken. The overall level of therapy prescribed was, in general, related to both the objective severity of the patients' asthma and the extent of symptoms. However, many individual patients received sub-optimal therapy. Prophylactic inhaled beta agonists were used infrequently. Inhaled steroids were prescribed to only one third of the patients and to less than half of severely affected patients. The results suggest that this group of adult asthmatics were relatively under treated in general practice, but a prospective study with proven compliance is necessary to confirm this.

Adolescent↗
PubMed1989

An audit of morbidity associated with chronic asthma in general practice.

A survey of 312 adult asthmatic subjects has been undertaken. Only 3.5% of the total adult list were known to have asthma and this may represent underdiagnosis. Spirometry was normal in under half the patients and below 50% predicted in one fifth. Forced expired volume in 1s had declined more rapidly than expected with increasing age, particularly amongst smokers. Morbidity from asthma was extensive, patients reporting substantial breathlessness and restrictions of their life style; nearly half had lost time from work in the preceding twelve months. Morbidity was correlated with spirometry.

Adult↗
PubMed1989

Motor neurone disease.

Motor neurone disease is one of the incurable diseases; it is a tragic and distressing condition, leading from full health through paralysis to death within a few years. Although powerless to prevent or arrest the disease, doctors and all who work with those affected and their families can do much to ameliorate and bring comfort and understanding to sufferers of this disease.

Activities of Daily Living↗
PubMed1988

Long term treatment of severe asthma with subcutaneous terbutaline.

We have investigated the use of subcutaneous terbutaline in 17 patients with brittle asthma and five patients with chronic severe asthma. Twelve of the 17 patients with brittle asthma improved both subjectively and objectively (mean lowest daily PEF rising from 142 litres/min to 297 litres/min), with reduction in oral steroid dose, nebulized beta-agonist dose and number of hospital admissions. Both continuous infusion and 6-hourly divided dose regimens were equally effective. Only one of the five with chronic severe asthma showed any lasting response. Eighteen patients have continued to use subcutaneous terbutaline over long periods (2-40 months). Overall 11 patients suffered side-effects of usually minor degree, although one patient had to withdraw because of the development of painful subcutaneous nodules. We conclude that subcutaneous terbutaline delivered by infusion or by intermittent injections is a useful addition to the therapy of some patients with brittle asthma.

Adult↗
PubMed1988

Amputee walking training: a preliminary study of biomechanical measurements of stance and balance.

Biomechanical parameters of stance and balance were recorded in ten unilateral lower limb amputees at the beginning and end of walking training. Measurements were carried out using a Double Video Forceplate (DVF), a machine developed at University College, London, Bioengineering Centre, Roehampton. During free standing on the DVF there was a mean increase in weight-bearing under the prosthetic foot from 32% body weight (1st session) to 41% body weight (final session), p less than 0.01. Maximum weight-bearing during leaning as far as possible onto the prosthesis increased from a mean of 54% body weight to 63% body weight, p less than 0.01. These simple measurements of weight distribution between the feet can be of value during walking training to monitor progress and can accurately record improvement for research purposes.

Aged↗
PubMed1987

An unusual local reaction to continuous subcutaneous infused terbutaline in unstable asthmatics.

Three out of nine unstable asthmatics whose asthma is subjectively and objectively better controlled on continuous subcutaneous terbutaline infusions (6-12 mg/24 hours) developed tender indurated subcutaneous swellings at the infusion site. In the two cases reported here in detail, histologically the lesions were areas of panniculitis and deep dermal collagen necrosis. Further investigation of the possible causative mechanism for these lesions--drug solution pH, osmolality, or impurities--suggests that impurities in the solution are the most likely cause.

Adult↗
PubMed1987

Is there a circadian variation in respiratory morbidity?

In a retrospective study of the time of presentation to an accident and emergency department patients with acute respiratory symptoms presented more commonly at night compared to a control group with abdominal pain. In a subsequent prospective study doctors from a GP deputizing service were called much more frequently at night by patients with asthma than by those with other symptoms. These findings refute the suggestion that the observed increased mortality from respiratory diseases at night results from reduced medical care as a consequence of a reluctance of patients to present during the night.

Acute Disease↗
PubMed1987

Emergency use of nebulised bronchodilator drugs in British hospitals.

A telephone survey was conducted to determine the emergency use of nebulised bronchodilator drugs by the registrar or senior house officer on duty for medical admissions at 67 British hospitals. All used a nebulised beta agonist (usually 5 mg salbutamol) as first line treatment for severe acute asthma or reversible obstructive lung disease. Twenty three doctors used ipratropium bromide occasionally and 38 used it frequently, usually mixing ipratropium and a beta agonist in the nebuliser chamber. Only five doctors routinely specified whether the nebuliser should be driven by air or by oxygen. In the case of a hypercapnic patient with chronic bronchitis, 11 respondents would not specify which gas should be used and a further 14 would use oxygen, a potentially dangerous practice. In the case of a hypoxic asthmatic patient, 22 doctors would not prescribe oxygen as the driving gas. The driving gas flow rate was almost invariably determined by nursing staff. Intravenous aminophylline was used by all 67 respondents (52 of them frequent users) but only 24 used intravenous beta agonists (five of them frequent users). It is concluded that nebulised bronchodilator drugs are the most commonly used treatment for acute asthma and reversible obstructive lung disease in hospital, but further instruction in their use is required for the staff who use them most frequently.

Aerosols↗
PubMed1987

Foot loading characteristics of amputees and normal subjects.

The foot loading characteristics of 100 consecutively attending amputees wearing their definitive prostheses were studied during their routine visits to the Artificial Limb and Appliance Centre. Results were compared with observations on 100 age and sex matched controls who were free from any locomotor disability. The parameters measured were the percentage of body weight borne on each foot, the positions of the centres of pressure under each foot and the position of the overall centre of foot pressure. The results demonstrate the range of variability of these parameters in normal subjects of different ages and provide preliminary indications of the patterns associated with different types of prostheses and different levels of amputation. The information was collected using the Double Video Forceplate (DVF) a tool developed for the rapid assessment of stance, at University College London Bioengineering Centre. It is proposed that the DVF may be useful in assisting prosthetic alignment, in clinical teaching of prosthetists, physiotherapists and doctors and in monitoring of patients with lower limb amputation.

Amputees↗