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H Magnussen

Publications and source records attributed to H Magnussen.

At least 199 records · Page 11Linked to original sources
PubMed1993

[Diagnosis of bronchopulmonary aspergillosis is often made too late].

ABPA may occur in patients with longstanding bronchial asthma. The most important diagnostic criteria include a history of asthma with peripheral blood eosinophilia, immediate skin reactivity, elevated serum IgE, precipitating antibodies against Aspergillus species, migrating infiltrates, and central bronchiectases. Here we report on the clinical characteristics in 15 patients in whom the diagnosis of ABPA could be established. Mean diagnostic latency between the occurrence of first symptoms and the diagnosis was 10 +/- 10 years. We therefore conclude that the diagnosis and therapy of ABPA is often delayed.

Adult↗
PubMed1993

Pulmonary tuberculosis due to bacille Calmette-Guérin.

Immunotherapy using bacille Calmette-Guérin (BCG) has gained increasing acceptance in the management of superficial bladder cancer. Systemic reactions after intravesical instillation of BCG are rare. However, when the therapy is complicated, the lung often becomes involved. Since the pathogenesis of lung infiltrates after immunotherapy is unknown, we report on a patient who developed a lung infiltrate after receiving BCG immunotherapy for bladder cancer. The infectious etiology was established by culture confirmation of a BCG strain in the bronchoalveolar lavage fluid.

Aged↗
PubMed1993

Increased secretion of tumor necrosis factor-alpha, interleukin-1-beta, and interleukin-6 by alveolar macrophages from patients with sarcoidosis.

BACKGROUND: Alveolar macrophages from patients with sarcoidosis were analyzed for their ability to secrete tumor necrosis factor-alpha (TNF-alpha), interleukin-1-beta (IL-1-beta), and interleukin-6 (IL-6). RESULTS: Constitutive release of all three monokines in these patients was concomitantly increased in the active state of disease in comparison with inactive sarcoidosis or healthy control subjects. Alveolar macrophages from patients with inactive sarcoidosis compared with cells from healthy subjects showed increased spontaneous secretion of TNF-alpha and IL-6 only, whereas the constitutive release of IL-1-beta was similar as in healthy volunteers. In vitro stimulation of alveolar macrophages from healthy control subjects with lipopolysaccharide or pokeweed mitogen led to a time- and dose-dependent enhanced secretion of TNF-alpha, IL-1-beta, and IL-6. In a similar manner, with corresponding cells from patients with sarcoidosis the secretion of all three cytokines could be further increased by stimulation with lipopolysaccharide or pokeweed mitogen. CONCLUSIONS: The data presented indicate that an increased release of TNF-alpha, IL-1-beta, and IL-6 correlates to disease activity and may play a critical part in the pathogenesis of sarcoidosis.

Adult↗
PubMed1993

The effect of 10, 50 and 200 micrograms inhaled fenoterol on exercise induced asthma.

In a randomized, double-blind cross-over study we investigated the protective effect of low doses of fenoterol on the airway response to exercise during cold air breathing. In 12 mild to moderate asthmatics with exercise induced asthma (mean age: 26 [range 19-25] years), mean FEV1 87% of predicted, exercise challenges were performed under control conditions and 30 min after the inhalation from a metered dose inhaler of either placebo, or 10, 50, and 200 micrograms fenoterol within a 4 week period. Airway response was determined by measuring specific airway resistance, sRaw. Standardization of exercise challenges was achieved by individually maintaining a constant respiratory heat exchange, with an average (range) of 1.24 (0.98-1.61) kcal/min. Fenoterol aerosol was an effective bronchodilator at all doses administered (P < 0.05), with 200 micrograms significantly more effective than 10 micrograms. Mean sRaw (s.e.m.) pre vs maximal post exercise after control conditions, placebo and 10, 50, and 200 micrograms fenoterol aerosol was 12.9 (1.4) vs 41.8 (6.3), 13.1 (1.6) vs 41.3 (6.3), 9.6 (1.5) vs 26.6 (6.2), 7.9 (0.9) vs 16.4 (3.6) and 5.5 (0.5) vs 7.4 (0.9) cmH2O.s. The protective effect of fenoterol against exercise induced bronchoconstriction was dose-dependent and was significantly different from placebo at 50 and 200 micrograms (P < 0.05). From these observations we suggest that in mild to moderate asthmatics 50 micrograms of fenoterol in a dose which is sufficient to protect against this naturally occurring stimulus.

Administration, Inhalation↗
PubMed1993

Effects of beta-adrenoceptor agonists in human bronchial smooth muscle.

1. We have investigated the potency and duration of action of isoprenaline and a range of beta-adrenoceptor agonists as relaxants of inherent tone in human superfused, isolated bronchial smooth muscle, a tissue reported to contain a homogeneous population of beta 2-adrenoceptors. 2. All of the beta-adrenoceptor agonists caused concentration-related inhibition of inherent tone, with isoprenaline having an EC50 of 27 nM. The rank order of agonist potency was: formoterol > or = -salmeterol > or = clenbuterol > fenoterol = isoprenaline > terbutaline > or = salbutamol > quinprenaline. 3. Relaxant responses to salmeterol were fully reversed by the selective beta 2-adrenoceptor blocking drug, ICI 118551, demonstrating the involvement of beta 2-adrenoceptors. 4. Rt50, i.e. the time taken for 50% recovery from the effects of an EC50 concentration of agonist, differed considerably between the different beta 2-adrenoceptor agonists. Most agonists were short-acting, having Rt50 values less than 13 min. Quinprenaline was of moderate duration, with an Rt50 value of > or = 20 min. In contrast, salmeterol was extremely long-acting, with no sign of recovery within 4 h. 5. Estimates of relative potency and duration of action were similar to those previously determined for these agonists in the guinea-pig isolated trachea. These results suggest, therefore, that guinea-pig trachea is a suitable alternative to human bronchus for the evaluation of the actions of beta-adrenoceptor agonists on airways smooth muscle.

Adrenergic beta-Agonists↗
PubMed1993

Phosphodiesterase isozymes modulating inherent tone in human airways: identification and characterization.

The effects of the nonselective phosphodiesterase (PDE)-inhibitor 3-isobutyl-1-methylxanthine (IBMX) and the selective PDE inhibitors SKF 94120 (type III), rolipram (type IV), zardaverine (type III/IV), and zaprinast (type V) on inherent tone in human airways were investigated. Substantial relaxation was achieved by IBMX [concentration eliciting 50% of maximum response (EC50): 2.9 microM, n = 14] and SKF 94120 (EC50: 1.4 microM, n = 15); rolipram and zaprinast were almost ineffective. Zardaverine (EC50: 0.31 microM, n = 8), and the combination of SKF 94120 and rolipram (1 microM; EC50: 0.41 microM) were effective relaxants. Biochemical studies revealed the presence of PDE isozymes I, III, IV, and V in the cytosolic and particulate phase of airway homogenates, whereas PDE II was present only in the cytosol. Partial inhibition of total PDE adenosine 3',5'-cyclic monophosphate-hydrolyzing activity was achieved with rolipram and a selective type III inhibitor, whereas there was almost complete inhibition of total PDE activity with either zardaverine or the combination of type III and IV inhibitors. We conclude that all five PDE isozyme families are present in crude preparations of human peripheral airways. Inherent tone in this tissue is most effectively relaxed through selective type III/IV PDE inhibitors.

1-Methyl-3-isobutylxanthine↗
PubMed1993

Effects of acute passive smoking on exercise-induced bronchoconstriction in asthmatic children.

This study was designed to investigate the acute effects of environmental tobacco smoke (ETS) in children with mild asthma during rest and exercise. We studied 13 children [8 males, 5 females; mean age 10 (range 8-13) yr; mean forced expired volume in 1 s (FEV1) 93% (range 82-108%) of predicted] with exercise-induced bronchoconstriction [46 +/- 4% (SE) fall in FEV1 after exercise during cold air breathing]. Children were exposed to ETS (20 ppm carbon monoxide) or ambient air (AA) for 1 h. During the first 54 min of exposure, children were at rest, and during the last 6 min they exercised on a bicycle ergometer (2 W/kg body wt). Spirometry was performed before and during exposure and after exercise. Respiratory symptoms were recorded before and after exposures. In seven children the experiments with AA and ETS were done in duplicate. FEV1 between 5 and 54 min of exposure at rest decreased by 3.2 +/- 0.8% (SE) during AA and by 7.2 +/- 2.3% during ETS exposure compared with preexposure values; the difference between AA and ETS was statistically significant (P = 0.04). The drop in FEV1 was achieved within 5 min and did not change with ongoing exposure. Analysis of individual data revealed that the mean changes during ETS were mainly effected by three children with a significant fall and one child with a significant improvement in FEV1 (P < 0.05). Maximum postexercise fall of FEV1 was 25 +/- 4% after AA and 24 +/- 3% after ETS, which did not differ significantly. Upper and lower respiratory tract symptoms were not significantly different between exposures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Comparison of the effects of salmeterol and formoterol on airway tone and responsiveness over 24 hours in bronchial asthma.

The recent development of new beta 2-adrenoceptor agonists with a duration of action in excess of 12 h may change strategies in the treatment of bronchial asthma. This study aims at the direct comparison of the main representatives of this new class of drugs, formoterol (F) and salmeterol (S), in asthmatic patients over the course of 24 h. Twelve patients with mild bronchial asthma participated in a double-blind, randomized, placebo-controlled clinical trial. In a dose-finding study we determined the protective and bronchodilating effects of 12 and 24 micrograms F aerosol vs 50 and 100 micrograms S 30 min after inhalation. In a 24-h study we investigated the effects of 12 micrograms F and 50 micrograms S on airway tone and responsiveness. Bronchial responsiveness was assessed as the dose of methacholine necessary to decrease FEV1 by 20%. In the dose-finding study, compared with placebo, all doses of F and S equally increased FEV1 (p < 0.003) and protected against inhaled methacholine (p < 0.0001). In the 24-h study 12 micrograms F and 50 micrograms S increased FEV1 and significantly protected against methacholine-induced bronchoconstriction up to 24 h (p < 0.05), compared with placebo. Phase and amplitude of the circadian variation of FEV1 and airway responsiveness were not affected. Clinically recommended doses of aerosolized F (12 micrograms) and S (50 micrograms) have a duration of action up to 24 h and are equally effective at bronchodilation and protection in acute experiments in patients with mild bronchial asthma.

Administration, Inhalation↗
PubMed1993

Effects of theophylline withdrawal in severe chronic obstructive pulmonary disease.

To determine the value of theophylline in the maintenance therapy of patients with severe chronic obstructive pulmonary disease (COPD), we conducted a trial of theophylline therapy withdrawal in 38 clinically stable patients with severe COPD (FEV1 < 60 percent) predicted. Symptoms, lung function, blood gases, and 6-min walking distance were assessed on days 1 and 2. Quality of life and overall dyspnea were scored using four different clinical rating scales. Theophylline therapy was continued in 20 patients and replaced by placebo from day 3 on in the remainder; measurements were repeated on days 5 and 6. Withdrawal of theophylline therapy resulted in significant (p < 0.05) deterioration in lung function, exercise performance, and two indices of overall dyspnea, and a significant increase in scoring of symptoms and auscultation findings. Individual analysis revealed a clinically relevant deterioration in 72 percent of patients from whom theophylline therapy was withdrawn, while only 15 percent of patients receiving theophylline exhibited deterioration. No major side effects were observed. Our data show that about half of the patients with severe COPD can be considered as theophylline responders. The response of these patients to withdrawal of theophylline therapy suggests that the clinical effectiveness of this drug cannot be explained exclusively by bronchodilation. Due to the inherent difficulties in predicting response to theophylline, its effectiveness in patients with severe COPD should be determined individually, including assessment of exercise performance and ratings of dyspnea.

Aged↗
PubMed1993

[Theophylline in therapy of obstructive sleep apnea?].

We examined the effect of 375 mg theophylline at night in 95 patients (14 women, 81 men) with obstructive sleep apnoea. The apnoea-hypopnoea index decreased significantly from 20.9 +/- 17.2 to 13.5 +/- 15.8/hour, the nadir of oxygen saturation increased from 80.6 +/- 8.5 to 82.4 +/- 8%. A survey of the longterm effects of theophylline in 16 initially responding patients revealed after 31-922 (190 +/- 217) days therapy no statistically significant change of the apnoea-hypopnoea index; however, the nadir of oxygen saturation was lower compared to the beginning of the therapy (83.8 +/- > 79.3 +/- 7.6%). We believe that theophylline is useful in single cases of patients with obstructive sleep apnoea, but is necessary to reconfirm the positive effect.

Adult↗
PubMed1993

Protein profile in bronchoalveolar lavage fluid from patients with sarcoidosis and idiopathic pulmonary fibrosis as revealed by SDS-PAGE electrophoresis and western blot analysis.

So far bronchoalveolar lavage (BAL)-protein in interstitial lung disease (ILD) is evaluated by measuring concentrations of single proteins. Due to the high dilution of most proteins in BAL, analysis of protein profile has been disappointing. This study describes a new method to overcome this problem and to reveal a highly differentiated picture of BAL proteins. Eighteen patients with pulmonary sarcoidosis, 18 patients with idiopathic pulmonary fibrosis (IPF) and 22 patients with no clinical, roentgenologic or functional evidence of ILD underwent BAL. Total and differential cell count was performed. Normal values for the control group, a lymphocytic alveolitis in sarcoidosis and a granulocytic alveolitis in IPF-patients were found. Median total protein concentration in sarcoidosis showed an increase five times higher than that of the controls (150 mg 1(-1) and 27 mg 1(-1), respectively) with p < 0.001, IPF protein concentration (58 mg 1(-1)) exceeded twice the control values (0.01 > p > 0.001). Analysis of electrophoretic protein profile in controls with Western blot analysis and the biotin/streptavidin staining system revealed a highly differentiated range of bands. Staining with immunoglobulin antibody identified six bands. Four proteins with molecular weight < 21.000 dalton were present only in sarcoidosis patients. These proteins may be identical with fragmented serum proteins or different cell mediators detected in alveolar cell supernatants. Furthermore, in sarcoidosis the intensity and number of bands with molecular weight more than 67.000 dalton was increased. This gives strong evidence for an injury of the alveolar membrane integrity in the alveolitis during the course of sarcoidosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Increased LTB4 metabolites and PGD2 in BAL fluid after methacholine challenge in asthmatic subjects.

The bronchoconstrictor potency of inhaled methacholine is widely used to assess airway responsiveness. However, evidence has accumulated that methacholine inhalation challenge may lead to an inflammatory response in the lower respiratory tract. We therefore compared cellular, leukotriene and prostanoid profiles in bronchoalveolar lavages (BAL) obtained five hours after methacholine challenge to control lavages without prior challenge. Eight subjects with asymptomatic to mild bronchial asthma and nine nonatopic healthy controls were enrolled in the study. Without prior challenge, the percentage of BAL eosinophils was higher in the asthmatic subjects ((mean +/- SD), 1.1 +/- 0.9%) than in the control subjects (0.1 +/- 0.1%. Leukotriene B4 (LTB4), and its omega-oxidation products (20-OH-LTB4 and 20-COOH-LTB4) were the only leukotrienes detectable in the baseline BAL fluids in five of the eight asthmatic patients. After methacholine challenge, no change in BAL cell profile occurred, but in the asthmatic patients, the total amounts of LTB4 and its omega-oxidation products rose from 0.52 +/- 0.50 ng.ml-1 (pre-challenge) to 1.55 +/- 1.32 ng.ml-1 (post-challenge), and prostaglandin D2 (PGD2) rose from 49.1 +/- 15.7 (pre-challenge) to 94.4 +/- 25.4 pg.ml-1 (post-challenge), with no change in 6-keto-PGF1 alpha, thromboxane B2 (TXB2), and prostaglandins F2 alpha and E2 (PGF2 alpha and PGE2). In the healthy controls, no consistent change in BAL cell profile and mediators occurred after methacholine provocation. We conclude that inhaled methacholine stimulates LTB4 and PGD2 release in asthmatics, but not in healthy controls, without affecting the number of inflammatory cells in BAL fluid.

Adult↗
PubMed1992

Prevalence of asthma and allergic disorders among children in united Germany: a descriptive comparison.

OBJECTIVES: To compare the prevalence of asthma and allergic disorders among children in Munich, western Germany, and Leipzig, eastern Germany, where environmental exposure, particularly air concentrations of sulphur dioxide and particulate matter, and living conditions have differed over the past 45 years. DESIGN: Prevalence surveys among school-children aged 9-11 years in Leipzig and Munich. Self completion of written questionnaire by the children's parents and lung function measurements. SUBJECTS: 1051 children in Leipzig and 5030 in Munich. SETTING: Primary schools. MAIN OUTCOME MEASURES: Reported lifetime prevalence of asthma and allergic disorders, and bronchial hyperresponsiveness assessed by cold air inhalation challenge. RESULTS: The lifetime prevalence of asthma diagnosed by a doctor was 7.3% (72) in Leipzig and 9.3% (435) in Munich; prevalence of wheezing were 20% (191) and 17% (786) respectively. The prevalence of diagnosed bronchitis was higher in Leipzig than Munich (30.9% (303) v 15.9% (739); p < 0.01). A significant drop in forced expiratory volume (> 9%) after cold air challenge was measured in 6.4% (57) of children in Leipzig and in 7.7% (345) of those in Munich. Hay fever (2.4% (24) v 8.6% (410); p < 0.01) and typical symptoms of rhinitis (16.6% (171) v 19.7% (961); p < 0.05) were reported less often in Leipzig than in Munich. CONCLUSIONS: No significant differences were seen in the lifetime prevalence of asthma, wheezing, and bronchial hyperresponsiveness between children in Leipzig and Munich. The lifetime prevalence of bronchitis was higher in Leipzig than in Munich. The lower prevalence rates of allergic disorders in Leipzig could point toward aetiological factors that are associated with Western lifestyle and living conditions.

Asthma↗
PubMed1992

[Memento intestinal tuberculosis].

We report the history, symptoms and diagnostic procedures of eight patients (four female, four male; mean age 44.5 years) with abdominal tuberculosis. In all cases differential diagnosis was complicated by an inadequate interpretation of chest X-rays. Only two patients were immigrants. Chemotherapy of tuberculosis was successful in seven patients, one 65-year old female with miliary tuberculosis and ileus died.

Adult↗