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Biomedical subjects

J Crane

Publications and source records attributed to J Crane.

At least 199 records · Page 11Linked to original sources
PubMed1989

Prescribed fenoterol and death from asthma in New Zealand, 1981-83: case-control study.

A case-control study was conducted to examine the hypothesis that fenoterol by metered dose inhaler (MDI) increases the risk of death in patients with asthma. The case group comprised 117 patients aged 5-45 who died of asthma between August, 1981, and July, 1983. For each case, 4 controls, matched for age and ethnic group, were selected from asthma admissions to hospitals to which the cases themselves would have been admitted, had they survived. The relative risk of asthma death in patients prescribed fenoterol by MDI was 1.55 (95% CI 1.04-2.33, p = 0.03). The possibility of confounding or effect modification by severity was assessed by consideration of subgroups defined by markers of asthma severity. The fenoterol MDI relative risk was 2.21 (95% CI 1.26-3.88, p = 0.01) in patients prescribed three or more categories of asthma drugs, 2.16 (95% CI 1.14-4.11, p = 0.02) in patients with a hospital admission for asthma during the previous 12 months, and 6.45 (95% CI 2.72-15.3, p less than 0.01) in patients prescribed oral corticosteroids at time of death or admission. In the group of patients with the most severe asthma (defined by a hospital admission during the previous year and prescription of oral corticosteroids) the fenoterol MDI relative risk was 13.29 (95% CI 3.45-51.2, p less than 0.01). After adjustment for severity, no other asthma treatment commonly used in New Zealand seemed to be associated with an increased risk of asthma death. Not all sources of bias can be definitely excluded; however, when considered together with other epidemiological and experimental evidence, these findings are consistent with the hypothesis that use of fenoterol by MDI increases the risk of death in severe asthma.

Acute Disease↗
PubMed1989

Symptoms of asthma, methacholine airway responsiveness and atopy in migrant Tokelauan children.

503 migrant Tokelauan children between five and 15 years resident predominantly in Porirua and the Hutt Valley were surveyed as part of a study of asthma prevalence in a recently migrant population. The survey consisted of domiciliary interview with parents, physical examination, assessment of bronchial hyperresponsiveness and atopy, by allergen skin prick testing. Forty-three children (8%) had a history of wheezy breathing or asthma. 160 children (32%) had evidence of increased airway responsiveness defined as a PD20 (provocative dose of methacholine causing a less than or equal to 20% fall in FEV1, of less than or equal to 12.2 mumoL methacholine). Of the 43 children with a history of asthma, 40 (93%) had evidence of bronchial hyperresponsiveness, 36 (84%) were atopic and 35 (81%) had both bronchial hyperresponsiveness and atopy. Forty-five children (9%) were found to be wheezing on the day of examination only 16 of these had a history of wheezing. Twenty seven of the wheezing children demonstrated bronchial hyperresponsiveness and 22 of these were atopic. Of the 18 children wheezing but with no evidence of bronchial hyperresponsiveness only six were atopic. These contrasting findings suggest differences in the cause of symptoms among the children. Regional differences were observed for the prevalence of symptoms and signs of asthma, bronchial hyperresponsiveness and atopy. Hutt Valley Tokelauan children exhibited a higher prevalence than the Porirua children. Migrants to the Hutt Valley and Porirua are from different atolls, and these differences raise the possibility of a genetic influence on the development of asthma.

Adolescent↗
PubMed1989

A comparison of the extent and duration of hypokalaemia following three nebulized beta 2-adrenoceptor agonists.

The hypokalaemic effects of equal doses (5 mg) of fenoterol, salbutamol, terbutaline and an equal volume of saline administered by nebulization were compared in eight healthy subjects. Plasma potassium was measured at 15-min intervals for 60 min and at 90 min, 2, 4 and 6 h following administration. Fenoterol, salbutamol and terbutaline all significantly decreased plasma potassium when compared to saline; however, the magnitude and duration of this effect differed between the active agents. Both fenoterol and terbutaline significantly reduced plasma potassium for 4 h whereas salbutamol was only different from 30 to 120 min. The maximum decrease occurred with fenoterol (-0.78 mmol/l), followed by terbutaline (-0.70 mmol/l) and salbutamol (-0.33 mmol/l). Both terbutaline and fenoterol had a significantly greater effect compared with salbutamol. When administered by nebulization fenoterol and terbutaline are likely to have a greater hypokalaemic effect than salbutamol and this effect is likely to be more long lasting.

Administration, Inhalation↗
PubMed1989

The relationships between atopy, bronchial hyperresponsiveness, and a family history of asthma: a cross-sectional study of migrant Tokelauan children in New Zealand.

We have examined age-related changes in the association between nonspecific bronchial hyperresponsiveness (BHR) and atopy in 494 second-generation Polynesian migrant children, aged 5 to 15 years. BHR (provocative dose of methacholine, less than or equal to 7.8 mumol, causing a 20% fall in FEV1) was present in 125 children (25.3%). Atopy (skin wheal, greater than or equal to 4 mm diameter) was present in 157 children (32%). BHR associated with atopy demonstrated a constant age-related frequency in the 7- to 15-year-old children that was influenced by a family history (FH) of asthma (FH, 50%; no FH, 34%; p = 0.051). BHR not associated with atopy demonstrated a marked decreasing frequency with age from 25% in 5- to 7-year-old children to 3% in 13- to 15-year-old children and was uninfluenced by an FH of asthma. We conclude that the differences in the frequency of BHR with age, together with the genetic influence on BHR associated with atopy, compared with the findings in nonatopic children, indicate distinct heterogeneity in the pathogenesis of BHR in these Tokelauan children. These differences may be important for understanding the relationships between nonspecific BHR, atopy, and asthma in children.

Adolescent↗
PubMed1989

Cardiovascular and hypokalaemic effects of inhaled salbutamol, fenoterol, and isoprenaline.

The cardiovascular and hypokalaemic effects of equal doses of inhaled fenoterol, isoprenaline and salbutamol were compared in eight healthy male volunteers, in a double blind, placebo controlled study. Increasing doses of 400, 600, and 800 micrograms were given from a metered dose inhaler at 15 minute intervals, followed by measurements of heart rate, blood pressure, total electromechanical systole (as a measure of inotropic response), QTc interval, and plasma potassium concentration. After repeated inhalation, fenoterol resulted in significantly greater chronotropic, electrocardiographic, and hypokalaemic effects than either isoprenaline or salbutamol. The maximum inotropic effect of fenoterol was similar to that of isoprenaline.

Administration, Inhalation↗
PubMed1989

Unsuitability of the human erythrocyte as a model for in vivo sodium transport activation by beta 2 adrenergic agonists.

Administration of the beta 2 adrenergic agonists fenoterol, salbutamol and terbutaline to volunteers significantly reduced plasma potassium concentration in a double-blind crossover study. There was no consistent effect of the three active compounds on erythrocyte sodium concentration. Storage of whole blood at 4 degrees C increased erythrocyte sodium concentration by 33% after 2 h; this could explain the differences between this and another study of the effects of beta 2 adrenergic agonists on erythrocyte sodium concentration. We conclude that the human erythrocyte is unsuitable as an indirect in vivo model to demonstrate stimulation of cellular sodium potassium transport mediated by beta 2 adrenergic agonists.

Adrenergic beta-Agonists↗
PubMed1989

The relationship between blood and urine alcohol concentrations at autopsy.

The relationship between the blood alcohol concentration and the urine alcohol concentration was studied in 109 routine coroner's autopsies. Although the average ratio for urine alcohol concentration to blood alcohol concentration lay close to the ratio of 4:3 quoted in the literature, the actual ratios determined were widely scattered around this value. Thus the use of this simple ratio to estimate the blood alcohol concentration from the urine alcohol concentration at post-mortem was unreliable. An equation determined by employing linear regression analysis was similarly unhelpful in enabling one to derive a precise value for the blood alcohol concentration from a given urine alcohol concentration. It was concluded that the main value in determining the urine alcohol concentration at autopsy was to exclude the possibility of the alcohol present in the blood sample having been generated during the post-mortem interval.

Autopsy↗
PubMed1989

The cardiovascular effects of inhaled fenoterol alone and during treatment with oral theophylline.

We have investigated whether oral theophylline potentiated the cardiovascular effects of fenoterol administered by metered-dose inhaler. Eight healthy subjects were investigated on four occasions. On successive days (1 and 2), the subjects were given doses of 400 micrograms, 600 micrograms, and 800 micrograms of fenoterol at 15-minute intervals (total dose, 1.8 mg) or matched placebo. Systolic time intervals, blood pressure, and the ECG were recorded at baseline and five minutes after each inhalation. Thereafter, the subjects were treated with slow-release theophylline for eight days. On days 9 and 10, the procedures on days 1 and 2 were repeated. The order of treatment was applied according to a crossover Latin-square design. The effects after theophylline alone were no different from placebo. Theophylline potentiated those hemodynamic effects of fenoterol due to enhanced cardiac sympathetic tone (mean +/- SE) as measured by a decrease in Q-S2I (-41.6 +/- 7.6 ms vs -27.3 +/- 5.9 ms; p = 0.0004), an increase in systolic BP (23.5 +/- 2.8 mm Hg vs 9.0 +/- 5.3 mm Hg; p = 0.00001), and an increase in heart rate (15.8 +/- 1.6 bpm vs 9.1 +/- 3.7 bpm; p = 0.0013). The responses mediated by beta 2-adrenergic receptor stimulation, namely, a decrease in PEP and diastolic BP, were not potentiated. Although fenoterol prolonged the Q-Tc interval and decreased T-wave amplitude, these effects were not potentiated by theophylline. Oral theophylline potentiates the positively inotropic and chronotropic effects of fenoterol.

Administration, Inhalation↗
PubMed1989

Acute pancreatitis as a cause of sudden or unexpected death in Northern Ireland.

Utilising incomplete data supplied by the Hospital Inpatient Analysis, the annual incidence of acute pancreatitis in Northern Ireland was estimated to be about 170 cases per million population. The annual mortality rate for the years 1974-1983, using figures obtained from the Registrar-General for Northern Ireland, was 12.3 cases per million. An increase in both incidence and mortality from acute pancreatitis was demonstrated during the study. There was 191 deaths from pancreatitis during the study period and in 27 of these the diagnosis was made only at postmortem examination. Of the undiagnosed fatalities, 10 occurred in individuals with a history of alcohol abuse. Eight of the 27 undiagnosed cases had not sought medical attention, five had presented with a systemic complication of acute pancreatitis, and a further five had only minor gastrointestinal tract symptoms prior to death. The diagnosis of acute pancreatitis requires a high index of suspicion and should be considered in acutely ill patients, particularly those with a history of alcohol abuse, who fail to respond to appropriate therapy.

Acute Disease↗
PubMed1987

Comparison of a fenoterol/ipratropium combination with salbutamol from metered dose inhalers in subjects with chronic partially reversible airways obstruction.

We have compared the acute bronchodilator response following salbutamol 200 micrograms and fenoterol 200 micrograms with ipratropium 80 micrograms, from metered dose inhalers in ten subjects with severe partially reversible airflow obstruction. Treatment with the combination resulted in a similar degree of bronchodilation but with a significantly longer duration of action.

Aged↗
PubMed1987

Hypokalaemic and electrocardiographic effects of aminophylline and salbutamol in obstructive airways disease.

The hypokalaemic and electrocardiographic effects of nebulised salbutamol (2.35 mg x 2, 120 min apart) and intravenous aminophylline (6 mg/kg followed by 0.5 mg/kg/hr infusion) alone and in combination, were investigated in eight patients with stable asthma. Both agents produced significant hypokalaemia, mean maximum for salbutamol 0.55 mmol/l, mean maximum for aminophylline 0.29 mmol/l. Salbutamol increased the QTc interval and depressed T-wave amplitude whilst aminophylline decreased PR interval. These effects were increased when they were given in combination but were highly variable between individuals. It is likely that arrhythmias may be precipitated in patients with hypoxaemia, acidosis or those with preexisting cardiovascular disease.

Administration, Inhalation↗
PubMed1987

Knee pain in sports people--a prospective study.

Knee pain caused by sport is a common cause of rheumatic symptoms. Clinical diagnosis is frequently difficult and an attempt was therefore made to determine whether particular symptoms and signs were sufficiently characteristic in 129 patients to enable easier recognition of knee disorders. Strict criteria for arthrography and arthroscopy included classical features of internal derangement or disabling pain. Arthrograms were performed in 39 and arthroscopy in 30, revealing good concordance for meniscal tears but none for cruciate tears. Classical histories and signs were often absent from patients with meniscal and cruciate tears. Patellar pain was a prominent symptom of 58 (45%). Questionnaires one year after assessment were returned by 91 (70%). Many patients had persistent symptoms or were unable to resume their sports. The unreliability of clinical diagnosis suggests that more frequent arthroscopic examinations could have increased the recognition of meniscal and cruciate tears.

Adolescent↗
PubMed1986

Single dose comparison of salbutamol and a fenoterol/ipratropium combination from metered aerosols in patients with asthma.

The single dose spirometric response to a combination metered aerosol product, fenoterol/ipratropium was compared with salbutamol from a metered aerosol in ten stable asthmatics. Two puffs from the combination aerosol (fenoterol 100 micrograms and ipratropium bromide 40 micrograms/puff) were compared with two puffs of salbutamol (100 micrograms/puff). The study was a cross-over design, using a double dummy technique and was placebo controlled. All subjects had demonstrated prior reversibility and baseline FEV1, values were within 15% on each study day.

Adult↗
PubMed1986

The comparative cardiovascular effects of digoxin and food alone and in combination in normal males.

The effects of the ingestion of food and digoxin on the cardiovascular system alone and in combination have been observed in eight healthy subjects. A positive inotropic response was seen following food (2.5 MJ) and intravenous digoxin (0.01 mg/kg) with significant decreases in QS2Index (QS2I) pre-ejection period (PEP) and PEP/LVET (LVET - left ventricular ejection time). These responses were potentiated when food and digoxin were combined. Opposing effects of food and digoxin on % diastole (%D) and diastolic time were observed, food decreasing %D and DT while digoxin increased these variables. Both food and digoxin decreased T-wave amplitude, and digoxin alone or in combination with food decreased QTc. The positive inotropic effect of a 2.5 MJ mixed meal and a loading dose of digoxin in healthy subjects are of similar degree, different mechanism, and are potentiated in combination.

Adult↗
PubMed1986

The hemodynamic effects of aminophylline and salbutamol alone and in combination.

We have studied the hemodynamic effects of salbutamol and aminophylline in eight patients with obstructive airways disease. Aminophylline was administered intravenously as a bolus and an infusion for 150 minutes. Salbutamol was administered by nebulizer after 30 minutes and at the end of the infusion. Compared with placebo, salbutamol decreased ventricular afterload (decreased preinjection period and preinjection period to left ventricular ejection time ratio and diastolic blood pressure). Aminophylline decreased total electromechanical systole, corrected for heart rate, only (mean decrease -10.7 msec; range -6.5 to -15.1), indicating a mild positive inotropic effect. When both active treatments were combined, the effect on total electromechanical systole, corrected for heart rate, was potentiated (mean decrease -23.3 msec; range -19.1 to -33.1). Neither aminophylline nor the combination affected heart rate or blood pressure, suggesting no increase in myocardial oxygen consumption. The hemodynamic effects of aminophylline and salbutamol are potentiated in combination but are unlikely to be harmful in patients with obstructive airways disease.

Adult↗
PubMed1986

Single-dose comparison of salbutamol and Duovent-Berodual in asthma.

Duovent-Berodual was compared with salbutamol from metered aerosols, in subjects with asthma, in a double-blind, randomised, placebo-controlled cross-over study. 10 stable asthmatics, 9 females and 1 male, all on regular inhaled bronchodilators and steroid treatment, were studied following prior assessment of reversibility. This was confirmed by at least a 15% improvement in forced expiratory volume in 1s (FEV1) following 200 micrograms of inhaled salbutamol. Inhaled bronchodilator therapy and oral theophyllines (4 subjects) were withheld for 8 and 48 h prior to investigation. Baseline FEV1 for each study day varied by less than 15%. Duovent-Berodual produced a greater improvement in mean FEV1 and mean peak expiratory flow rate (PEFR) compared with salbutamol at all time points. This was significant (p less than 0.05) for FEV1 at 120, 180, 210 and 240 min post-treatment. For PEFR a significant difference in response (p less than 0.05) was achieved at 90, 120, 150 and 210 min post-treatment. No significant difference was demonstrated for forced vital capacity (FVC) between the two active treatments at any time point. Ipratropium has been shown to improve FVC disproportionately to FEV1 and this has been attributed to dilatation of small airways. Seven subjects in this study described their asthma as lifelong. The failure to demonstrate significant differences in FVC response may reflect damage to small airways that render them unresponsive to ipratropium. This study demonstrates that Duovent-Berodual provides a significant improvement in bronchodilatation extending through to 4 h when compared with salbutamol.

Adult↗