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Biomedical subjects

J Kolbe

Publications and source records attributed to J Kolbe.

At least 55 records · Page 3Linked to original sources
PubMed1996

The association between asthma drugs and severe life-threatening attacks.

OBJECTIVES: To measure the association between asthma drugs and death or ICU admission due to asthma (severe life-threatening attack of asthma [SLTA]), and to assess the possibility that these associations may not be causal but due to the prescription of these drugs to patients with more severe disease (confounding). DESIGN: Retrospective cohort study of 655 asthmatics who attended an emergency department in 1986 to 1987 followed till death or May 1989. METHODS: Outcome events were death or ICU admission due to asthma (SLTA). All hospital attendances were identified and patients classified at each according to drug exposure and a wide variety of measures of asthma severity. Incidence rates were computed as total outcome events divided by person-time contributed for each subject classified according to drug use and asthma severity. Rate ratio (RR) estimates for severe asthma outcomes associated with use as compared to nonuse of asthma drugs were calculated. Severity markers were identified and used to adjust the crude RR estimates. RESULTS: One hundred five SLTAs (15 deaths, 90 ICU admissions) occurred in 66 patients. Like inhaled fenoterol, oral beta-agonists, theophylline, cromolyn, inhaled steroids, and oral steroids were all associated with an increased risk of SLTA. When adjusted progressively for measures of severity, these increased risks became insignificant except for cromolyn. CONCLUSION: Unadjusted RR estimates for severe asthma events comparing exposure to a particular drug with nonuse are overestimates due to confounding. Control with two severity markers (hospital admission in the last year, use of oral corticosteroid at the time of previous admission) removes some confounding but control for additional severity markers not available in previous studies reduces the effect estimates further. These results suggest that the problem of confounding is substantial in nonrandomized epidemiologic studies of asthma drugs. Previous studies reporting RR estimates are likely to be confounded.

Acute Disease↗
PubMed1996

Differential influences on asthma self-management knowledge and self-management behavior in acute severe asthma.

AIM: While asthma education increases knowledge, it is less clear whether education influences actual patient behavior. To determine whether there are differences between asthma self-management knowledge and the actual behavior of patients during an acute severe asthma attack and to determine which clinical and psychosocial factors are associated with knowledge and behavior. METHODS: Validated hypothetical scenarios describing the development of life-threatening asthma and patients' reported actual behavior were scored (out of 25) using a system based on Thoracic Society of Australia and New Zealand and British Thoracic Society criteria. RESULTS: In 137 patients admitted to the hospital with severe asthma, the pattern of the index attack was slow onset (> or = 6 h) in 96%. The score for the hypothetical attack (knowledge) was 13.8 +/- 4.6, while that for the timeline (behavior) was 10.2 +/- 3.9 (p < 0.001) with 56% and 84%, respectively, having a score of less than 15 (regarded as inadequate). Certain components showed marked discrepancy (eg, appropriately seeking medical help 82% vs 52% (p < 0.001) and calling ambulance 61% vs 23% (p < 0.001). Factors such as physician-patient relationship, previous asthma morbidity, availability of peak flowmeter, action plan, and oral steroids correlated positively with both measures. Knowledge was negatively associated with being non-European, with anxiety, pessimism, and stigmatization. Behavior (but not knowledge) was negatively associated with lack of knowledge of what to do in the index attack, previous emotional counseling, and business failure. Those factors associated with the difference between knowledge and behavior scores (knowledge-behavior gap) were being non-European, anxiety, pessimism, and stigmatization, concerns about medical costs, and the only income for the household being a Social Security benefit. CONCLUSION: There are marked differences between patients' self-management knowledge and their actual behavior, particularly in terms of potentially life-saving actions. Psychological, health-care, and socioeconomic factors have a powerful and differential influence on knowledge and behavior. Improved understanding of the discrepancies between knowledge and behavior and which factors influence them may lead to more effective asthma educational interventions.

Acute Disease↗
PubMed1996

Involvement of an enchondroma in relapsing polychondritis.

We describe a 49-year-old Caucasian woman with relapsing polychondritis involving ears, eyes, nose, and airways. An enchondroma in the left humerus was also involved. This unusual manifestation of the disease has not been previously reported.

Biopsy↗
PubMed1995

The effects of privet exposure on asthma morbidity.

AIM: To determine whether privet may be an important cause of asthma morbidity. METHODS: The study was conducted in two parts; (1) a longitudinal study of asthma symptoms, medication use, peak expiratory flow rate and airway responsiveness during and after the privet-flowering season, and (2) bronchial challenge of 17 subjects with two species of flowering privet. Subjects were asthmatics who attributed worsening asthma symptoms to privet exposure. All subjects were atopic and had perennial asthma symptoms requiring treatment with inhaled steroids and beta agonists. RESULTS: 1. Twenty subjects completed the longitudinal study. Airway responsiveness (PD20 histamine) was significantly greater during the privet-flowering season (0.4 mumol vs 0.73 mumol, p < 0.05). Symptom scores and bronchodilator use were higher and peak expiratory flow rates lower during the privet-flowering season, but the changes were small and not statistically significant. 2. Seventeen subjects from the longitudinal study subsequently had bronchial challenge studies performed. There were no isolated early responses, but six had late asthmatic responses. Eleven had no airway constrictor response to challenge with either of the two local varieties of privet. CONCLUSION: Although significant increases in airway responsiveness occur during the privet flowering season, only a proportion of this highly select group had a constrictor response to direct challenge. Privet exposure may cause bronchoconstriction in certain individuals, but it is unlikely to be responsible for a large proportion of asthma morbidity in New Zealand.

Adolescent↗
PubMed1995

Major reduction in asthma morbidity and continued reduction in asthma mortality in New Zealand: what lessons have been learned?

Increasing financial barriers to primary health care against a background of social and economic decline are likely to have contributed to asthma morbidity and mortality in New Zealand. Although there would not have been a sufficient increase in asthma prevalence to have accounted for the threefold increase in mortality rates, whether or not there was an increase in asthma severity in the late 1970s remains open to debate. Misuse or poor use of newly available and potent bronchodilator medications by those with the most severe asthma may simply have contributed to further delays in obtaining appropriate care and therefore to an increase in frequency of severe attacks in the community. Despite substantial increases in the use of bronchodilator therapy in New Zealand, there was no immediate improvement in indices of either asthma morbidity or mortality. The initial reduction in mortality rates in the 1980s happened at a time when first admissions for asthma were still increasing and seems to be best explained by an improvement in utilisation of hospital services (which were free until 1992) rather than a reduction in asthma severity. However, the recent reductions in all measures of asthma morbidity and further reduction in asthma mortality since 1989 does now suggest a reduction in asthma severity and would be best explained by the substantial increase in medium and high dose inhaled corticosteroid use, and to the endorsement of the current management strategies for asthma which are being promoted internationally and which were given considerable publicity in New Zealand in 1989 and 1990. Whilst sales of inhaled beta agonists were higher in 1991 than 1989, this may not reflect their pattern of use by individual patients since the need for an increase in inhaled beta agonist treatment has been accepted as indicating a lack of control and the need for either starting or increasing the dose of inhaled steroid treatment.

Adolescent↗
PubMed1993

Demographic characteristics of patients with severe life threatening asthma: comparison with asthma deaths.

BACKGROUND: Studies of mortality from asthma have suggested that a very severe asthma attack identifies a group at greatly increased risk of subsequent death from the disease. This study compares the demographic characteristics of asthmatic patients who required management in an intensive care unit for a severe life threatening attack between 1981 and 1987 with a group who died of asthma between 1980 and 1986. The outcome of the group admitted to an intensive care unit is described. METHODS: The groups comprised all cases aged between 15 and 49 years arising from the Auckland Area Health Board (AAHB) population who required admission to an intensive care unit for asthma between 1981 and 1987 (n = 413) and all deaths from asthma in those aged 15 to 49 years arising from the New Zealand population between 1980 and 1986 (n = 466). Details of age, sex, and information on the day and month of the attack were collected. For the group requiring admission to an intensive care unit, outcome in terms of mortality and readmission to intensive care was determined. RESULTS: The age distributions of the two groups were dissimilar, with the severe life threatening attack group having an excess of asthmatic patients under 30 years old. The distribution of events by calendar month was uniform in both groups, but there was an unexpected increase in frequency of attacks on Sundays in both groups. Over the study period, mortality fell from 5.3 per 100,000 to 3.5 per 100,000 but the admission rate to intensive care increased from 10.8 per 100,000 to 17.9 per 100,000. At least 24% of asthma deaths occurring in the AAHB region during the study period had previously experienced a severe life threatening attack. CONCLUSIONS: The similarities between the groups suggest that asthmatic patients who experience severe life threatening attacks are likely to come from the same subgroup of the asthma population as those who die. The group who experience severe life threatening attacks are at high risk of subsequent morbidity and mortality and further studies may produce information relevant to reducing mortality from asthma.

Adolescent↗
PubMed1992

Structure of the glycan chain from the surface layer glycoprotein of Clostridium thermohydrosulfuricum L77-66.

The thermophilic eubacterium Clostridium thermohydrosulfuricum L77-66 is covered by a crystalline surface layer composed of identical glycoprotein subunits which are arranged in a hexagonal lattice with centre-to-centre spacings of approx. 14.3 nm. Sodium dodecyl sulphate-polyacrylamide gel electrophoresis of cell wall preparations showed the presence of several broadened, carbohydrate-containing bands in a molecular mass range of 90 to 200 kDa. A total carbohydrate content of approx. 14% was determined in the purified surface layer glycoprotein. Chemical deglycosylation of this material by trifluoromethanesulfonic acid resulted in the disappearance of the complex banding pattern. Only a single band with a molecular mass of 82 kDa remained visible upon Coomassie staining. After proteolytic digestion of the surface layer glycoprotein a single glycopeptide fraction with an apparent molecular mass of approx. 25 kDa was obtained by gel filtration. Composition analysis, methylation, periodate oxidation and a combination of homonuclear and 1H-detected heteronuclear shift-correlated nuclear magnetic resonance experiments established the following structure for the glycan chain of the surface layer glycoprotein.

Bacterial Outer Membrane Proteins↗
PubMed1992

Fibreoptic bronchoscopy and bronchoalveolar lavage in the investigation of the immunocompromised lung.

The records of 18 immunocompromised patients with recent onset of pulmonary disease who had fibreoptic bronchoscopy and bronchoalveolar lavage over a two year period (1989-90) were reviewed. The underlying diseases were human immunodeficiency virus (HIV) infection (n = 7), organ transplantation (n = 9), and chemotherapy for malignancy (n = 2). Four patients were receiving prophylactic therapy and 12 had been started on empirical therapy for infection. Patients proceeded to bronchoscopy either because of atypical disease presentation or failure to respond to empirical therapy. Bronchoscopy with bronchoalveolar lavage was diagnostic in 13/18 (72%) patients and provided clinically useful information in 16/18 (89%). There was one diagnostic failure (6%); Pneumocystis carinii pneumonia in an HIV positive patient receiving nebulised pentamidine prophylaxis was missed. Transbronchial biopsies were not routinely performed and provided additional diagnostic information in only 1/6 (17%) patients. Overall, the commonest diagnoses were Pneumocystis carinii pneumonia (61%) and cytomegalovirus pneumonitis (28%). There were no complications of the procedures. In this highly selected setting of diagnostic or therapeutic uncertainty, fibreoptic bronchoscopy with bronchoalveolar lavage remains an effective and safe technique for evaluating pulmonary disease in immunocompromised patients.

Adult↗
PubMed1992

Analysis of a novel linkage unit of O-linked carbohydrates from the crystalline surface layer glycoprotein of Clostridium thermohydrosulfuricum S102-70.

The surface layer glycoprotein of Clostridium thermohydrosulfuricum S102-70 was shown to contain a new type of glycan chain. Different from all known eubacterial glycoproteins, the saccharide moiety consists only of six sugar residues without any repeat sequences. Proteolytic digestion of purified S-layer glycoprotein resulted in isolation of several glycopeptide fractions. These are composed of the same hexasaccharide portion but are linked to oligopeptides of different length. One of them contains only a single amino acid. As concluded from chemical analyses and proton and carbon nuclear magnetic resonance spectroscopy of this preparation, the hexasaccharide moiety is linked via a novel O-glycosidic linkage. This is a beta-D-glucose residue linked to the phenolic hydroxyl group of tyrosine in intact S-layer glycoprotein.

Bacterial Outer Membrane Proteins↗