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Biomedical subjects

J S Legge

Publications and source records attributed to J S Legge.

At least 37 records · Page 2Linked to original sources
PubMed1994

Outcome of wheeze in childhood. Symptoms and pulmonary function 25 years later.

The outcome after 25 yr was studied for three groups of children classified in a random community survey in 1964 as having asthma (121 subjects), wheeze in the presence of infection (167 subjects), or no respiratory symptoms (167 comparison subjects). Approximately 80% of the subjects in each group, now aged 34 to 40 yr, were successfully traced. Current symptoms and smoking habit were recorded by questionnaire, and ventilatory function, peak flow variability, and bronchial reactivity to inhaled methacholine were measured. Subjects who had asthma in childhood were more likely to wheeze (odds ratio [OR] 14.4) or produce phlegm (OR 3.3) than comparison subjects. They also had significantly lower FEV1 values and greater bronchial reactivity than comparison subjects. Adult FEV1 correlated with childhood FEV1 (both expressed as % of predicted) (r = 0.44, p < 0.01). The prognosis for those children who were classed as having wheeze in the presence of infection in 1964 was better than for those who had asthma. Although they also were more likely to report wheeze (OR 3.8) or phlegm (OR 4.4) than comparison subjects, the wheezy symptoms were unlikely to interfere with activities and the ventilatory function and bronchial reactivity to methacholine did not differ from those of comparison subjects. Smokers were more likely to report wheeze (OR 2.0), cough (OR 7.2), and phlegm (OR 3.1) than never-smokers, and current smokers with current wheezy symptoms had significantly reduced FEV1 values, although smoking was not associated with increased methacholine reactivity.(ABSTRACT TRUNCATED AT 250 WORDS)

Asthma↗
PubMed1993

Spontaneous sternal fractures in four patients with chronic airflow obstruction taking corticosteroids.

Four patients with chronic airflow obstruction developed spontaneous sternal fractures. All had received repeated courses of high dose corticosteroids and three were receiving long term treatment with low dose corticosteroids. It is important to consider sternal fracture in the differential diagnosis when patients with chronic airflow obstruction present with chest pain.

Adrenal Cortex Hormones↗
PubMed1993

Predicting patient attitudes to asthma medication.

BACKGROUND: Studies of patient attitudes to asthma and its control have focused on crisis action, and little attention has been paid to attitudes to regular preventive medication. It is not clear whether attitudes to regular medication are related to the degree of distress or interference with life perceived by patients as being caused by their asthma. For this reason this study examined how far dislike of medication related to dislike of other aspects of interference of asthma with daily life. METHODS: Three hundred and ninety one patients were surveyed with a questionnaire which assessed their dislike of the interference of asthma with their physical, social, and emotional functioning, together with dislike of regular asthma medication. A response was received from 320 patients (82%). RESULTS: Four attitude clusters were identified. Recorded in descending factor order, these were (1) dislike of asthma medication, (2) dislike of disability, (3) dislike of public life interference, and (4) dislike of social and emotional interference. The attitude clusters were not related: in particular, dislike of asthma medication could not be predicted from other dislikes, or from asthma best function ratio (ratio of best recorded peak expiratory flow rate in the previous year to predicted value), age, or sex. The most significant predictors of the patients' dislike of taking their own inhaled steroid were (1) dislike of using bronchodilator, (2) dislike of steroids generally, and (3) dislike of taking medicine every day. CONCLUSIONS: Patient attitudes to regular asthma medication are not related to general anxieties and dislikes about asthma, nor to the potential for asthma control as judged by the best function ratio. Patients were not always consistent in their attitude to inhaled steroids in general, nor to their own named inhaled steroid in particular. A general cluster of antimedication attitudes existed, independent of whether the medication was for prophylaxis or relief. Attitudes to asthma medication may be helpful in predicting patient behaviour.

Administration, Inhalation↗
PubMed1991

Accelerated silicosis in Scottish stonemasons.

A small group of stonemasons working with sandstone was exposed to levels of respirable quartz up to 130 times the workplace standard over a period of up to 6 years. Two died of accelerated silicosis, a disease that caused serious diagnostic difficulties and was initially not recognised by the doctors of the then Department of Health and Social Security Medical Boarding Centre (respiratory diseases). Previous descriptions of this disease in the UK date back to the years of the industrial revolution (late 18th century). One other mason on the site proved to have an earlier stage of accelerated silicosis and two had radiographic changes of early classic silicosis. Regulations intended to prevent silicosis have been in place in the UK for many decades and were strengthened by the Health and Safety at Work Act in 1974. Although the workers had been aware of a health risk from quartz, they had not been able to persuade management to take effective preventive action until serious illness had occurred. Current pressures on management to cut overheads and to achieve maximum productivity could, as in this instance, lead to neglect of health and safety standards.

Adult↗
PubMed1991

Air-driven nebulised high-dose salbutamol in severe chronic obstructive airways disease: is it safe?

The increasing use of air-driven nebulised bronchodilators by patients with airflow obstruction has raised concern about the safety of this practice. We have investigated the effects of 10 mg salbutamol, nebulised in air, on blood gas tensions, heart rate and plasma potassium (K+), when administered alone to 9 patients with severe chronic obstructive airway disease and then in combination with a therapeutic dose of oral sustained-release theophylline to 5 of them on 2 separate occasions. No significant reductions in PaO2 were observed with either treatments. Heart rate increased significantly from 77.8 +/- 3.7 beats/min (mean +/- s.e.m.) at baseline to a peak of 87.1 +/- 4.4 beats/min at 45 min (p less than 0.001) with salbutamol alone and there was a similar trend of increase after combined therapy. K+ decreased significantly from a baseline of 4.0 +/- 0.3 to a minimum of 3.6 +/- 0.2 mmol/l at 90 min (p less than 0.001) with combined therapy but did not change significantly with single therapy. No subject developed any significant cardiac arrhythmias on either occasion. Although the number of subjects studied is small, our data suggest that air-driven nebulised high-dose salbutamol may be safe in the treatment of severe chronic obstructive airway disease but when combined with oral theophylline, a significant fall in plasma potassium may occur. This could be of clinical significance in hypokalaemic patients. When combination treatment is used, monitoring of plasma potassium is recommended.

Aged↗
PubMed1988

Use of nebulised saline and nebulised terbutaline as an adjunct to chest physiotherapy.

To determine whether sputum clearance is increased by using nebulised saline or terbutaline as an adjunct to chest physiotherapy, a radioaerosol method (using technetium-99m labelled human albumin millimicrospheres) was employed in eight patients with stable bronchiectasis on four occasions, for comparison of sputum clearance with four different regimens. These were: control, with the patient resting in an upright position; chest physiotherapy, by the forced expiration technique with postural drainage; and chest physiotherapy following five minutes' inhalation of either nebulised normal saline or nebulised terbutaline 5 mg. Use of both nebulised saline and nebulised terbutaline immediately before chest physiotherapy gave a significantly greater yield of sputum than did physiotherapy alone, and terbutaline also significantly increased radioaerosol clearance from the whole lung and from regions of interest. The mechanism is unclear, but this method may provide a simple way of increasing the efficacy of conventional chest physiotherapy.

Adult↗
PubMed1985

Clinical efficacy, tolerance and pharmacokinetics of temocillin in patients with respiratory tract infections.

In this study 13 patients with a history of chronic respiratory disease were treated with temocillin for severe infection of the lower respiratory tract. Eleven patients were clinically improved or cured at the end of treatment and 4 remained free of infection at follow up. However, the 2 remaining patients failed to respond clinically and bacteriologically to temocillin. Blood and sputum pharmacokinetics were studied in patients receiving temocillin at 12-hourly intervals in doses of either 1g by intravenous bolus or 2g by intravenous infusion. On the first day of treatment the mean peak serum concentration was 102 mg/L for the 1g dose and 220 mg/L for the 2g dose, falling to 11 mg/L (1g) and 18.8 mg/L (2g) at 12 hours. Similar results were recorded on the last day of treatment. Temocillin concentrations in the sputum ranged from 1.5 to 2.8 mg/L, with no difference being found in the sputum concentrations of the 2 doses. Temocillin was well tolerated and was found to be an effective treatment for Gram-negative bacterial infections of the lower respiratory tract.

Drug Tolerance↗
PubMed1982

A VNA home health care program: predicting patients who refuse services.

Many studies have been compiled which report patient characteristics and patterns in the utilization of health care services. Very little information is available on the characteristics of patients who refuse services in a particular program. This article employs a sample of 246 home health care patients to describe the characteristics of persons refusing services compared to a group "normally" terminating service. The method employed is discriminant analysis. The results of the study are substantively consistent with the theoretical and empirical literature on health care utilization. Those refusing service were less likely to be insured and tended to have multiple admissions to the program. They were less inclined to improve in functional status, despite a tendency toward a longer stay in the program. Curiously, fewer nursing visits occurred for these patients, despite their longer stays. Implications of the study for program management are discussed.

Analysis of Variance↗