Do corticosteroids really alter mood?
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Adrenal Cortex Hormones↗
Biomedical subjects
J V Collins
Publications and source records attributed to J V Collins.
Psychological changes and improvement in chronic airflow limitation after corticosteroid treatment.
Corticosteroids may produce mood changes. This could account for improvement in patients with chronic airflow limitation following trials of oral corticosteroid treatment as mood elevation might improve performance in objective measurements. This proposition was tested in 21 patients with chronic airflow limitation, who underwent detailed psychological assessment during a randomised controlled double blind crossover trial of the effect of prednisolone 40 mg daily compared with that of a placebo. Self rating visual analogue scales for various qualities of mood were completed before the study and after each phase in addition to depression and psychological symptom questionnaires. After treatment with the placebo, patients showed increases in cheerfulness (p less than 0.01) and sociability (p less than 0.01) and a decrease in depression (p less than 0.01). After treatment with prednisolone there were increases in cheerfulness (p less than 0.01), optimism (p less than 0.01), activity (p less than 0.05), and sociability (p less than 0.02) and there was a decrease in depression (p less than 0.01). When placebo and prednisolone values were compared, however, there were no significant differences. Some patients showed improvements (greater than 20%) in peak expiratory flow, FEV1 or forced vital capacity (FVC) after prednisolone, but nearly all had improvements in at least one psychological test. There were no detectable associations between changes in objective measurements and changes in psychological test ratings. This study suggests that in patients with chronic obstructive lung disease significant psychological changes are no more likely to follow treatment with a corticosteroid than treatment with a placebo and that physiological improvement after corticosteroid treatment is not tied to psychological changes.
Aged↗
Assessment and management of acute asthma in the elderly: a comparison with younger asthmatics.
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Acute Disease↗
Pulmonary Munchausen's syndrome.
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Adult↗
Severe acute asthma: a comparison of three methods of inhaling salbutamol.
The effects of salbutamol inhaled by three different methods were compared in groups of adult patients with severe acute asthma. 2 x 400 micrograms Rotacaps was the optimum dose of dry powder but about 40% of patients failed to respond to it. 5 mg salbutamol nebulized with IPPB resulted in a significant increase in peak expiratory flow rate when given before or after either Rotacaps or salbutamol nebulized without IPPB, whereas neither the dry powder nor the nebulized drug without IPPB resulted in significant change when given after salbutamol nebulized with IPPB. The extra benefit derived with IPPB is only slight and requires a device of appropriate characteristics. Occasional patients fail to respond to salbutamol inhaled by any means, generally those with the most severe airflow limitation.
Acute Disease↗
Pharmacokinetics of prednisolone in normal and asthmatic subjects in relation to dose.
The pharmacokinetics of prednisolone have been studied in asthmatic patients following intravenous injection at three different doses and in normal volunteers at five oral doses. Plasma prednisolone concentrations were measured by radioimmunoassay. With increasing dose there is an increase in the apparent volume of distribution, plasma clearance and half life. The relationship between area under the plasma concentration time curve, maximum concentration and dose is linear but the regression lines do not pass through the origin. These findings following oral and intravenous administration confirm that prednisolone shows non-linear kinetics.
Adult↗
Transbronchial lung biopsy with the fibreoptic bronchoscope: analysis of results in 433 patients.
Transbronchial lung biopsy was performed via the fibreoptic bronchoscope in 433 patients. In 183 patients, whose chest radiographs showed bilateral diffuse shadows a histologic diagnosis was established by transbronchial biopsy in 61%, including sarcoidosis (58), fibrosing alveolitis (18) and carcinoma (14). Histologically normal lung or inadequate pulmonary tissue for diagnosis was obtained from 71 patients in this group. In 225 patients with solitary chest radiography opacity, a diagnosis of bronchial carcinoma was finally made in 130, of whom 82 (63%) had a histological diagnosis established by transbronchial biopsy. In 84 patients finally shown to have sarcoidosis, 65 (77%) had positive histology by transbronchial biopsy whereas only 19 (40%) of 48 patients with fibrosing alveolitis yielded histology compatible with the diagnosis. Pneumothorax developed in three patients after the procedure but only one required intercostal drainage. Haemorrhage of 50-100 ml occurred in seven patients and bleeding ceased spontaneously in all cases. There were no fatalities.
Adolescent↗
Comparison of radioimmunoassay and thin layer chromatographic assay methods for estimation of plasma prednisolone concentrations.
Radioimmunoassay and thin layer chromatographic methods of assay for prednisolone in plasma have been compared. These methods are comparable in terms of ease, speed of execution, and cost. They yielded similar estimates of prednisolone concentration without important bias over the concentration range generally encountered in clinical practice and may be considered comparable for pharmacokinetic studies.
Antibody Specificity↗
Value of chest radiographs in severe acute asthma.
Chest radiographs were obtained in 117 adults admitted with severe acute asthma. In 10 (9%) patients abnormalities were seen that affected management and in nine the presence of pulmonary collapse or consolidation was shown which was not detected by clinical examinations. Over-inflation was common and correlated significantly with tachycardia, pulsus paradoxus and decrease in FEV1. Bronchial wall thickening was common and prominence of hilar vessels was also noted in a few patients. Chest radiography is strongly recommended in severe exacerbation of asthma and antero-posterior views are adequate for interpretation.
Acute Disease↗
Prednisolone pharmacokinetics compared between night and day in asthmatic and normal subjects.
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Adult↗
Cells, enzymes and interstitial lung disease. The Philip Ellman Lecture.
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Alveolitis, Extrinsic Allergic↗
Fibreoptic bronchoscopy: ten years on.
Fibreoptic bronchoscopy was introduced more than 10 years ago and is now in many centres a routine diagnostic procedure, having superseded rigid bronchoscopy. Its major role is in the diagnosis of bronchial carcinoma, where the results are as good as, if not better than, results with the rigid instrument. Other major applications have been found in investigating haemoptysis, transbronchial lung biopsy in interstitial lung disease, and in the critically ill patient in the intensive care unit. More recently, the instrument has been used to perform bronchoalveolar lavage in investigating interstitial lung diseases and to enable lobar and segmental lung function studies to be performed. Fibreoptic bronchoscopy is a major advance in the diagnosis of pulmonary diseases, but there will always be times when rigid bronchoscopy is preferable.
Adolescent↗
Transbronchial lung biopsy through fibreoptic bronchoscope in diagnosis of sarcoidosis.
Sarcoidosis was ultimately diagnosed in a consecutive series of 79 patients, of whom 24 presented with unusual features. Histological support for this diagnosis was obtained in 37 out of 42 patients who underwent transbronchial biopsy; epithelioid and giant-cell granulomas were also found on biopsy of the bronchial mucosa in 17 out of 22 patients. Kveim tests were completed in 44 patients: results were positive in 19, equivocal in 11, and negative in 14. In 16 patients histological support was obtained on biopsy of various other tissues. The clinical presentation of the disease and the degree of histological support provided by the various procedures used in reaching a diagnosis of sarcoidosis varied considerably. Transbronchial biopsy of the lung is a useful advance in diagnosing sarcoidosis and provided a higher diagnostic yield than any other method.
Biopsy↗
A pressure-sensitive transistor spirometer for the assessment of human ventilatory capacity from forced expiratory manoeuvres.
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Electronics, Medical↗
An evaluation of cusum analysis in asthma.
It has been claimed that cusum analysis may be a clearer way of expressing trends in serial peak flow (PF) measurements in asthma than visual inspection of peak flow charts. To assess this we have applied cusum analysis to serial PF measurements in patients receiving various forms of treatment for airflow obstruction. We found that cusum analysis usually gave no additional advantage over simple graphs of PF data. In cases in which trends were apparent only by cusum analysis, their dimension was such that they were unlikely to form the basis of decisions on treatment.
Asthma↗
Bronchoalveolar lavage in pulmonary fibrosis: comparison of cells obtained with lung biopsy and clinical features.
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Adult↗
Bronchoalveolar lavage fluid cell counts in cryptogenic fibrosing alveolitis and their relation to therapy.
Bronchoalveolar lavage was used to sample inflammatory cells from the lungs of 51 patients with cryptogenic fibrosing alveolitis (CFA) (24 smokers, 12 ex-smokers, and 15 non-smokers). The smokers with CFA have been compared with 15 smoking control subjects in whom there was no radiographic abnormality or clinical evidence of chronic bronchitis. Significantly lower volumes of lavage fluid were recovered from the smokers with CFA (p < 0.001) and the fluid contained lower percentages of macrophages (p < 0.01), reflecting increased percentages of eosinophils (p < 0.001) and neutrophils (p < 0.01). Similar changes were seen in the ex-smokers and non-smokers. There was also an increase in the percentages of lymphocytes when the whole group of CFA patients was compared with the control subjects (p less than or equal to 0.05). No significant differences were found when patients with "lone" CFA were compared with those having associated systemic disease. The only feature distinguishing smokers from non-smokers with CFA was the presence of pigmented cytoplasmic inclusions in the macrophages from the smokers (p < 0.001). However, there were lower numbers of pigmented macrophages in the smoking CFA patients by comparison with the control subjects suggesting either a change in phagocytic capacity or turnover rate in this disease. Profiles of differential cell counts in individual patients showed that increases of eosinophils over 3% or neutrophils over 4% or both with lymphocyte counts of less than 11% related to a poor clinical response to corticosteroids, but lymphocyte percentages greater than 11% related to improvement (p < 0.05).
Adult↗