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Biomedical subjects

K Kiviranta

Publications and source records attributed to K Kiviranta.

13 recordsLinked to original sources
PubMed1994

Effects of reducing or discontinuing inhaled budesonide in patients with mild asthma.

BACKGROUND: In a previous study, we found that two years of treatment with an inhaled corticosteroid, budesonide, was more effective than treatment with an inhaled beta 2-agonist, terbutaline, in patients with newly diagnosed, generally mild asthma. We continued this study for a third year to investigate whether the steroid dose could be reduced or discontinued and what effect crossover of patients from beta 2-agonist therapy to corticosteroid therapy would have. METHODS: A total of 37 patients treated for two years with inhaled budesonide at a dose of 1200 micrograms per day were randomly assigned to treatment with 400 micrograms of budesonide per day (19 patients) or placebo (18 patients) in a double-blind manner. Another 37 patients, who had received terbutaline during the first two years, were crossed over in an open-label manner to treatment with 1200 micrograms of budesonide per day during the third year. RESULTS: Treatment with the reduced dose of budesonide was sufficiently effective in 74 percent of the patients to maintain bronchial responsiveness at a level similar to that achieved with the higher dose. In contrast, improvement was maintained in only 33 percent of the patients receiving placebo, and the differences in pulmonary function between the steroid and placebo groups were significant (for forced expiratory volume in one second, P = 0.007; for bronchial responsiveness to histamine, P = 0.025; and for peak expiratory flow in the morning, P = 0.040). The condition of patients who were crossed over from terbutaline therapy to treatment with 1200 micrograms of budesonide per day improved. However, the degree of improvement in these patients appeared to be less than in those who were treated with budesonide at the beginning of the three-year study. CONCLUSIONS: Early treatment with inhaled budesonide results in long-lasting control of mild asthma. Maintenance therapy can usually be given at a reduced dose, but discontinuation of treatment is often accompanied by exacerbation of the disease.

Administration, Inhalation↗
PubMed1993

Evaluation of a new spacer device for drug inhalation.

We have studied the efficacy and acceptability of a new inhalation spacer device. The functional principle of the device, differing from that of conventional spacers, is based on evaporation of the propellant during circular movement of the aerosol in a small spherical chamber. We assessed the bronchodilating effect of salbutamol (Salbuvent) inhaled with the new spacer (Rondo) compared with salbutamol (Ventoline) inhaled with the spacer Volumatic and with salbutamol (Salbuvent) inhaled with a conventional metered dose actuator using a double-blind cross-over arrangement. Fifteen asthmatic patients were treated over a period of 4 weeks. They used each of the three different devices for 2-3 days every week. Peak expiratory flow rates were recorded every morning after one and after two puffs of the study drugs. The bronchodilator responses to the three treatments were similar within narrow ranges of estimate. By visual analogue scale assessment the new spacer was significantly easier to handle (P < 0.05) and more convenient to carry around (P < 0.01) than Volumatic.

Adult↗
PubMed1993

Effect of eight months of inhaled beclomethasone dipropionate and budesonide on carbohydrate metabolism in adults with asthma.

BACKGROUND: The safety of high dose inhaled steroids has been a subject of debate. The efficacy and safety of beclomethasone dipropionate and budesonide inhalations were evaluated by measuring their effects on pulmonary function, on the hypothalamic-pituitary-adrenocortical axis, and on carbohydrate metabolism in adults with unstable asthma. METHODS: Fifteen adults with unstable asthma and 15 healthy controls were studied. Eight patients were treated with beclomethasone dipropionate in initially high (2 mg/day for five months) and subsequently lower (1 mg/day for three months) doses. Seven patients were treated with budesonide at doses of 1.6 mg/day for five months followed by 0.8 mg/day for three months. Blood glucose and serum insulin were measured in an oral glucose tolerance test and plasma cortisol in an adrenocorticotrophic hormone test. The antiasthmatic effect of treatment was evaluated by measuring peak morning expiratory flow rates and forced expiratory volume in one second (FEV1). RESULTS: The FEV1 increased significantly after one month of treatment (medians 88% v 96%, p < 0.01), and nocturnal symptoms disappeared within two weeks of treatment in both groups. At one month, the high dose significantly decreased serum insulin concentrations as calculated from the areas under the incremental two hours curves in the glucose tolerance test. The decrease was 59% for beclomethasone dipropionate (medians 76 v 31 mU/l/h, p < 0.005) and 42% for budesonide (medians 79 v 46 mU/l/h, p < 0.01). The median areas at five and eight months were intermediate for both drugs. No significant differences were found when the five and eight month values were compared either with the baseline or with one month values. The difference between the baseline values of both groups and the respective values in healthy controls was significant (medians 79 v 49 mU/l/h, p < 0.01). The one month values for the patients and control subjects were similar. Paralleling the changes for insulin, the area under the incremental two hour blood glucose curve decreased significantly (medians 1.4 v 0.4 mmol/l/h, p < 0.05) during the first month of treatment. The five and eight month values were intermediate (medians 0.8 and 0.7 mmol/l/h, respectively). These changes were not significant compared with the baseline or the one month areas. Similar changes were seen in both treatment groups. Neither treatment had any significant effect on plasma cortisol in the one hour adrenocorticotrophic hormone test. CONCLUSIONS: In patients stressed by uncontrolled asthma, the antiasthmatic effect of high dose beclomethasone dipropionate and budesonide was accompanied by a significant initial decrease in insulin resistance with a parallel improvement in glucose tolerance. During prolonged treatment a small increase in insulin sensitivity was found. The overall effect of beclomethasone dipropionate and budesonide inhalations on carbohydrate metabolism may be beneficial in patients with uncontrolled asthma.

Administration, Inhalation↗
PubMed1991

Comparison of a beta 2-agonist, terbutaline, with an inhaled corticosteroid, budesonide, in newly detected asthma.

BACKGROUND: The presence of airway inflammation even in mild asthma points to the potential value of antiinflammatory therapy. We compared the effect of an inhaled corticosteroid, budesonide, with that of an inhaled beta 2-agonist, terbutaline, in the long-term treatment of newly detected asthma. METHODS: We studied 103 patients (29 male and 74 female patients 15 to 64 years old) in whom asthma had appeared within the previous year. The patients were randomly assigned in blinded fashion to two treatment groups: one to receive 600 micrograms of inhaled budesonide twice a day, and the other to receive 375 micrograms of inhaled terbutaline twice a day. The study period was two years. RESULTS: After six weeks of treatment, the patients treated with budesonide tolerated inhaled histamine better than the patients treated with terbutaline (a difference of one doubling dose step, P less than 0.001), and the difference was sustained. Patients' diaries kept during the first three months of the study and during the last month of the first and second years showed budesonide to be more effective than terbutaline in improving peak expiratory flow in the morning (average increase from the pretreatment value, 32.8 liters per minute for budesonide vs. 4.8 liters per minute for terbutaline; P less than 0.001) and in the evening (P less than 0.01). Budesonide was also more effective in reducing the symptoms of asthma (P less than 0.01) and the use of supplemental beta 2-agonist medication (P less than 0.01). Ten patients were withdrawn from the terbutaline group because treatment was insufficiently effective, whereas only one dropped out of the budesonide group. The adverse reactions to both treatments were few and mild. CONCLUSIONS: Antiinflammatory therapy with inhaled budesonide is an effective first-line treatment for patients with newly detected, mild asthma, and it is superior to the use of terbutaline in such patients.

Adolescent↗
PubMed1989

The reducing effects of tazifylline on histamine-induced bronchoconstriction in atopic asthmatics.

Percentage reductions in the peak flow rates to a standardized number of histamine inhalations were compared after 7 days of treatment with 10 mg bd tazifylline and after 7 days of placebo in a randomized crossover study in 11 male seasonal atopic asthmatics. After tazifylline, mean % reductions in peak flow rates were significantly lower than after placebo (p = 0.03). The effects of tazifylline had disappeared within 7 days of stopping treatment. Using a 50% decrease in bronchial reactivity as the criteria of "protection", 7 of the subjects were "protected" by tazifylline only and none by placebo only (p = 0.03).

Adolescent↗
PubMed1988

Influence of terbutaline on natural killer cell activity.

Studies on the effect of cAMP-inducing agents on NK activity have been contradictory. The aim of this study was to investigate the acute effects of beta-agonists on NK activity in vivo in 15 asthmatics and 3 healthy volunteers. Blood samples of NK activity were taken at regular intervals after placebo and after subcutaneous injection of 7 micrograms/kg of terbutaline. NK activity was measured by the standard 4-h Chromium51 release assay against the leukemic line K 562 at a 50:1 effector/target cell ratio. Compared with placebo, terbutaline induced within 30-60 min a significant increase in NK activity which lasted less than 2 h. Further studies are necessary to investigate the effect of long-term beta-agonist treatment on NK activity.

Adolescent↗
PubMed1987

Gas chromatographically quantitated lactate in empyema and other pleural effusions.

To determine the value of gas chromatographically measured lactate in distinguishing between empyema and other causes of pleural effusion, consecutively collected samples of pleural fluid were studied. In 15 cases of empyema the mean lactate concentration was 11.60 mM and higher than in 41 patients with other diagnoses (mean 3.98 mM). The concentration of lactate remained unchanged during storage at 4 degrees C for two years. Gas chromatographic quantitation of lactate is useful in the presumptive diagnosis of empyema, and stability of the lactate concentration allows retrospective analyses.

Adult↗
PubMed1985

Fenoterol inhalation powder and aerosol in the treatment of asthma.

Twenty patients with asthma were studied. They were given either fenoterol powder or fenoterol MDI for 2-week periods using a double-blind cross-over design. Identical doses of fenoterol (0.2-0.4 mg 2-4 times daily) were given to an individual patient throughout the 4-week study period. Both forms of treatment produced an almost identical bronchodilation, and there were no statistically significant differences in symptoms or side effects. It is concluded that fenoterol powder and fenoterol aerosol are equally effective.

Adolescent↗
PubMed1984

Round atelectasis.

Round atelectasis is a little-known form of peripheral pulmonary collapse which may mimic a neoplastic tumor. Usually the atelectasis forms a well-demarcated round or oval intrapulmonary pleural-based mass at the basal, posterior or interlobar pleura. It is thought to be a sequela of a pleural effusion. If the radiographic features are characteristic, and fine-needle biopsy finding negative, the diagnosis of round atelectasis can be made with assurance, and unnecessary procedures such as thoracotomy and pulmonary resection can be avoided. In this paper experiences of 11 patients with this condition are presented. In 4 the diagnosis was established by surgery and in 7 a long-term follow-up confirmed the diagnosis of a nonmalignant intrapulmonary lesion. The pathogenesis, clinical and radiological features, and the diagnostic workup are discussed.

Adult↗