Biomedical subjects

L Bielory

Publications and source records attributed to L Bielory.

At least 37 records · Page 2Linked to original sources

PubMed1999

Comparison of emergency room asthma care to National Guidelines.

BACKGROUND: National Asthma Education and Prevention Program (NAEPP) guidelines were first released in 1991. To date there have been no studies published comparing them with actual care given. OBJECTIVE: The aim of this study was to compare the documented care given in the emergency room (ER) of an urban tertiary care hospital with 1991 NAEPP guidelines. METHODS: A total of 1858 urban emergency room records with a diagnosis of asthma or reactive airway disease were recovered in 1 year (9/95 to 8/96) from pediatric and adult patients seen in the ER. Ten percent (n = 181) of the charts were reviewed for documentation of history, assessment of severity of attack, treatment given, and disposition. RESULTS: History of present attack was documented consistently in all age groups. Nocturnal symptoms were noted in 11%, and frequency of beta agonist use in 38% of the charts. Previous ER visits, hospitalization, ICU admissions, and intubations (HCUM) were documented in 70%. Accessory muscle use was recorded in 76% of the infants and 21% of the adults. Peak flows were obtained in 31% of children and 64% of adults. Steroids were given in the ER in 59% of infants, 83% of children, and 49% of adults. Pediatric patients were referred to their primary care provider 90%, and to pulmonary or allergy clinic 4% of the time. Adults were referred to allergists or pulmonologists 32% of the time. CONCLUSION: There are significant differences in ER evaluation and treatment when compared with the 1991 NAEPP guidelines. Differences also exist between various age groups within the same institution.

Administration, Inhalation↗

PubMed1999

Herbal interventions in asthma and allergy.

This paper reviews the role of herbal-based medicines in the treatment of asthma and allergic rhinitis. A comprehensive literature search was performed of relevant English-language papers and abstracts were identified through a MEDLINE search and from bibliographies of the identified papers. Papers and studies pertaining to the use of medicinal plants in the treatment of asthma and allergic rhinitis were identified. They were then analyzed according to design, inclusion and exclusion criteria, population studied, variables tested, method of treatment (i.e., specific medicinal plants or herbal combinations), and results. The data have been reviewed and divided on the basis of culture and the effects of medicinal plants in asthma and allergy. A number of studies were found that support the use of some herbal medicines in asthma and allergy. Various derivatives from specific medicinal plants were identified as the antiasthma components and some mechanisms of action were explored. The results show positive effects of these herbs on bronchodilation, pulmonary function tests, and antagonism of asthma mediators such as histamine and platelet activating factor, corticosteroid levels, and clearance of mucus. Improved symptoms were also seen in patients with allergic rhinitis specifically on histamine-induced reactions, e.g., rhinorrhea, sneezing, and itching. From the review, there has been a role for some herbal medicines in the treatment of asthma and allergic rhinitis. Usage of herbal medicines has increased in recent years. Many of these medicinal plants provided relief of symptoms equal to allopathic medicines used. Specific chemical derivatives have been isolated from many of these plant products which act on the mechanisms and mediators that cause asthma and allergies. The amount of research on these products, especially in the United States, is limited. There is a lack of control of quantity and quality of the components in these remedies. Yet, many have fewer side effects than current therapy. Throughout the history of medicine, drugs have been developed from traditional medicine. By continuing to investigate how some of these herbal interventions work, we may be able to find additional effective medicines to treat asthma and allergies.

Animals↗

PubMed1998

Zafirlukast improves asthma symptoms and quality of life in patients with moderate reversible airflow obstruction.

BACKGROUND: Previous trials demonstrated the effectiveness of the leukotriene receptor antagonist zafirlukast in patients with mild-to-moderate asthma. OBJECTIVES: We sought to assess the efficacy and safety of zafirlukast and its effect on patients' quality of life (QOL) during a 13-week, double-blind, placebo-controlled, multicenter trial in adults and adolescents with moderate reversible airflow obstruction. METHODS: Patients (age range, 12 to 68 years) with total daytime asthma symptoms scores of 10 or greater over 7 consecutive days (maximum, 21/wk), FEV1 45% or greater but less than or equal to 80% of predicted value (>/=6 hours after beta2 -agonist), and reversible airway disease were randomized to 20 mg zafirlukast twice daily (nZ = 231) or placebo twice daily (nP = 223). Efficacy was assessed from changes in daytime and nocturnal symptoms, beta2 -agonist use, nasal congestion score, and pulmonary function. QOL was evaluated with a disease-specific Asthma Quality of Life Questionnaire. Safety was determined from adverse event information and clinical laboratory test results. RESULTS: Zafirlukast was significantly (P <.001) more effective than placebo, with reductions from baseline in the daytime asthma symptoms score (-23%), nighttime awakenings with asthma (-19%), and beta2 -agonist use (-24%) and improvements from baseline in morning (+25 L/min) and evening (+18 L/min) peak expiratory flow rates. Compared with placebo, zafirlukast significantly (P </=.018) improved scores for QOL domains (activity limitations, symptoms, emotional function, and exposure to environmental stimuli) and overall QOL, with a significantly greater proportion of zafirlukast-treated patients demonstrating clinically meaningful improvements (>/=0.5-unit change from baseline; P </=.037). The safety profile of zafirlukast was clinically indistinguishable from that of placebo. CONCLUSIONS: Zafirlukast is effective and well tolerated and improves QOL in the long-term treatment of patients with moderate reversible airflow obstruction.

Adolescent↗

PubMed1998