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Biomedical subjects

M H Williams

Publications and source records attributed to M H Williams.

At least 109 records · Page 6Linked to original sources
PubMed1982

Fear of flight: behavior therapy versus a systems approach.

Systematic desensitization is re-examined as a treatment for flight fear from the perspective of family-systems theory. The problem of the person who avoids flight is considered first from the viewpoint of behavior therapy, and behavioral treatment is briefly described. This problem is next described in terms of the patients's to society, family, and the therapist. From this perspective, the flight-avoidant person is seen to be an "identified patient"-someone defined as ill by the system in which he or she is enmeshed. The problem is then redefined, not as flight fear, but as the pressure to fly, and implications for treatment are discussed.

Attitude of Health Personnel↗
PubMed1981

Comparison of oral aminophylline and aerosol metaproterenol in asthma.

The bronchodilator efficacy of oral aminophylline and aerosol metaproterenol was compared in 18 asthmatic patients in a stable clinical condition. Treatment consisted of four regimens in a double-blind random sequence on four different days after withholding bronchodilators: (1) the administration of aminophylline tablets, 0.4 to 0.6 g, orally, (2) 3 puffs of aerosol metaproterenol administered in a sequential manner, (3) a combination of both, (4) placebos. Both oral aminophylline and aerosol metaproterenol produced significant bronchodilatation measured by forced expiratory volume in 1 second (FEV1). After the administration of aerosol metaproterenol, there was a more prompt and larger improvement in FEV1 than after the administration of aminophylline (p less than 0.01). The combined therapy produced a response which was larger, but not significantly, than the effect of metaproterenol. Side effects were frequent after the administration of aminophylline but absent after aerosol metaproterenol. The advantages of the aerosol adrenergic agonists are the prompt onset of action and efficacy, small dosage preferentially delivered to the bronchial tree and lack of side effects.

Administration, Oral↗
PubMed1981

Beclomethasone dipropionate.

Experience with beclomethasone dipropionate during the past 5 years has confirmed and extended the original observation that it is an effective, topically active corticosteroid of great value in treating asthma. Most steroid-dependent asthmatic patients can be successfully controlled with the drug, at least most of the time, and the therapeutic effect is dose dependent. Although high doses may be associated with some adrenal suppression such doses do not cause systemic symptoms, and side effects are of little consequence. It is important that patients treated with steroid aerosols continue to receive other effective therapeutic agents, notably adrenergic drugs, particularly by aerosol, and theophylline compounds; that they learn how to inhale the aerosol properly; and, most important, that they promptly start taking oral steroids when they experience an exacerbation of asthma.

Aerosols↗
PubMed1981

The effect of induced erythrocythemia upon 5-mile treadmill run time.

The purpose of this experiment was to investigate the effect the infusion of 920 ml equivalent of autologous blood would have upon 5-mile time (5MT) and both local (RPE-L) and cardiovascular-respiratory (RPE-B) ratings of perceived exertion. Twelve long-distance runners undertook a series of four competitive 5MT trials on a treadmill. Four test conditions were utilized: pre-saline trial; post-saline trial after 920 ml saline solution; pre-blood trial; and post-blood trial after 920 ml equivalent of whole blood. All subjects took all trials in this double-blind placebo crossover experimental design. Running time and RPE were recorded at each 0.5 mile split. Blood samples were taken before and after each trial. The data were analyzed via a repeated-measures ANOVA. In general, the following results were noted following the blood infusion when compared with the other three trials: a significantly higher hemoglobin (Hb) concentration; a significantly lower RPE-L and RPE-B during the first two miles of the run; and a significantly faster 5MT. Within the limitations of this experiment, it was concluded that the infusion of 920 ml equivalent autologous blood would increase performance capacity in an athletic event characterized by high levels of aerobic energy expenditure.

Adult↗
PubMed1980

Evaluation of the severity of asthma: patients versus physicians.

It is clear that accurate assessment of the severity of asthma requires a measurement of airway obstruction, such as peak expiratory flow rate. In this study, physicians were quite inaccurate in estimating the peak expiratory flow rate by examining patients, whereas the patients themselves were far more accurate in guessing the measurement. In addition, they were able to tell whether the peak expiratory flow rate was better, the same or worse from day to day. Patients' symptoms are important indices of the severity of airway obstruction which should be exploited in management.

Airway Obstruction↗
PubMed1980

The effect of sequential inhalations of metaproterenol aerosol in asthma.

In 19 asthmatic patients, three inhalations of metaproterenol (0.65 mg per puff) followed by placebo at 10 and 20 min were compared with one inhalation of the drug every 10 min for the same total of three doses. Metaproterenol 0.65 mg produced just as much increase of 1-sec forced expiratory volume (FEV1) as did the much larger dose (1.95 mg), but each subsequent inhalation of the drug produced further, significant increase of FEV1 suggesting better penetration of the bronchidilator aerosol after some bronchodilation had been achieved. After completion of treatment, the FEV1 was significantly higher when the drug was given sequentially rather than all at once. These data have important implications with respect to the utilization of bronchodilator aerosols in the treatment of asthma and indicate the unsuitability of sequential inhalation for study of dose response of these agents.

Administration, Intranasal↗
PubMed1980

The adequacy of inhalation of aerosol from canister nebulizers.

Thirty patients hospitalized with asthma who had been taking aerosol bronchodilators from canister nebulizers were evaluated for their aerosol inhalation technique. Fourteen patients (47 percent) used an incorrect technique. The most frequent mistake was to inhale first, then to actuate the canister and breathhold. These patients were taught the correct technique. Some learned it easily but others had difficulty. With a teaching aid, incorporating a horn which is actuated by inspiration, all 14 patients learned to inhale the aerosol correctly. When retested five of the 10 patients had reverted to the old incorrect technique and required another lesson. Physicians who prescribe aerosol medication from a canister nebulizer should evaluate each patient for the aerosol inhalation technique. Those who inhale incorrectly should be taught repeatedly until they learn the correct technique and retain it. The teaching aid, utilizing an audio signal, is helpful in this training.

Aerosols↗
PubMed1980

Bronchial response to oral versus aerosol metaproterenol in asthma.

We tested the relative efficacy of bronchodilators delivered in aerosol and in oral form in 17 patients with asthma in a double-blind randomized sequence. Treatment consisted of a 20-mg tablet of metaproterenol sulfate, five puffs of metaproterenol aerosol (0.65 mg in each puff for a total of 3.25 mg) administered 20 minutes apart between puffs, a combination of both, and placebos. Bronchodilator response measured by forced expiratory volume in 1 second (FEV1) was significantly greater on the aerosol and the combined regimen than on the oral and placebo regimen. The combined regimen produced a greater bronchodilator response than the aerosol alone, but the difference was not significant. Side effects were frequent after oral medication but absent after the aerosol. Sequential inhalation of aerosol is the preferred route of administration of adrenergic bronchodilator drugs in asthma.

Administration, Oral↗
PubMed1980

Life-threatening asthma.

I review my experience with life-threatening asthma, defined as hypercapnia, need for intubation, or death, at a large municipal hospital during a ten-year period. Such severe illness is rare among asthmatics and predicting its occurrence is difficult. Eighty patients had 111 admissions for life-threatening asthma; 773 patients were hospitalized for asthma 851 times during the study period. Only 15% of these 773 patients had experienced severe asthma previously and the duration of asthma and frequency of hospitalization was similar to that of the other patients admitted for asthma. Follow-up study of the survivors of life-threatening asthma has revealed a very high rate of recurrence. More than 35% had a recurrence in one to ten years, and those who had three to four episodes had a recurrence rate of 45% and 60%, respectively. Although life-threatening asthma is rare, unpredictable, and occurs only after many years of symptomatic illness, once it does occur there is a real risk of recurrence. Patients who have experienced such a severe episode of asthma require continuing careful supervision and management.

Asthma↗
PubMed1978

Pulsus paradoxus in asthma.

Ninety-three patients with asthma were examined on 308 occasions for systolic fluctuation of blood-pressure during quiet breathing. Pulsus paradoxus (fluctuation of 10 mm Hg or greater) was present on 110 occasions. A pulses paradoxus was associated with greater airflow obstruction (average peak expiratory flow-rate 33.6% of the predicted) than an absent pulsus paradoxus which was associated with a peak expiratory flow-rate of 55.4%. However, pulsus paradoxus was often present in mild obstruction and absent in severe obstruction. In six patients the effect of changing respiratory pattern on systolic fluctuation was studied. Systolic fluctuation was directly related to the inspiratory flow-rate. This is probably one of the major reasons why association of airflow obstruction with pulsus paradoxus is not constant.

Airway Obstruction↗
PubMed1978

Response to corticosteroids in chronic bronchitis.

Corticosteroid drugs are often employed in the treatment of patients with chronic bronchitis. Although some patients respond favorably to such therapy, the characteristics of such patients are not known. Twenty-four patients with chronic bronchitis were treated with prednisone 30 mg daily or placebo for one week each in a double-blind crossover study. The following were monitored before and after each treatment period: physical examination, symptoms, peripheral blood eosinophil count, sputum cell exmination, forced vital capacity (FVC), before and after isoproterenol aerosol. Seven of 24 patients had an FEV1 increase greater than 30% of the control value on prednisone but not on placebo. Blood eosinophil count was elevated (greater than or equal to 350/mm(3)) in 7 patients; 2 of these 7 improved on steroid. Sputum cell examination revealed preponderance of eosinophils in 1, and occasional clumps of eosinophils in 8. Seven of these 9 responded to steroid. Sputum but not blood eosinophilia is a good predictor of a favorable response to steroid therapy.

Aged↗