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Biomedical subjects

M Tsukino

Publications and source records attributed to M Tsukino.

36 records · Page 2Linked to original sources
PubMed1998

Effects of theophylline and ipratropium bromide on exercise performance in patients with stable chronic obstructive pulmonary disease.

BACKGROUND: The effects of theophylline or anticholinergic agents on exercise capacity in patients with chronic obstructive pulmonary disease (COPD) remain controversial. The aim of the present study was to compare the effect of an oral theophylline with an inhaled anticholinergic agent and to examine the effects of combined therapy on exercise performance using progressive cycle ergometry. METHODS: Twenty one men with stable COPD and a mean (SD) forced expiratory volume in one second (FEV1) of 1.00 (0.40) 1 were studied. Theophylline (600 or 800 mg daily), ipratropium bromide (160 micrograms), a combination of both drugs, and placebo were given in a randomised, double blind, four period crossover design study. Spirometric data, pulse rate, and blood pressure were assessed before and at 90 and 120 minutes after inhalation. Symptom limited progressive cycle ergometer exercise tests (20 watts/min) were performed 90 minutes after each inhalation, and dyspnoea was measured during exercise using the Borg scale. RESULTS: The mean (SD) serum theophylline concentration was 18.3 (6.3) micrograms/ml, and seven patients had side effects during treatment with theophylline. Theophylline and ipratropium bromide produced greater increases in FEV1, maximal oxygen consumption, maximal minute ventilation, and several dyspnoea ratios than placebo. There were no differences between theophylline and ipratropium bromide except in maximal heart rate. A combination of both drugs produced greater improvements in pulmonary function and exercise capacity than either drug alone. CONCLUSIONS: Both high dose theophylline and high dose ipratropium bromide improved exercise capacity in patients with stable COPD. Although data based on short term effects cannot be directly applied to long term therapy, theophylline added to an inhaled anticholinergic agent may have beneficial effects on exercise capacity in patients with COPD.

Aged↗
PubMed1998

Comparison of discriminative properties among disease-specific questionnaires for measuring health-related quality of life in patients with chronic obstructive pulmonary disease.

Three disease-specific, health-related quality of life (HRQL) questionnaires have been introduced to assess patients with chronic obstructive pulmonary disease (COPD): the St. George's Respiratory Questionnaire (SGRQ), the Breathing Problems Questionnaire (BPQ), and the Chronic Respiratory Disease Questionnaire (CRQ). The purpose of the present study was to make comparisons between the SGRQ, the BPQ, and the CRQ in their discriminative properties, and to clarify the characteristics of each questionnaire. One hundred forty-three patients with mild to severe COPD completed pulmonary function tests, progressive cycle ergometer testing for exercise capacity, assessment of dyspnea, anxiety, and depression, and assessment of HRQL. The frequency distributions of the questionnaire scores showed that the SGRQ and the CRQ were normally distributed and that the BPQ was skewed toward low scores. Relationships between all dimensions of the three questionnaires were significant (correlation coefficients [Rs] = 0.74 to 0.86). The three questionnaires had significant but weak correlations (Rs = -0.24 to -0.36) with some physiologic variables (VC, FEV1, and DL(CO)/VA) and mild to moderate correlations with exercise capacity and assessment of dyspnea, anxiety, and depression. Stepwise multiple regression analyses revealed that the Baseline Dyspnea Index (BDI) score, anxiety by the Hospital Anxiety Depression Scale (HAD), and maximal oxygen uptake (VO2max) accounted for 61% of the variance in the SGRQ and that the BDI and anxiety of the HAD accounted for 53 and 49% of the variance in the BPQ and the CRQ, respectively. Dyspnea and psychologic status impacted the HRQL in patients with COPD. Although no substantial differences between the SGRQ, the BPQ, and the CRQ were evident in the correlations with physiologic parameters and the influential factors, the BPQ was found to be less discriminatory than the SGRQ and the CRQ in evaluating HRQL cross-sectionally.

Aged↗
PubMed1998

Analysis of clinical methods used to evaluate dyspnea in patients with chronic obstructive pulmonary disease.

When dyspnea must be assessed clinically, there are three methods of assessment: the measurement of dyspnea with activities of daily living using clinical dyspnea ratings such as the modified Medical Research Council (MRC), the Baseline Dyspnea Index (BDI), and the Oxygen Cost Diagram (OCD); the measurement of dyspnea during exercise using the Borg scale; to assess the influence of dyspnea on health-related quality of life (HRQoL) using disease-specific questionnaires such as the St. George's Respiratory Questionnaire (SGRQ) and the Chronic Respiratory Disease Questionnaire (CRQ). The purpose of the present cross-sectional study was to clarify relationships between dyspnea ratings and HRQoL questionnaires by applying factor analysis. One hundred sixty-one patients with mild to severe COPD completed pulmonary function tests, progressive cycle ergometer testing for exercise capacity, assessment of dyspnea, HRQoL, anxiety, and depression. Factor analysis demonstrated that the MRC, BDI, OCD, and Activity of the SGRQ, and Dyspnea of the CRQ, were grouped into the same factor, and the frequency distribution histograms of these five measures showed virtually the same distribution. The Borg scale at the end of maximum exercise was found to be a different factor. The MRC, BDI, OCD, and Activity in the SGRQ, and Dyspnea in the CRQ demonstrated the same pattern of correlation with physiologic data, and they had significant relationships with FEV1 (correlation coefficients [Rs] = 0.31 to 0. 48) and maximal oxygen uptake (Rs = 0.46 to 0.60). Disease-specific HRQoL questionnaires, the SGRQ and the CRQ, which contain a specific dimension for evaluating dyspnea, may be substituted for clinical dyspnea ratings in a cross-sectional assessment. Dyspnea rating at the end of exercise may provide further information regarding dyspnea.

Activities of Daily Living↗
PubMed1998

[Effect of treatment on health-related quality of life in patients with asthma].

The aim of the study was to assess the effect of treatment on health-related quality of life (HRQoL) in patients with asthma. We used the Japanese version of the Living With Asthma Questionnaire (LWAQ) as an asthma-specific HRQoL measure. Thirty-four new patients were enrolled and treated according to Guidelines on the Management of Asthma by the British Thoracic Society. The LWAQ and spirometry were evaluated on the initial visit, and three and six months after treatment. The LWAQ score, forced expiratory volume in one second (FEV1), and forced vital capacity (FVC) were significantly improved three months after treatment. The Japanese version of the LWAQ was reliable. For the first three months, there were no correlations between changes in FEV1 or FVC and LWAQ scores (Rs = 0.11-0.25). Pulmonary functions could not predict HRQoL well. Therefore, HRQoL should be measured directly to assess HRQoL in asthmatics.

Administration, Inhalation↗
PubMed1996

Dose response study of ipratropium bromide aerosol on maximum exercise performance in stable patients with chronic obstructive pulmonary disease.

BACKGROUND: Although the bronchodilating effect of inhaled anticholinergics has been established in patients with chronic obstructive pulmonary disease (COPD), their effects on exercise capacity are still controversial. Previous studies have suggested that the standard dosage hardly affects exercise tolerance, whereas higher doses might elicit an improvement. The aim of the present study was to determine the dose of ipratropium bromide aerosol that improves exercise performance using progressive cycle ergometry in patients with stable COPD. METHODS: Twenty men with stable COPD of mean (SD) age 69.2 (4.6) years and forced expiratory volume in one second (FEV1) 1.00 (0.37) 1 were studied in a randomised double blind manner. Each patient received ipratropium bromide in doses of 240 micrograms, 160 micrograms, 80 micrograms, 40 micrograms, and placebo from a metered dose inhaler (MDI) with an InspirEase spacer on five separate days. Spirometric parameters were assessed before and at 30, 60, 90, and 120 minutes after each inhalation, and pulse rate and blood pressure were also measured immediately before each spirometric measurement. Symptom limited progressive (20 watts/min) cycle ergometer exercise tests were performed 90 minutes after each inhalation. RESULTS: Ipratropium bromide in doses of 160 micrograms and 240 micrograms produced a greater increase in FEV1 than 40 micrograms or 80 micrograms ipratropium bromide at all time points. Doses of 160 micrograms and 240 micrograms ipratropium bromide also produced greater increases in maximal work load and maximal oxygen consumption than placebo, whereas 40 micrograms and 80 micrograms ipratropium bromide did not. There was a weak correlation between the change in FEV1 and the change in maximal work load (r = 0.45). No differences were found in pulse rate or blood pressure between the treatment and placebo groups, and no side effects were noted throughout the study. CONCLUSIONS: A dose of at least four times the standard dose of ipratropium bromide from an MDI with a spacer device was necessary to improve maximal cycle exercise capacity in patients with stable COPD. Although the data from cycle ergometry cannot be directly applied to exercise performed during day to day activities, it is conceivable that the recommended doses of ipratropium bromide do not elicit the optimal clinical benefits.

Aerosols↗
PubMed1996

Physiologic factors that determine the health-related quality of life in patients with COPD.

STUDY OBJECTIVE: To determine the physiologic factors that influence the health-related quality of life (HRQL) in patients with stable COPD and to identify the factors that most influence HRQL. METHODS: The Nottingham Health Profile (NHP) was used as a general HRQL measure and the Chronic Respiratory Disease Questionnaire (CRQ) was used as a disease-specific HRQL measure to investigate 132 patients with stable COPD, and measurements of HRQL were compared with physiologic measures. RESULTS: Vital capacity, FEV1, the ratio of the FEV1 to the FVC, diffusion capacity for carbon monoxide, diffusion capacity corrected for alveolar volume, lifetime cigarette consumption expressed as pack-years, and age were weakly correlated with several dimensions of both the NHP and the CRQ. Factor analysis reduced these variables to three factors. Two factors mainly referring to airflow limitation and diffusing capacity were weakly correlated with several dimensions of both the NHP and the CRQ. Logistic regression analysis identified 4 independent predictors of HRQL: airflow limitation (odds ratio [OR] = 0.59 to 0.69), diffusing capacity (OR = 0.75 to 0.82), pack-years (OR = 1.20 to 1.23), and age (OR = 2.13). The CRQ was more sensitive to impairment of HRQL than the NHP. CONCLUSIONS: The HRQL of patients with stable COPD is partly determined by airflow limitation, diffusing capacity, pack-years, and age. However, these factors could not predict the whole spectrum of HRQL, and the contribution of these factors to HRQL was limited. Therefore, HRQL should be measured directly in addition to physiologic measures.

Aged↗
PubMed1996

[Symptoms, FEV1/FVC, and peak flow as indices of the control of asthma].

In a cross-sectional study, we evaluated success in the control of asthma as defined by criteria for symptoms, for FEV1/FVC, and for peak flow rates. One hundred and three patients with chronic asthma who had been treated with inhaled steroids were studied. Chest tightness, dyspnea, wheezing, sputum production, and coughing were each scored from 1 (worst) to 5 (best). Symptoms were said to have been controlled if the symptoms scores for the preceding 4 weeks were greater than or equal to 20; FEV1/FVC was said to be under control if it was greater than or equal to 70% when measured in the clinic; peak flow was said to have been controlled if the lowest peak flow in the preceding 4 weeks was greater than or equal to 80% of the highest measured value. Symptoms were controlled in 72% of the patients, FEV/FVC was under control in 83%, and peak flow was controlled in 66%. The patients were grouped by severity of disease into four classes, and these percentages did not differ significantly among the classes. In 22 out of 74 (30%) patients in whom symptoms were controlled, peak flow was not controlled. Furthermore, in 18 out of 64 (28%) patients in whom symptoms and FEV/FVC were controlled, peak flow was not controlled. We concluded that in treating asthma, not should symptoms be controlled, but peak flow should also be measured each day to avoid undertreatment.

Adult↗
PubMed1996

[Effects of reducing or stopping inhaled beclomethasone dipropionate on airway hyperresponsiveness in stable chronic asthma].

Effects of reducing or stopping inhaled beclomethasone dipropionate (BDP) on airway hyperresponsiveness (AHR) were evaluated in stable chronic asthma. In 16 patients, after the best control (no symptoms, peak expiratory flow rate [PEF] > 80% best) was achieved for at least 3 months, the dose of BDP was reduced to 2/3 to 1/2. No differences were observed in the mean FEV1, PEF and AHR between before and 3 months after the reduction of BDP. In 7 patients, after the almost normal level of AHR was achieved, the dose of BDP was gradually reduced and then discontinued. Three out of the 7 patients had maintained the adequate level of AHR over 14 months, but in the other 4 patients AHR deteriorated below normal level and re-administration of BDP was needed due to worsening of symptoms and PEF. In conclusion, a gradual reduction of the dose of BDP is possible, if the best control is achieved for at least 3 months. The possibility of discontinuation of BDP may exist in some patients after achieving adequate AHR.

Administration, Inhalation↗
PubMed1996

[Pharmacologic therapy for patients with stable chronic obstructive pulmonary disease--emphasis on inhaled agents].

One dose of an anticholinergic agents has about the same bronchodilatory effect as one of a beta 2-agonist. Anticholinergic agents may be used first in patients with stable chronic obstructive pulmonary disease, because of the possible adverse effects of beta 2-agonists. One puff of a metered-dose inhaler will not cause a maximal bronchodilatory effect. Both anticholinergic and beta-adrenergic drugs cause dose-dependent bronchodilation when given as aerosols from metered-dose inhalers, and a combination of the two can provide better results. If the response to a single agent is unsatisfactory, use of higher doses is advised and the use of a combination of anticholinergic agents and beta-agonists is recommended. With regard to inhaled corticosteroids, a high dose of inhaled beclomethasone dipropionate (1,500 micrograms per day) can be a effective as oral corticosteroids. Step-by-step pharmacologic therapy with the drugs mentioned above should be used in outpatient management of patients with chronic obstructive pulmonary disease.

Administration, Inhalation↗
PubMed1995

[Effect of one year of treatment with inhaled beclomethasone dipropionate on airway hyperresponsiveness in stable chronic asthma].

To study the effects of an inhaled steroid on airway hyperresponsiveness (AHR) in chronic stable asthma, AHR was measured every month for 1 year in seven patients after their asthma had stabilized, i.e., when they had no wheezing or dyspnea, and their peak expiratory flow rates (PEFR) were at least 80 percent of the highest value. During the study period, no patient wheezed or had dyspnea, and daily variation in PEFR was less than 20 percent. In six patients, FEV1 was stable, and PEFR was always at least 80 percent of the highest value. AHR became less severe, by a factor of at least 2, in five of these six patients, but one patient's condition did not improve. The one patient whose PEFR fell below 80 percent of the highest value had more than a 4-fold increase in the severity of AHR. In conclusion, the severity of AHR can be reduced, even in patients with chronic stable asthma, if daily PEFR can be maintained in an optimal range by long-term use of inhaled corticosteroids.

Administration, Inhalation↗
PubMed1995

[Efficacy of high-dose beclomethasone in patients with stable chronic obstructive pulmonary disease].

To study the role of inhaled steroids in treating patients with chronic obstructive pulmonary disease (COPD), 1.6 mg of beclomethasone dipropionate (BDP) were given for 2 weeks after 0.5 mg/kg of oral prednisolone (PSL) for 2 weeks to 43 patients with COPD (mean age 68.7 +/- 5.2 years, mean baseline FEV1, 1.13 +/- 0.44 L). When responders to a corticosteroid (PSL or BDP) were defined as those with a post-steroid EFV1/baseline FEV1 > or = 115% and a post-steroid FEV1-baseline FEV1 > or = 0.2 L, 12 out of 43 patients responded to 30 mg of PSL for 2 weeks and 13 responded to 1.6 mg of BDP for 2 weeks. We considered those 17 patients who responded to 2 weeks of PSL or 2 weeks of BDP or both, to be possible steroid responders, and they continued inhaling BDP for 4 more weeks. In 8 of these 17 patients (19%), FEV1 had increased by the end of the 6 weeks. Inhaled BDP was considered useful in treating some patients with COPD.

Administration, Inhalation↗
PubMed1995

[High-dose inhaled beclomethasone dipropionate and maximal improvements in patients with stable chronic obstructive pulmonary disease].

High doses of inhaled beclomethasone dipropionate (BDP) are effective in some patients with chronic obstructive pulmonary disease (COPD). However, dose-response data for this agent are limited. To determine whether patients receive maximum benefit from 1600 micrograms of BDP, we performed a randomized, double-blind, placebo-controlled, cross-over trial. Twenty-one patients with stable COPD [mean +/- SD: age, 69.1 +/- 6.8 yrs; FEV1, 0.86 +/- 0.28 L] were treated with both inhaled bronchodilators and 1600 micrograms of BDP daily for at least 3 months. Each patient received 30 mg of oral prednisolone or a placebo for 3 weeks. In addition to end-point spirometric assessments daily peak expiratory flow rate, symptom scores, and scores on a chronic respiratory disease questionnaire were recorded for the last week of each 3-week period. Oral prednisolone did not improve FEV1, FVC, symptoms or scores on the questionnaire. We conclude that 1600 micrograms of BDP in addition to inhaled bronchodilators produces maximal improvements in stable patients with COPD.

Administration, Inhalation↗
PubMed1992

[Clinical study on benefit and safety of frequent inhalation of aerosolized procaterol hydrochloride in aged acute asthmatics].

We studied the hemodynamic effects of frequent inhalation of aerosolized procaterol hydrochloride (PRC) in the treatment of status asthmaticus. Twenty patients were enrolled and divided into 2 groups; younger group (less than 55 years; n = 11) and older group (more than 55 years; n = 9). All patients were treated with intravenous hydrocortisone (4 mg/kg/4 h) and PRC inhalation (30 micrograms; 0.3 ml) every hour via a jet nebulizer with 3 l/min oxygen for four consecutive days. Holter ECG monitoring was performed on the 1st, 4th, and 7th days of hospitalization to evaluate mean heart rate, tachycardiac incidence, and arrhythmias. Blood pressure, serum potassium levels, and peak expiratory flow rate (PEFR) were measured on the same day. Even though the total dosage of inhaled PRC on the 1st day was 496.4 +/- 62.61 micrograms for the younger group and 490.0 +/- 36.73 micrograms for the older group (p = NS), total arrhythmic ratios were less than 1% in both group. Both blood pressure and heart rate decreased with improvement of symptoms and PEFR value. Serum potassium levels tended to decline according to the administered dosage of PRC (p < 0.01); however, severe hypokalemia less than 3.0 mmol/l was not observed. We conclude that frequent inhalation of PRC (up to 500 micrograms/day) via a jet nebulizer provides rapid relief from acute asthmatic attacks, and is safe clinically even in aged asthmatics receiving intravenous steroids.

Administration, Inhalation↗
PubMed1991

[The clinical benefit of high dose inhalation therapy with beclomethasone dipropionate for patients with chronic bronchial asthma].

Conventional doses of aerosolized beclomethasone dipropionate (BDP) of up to 400 micrograms/day by inhalation has often failed to normalize the pulmonary function of chronic adult patients. Therefore it may be necessary to administer the individual maximum dose of BDP to reduce bronchial inflammation. In 13 patients (2 males and 11 females, mean age 49.2 +/- 3.7 years old) with chronic asthma whose minimum %PEFRs were lower than 80% under treatment with conventional doses of BDP, the clinical benefit of high dose inhalation therapy with BDP was studied for four consecutive weeks by comparing % peak expiratory flow rate (%PEFR) measured four times a day both before and 10 minutes after inhaled procaterol (PCR) in a cross-over fashion. Mean morning %PEFRs before inhaled PCR during the first two weeks with a lower dose of BDP (419 +/- 24 micrograms/day) and during the following two weeks with a higher dose of BDP (904 +/- 55 micrograms/day) were 60.6 +/- 3.1% and 77.5 +/- 4.1%, respectively (p less than 0.01). Average increases in %PEFR during the higher dose period before and after inhaled PCR were 12.1% and 12.4%, respectively, which was observed by the end of the first week after the start of higher dose of BDP in 12 out of 13 patients. Since there were no adverse reactions such as hoarseness, oral thrush and candidiasis during the period with higher doses of BDP, it was concluded that we should promptly employ higher doses of BDP in patients who did not respond satisfactorily to conventional doses of BDP.

Administration, Inhalation↗
PubMed1990

[A clinical trial to determine whether intravenous aminophylline is indispensable in the treatment of status asthmaticus].

In Japan, intravenous aminophylline (AMP) is considered as the first treatment of choice for status asthmaticus, whereas inhaled beta 2-agonist is considered to be of no value for acute severe asthma. To determine the optimal therapy for acute asthma, the authors clinically investigated bronchodilating effects and the clinical role of aerosolized beta 2-agonist inhalation and intravenous AMP in 55 patients with status asthmaticus. Patients were classified into two groups treated without intubation and with artificial ventilation. Intravenous steroid (equivalent to 4 mg/kg of hydrocortisone) was administered in all cases. Further, all patients were randomly divided into two subgroups according to treatment regimen, i.e. repeated inhalation of aerosolized beta 2-agonists only, and combined with intravenous AMP. In all groups, the duration of treatment was significantly shorter in the subgroups treated with repeated aerosolized beta 2-agonist inhalation than those treated with intravenous AMP. The failure of intravenous AMP to effect more rapid or profound improvement both in objective and subjective parameters suggested that inhaled beta 2-agonist with intravenous steroid should be a rational choice in the initial treatment of acute asthma. Moreover, inhaled beta 2-agonist used optimally produces good bronchodilation several times greater than that produced by intravenous AMP. We concluded that repeated inhalation of aerosolized beta 2-agonists is the drug of choice combined with intravenous steroid regardless of the severity of attacks for short-term therapy of acute severe asthma, and that intravenous AMP may have only minor bronchodilating effects.

Administration, Inhalation↗
PubMed1990

[Reproducibility of peak expiratory flow rate measured at home].

In 8 stable patients with chronic asthma, the reproducibility of peak expiratory flow rate (PEFR) measured and recorded 4 times per day for longer than 1 month at home and at work was assessed. Average %PEFRs of individuals through the periods observed were higher than 80%, and coefficients of variation were less than 10% regardless of the time measured. This suggested that a decrease in %PEFR more than 10% reflects early phase of deterioration of airways narrowing and frequent measurement of PEFR is essential for long-term management and for self-assessment of chronic asthma.

Adolescent↗