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Biomedical subjects

N Eiser

Publications and source records attributed to N Eiser.

10 recordsLinked to original sources
PubMed2001

The role of domiciliary nebulizers in managing patients with severe COPD.

The difficulty of assessing nebulizer responses in chronic obstructive pulmonary disease (COPD) has been demonstrated before. This study aims to re-examine both the role of domiciliary nebulizers in COPD and also bronchodilator (BD) assessment in individuals. In a double-blind, randomized, cross-over trial, 19 stable patients with severe COPD were given the following medication 6-hourly for 2-week periods: (1) nebulized salbutamol 2.5 mg with ipratropium 0.5 mg and placebo inhalers (MDI) with spacer; (2) placebo nebules and inhaled salbutamol 400 microg with ipratropium 80 microg via MDI with spacer; (3) inhaled salbutamol 400 microg with ipratropium 80 microg via MDI with spacer (but no placebo nebulized drugs). Both nebulized and MDI drugs produced highly significant improvements in forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC), specific airways conductance, 6-min walking distance (6MWD) and residual volume. There were no significant differences between BD responses obtained after active nebulized and active MDI BDs. From the diary cards, 2 weeks of active nebulized BDs produced a slightly higher median peak expiratory flow (PEF) than active MDI BDs (236 and 219 l m(-1), respectively, P=0.01) and slightly less extra inhaler use (0.8 and 1.1 puffs, respectively, P<0.05) but no significant difference in dyspnoea or quality of life (QOL) scores. There were significant correlations between domiciliary PEF and acute BD-induced changes in FVC and 6MWD, and also between domiciliary dyspnoea scores and acute changes in both total lung capacity and 6MWD. In conclusion, nebulized medication conferred little clinical advantage over the regular use of inhalers with spacers in this group of patients with severe COPD. However, acute changes in total lung capacity, FVC and 6MWD may be useful predictors of the longer-term effects of nebulized BDs in individual patients.

Administration, Inhalation↗
PubMed1997

Effects of psychotherapy in moderately severe COPD: a pilot study.

Anxiety is common in the "pink puffer" syndrome associated with chronic obstructive pulmonary disease (COPD). The degree of anxiety correlates well with perceived dyspnoea. This pilot study examines the effect of group psychotherapy on anxiety, exercise tolerance, dyspnoea and quality of life. Ten patients with moderately severe, stable COPD (mean forced expiratory volume in one second (FEV1)-1.15 L) had six 90 min sessions of cognitive and behavioural psychotherapy at weekly intervals. Patients completed the Hospital Anxiety and Depression Scale (HADS), Medical Research Council Questionnaire (MRCQ) and St George's Respiratory Questionnaires (SGRQ), 1 week before and after therapy. FEV1, forced vital capacity (FVC), slow vital capacity (SVC), blood gas tensions and 6 min walking distance (6MWD) were measured. Eight control patients attended weekly for lung function and 6MWD for 6 weeks, but had no psychotherapy. Mean baseline HADS score was significantly higher in the psychotherapy group (12) than in controls (7), but otherwise there were no differences in lung function, blood gas tensions, 6MWD, or the other questionnaire scores between groups. After treatment, the physiological and psychological parameters where unchanged in both groups with the exception of the mean 6MWD, which had improved in the psychotherapy group only, from 351 to 423 m (p<0.001), an increase of 24%. Three months after treatment, the 6MWD was still 16% above the baseline value (p=0.02). In conclusion, six sessions of cognitive and behavioural psychotherapy produced a sustained improvement in exercise tolerance in a group of 10 anxious patients with severe chronic obstructive pulmonary disease, without any change in anxiety scores on the Hospital Anxiety and Depression Scale. Further studies of more prolonged, intensive psychotherapy would establish whether better symptom and quality of life scores accompany more dramatic increases in exercise tolerance in "pink puffers".

Aged↗
PubMed1994

Histamine receptors in the human nose.

The aim of this study was to determine the role of histamine receptors in the nose. The effects of intranasal histamine challenge were compared with those of a specific H1-receptor agonist, betahistine and a specific H2-receptor agonist, impromidine, in 11 normal individuals and four with rhinitis. Sneezing, nasal irritation and hypersecretion were induced by histamine and the H1-receptor agonist, betahistine only. Nasal airway resistance (Rna) was measured by passive anterior rhinomanometry. Histamine, betahistine and impromidine all induced rises in Rna in both normal individuals and those with rhinitis but histamine had the most potent effect; the H2-receptor effect on Rna was predominant over that of the H1-receptor. The sensitivity to all three agonists was greater in the individuals with rhinitis.

Adult↗
PubMed1991

The effect of a beta 2-adrenergic agonist and a histamine H1-receptor antagonist on the late asthmatic response to inhaled antigen.

In this double-blind, randomized, cross-over trial, the role of histamine and the possible protective effect of a beta 2-adrenergic agonist in the later asthmatic response to inhaled antigen was investigated in nine atopic asthmatic patients. On four study days, 2-4 weeks apart, patients were given either: placebo; salbutamol aerosol 400 micrograms before and 200 micrograms 2-hourly after challenge; oral terfenadine 120 mg 2 h before and 10 h after challenge; and, on the final day, lung function was monitored without medication or antigen challenge. A nebuliser-dosimeter system was used to deliver a predetermined, single dose of antigen aerosol. Response was assessed by specific airways conductance (SGAW) measured in a body plethysmograph; FEV1 and PEFR were measured with a Pocket Spirometer. All measurements were made for 10 h in the clinic and then the patients continued to record PEFR and FEV1 at home for at least 2 more hours. Similar findings were obtained with all three lung function parameters. After challenge, the early response (ER) was small when compared with the late response (LR). All patients had a definite LR on the placebo day when FEV1 was compared with 'no challenge day'. Neither drugs had much effect on the small ER. The LR was not altered by terfenadine but was very significantly attenuated by salbutamol; the mean maximum fall in FEV1 during LR being 31, 29 and 12% after placebo, terfenadine and salbutamol, respectively. It is unlikely that histamine plays an important role in the LR to inhaled antigen but beta 2-adrenergic stimulants can attenuate LR, probably by directly preventing bronchial smooth muscle constriction and also by stabilising bronchial mast cells.

Administration, Inhalation↗
PubMed1991

Oral diamorphine: lack of effect on dyspnoea and exercise tolerance in the "pink puffer" syndrome.

The aim of this study was to assess the effects of diamorphine on breathlessness and exercise tolerance in patients with severe chronic airflow obstruction and normal arterial carbon dioxide tension (PCO2) levels ("pink puffer" syndrome). In this double-blind, cross-over, randomized study we examined both acute and chronic effects of single and multiple doses of oral diamorphine in 14 "pink puffer" patients. Their mean resting forced expiratory volume in one second (FEV1) was 36% predicted normal, mean arterial oxygen tension (PaO2) was 9.2 kPa and mean PaCO2 was 5.2 kPa. Ten patients took either diamorphine 2.5 or 5 mg or placebo elixir 6 hourly for 2 weeks, recording on a diary card dyspnoea, sleepiness and well-being on a visual analogue scale (VAS). The final treatment was given 30 min before measuring spirometry, arterial blood gases, plasma morphine levels, 6 min walking distances, time walked on treadmill and self-assessment of dyspnoea on a VAS scale after exercise. On two further days, eight patients took two doses, 4 h apart, of either diamorphine 7.5 mg or placebo elixir. Spirometry, 6 min walking distance with a VAS score for dyspnoea were measured before and at 1 h after each dose. Morphine levels and blood gases were also measured. Whether given in single or repeated doses, oral diamorphine had no significant effect on exercise tolerance and breathlessness when compared with placebo. Diamorphine 2.5-7.5 mg produced neither sleepiness nor a deterioration in blood gases. However, plasma levels associated with analgesic efficacy were not achieved with these doses. Thus, as given in this study, oral diamorphine is unlikely to have therapeutic potential in the treatment of dyspnoea in the "pink puffer" syndrome.

Administration, Oral↗
PubMed1987

Histamine receptors and pulmonary epithelial permeability.

In seven normal subjects and five asthmatics we have compared the effects of inhaled histamine with that of betahistine (a relatively selective H1-receptor agonist) and that of impromidine (a relatively H2-receptor agonist) on pulmonary epithelial permeability, as measured by the half-time clearance from lung to blood of inhaled 99mTc-DTPA (t1/2LB). Both histamine and betahistine produced statistically significant falls in baseline t1/2LB and peak expiratory flow rate, while impromidine produced no significant effects on either parameter. Similar results were obtained in normal subjects and asthmatics alike. In four of the normal subjects, histamine-induced falls in t1/2LB and peak expiratory flow rate were prevented by oral pretreatment with terfenadine 120 mg but not by cimetidine 400 mg. Histamine-induced increases in lung permeability and bronchoconstriction are both mediated via H1-receptors in normal and asthmatic subjects.

Adult↗
PubMed1985

Effects of histamine on lung permeability in normal and asthmatic subjects.

The permeability of respiratory mucosa, as measured by clearance of diethylenetriamine penta-acetate (DTPA) labelled with technetium 99m, was similar in seven normal and nine asthmatic subjects. Histamine induced bronchoconstriction was associated with a 50% increase in permeability in both groups of subjects. In normal subjects inhaled salbutamol, given as 1 mg acutely or as 200 micrograms four times daily for two weeks, had no effect on pulmonary permeability. Salbutamol, given before histamine challenge, prevented bronchoconstriction, but did not affect the increase in permeability seen in normal subjects. Low doses of histamine, sufficient to cause bronchoconstriction in the asthmatic subjects, produced little bronchoconstriction in normal subjects but caused increases in lung permeability similar to those seen in asthmatic subjects. These studies suggest that these two effects of inhaled histamine, bronchoconstriction and increased permeability, are independent.

Adult↗