In order to delineate the clinical profiles which correspond to different patterns of responsiveness to inhaled anticholinergic drugs (i.e. atropine methonitrate, ipratropium bromide), 102 subjects tested with these drugs and with beta 2-adrenergic bronchodilators were classified into three groups, namely: a group with positive skin prick tests (group 1), a group with blood or sputum eosinophilia but negative skin prick tests (group 2), and a group with negative skin prick tests and neither blood nor sputum eosinophilia (group 3). All had reversible airflow obstruction and their clinical profiles closely corresponded to atopic asthma, non-atopic asthma and chronic bronchitis, respectively, but the prevalence of mucus hypersecretion was similar in all three groups. Pharmacologically, group 1 patients were distinguished from the other two groups by their significant impairment of 1-second forced expiratory volume response to the bronchodilator action of anticholinergic drugs. This is the physiological correlate of atopic asthma.

Adult↗

PubMed1984

Asthma vs. non-specific reversible airflow obstruction: clinical features and responsiveness to anticholinergic drugs.

85 subjects with 20% reversibility in FEV1 were classified into the categories of asthma (55 patients) and non-specific airflow obstruction (30 patients), respectively, on the basis of the presence or absence of eosinophilia (in the blood or sputum). Asthmatics were further subdivided into the atopic and non-atopic subgroups, respectively, on the basis of skin prick tests. Clinically, paroxysmal nocturnal wheezing was more significantly associated with asthma than with non-specific airflow obstruction. Atopic asthmatics were distinguished from patients with non-specific airflow obstruction by their younger age at presentation and at onset of obstructive symptoms, by a history of allergic provocation of wheezing, a family history of asthma and other atopic diseases, and by a lower incidence of mucus hypersecretion. The last 3 symptoms also distinguished atopic from non-atopic asthma. Furthermore, unlike patients with non-atopic asthma or patients with non-specific airflow obstruction, atopic asthmatics had a significant impairment of bronchodilator responsiveness to inhaled anticholinergic drugs.

Adolescent↗

PubMed1984

Atropine resistance in asthma: definition and provisional hypothesis.

Out of a group of 55 asthmatics, 16 fitted the strict definition of atropine resistance (less than 20% FEV1 response to inhaled anticholinergic drugs, with a 20% or more FEV1 response to subsequent inhalation of beta 2-adrenergic stimulants). 26 were defined as atropine responsive in that they had a 20% or more FEV1 response to anticholinergic drugs. Significantly more atopic than non-atopic asthmatics were in the atropine-resistant group (chi 2 = 6.12; p less than 0.025). Atropine resistance is not related to age. It is probably due to excessive vagal activity resulting from sensitization of vagal irritant receptors by antigen. Atropine resistance appears to be ameliorated by treatment with corticosteroid drugs or disodium cromoglycate. These features suggest a link between allergic and vagal components in asthma.

Adolescent↗

PubMed1984

Changing clinical pattern of gastric ulcer: are anti-inflammatory drugs involved?

The changing pattern of gastric ulcer (GU) has been studied in a series of 528 cases presenting in one hospital department during the past 20 years. The male:female ratio has declined and is now equal, and age-adjusted figures show that this applies to all age groups. There was a significant decline in mid-gastric ulcers in men. There was a 4-fold increased incidence of haemorrhage in proximal as opposed to antral ulcers and a 7-fold excess of haemorrhage in older women as opposed to younger women. GU in elderly women taking non-aspirin non-steroidal anti-inflammatory drugs (NANSADs) showed an increased tendency to bleeding, accounting for half of all haemorrhages in women over 70 years. However, on statistical analysis NANSAD-associated ulcers showed no other distinguishing features, and the use of NANSADs did not contribute significantly to the changing sex ratio. There is still no satisfactory evidence that these drugs play a causal role in chronic GU.

Adult↗

PubMed1983

Splenic abscess: successful non-surgical therapy.

A 57-year-old man with splenic abscess, demonstrated by isotope scanning, ultrasonography and computerized axial tomography (CAT scan) during the course of a septicaemic illness resulting from culture-positive bacterial endocarditis, was successfully treated with antibiotics alone, resolution of the abscess being confirmed by 2 further scans. This is the second case report of successful conservative treatment of splenic abscess.

Abscess↗

PubMed1983

Streptococcus bovis endocarditis and colonic polyp.

Explore the source record for details and available documents.

Colonic Polyps↗

PubMed1983

Asthma, pulmonary eosinophilia, and eosinophilic pericarditis.

Explore the source record for details and available documents.

Adult↗

PubMed1983

Impaired atropine responsiveness in asthma: role of atopy.

Responsiveness to anticholinergic bronchodilators was assessed in 19 atopic and in 36 non-atopic asthmatics of comparable mean age and basal FEV1. Atopic subjects had a significantly lower degree of responsiveness (p less than 0.01). When the 19 atopic subjects were matched for FEV1 and age with 19 non-atopic subjects (selected from the group of 36) the difference in responsiveness to anticholinergic drugs was still evident (p less than 0.01). Atopic status thus appears to have a significant effect on bronchial reactivity to inhaled anticholinergic drugs.

Adult↗

PubMed1983