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Biomedical subjects

P Fireman

Publications and source records attributed to P Fireman.

At least 19 recordsLinked to original sources
PubMed1992

Diagnosis of sinusitis in children: emphasis on the history and physical examination.

Sinusitis can occur as an acute, subacute, recurrent acute, or chronic clinical disease process in children. Sinusitis most often manifests as a prolongation or complication of a viral upper respiratory tract infection. Because children average six to eight upper respiratory tract infections per year, sinusitis is probably a more frequent diagnosis in the pediatric age group compared with adults who average two to three upper respiratory infections per year. Upward of 5 to 13% of children may experience sinusitis, but precise incidence data are not available because many imaging techniques currently available are inappropriate procedures for a prospective pediatric survey. Symptoms of acute sinusitis in children can vary from the more common persistent, purulent rhinorrhea and cough to the less common symptoms of fever, headache, facial pain, and swelling. Recurrent acute and chronic sinusitis may be associated with another condition such as a host-defense defect, cystic fibrosis, asthma, or a local condition that predisposes to obstruction of the sinus ostia such as nasal polyps, deviated septum, foreign body, or allergic inflammation. Diagnosis of sinusitis can be made on the basis of a careful history and physical examination with radiography reserved for confirmation of clinical impression or documentation of disease. Although fiberoptic rhinoscopy is used more frequently as an adjunct in adults for the evaluation and management of sinusitis, more studies need to be performed to document its clinical usefulness in children.

Acute Disease↗
PubMed1992

Rhinovirus 39 infection in allergic and nonallergic subjects.

To determine if individuals with allergic rhinitis are hyperresponsive to upper respiratory tract viral infections, 20 allergic and 18 nonallergic, susceptible, adult volunteers were challenged and infected with rhinovirus type 39 before the pollen seasons. Before challenge and on each of 6 days of cloister, all volunteers were interviewed for symptoms and completed a test battery consisting of evaluations of secretion production by weighed tissues, nasal patency by active posterior rhinomanometry, nasal clearance by the dyed saccharin technique, pulmonary function by spirometry, eustachian tube function by sonotubometry, and middle ear status by tympanometry. The symptomatology and pathophysiology resulting from the rhinovirus infection were consistent with those reported in previous studies with this challenge system. Between-group comparisons revealed no differences in symptom presentation, nasal secretion production, or overall pathophysiologic response. However, for decreased mucociliary clearance rate, increased nasal congestion, eustachian tube dysfunction, and symptoms of sneezing, the allergic group demonstrated an earlier onset compared with that of the nonallergic group. The biologic significance of the differences in onset of dysfunction is tempered by the observation that the temporal pattern of responses in the allergic group was similar with that of nonallergic subjects in previous studies. The results of the present study do not support the hypothesis of a physiologic hyperresponsiveness to rhinovirus type 39 infection in allergic subjects during nonallergy seasons.

Humans↗
PubMed1992

Double-blind study of intranasal ipratropium bromide in nonallergic perennial rhinitis.

We undertook this trial to determine whether ipratropium bromide nasal spray 0.03% (IB) reduced the nasal hypersecretion associated with nonallergic perennial rhinitis (NAPR) without causing excessive dryness or irritation of the nasal mucosa. We compared two drug doses of IB (21 micrograms and 42 micrograms per nostril) to a placebo, administered as two sprays to each nostril twice daily. The study design consisted of a 1-week screening period without treatment, a 1-week single-blind placebo period, a 4-week double-blind treatment comparison period, and a 1-week follow-up period without medication to evaluate nasal rebound. One hundred fifty-two patients were entered and 140 completed the trial. Both doses of IB reduced the severity and duration of rhinorrhea compared with placebo (P = .05 and .03, respectively). Treatment differences were noticeable during the first week of therapy, continued to widen during the second week, and then remained stable throughout the next 2 weeks. There was no evidence of nasal rebound observed during the week after treatment. The drug was well tolerated with side effects limited to infrequent nasal adverse events of nasal dryness, blood-tinged mucus, and epistaxis occurring in 2% to 6% of patients. We conclude that IB is a safe and effective therapy for control of rhinorrhea associated with NAPR.

Administration, Intranasal↗
PubMed1991

Effect of terfenadine on nasal, eustachian tube, and pulmonary function after provocative intranasal histamine challenge.

Previous studies have documented that intranasal histamine challenge results in nasal and eustachian tube obstruction (ETO) in human volunteers. The purpose of the present study was to assess the effect of pretreatment with terfenadine, a nonsedating antihistamine on the pathophysiologic consequences of intranasal histamine challenge. Fifteen subjects with allergic rhinitis were challenged intranasally with saline and increasing histamine doses (0.01, 0.1, 0.5, 1.0, 5.0, and 10.0 mg) before pretreatment (baseline) and after 1 week of pretreatment with terfenadine, 60 mg b.i.d., terfenadine, 120 mg b.i.d., and placebo. Nasal conductance as measured by posterior rhinomanometry showed a dose-dependent, monotonic decrease following sequential administration of the histamine solutions, but there were no apparent differences in the average responses among the four challenge sessions. The frequency of ETO after histamine challenge was decreased by pretreatment with both doses of terfenadine, although this was not significant. Histamine-induced sneezing and rhinorrhea, but not congestion, were significantly reduced by terfenadine pretreatment. There was no evidence of extension of the histamine effects to the lower airway. The results of the present study suggest that terfenadine, a nonsedating antihistamine, had a favorable effect on sneezing and rhinorrhea after provocative intranasal histamine challenge, but did not significantly attenuate the subjective or objective nasal and ET obstructive responses.

Administration, Intranasal↗
PubMed1991

Once daily fluticasone propionate aqueous nasal spray is an effective treatment for seasonal allergic rhinitis.

A multicenter double-blind, randomized, parallel group study was conducted to evaluate the once daily administration of fluticasone propionate, a potent, new corticosteroid preparation, for the treatment of seasonal allergic rhinitis. Adult patients (n = 227) were treated for 2 weeks with fluticasone propionate aqueous nasal spray 200 micrograms QD or 100 micrograms BID or matching placebo during the autumn pollen season. Overall, the administration of fluticasone propionate once daily in the morning was as effective as the twice daily dosage regimen, and either regimen was more effective than placebo. Improvement in clinician-rated and patient-rated nasal symptom scores, including morning nasal obstruction, was evident within three days of fluticasone propionate therapy and continued throughout the treatment period. Fewer patients receiving fluticasone propionate used rescue medication and had nasal eosinophilia compared with patients receiving placebo. Adverse events were similar in frequency and nature in all three treatment groups. Morning plasma cortisol concentrations and response to cosyntropin stimulation were similar across groups and offered no evidence of HPA axis suppression. We conclude that fluticasone propionate aqueous nasal spray administered once daily is a safe and effective treatment for seasonal allergic rhinitis. The convenience of a once daily regimen may encourage better compliance.

Administration, Intranasal↗
PubMed1990

The role of antihistamines in otitis.

Chronic and recurrent otitis media can manifest as otitis media with effusion. Both infection and eustachian tube obstruction (ETO) have been found to play an important role in its pathogenesis. ETO can be demonstrated during both early- and late-phase reactions in patients with allergic rhinitis after intranasal challenge with an allergen. Intranasal challenge with either histamine or prostaglandin D2 also provokes ETO, with the latter mediator perhaps more potent than the former. Middle ear effusions from patients with chronic or recurrent otitis media have been found to contain dramatically increased concentrations of histamine relative to the concentrations in their plasma. The development of nasal and eustachian tube obstruction in allergic rhinitis patients has been prevented by pretreatment with an antihistamine plus decongestant before intranasal challenge with pollen allergen. Investigations are currently under way to assess the effect of antihistamine pretreatment on nasal and eustachian tube obstruction in patients undergoing intranasal histamine challenge.

Ear Diseases↗
PubMed1990

Plasma elevations of histamine and a prostaglandin metabolite in acute bronchiolitis.

Acute bronchiolitis (AB) is a common lung disease in infants manifested clinically by dyspnea and wheezing. The purpose of this study was to measure simultaneous plasma levels of histamine and a stable prostaglandin F2 alpha metabolite [13,14-dihydro-15-keto-PGF2 alpha (PG metabolite)], by radioenzymatic and radioimmunoassays, respectively, during and after recovery from AB. Blood was obtained from 15 infants during AB and from 14 and 9 of these infants when re-evaluated 6 and 18 months later, respectively. Mean (+/- 1 SEM) pre- and posttherapy (inhaled isoetharine) histamine levels (pg/ml), 1,923 +/- 980 and 1,035 +/- 250 during AB, respectively, were markedly higher than those of the same nonwheezing subjects at 18 months, 360 +/- 125, but unexpectedly lower than those at 6 months, 9,210 +/- 5,242. Of the 14 infants evaluated at 6 months, 7 had elevated histamine levels along with histories of recurrent wheezing after AB. Similarly, pre- and posttherapy PG metabolite levels (pg/ml), 1,033 +/- 419 and 1,613 +/- 527, respectively, were significantly higher than those of the same children when asymptomatic at 6 (27 +/- 7) and 18 months (68 +/- 25). Pre- and posttherapy levels of histamine and PG metabolite were higher than those of normal and sick, nonwheezing infants. These data indicate that histamine and PG metabolite are detectable in plasma during AB and suggest a role for histamine and PGF2 alpha in the pathogenesis of airways inflammation in AB.

Bronchiolitis, Viral↗
PubMed1990

Nasal physiology and inflammatory mediators during natural pollen exposure.

Nasal allergen challenges in allergic rhinitis subjects provoke characteristic alterations in nasal and eustachian tube (ET) function. The purpose of this study was to examine the effect of natural pollen exposure on nasal physiology and inflammatory mediators. Grass pollen counts, ET function (sonotubometry), nasal resistance (rhinomanometry), symptoms, mediator levels (saline wash), and skin test reactivity in nine adults with grass allergy were monitored weekly before (week 1), during (weeks 2 to 9) and after (weeks 10 and 11) grass pollen season. Pollen counts peaked at week 3, and then decreased gradually. Mean nasal resistance (cm H2O/L/sec) increased from a baseline of 2.4 +/- 0.5 to 3.7 +/- 1.1 at week 3, peaked at week 4 (5.3 +/- 1.2), remained elevated (weeks 5-8), peaked again at week 9 (6.6 +/- 1.4), and then decreased, Bilateral ET obstruction was not present in any of the subjects at baseline, but was present in five of the nine subjects at week 4. Symptom severity paralleled grass pollen counts. Peak mediator levels were observed at weeks 2 and 9 for histamine and at weeks 3 and 10 for leukotriene C4. Seasonal increases in grass and histamine-induced wheal sizes were also observed. These data show that measurable changes in the function of the nose and ET and the levels of nasal mediators and dermal reactivity accompany and track pollen counts during seasonal exposure and suggest that therapy for seasonal allergic rhinitis should be (1) directed at reducing airway inflammation and (2) continued well beyond the time of peak pollen exposure.

Adult↗
PubMed1989

Increases in plasma concentrations of a prostaglandin metabolite in acute airway obstruction.

Plasma concentrations of a stable prostaglandin F2 alpha metabolite were measured by radioimmunoassay during and after recovery from acute airway obstruction in 15 infants. Mean (SEM) metabolite concentrations (ng/l) in plasma obtained both before (1033 (418)) and after (1470 (413)) initial treatment for airway obstruction were significantly higher than those obtained from the same subjects after resolution of the obstruction--25.5 (6.6)--and those obtained from two comparison groups. Infants positive for respiratory syncytial virus (mean 1122 (227)) had significantly higher concentrations than those who were negative (207.6 (46)). Additionally, seven subjects with a history of recurrent wheezing after resolution of airway obstruction had a significantly higher mean level (3500 (1400)) during attacks of airway obstruction than those without (600 (100)). These data suggest that prostaglandin F2 alpha mediates respiratory inflammation in airway obstruction and that trials of specific anti-inflammatory agents for the treatment of airway obstruction may be warranted.

Airway Obstruction↗
PubMed1988

Inflammatory mediators in chronic otitis media with effusion.

Otitis media with effusion (OME) is a common middle ear inflammatory disease in the pediatric population. This article determines concentrations of three functionally and metabolically distinct inflammatory mediators in middle ear effusions (MEE) and corresponding plasma of children with OME. One hundred two patients (mean age, 4.9 years) with persistent OME were studied. Middle ear effusions were collected from all subjects and plasma from a subset at the time of tympanostomy tube insertion. Histamine was assayed radioisotopically, 13,14-dihydro-15-keto-prostaglandin F2 alpha (stable PGF2 alpha metabolite) by radioimmunoassay, and neutrophil chemotactic factor of anaphylaxis by modified Boyden chamber. Mean MEE levels of the mediators (39 +/- 13 ng/mL, 462 +/- 179 pg/mL, and 264% +/- 57% positive control, respectively) were markedly higher than those of corresponding plasma (0.5 +/- 0.1 ng/mL, 285 +/- 127 pg/mL, and 47% +/- 5% positive control, respectively). The mean histamine content of mucoid effusions (43.2 +/- 56.9 ng/mL) was significantly higher than that of purulent (22.5 +/- 10.5 ng/mL) and serous (17.9 +/- 16.8 ng/mL) effusions. Higher histamine levels were observed in effusions positive for Haemophilus influenzae when compared with those with other pathogenic isolates. The high concentrations of these mediators in MEE and their potential for inducing or sustaining the inflammatory process supports a role in the pathogenesis of OME.

Adolescent↗
PubMed1988

Otitis media and nasal disease: a role for allergy.

Otitis media with effusion (OME) is common in children, although it can occur at any age. Allergies probably contribute to the development of OME, with other major risk factors being bacterial infection and eustachian tube obstruction (ETO). We have demonstrated that patients with allergic rhinitis often develop ETO when challenged with allergens; therefore, ETO could be a link between OME and allergies. Nasal obstruction and ETO in allergic rhinitis can be alleviated or attenuated by pretreatment with intranasal corticosteroids. Therapy for allergic rhinitis complicated by OME includes treatment of the ear infection with antibiotics and the relief of allergic symptoms with antiallergy medications, including antihistamines, intranasal cromolyn, and intranasal corticosteroids, as well as environmental control and appropriate immunotherapy.

Child↗
PubMed1988

Nasal provocation testing: an objective assessment for nasal and eustachian tube obstruction.

Nasal provocative testing is the introduction of a specific factor into the nose and the subsequent assessment of the pathophysiologic changes induced by the challenge. The provocative test primarily affects the nasal airway but also may affect the adjacent organs, including the eustachian tube, middle ear, sinuses, and lower respiratory tract. Recent advances in the measurement of nasal airway resistance with microcomputer-assisted rhinomanometry have improved the objective assessment of nasal airway obstruction. Eustachian tube obstruction has been shown after nasal provocation by a new procedure, sonotubometry, which can be performed in series with rhinomanometry and pulmonary spirometry. As will be described these procedures have helped elucidate the extent and pathophysiology of diseases affecting the upper airway, especially allergic rhinitis. At present, nasal provocation is primarily a clinical investigative test. It is anticipated that with further development and refinement, it can be used to a greater extent in the diagnosis and management of nasal diseases.

Allergens↗
PubMed1988

Otitis media and its relationship to allergy.

The importance of infection in the etiology of otitis media and the role of eustachian tube obstruction in the pathogenesis of otitis media with effusion are well known. Recently, allergic rhinitis has been documented to induce eustachian tube obstruction. When allergic rhinitis is diagnosed in a child with recurrent or chronic middle ear disease, allergy should be considered as another risk factor for the development of otitis media with effusion.

Child, Preschool↗
PubMed1988

Morbidity and mortality of asthma.

Morbidity and mortality of asthma has been on the upswing since the 1960s, as marked by increased hospitalizations with asthma since the early 1980s. This has not been explained adequately. The possibility of change in the natural history or increased exposure to environmental irritant chemicals or allergens has been suggested by some. There probably has been better recognition and diagnosis of asthma by distinguishing it from bronchitis, recurrent croup, and bronchiolitis in children. Despite evidence to suggest that this is the case, there are still some missing factors. The increase in asthma mortality is more understandable when one considers the fact the management of asthma has changed greatly in the past two decades. The use of corticosteroids orally, parenterally, and by inhalation has been a double-edged sword. There is no doubt that many asthmatics have a much improved sense of well-being and have lived more normal lives due to the use of corticosteroids. The inability of some patients, parents, or physicians to perceive impending respiratory difficulty, however, may result in underuse of drugs, including corticosteroids, leading to increased mortality. Other factors have led to increased mortality from asthma in recent years, and they include arrhythmias with combinations of theophylline, beta-agonists, and hypoxia. The psychological factors attendant to adolescence and psychological problems are probably quite important in the recent upsurge in asthma deaths in the 15- to 25-year age group. Many deaths are occurring outside of the hospital environment and may be largely preventable. There must be increased awareness by the patient, the family, and the physician. In view of the increased hospitalizations, the total number of deaths is not increasing at an alarming rate, yet it is necessary to make all of us who care for asthmatics aware and take corrective action as soon as we are aware of an asthmatic with respiratory problems.

Adolescent↗