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Biomedical subjects

R M Katz

Publications and source records attributed to R M Katz.

At least 37 records · Page 2Linked to original sources
PubMed1986

Use of a tube spacer to improve the efficacy of a metered-dose inhaler in asthmatic children.

Many children with asthma do not use the standard metered-dose inhaler (MDI) skillfully. To improve drug delivery, correct problems of hand-lung incoordination, and reduce local side effects, a number of spacer devices have been developed. We evaluated one such device, a tube spacer (Aerochamber), in 16 asthmatic children (5 to 12 years). On four separate days and in a randomized, double-blind, placebo-controlled manner, they received either metaproterenol sulfate by MDI aerosol (130 micrograms) or placebo with and without the tube spacer. To maximize techniques, at each visit the children had proper instructions, including viewing a videotape. Spirometry was performed at baseline and 5, 15, and 30 minutes, and hourly for six hours, and the patient was monitored. Analysis of the entire group (forced expiratory volume at 1 s and midmaximal expiratory volume) revealed no difference between metaproterenol administered with or without the tube spacer, and both were significantly different than placebo through two hours. Six children had longer and three had better bronchodilatation with the MDI plus tube spacer than with the MDI alone. Side effects and vital signs did not differ between treatments. Under the circumstances of our study, the tube spacer device might enhance the use of the MDI in children who are not properly taught and/or who forget or cannot perform proper technique.

Asthma↗
PubMed1986

Correlation between A-mode ultrasound and radiography in the diagnosis of maxillary sinusitis.

A-mode ultrasound examination of the maxillary sinuses with the Echosine and Sinusvu 2500 units was compared with roentgenographic examination in the diagnosis of maxillary and frontal sinusitis. A-mode ultrasound was primarily useful in the detection of secretions within the sinus and not mucosal thickening. Both ultrasound devices had high specificities (92% for Echosine and 94% for Sinusvu 2500) in the diagnosis of maxillary sinusitis, but the Echosine had a greater overall sensitivity (61%) than the Sinusvu 2500 (29%). More significantly, as the opacification of the roentgenogram increased (a higher probability of secretion), the Echosine demonstrated better agreement with the x-ray film. Ultrasound appeared to be less helpful in diagnosing frontal sinusitis, but there were too few cases of frontal sinusitis for statistical analysis. The Echosine is a useful screening device because of the high specificity of a positive result. Although A-mode ultrasound provides limited value in diagnosing mucosal thickening, it is particularly useful in following the course of therapy once a positive diagnosis of sinusitis has been established without subjecting the patient to additional x-ray exposure.

Adolescent↗
PubMed1986

Efficacy of doxepin in the treatment of chronic idiopathic urticaria.

Doxepin hydrochloride, a tricyclic antidepressant, was evaluated in a double-blind, placebo-controlled crossover trial for the treatment of chronic idiopathic urticaria in 16 adults. Efficacy was evaluated by symptom scores, concomitant antihistamine use, and suppression of histamine- and codeine-induced wheal response. Doxepin-treated subjects experienced fewer lesions (p less than 0.001), less waking hours with lesions (p less than 0.01), lesser degree of itch and/or discomfort (p less than 0.001), and less swelling or angioedema (p less than 0.001) as compared to placebo-treated subjects. Doxepin-treated subjects required less daily concomitant antihistamine use (mean 0.13 tablets versus 1.48 tablets, p less than 0.05). Doxepin also significantly suppressed histamine- and codeine-induced cutaneous wheal response as compared to placebo. Lethargy was commonly observed but diminished with continued use. Dry mouth and constipation were also commonly observed. We conclude that doxepin is an effective agent for the treatment of chronic idiopathic urticaria.

Chlorpheniramine↗
PubMed1986

Compliance of patients with asthma with an experimental aerosolized medication: implications for controlled clinical trials.

A Nebulizer Chronolog, a portable device that houses a standard nebulizer canister, was used in a unique method to measure compliance with aerosolized medication. Each actuation is tabulated to within 4 minutes of the actual time of usage and can subsequently be displayed in a day-hour-minute format. Of the 19 patients studied for 12 weeks with a cromolyn-like agent, appropriate usage four times a day ranged from 4.3% to 94.8%. Underusage exceeded overusage and ranged from 5.2% to 95% of the study days. Younger subjects and male subjects were less likely to use the aerosol appropriately. Patients failed to write the truth in their diaries with overreporting of appropriate usage more than 50% of the times. Lack of compliance with aerosolized medication represents an important medical issue for the physicians caring for patients with asthma. The Nebulizer Chronolog elicits new insight into the disparity between reported and observed compliance.

Adolescent↗
PubMed1986

Prevention with and without the use of medications for exercise-induced asthma.

Exercise-induced asthma or bronchospasm occurs in approximately 12% of the population. It can be prevented with proper techniques of exercise and environmental exposures and with medication. Exercise techniques include timing of exercise to less than 5-min interludes and continued repeat exercise every hour. Exercising to less than full tolerance may avoid the onset of exercise-induced asthma. In some individuals exercise in warm, humidified air is less asthmogenic than in dry, cold air. Medications that are effective and safe include bronchodilators such as theophylline and beta-agonists and prevention with cromolyn sodium in the atopic or sulfite exposed individual.

Asthma↗
PubMed1986

Efficacy of parenteral albuterol in the treatment of asthma. Comparison of its metabolic side effects with subcutaneous epinephrine.

Three parenteral routes of albuterol sulfate were compared with placebo in their effects on serum potassium and glucose levels, heart rate, and pulmonary function in adult asthmatic subjects. In addition, the metabolic effects of subcutaneous epinephrine were compared directly with subcutaneous albuterol. Intravenous (IV) albuterol (250 micrograms) caused similar decreases in serum potassium (mean 0.6 +/- 0.3 mEq/L) as 500 micrograms albuterol by intramuscular (IM) or subcutaneous routes. With the combined data from all three albuterol routes, glucose increases (mean 25 +/- 15 mg/dl) and heart rate increases (mean 11 +/- 6 beats/min) were clinically less important than potassium decreases. Subcutaneous epinephrine (0.3 ml, 1:1,000) gave changes in serum potassium, serum glucose, and heart rate statistically similar to those of subcutaneous albuterol (500 micrograms). Peak FEV1 improvement (mean 61 percent) was similar with IV albuterol (250 micrograms), IM albuterol (500 micrograms) or subcutaneous albuterol (500 micrograms). Although the efficacy of albuterol in the doses studied was similar, the decrement in serum K+ produced was also similar and comparable to that produced by a standard dose of epinephrine. The potassium decrease may have important clinical implications.

Adolescent↗
PubMed1986

Twice-daily beclomethasone dipropionate in the treatment of childhood asthma.

Chronic nonsteroid-dependent childhood asthma was treated by adding beclomethasone dipropionate (BDP) or placebo (P) to the daily regimen of theophylline (T). Subjects (6-12 years) were selected based on daily control of asthma by T at necessary T levels in sera of 10-20 micrograms. Active BDP (200 micrograms b.i.d.) and P groups were randomly assigned. Each subject's baseline values were evaluated on a 4-week open phase followed by a 10-12 week double-blind phase. Daily diaries were kept for signs, symptoms, Wright peak flow recordings, and medication requirements. Visits were monitored for urine and serum cortisols, pulmonary function tests (PFT), objective changes, and medication compliance. Demographics between both groups were nonsignificant (NS). Baseline PFTs in P group were significantly better than the BDP group. Serum and urine cortisols and ACTH responses were NS (p less than 0.05). Drug efficacy for asthma characteristics was significantly improved in the BDP group (p less than 0.05) only. The BDP group maximized their response by 8 weeks, with improvement of their FEV1 and FEF25-75 PFT. Thus, b.i.d. BDP provided good asthma control and the twice-daily program should insure improved compliance.

Adrenergic beta-Agonists↗
PubMed1986

Behavior abnormalities and poor school performance due to oral theophylline use.

Studies evaluating adverse effects of oral theophylline on learning and behavior have been performed on children with asthma receiving long-term theophylline therapy. To further differentiate the effects of asthma itself from the drugs used, we evaluated 20 asthmatic children (6 to 12 years of age) who had not received oral bronchodilators for at least 6 months. A double blind, placebo-controlled, parallel format was used with a 4-week theophylline or placebo period preceded by a 2-week baseline. Theophylline serum levels were maintained between 10 to 20 micrograms/mL. During baseline and treatment periods, the child's home and school behavior/performance were monitored independently by their parents and teachers using standardized report forms. A battery of psychologic tests was administered at the end of baseline and treatment periods. Seven children receiving theophylline were noted to have a change in school behavior and/or performance during their 4 weeks on drug compared to baseline, whereas none of the children receiving placebo were noted to be different (P = .004). Thus, the short-term administration of theophylline to asymptomatic asthmatic children not receiving oral bronchodilators can adversely affect school performance and behavior. Because this population represents the majority of asthmatic children, one needs to use theophylline cautiously in this age group, monitor school performance closely, or seek other treatment modalities.

Achievement↗
PubMed1985

Methylprednisolone and troleandomycin in treatment of steroid-dependent asthmatic children.

Oral methylprednisolone combined with troleandomycin has been reported to be successful in treating poorly controlled, severe asthma in adults. We found this drug combination to be effective in treating 11 steroid-dependent children with poorly controlled asthma who were aged 7 to 13 years, for 12 to 28 months. Improvement of clinical and pulmonary functions was achieved within seven days, with the forced expiratory volume in 1 s increasing by 38% and the maximal midexpiratory flow rate increasing by 55% over the baseline value. By one year, the former improved to 98% of predicted value and the latter, to 79% of predicted value. Compared with the prior 12 months, patients at this time required fewer emergency visits, missed fewer days of school, and had fewer hospitalizations. Side effects included transient-increased cushingoid features, abdominal pain, and liver enzyme level elevation. Patients showed less evidence of adrenal suppression.

Administration, Oral↗
PubMed1985

A placebo-controlled trial of procaterol: a new long-acting oral beta 2-agonist in bronchial asthma.

Procaterol hydrochloride, a potent beta 2-adrenergic bronchodilator developed in Japan, was evaluated in a double-blind, placebo-controlled study for efficacy and safety in 45 patients (ages 18 to 55 yr) with chronic documented reversible airway disease. After a 1-week placebo washout period, patients were administered either 0.05 mg or 0.10 mg of procaterol or placebo twice daily for 2 wk. Spirometric determinations, vital signs, and ECGs were obtained at 1/2, 1, 2, 4, 6, and 8 hr after the first dose and at the same time intervals after 1 and 2 wk of treatment. Patients recorded on a daily basis peak flow rates, asthma symptoms, need for supplemental aerosol, concurrent medications, and side effects. Spirometry results indicated significant improvement in pulmonary function with both doses of procaterol compared with placebo (P less than 0.05). The larger dose was generally more effective. Bronchodilatation was evident 1/2 hr after dosing and peaked at 2 hr. At 8 hr after 0.10 mg of procaterol, FEV1 was still above predose values. Daily peak flow rates were significantly higher with 0.10 mg than with 0.05 mg (P less than 0.05) and placebo (P less than 0.001). Tremor and nervousness were the most frequent side effects. They occurred in a dose-related frequency, were mild and transient, and occurred early in treatment. No significant drug-related changes were noted in ECGs, heart rate, blood pressure, or clinical laboratory data. Procaterol was found to be an effective, well-tolerated oral bronchodilator with a long duration of action, especially at 0.10 mg twice daily.

Adolescent↗
PubMed1984

Rhinitis in the athlete.

Trauma is the most common problem involving the nose in sports and athletic events. Injury may lead to "vasomotor syndrome" and chronic rhinitis. Nasal and sinus obstruction may cause additional discomfort. Exposure to irritants, particularly solvents, cleaning solutions, paints, and varnishes as well as air pollutants exacerbates vasomotor rhinitis. Allergic rhinitis is another major problem of atopic athletes. It may be caused by exposure to pollens, molds, dust, or animal danders. Treatment is aimed at reducing the exposure to etiologic factors as well as pharmacologic management. Antihistamines, topical cromolyn, and topical steroids may be used to control rhinitis without violating " antidoping " regulations.

Allergens↗
PubMed1984

Chronic sinus disease with associated reactive airway disease in children.

Sinus disease has been described as one of several aggravating factors for chronic adult-onset asthma. Forty-eight children whose reactive airway disease (asthma) was significantly improved with treatment of their sinusitis have been observed. All of the subjects were seen in the office with chronic (more than 3 months) respiratory symptoms; all had daytime and nighttime cough and/or wheeze. The 48 children (32 male and 16 female) had a mean age of 8.2 +/- 1.2 (SD) years (range 4 to 13 years). Fourteen (35%) were nonatopic as determined by family history, personal history, and skin test reactivity to inhalant and pollen antigens. Eighteen of the patients were receiving or had recently received oral corticosteroids. All had been taking bronchodilators daily for at least 3 months without adequate control of the asthma. Sinus radiographs (Waters view) revealed the following abnormalities of the maxillary sinuses: greater than 6 mm of mucosal thickening (ten children [21%]), one opacified (12 children [25%]), bilateral opacification (18 children [38%]) and air fluid level(s) (eight children [17%]). All children were treated with antimicrobial agents for 2 to 5 weeks. Thirty-nine responded both clinically and radiologically. Antral lavage was performed in nine children. Of the 48 subjects, 38 (79%) were able to discontinue taking the bronchodilators with resolution of their sinusitis. It is concluded that sinus disease in children may be an aggravating factor for chronic reactive airway disease and that proper, aggressive treatment of the former will notably improve the latter.

Adolescent↗
PubMed1983

Bronchodilator characteristics of nebulized metaproterenol sulfate, isoetharine, and atropine in chronic asthma.

A randomized double-blind comparison of aerosolized META, ISO, ATR, and PI solutions delivered by motorized mist nebulizer was conducted in subjects with known reversible airway obstruction. Vital signs and spirometric parameters were monitored sequentially during each of four 6 hr test periods. Abstention from all medication was required for at least 12 hr before each test period. Baseline percent predicted FEV1 and FEF25-75 among subjects for all test periods were statistically similar. Compared to the other agents tested META treatment (15 mg) resulted in significantly improved global response and higher mean percent increases in FEV1 and FEF25-75 over the entire test period as well as at individual measurement points up to 4 hr for FEV1 and 5 hr for FEF25-75. Peak FEV1 and FEF25-75 values with META treatment were noted at 30 min and persisted above baseline during the entire 6 hr. ATR (2 mg) treatment resulted in later onset of bronchodilatory effect and, as with ISO (125 micrograms), more rapid diminution in measured response. Administration of saline alone resulted in a net 9% increase in FEV1 and 11% in FEF25-75 over the entire test period. Clinically insignificant tremor was noted in 41% of META-treated subjects. Delivery of META by a motorized mist nebulizer provides safe, effective bronchodilation and META is superior to the other agents tested in terms of onset of action, peak reversal of airway obstruction, and duration of effect.

Adolescent↗
PubMed1983

Causes of death among registered nurses.

The mortality pattern of 2,157 female registered nurses was analyzed for the period 1963 through 1977 using death certificate data. Proportional mortality analysis was used to compare mortality among nurses with that of control groups derived from a population of other female workers. Results indicate an elevated risk of death from suicide among registered nurses.

Adolescent↗
PubMed1983

Theophylline administration in children with asthma: optimal pulmonary function and possible tolerance to chronic administration.

This study was performed to assess the need of obtaining serum theophylline (T) levels between 10--20 micrograms/ml to achieve maximum reversibility of airway obstruction in chronic childhood asthma. Twenty-seven children with daily asthma (ages 9--16 years mean 11.7) were studied to determine the serum T levels required to obtain optimal pulmonary function tests as measured by FEV1 and FEF25--75. Two parallel groups were created. Group 1 (13 subjects) received rapid release (RR) anhydrous T. Group 2 (14 subjects) received sustained release (SR) anhydrous T. The groups were identical in age, weight, height and PFT: p = values greater than or equal to .21 (t test for equivalent means). During initial titration maximal PFT's were obtained in Group 1 subjects with mean T level of 7.1 micrograms/ml and in Group 2 subjects with mean T level of 8.5 micrograms/ml. The PFT responses and theophylline dose responses of each group were not significantly different from each other. After two months of continuous high dose (10--20 micrograms/ml) therapy each subject was again titrated for dose response of PFT with serum T levels. PFT's were not significantly different from the acute studies. After continuous high dose theophylline therapy serum T levels needed (mean 11.5 micrograms/ml) to obtain the maximal PFT response were significantly higher than during the initial titration (mean 7.1 to 8.5 micrograms/ml). Maximal PFT's in many asthmatic children do not require serum T greater than or equal to 10 micrograms/ml in an acute dosage. The continuous use of high dose theophylline may lead to tolerance, thus requiring a higher theophylline dose and subsequent serum level to obtain maximal PFT.

Adolescent↗