Biomedical subjects

S Chodosh

Publications and source records attributed to S Chodosh.

At least 19 recordsLinked to original sources

PubMed1993

Sputum eosinophilia negates need to perform sputum Gram's stain.

A total of 1878 sputum specimens were evaluated to assess the potential of encountering a sputum Gram's stain with clinically useful positive data in the presence of sputum eosinophilia. Wet preparations were used to assess the adequacy of the specimen and to quantitate eosinophils. Quantitative sputum Gram's stains were performed. When more than 50% of the cells observed on sputum wet preparation were eosinophils, there were no positive Gram's stains. When more than 20% of the cells were eosinophils, there was a 1% prevalence of potentially clinically useful positive Gram's stains. The data strongly suggest that sputum eosinophilia obviates the need to perform a sputum Gram's stain since it is extremely unlikely that it would be useful in diagnosing a bacterial infection of the lower respiratory tract.

Bacterial Infections↗

PubMed1991

Treatment of acute exacerbations of chronic bronchitis: state of the art.

Effective treatment of acute bacterial exacerbations of chronic bronchitis (ABE) reduces the number of such exacerbations in such patients and may decrease or eliminate background symptoms and improve pulmonary function. The pathologic and physiologic abnormalities of the bronchial system in chronic bronchitis that predispose to bacterial infection probably include impaired mucociliary clearance, obstructed bronchioles, and bacterial infections of the bronchial epithelium. Exacerbations of bronchopulmonary symptoms are usually observed with ABE, although these symptoms are not unique to ABE. While culture and sensitivity testing is not usually required, microscopic examination of sputum is critical to determine the presence of bacterial infection. Bacteria in numbers significantly above the levels present when the patient's condition is stable and at least a doubling of the sputum neutrophil inflammatory level are essential criteria. Bacterial species observed with ABE include Haemophilus influenzae, Haemophilus parainfluenzae, Streptococcus pneumoniae, Moraxella catarrhalis, and Neisseria species, with a lesser incidence of Klebsiella and Pseudomonas species. One or more elements of background therapy for ABE should accompany antimicrobial therapy, for example, physiotherapy, bronchodilators, and so forth. Ampicillin is effective, safe, economical, and thus remains the drug of choice for ABE. Quinolones are an effective alternative when ampicillin cannot be tolerated or if organisms are resistant. Dosing is at the upper range of recommendations, and the chosen drug should be given for a 10-14-day regimen. Patients should be reevaluated if symptoms and physical findings do not return to baseline after 5-7 days.

Acute Disease↗

PubMed1991

Use of quinolones for the treatment of acute exacerbations of chronic bronchitis.

The availability of a new generation of quinolones expands the choices of antimicrobials for therapy of acute exacerbations of chronic bronchitis. These agents have broad antimicrobial activity, including good in vitro activity against respiratory pathogens, and advantageous pharmacokinetic characteristics, including bronchial tissue penetration. Ciprofloxacin, enoxacin, ofloxacin, and temafloxacin have been evaluated in a number of clinical trials, compared to the reference agents ampicillin, amoxicillin (with and without clavulanate), cefaclor, doxycycline, and erythromycin. Ciprofloxacin, ofloxacin, and temafloxacin have generally demonstrated greater clinical success than enoxacin. While these agents are effective against many respiratory pathogens, Streptococcus pneumoniae and Pseudomonas aeruginosa infections appear to pose problems. Temafloxacin and ciprofloxacin have been compared; temafloxacin eradicated S. pneumoniae more efficiently and did not interact with theophylline. Fluoroquinolones are an important addition to the agents useful for bacterial exacerbations of chronic bronchitis.

Acute Disease↗

PubMed1991

Temafloxacin compared with ciprofloxacin in mild to moderate lower respiratory tract infections in ambulatory patients. A multicenter, double-blind, randomized study.

The efficacy and safety of oral temafloxacin (600 mg) and ciprofloxacin (500 mg) twice daily for seven days were compared in patients with mild to moderate lower respiratory tract infections. Fifty-eight of 64 (91 percent) patients who received temafloxacin and 63 of 67 (94 percent) patients who received ciprofloxacin had clinical cure or improvement; bacteriologic cure occurred in 61 (95 percent) and 63 (94 percent), respectively. All 14 patients with pneumonia were clinically cured or improved and bacteriologically cured; 11 had complete resolution of roentgenographic evidence of pneumonia. Both quinolones eradicated most major respiratory pathogens. In the ciprofloxacin group, organisms persisted in three of seven Pseudomonas aeruginosa isolates and in one of eight Hemophilus parainfluenzae isolates; all these pathogens were eliminated with temafloxacin. Theophylline blood levels significantly increased by 25 percent in the ciprofloxacin group and decreased by 5 percent in the temafloxacin group. Adverse events, mostly dizziness, headache, and gastrointestinal effects, occurred in 43 percent of temafloxacin patients and in 31 percent of ciprofloxacin patients.

Ambulatory Care↗

PubMed1989

Comparison of ciprofloxacin with ampicillin in acute infectious exacerbations of chronic bronchitis. A double-blind crossover study.

Two separate acute bacterial exacerbations of chronic bronchitis and/or asthma were treated in 22 patients in a double-blind crossover study. One course of treatment consisted of 750 mg of ciprofloxacin twice daily and the other of 500 mg of ampicillin four times a day; each drug was given for 14 days. Patients were observed initially, every three to four days during therapy, and weekly during the post-therapy period. Observations that were recorded included graded chest symptoms and physical findings, vital signs, hematologic parameters, and objective sputum measurements (daily volume, purulence, differential quantitative cytology, bacterial counts, and physical properties). Both antibiotic regimens were effective in resolving these acute bacterial exacerbations. Paired t test analysis revealed that ciprofloxacin is as clinically effective as ampicillin in the treatment of acute bacterial exacerbations in chronic bronchial disease, and appears to be superior in clearing bacterial pathogens from the sputum.

Adult↗

PubMed1989

Prazosin in hypertensive patients with chronic bronchitis and asthma: a brief report.

The effects of prazosin therapy were recently evaluated in ambulatory patients with essential hypertension and chronic obstructive pulmonary disease. Both the ability of prazosin to control high blood pressure and its effects on pulmonary function were observed. Systolic and diastolic blood pressures were significantly reduced at the end of the maintenance period. Of the 17 patients completing the trial, 82.4 percent attained a target diastolic blood pressure of less than 90 mm Hg, and 70.6 percent attained a diastolic reduction of greater than 10 mm Hg. Results of six-hour pulmonary function tests showed no significant differences after dosing with placebo or with prazosin. There was a significant increase in the number of patients who noted increased wheezing, but these patients did not have any increase in cough or sputum symptoms.

Asthma↗

PubMed1989

Comparative effects of pirbuterol acetate, metaproterenol, and placebo aerosols on pulmonary function and incidence of cardiac ectopy.

This single-center, double-blind, randomized study compared the efficacy and safety of single-dose pirbuterol aerosol (0.2 mg and 0.4 mg) with metaproterenol (1.3 mg) and placebo aerosols. Twenty-four patients with asthma or chronic obstructive pulmonary disease (COPD) completed this crossover design study. Statistically significant improvement over placebo (p less than 0.05 to p less than 0.001) was noted for pirbuterol 0.2 mg and 0.4 mg in FEV1 (forced expiratory volume in 1 second) duration, peak, and area under the curve (AUC) responses, and in maximum midexpiratory flow rate (MMEF) peak and AUC responses. Pirbuterol at both the 0.2 mg and 0.4 mg doses demonstrated statistically significant improvements in pulmonary function tests and clinical assessment over metaproterenol 1.3 mg. Both drugs were well-tolerated and neither drug increased cardiac ectopy, as measured on 5-h Holter monitor tapes.

Adult↗

PubMed1988

The effects of dilevalol, metoprolol, and placebo on ventilatory function in asthmatics.

Dilevalol combines a nonselective blocking action on beta-receptors with selective beta 2-agonist activity. In this double-blind, three-way, crossover study, the effects of relatively high single doses of dilevalol (400 mg), metoprolol (200 mg), a placebo on pulmonary function and their interaction with isoproterenol (160 and 480 micrograms) were evaluated in 16 patients with reversible bronchial asthma [isoproterenol-induced increase in forced expiratory volume in 1 s (FEV1) of greater than or equal to 15%]. When the lowest or minimum values observed during the 2 h postdrug evaluation period were considered, there was no significant difference from baseline in the percentage change in FEV1 after placebo (-4.4%) and dilevalol (-10%), with the difference between these treatments not being statistically significant. However, following metoprolol, FEV1 decreased by 18.3%, a decrease significantly different (p less than 0.01), from baseline and from the effects of placebo (p less than 0.01), although not from dilevalol. Furthermore, following metoprolol, 7 of 16 patients (44%) showed a greater than or equal to 20% decrease in FEV1 as compared to only 3 patients (19%) following dilevalol and 1 patient (6%) following placebo. The effects of the three treatments on forced vital capacity (FVC) and maximal midexpiratory flow (MMEF) were qualitatively similar to those observed in FEV1. Both dilevalol and metoprolol similarly and significantly (p less than or equal to 0.01) inhibited the isoproterenol (160 and 480 micrograms) response in FEV1 as compared to placebo.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1988

Comparative trials of doxycycline versus amoxicillin, cephalexin and enoxacin in bacterial infections in chronic bronchitis and asthma.

The comparative efficacy of doxycycline versus amoxicillin, cephalexin, cefaclor and enoxacin was examined in four separate cross-over and blinded studies of acute bacterial bronchitis in chronic bronchitis and asthma. The efficacy of doxycycline over the eleven-year period (1975-1986) covered by these studies also was examined. Patients with acute bacterial exacerbations, defined by increased chest symptoms, increased bacteria and sputum neutrophilia, were randomly entered. When a new acute infection occurred, they were re-entered and received the other antibacterial. Response was recorded as successful or not; early rebound infections and the periods free of infection were noted. A total of 136 exacerbations were evaluated in the comparison of doxycycline with the other 4 antibacterials, and 93 exacerbations in the long-term efficacy of doxycycline. The acute success was similar for doxycycline with the other antibacterials and was superior to cefaclor. Early rebound infections occurred less frequently with doxycycline as compared to the cephalosporins and was similar versus amoxicillin and enoxacin. The infection-free period was longer after doxycycline than with the other four antimicrobials. Doxycycline maintained its efficacy to elicit a prompt response and provide a long infection-free period, but an increase of early rebound infections was noted over the eleven-year period.

Adult↗

PubMed1987

Acute bacterial exacerbations in bronchitis and asthma.

Symptomatic exacerbations are frequent problems in the management of chronic bronchitis and bronchial asthma. Identification of a bacterial etiology as the cause of specific exacerbations should be based on changes in clinical symptoms and documentation of significant bronchial bacterial flora and a neutrophilic inflammatory response. Most acute bacterial exacerbations in patients with bronchitis or asthma are caused by Hemophilus influenzae, Streptococcus pneumoniae, or Branhamella catarrhalis. Treatment with ampicillins, synthetic tetracyclines, or trimethoprim/sulfamethoxazole is successful in 80 to 90 percent of bacterial exacerbations. Emergence of resistant Hemophilus species and pneumococci motivates development of new orally administered antimicrobial drugs. Appropriate treatment depends on the prompt recognition that bacterial infection is present. Once instituted, antimicrobial therapy should be continued for a minimum of 10 to 14 days, which should increase the duration of the infection-free period until the next bacterial exacerbation. Adequate response should be evaluated by the return of symptoms to pre-infectious levels and by decreased sputum bacterial flora and neutrophilic inflammation.

Anti-Bacterial Agents↗

PubMed1985

A multicenter trial of the prophylactic effect of ketotifen, theophylline, and placebo in atopic asthma.

Three hundred seventy-four patients with asthma were entered into a year-long, double-blind, double-placebo controlled study comparing the prophylactic effect of ketotifen (229 patients), theophylline (73 patients), and placebo (72 patients). The ketotifen group was larger to allow the accumulation of additional long-term safety data. The primary measure of therapeutic effect was a decrease in concomitant medication without a significant increase in symptomatology or a decrement in pulmonary functions. A patient daily diary was used to document symptoms (cough, shortness of breath, and wheeze) and concomitant medications taken during the 2-week baseline and the subsequent 12 monthly periods. After 2 months of study-drug therapy, the ketotifen patients had a greater decrease in both concomitant medication and symptomatology than either of the other groups. This delay in the onset of therapeutic activity has been observed in other studies and is characteristic of this compound. The principal side effect observed with ketotifen is initial sedation, which was found to be self-limiting and of little concern to the patient after the first month.

Adolescent↗

PubMed1983

Sputum and blood eosinophils during corticosteroid treatment of acute exacerbations of asthma.

Eleven patients with chronic bronchial asthma were studied during a noninfectious exacerbation. Each patient received 80 mg of prednisone daily for three days. Spirometric values, total blood eosinophil counts, and 24-hour quantitation of sputum eosinophils were studied. Three patients had total blood eosinophil counts of less than 250 at the time of presentation. Statistical comparisons with findings on Day 0 showed significant improvements for the one-second forced expiratory volume, total blood eosinophil count, and sputum eosinophil number. On Day 7, the one-second forced expiratory volume maintained a statistically significant difference from that on Day 0, but the total blood eosinophil count did not. Analysis of correlation coefficients showed significant relation between the total blood eosinophil count and one-second forced expiratory volume, the sputum eosinophil count and one-second forced expiratory volume, and the sputum eosinophil and total blood eosinophil counts. The conclusions are (1) blood eosinophilia is not an invariable feature of acute exacerbations of asthma; (2) numbers of blood and sputum eosinophils reflect the response of an acute exacerbation of asthma to corticosteroids; (3) sputum eosinophils may be more meaningful for monitoring the stable postcorticosteroid state; (4) there is no support for the belief that eosinophils disappear from the sputum of asthmatic patients with clinically effective doses of corticosteroids.

Acute Disease↗

PubMed1983