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Biomedical subjects

S Kesten

Publications and source records attributed to S Kesten.

At least 19 recordsLinked to original sources
PubMed1995

Aprotinin reduces blood loss in lung transplant recipients.

After early experience with perioperative bleeding in sequential single-lung transplant recipients, aprotinin was introduced in an attempt to reduce this complication and the attendant morbidity. Records of sequential single-lung transplantations (n = 33) performed between January 1989 and November 1991 were reviewed to assess the impact of aprotinin on perioperative blood loss and blood product requirements. Recipients were divided according to whether or not they required cardiopulmonary bypass. In patients requiring cardiopulmonary bypass (n = 15), mean estimated postoperative blood loss was 3,000 +/- 500 mL in those who did not receive aprotinin (n = 4) compared with 1,177 +/- 253 mL in those who received aprotinin (n = 11) (p < 0.05). An average of 8.0 +/- 0.7 units of packed red blood cells were administered to patients not receiving aprotinin compared with 3.1 +/- 0.7 units to those who received aprotinin (p < 0.05). Requirements for fresh frozen plasma were similar in each group. There were no differences in blood loss or blood product replacement in the group not undergoing cardiopulmonary bypass (n = 18). Therefore, we conclude that aprotinin decreases postoperative blood loss and blood product requirements in patients undergoing sequential single-lung transplantation under cardiopulmonary bypass.

Aprotinin↗
PubMed1995

Adverse effects of inhaled corticosteroids.

Inhaled corticosteroids are considered by many to be the anti-inflammatory therapy of choice in adult asthma, given their remarkable efficacy and apparent safety. They are presently being prescribed to more patients, at larger doses, and for longer periods of time than ever before. Oropharyngeal candidiasis and dysphonia are the most commonly recognized adverse effects of therapy, but these topical phenomena cause no significant morbidity and are easily managed. By contrast, there is now increasing concern about the potential systemic effects of inhaled corticosteroids. These putative effects may include adrenal suppression, bone loss, skin thinning, increased cataract formation, decreased linear growth in children, metabolic changes, and behavioral abnormalities. Changes in adrenal function have been noted in patients using medications such as beclomethasone dipropionate and budesonide in doses exceeding 1,500 micrograms/day. The clinical relevance of these changes has yet to be clarified. Several short-term and cross-sectional studies have also revealed changes in biochemical markers of bone turnover and retrospective studies have found reduced bone density in asthmatics treated regularly with inhaled steroids. Long-term prospective studies assessing bone density changes remain to be done. Although much controversy exists, there is no unequivocal evidence that conventional doses of inhaled steroids significantly retard bone growth in children. Reports on skin changes, increased cataract formation, and behavioral changes are difficult to interpret because of several confounding factors. Although inhaled steroids should, at the present time, continue to be a recommended therapeutic option to all patients with symptomatic asthma, they should always be used in the lowest dosage compatible with disease control.

Administration, Inhalation↗
PubMed1995

Pleural complications in lung transplant recipients.

Pleural complications occurred in 30 (22%) of 138 patients after 53 single and 91 double lung transplants between September 1986 and February 1993. These were defined for the purpose of this study as pneumothorax persisting beyond the first 14 postoperative days, recurrent pneumothorax, or any other pleural process that necessitated diagnostic or therapeutic intervention. Overall, a higher pleural complication rate was seen in double lung transplantation (25 of 30) than in single lung transplantation (5 of 30) with no differences noted in the frequency among preoperative diagnostic groups (p > 0.05). Pneumothorax was the most frequent complication, affecting 14 of 30 patients, with 6 of 14 cases occurring after transbronchial biopsy. All pneumothoraces in single (n = 4) and double lung transplantation (n = 10) resolved spontaneously or with chest tube thoracostomy. One patient required placement of a Clagett window after open lung biopsy and another required thoracotomy and pleural abrasion after transbronchial biopsy. Parapneumonic effusion was observed in 4 of 30 double lung transplantations with spontaneous resolution in all cases. Empyema affected 7 of 30 patients and occurred exclusively in the double lung transplant group. Sepsis developed in three of the patients with this complication and they subsequently died. The risk of empyema was independent of preoperative diagnosis (p > 0.05). Of interest, all patients with cystic fibrosis (n = 3) with complicating empyema had Pseudomonas cepacia in the pleural fluid. Other miscellaneous complications included subpleural hematoma, chylothorax, and hemothorax. The latter two necessitated thoracic duct and bronchial artery ligation, respectively. In summary, a significant proportion of lung transplant recipients will have pleural space complications. The vast majority of these will resolve spontaneously or with conservative procedures. These complications were not related to preoperative diagnosis nor associated with a significant prolongation of hospital stay (p > 0.05). Empyema is the only pleural space complication associated with increased patient mortality and, as such, is an important clinical marker for those at risk for sepsis and death.

Adult↗
PubMed1995

Dose-related decrease in bone density among asthmatic patients treated with inhaled corticosteroids.

BACKGROUND: Inhaled corticosteroids are being prescribed more commonly and in higher doses than previously in the management of asthma. Although these topically active compounds have less potential for systemic impact than oral steroids, biochemical markers suggest that they are not devoid of systemic side effects. We conducted this study to investigate the effect of commonly prescribed doses of inhaled steroids on bone density. METHODS: We studied 36 patients with asthma. Those in group A (n = 18) had been taking inhaled beclomethasone dipropionate or budesonide in a dosage of 800 micrograms or more per day for at least 1 year. Those in group B (n = 18) had used only bronchodilator therapy. Adrenal function was assessed by morning serum cortisol level and by short adrenocorticotropic hormone stimulation test. Bone turnover was assessed by measurement of serum osteocalcin, alkaline phosphatase, and urinary pyridinium cross-links. Bone mineral density was measured by dual-energy x-ray absorptiometry with a Hologic QDR-1000 densitometer (Hologic Inc., Waltham, Mass.). RESULTS: Group A, mean age (SD) = 36.6 (8.4) years, had used inhaled corticosteroids at a mean dose of 1323 micrograms/day (range, 800 to 2000 micrograms/day) for a median duration of 24 months. Group B, mean age (SD) = 33.4 (8.1) years, had not been taking any form of steroid. Four patients from group A had suppressed morning serum cortisol; three of these had abnormal adrenocorticotropic hormone stimulation test results. All patients in group B had normal baseline adrenal function and an appropriate response to adrenocorticotropic hormone. Mean serum osteocalcin level in group A was significantly lower than that in group B (8.8 vs 14.2 ng/ml, p = 0.0003). Bone density measurements showed parallel changes: in group A the mean Z score (SD) of the femoral neck was -0.78 (1.02), significantly below predicted normal values (p = 0.0025). Mean Z scores of the lumbar spine and of femoral Ward's triangle were not significantly reduced. In group B the mean Z scores of the lumbar spine, femoral neck, and femoral Ward's triangle were all within normal limits. In group A the dose duration of inhaled corticosteroid therapy corrected for body mass index correlated negatively with bone density and adrenal function measurements. CONCLUSION: We conclude that the regular use of conventional doses of inhaled corticosteroids by patients with asthma can suppress adrenal function and decrease bone density in a dose-related fashion.

Administration, Inhalation↗
PubMed1995

Treatment of presumed and proven acute rejection following six months of lung transplant survival.

The gold standard for the diagnosis and subsequent treatment of acute rejection of lung allografts is the demonstration of rejection on transbronchial biopsy specimens. However, treatment may be initiated in the case of a compatible clinical scenario in the absence of definitive histologic documentation. In the Toronto Lung Transplant Program, we have treated patients with a decline in FEV1 and no evidence of infection with augmented systemic steroids for a presumed diagnosis of rejection. We retrospectively reviewed all episodes of acute rejection that occurred beyond 6 mo after transplant where treatment with augmented steroids had been initiated. A total of 72 treatments with augmented steroids were initiated in 45 patients who underwent 47 transplant procedures. FEV1 showed at least a 10% improvement following steroids in 14 of 72 (19%). FEV1 continued to decline by at least 10% in 32 of 72 (44%). Changes in FEV1 between +10 and -10% occurred in 26 of 72 (36%); of those episodes, 19 showed a decline of < 10%. Histologic evidence of at least grade II rejection was documented in only 16 cases. In those cases, FEV1 improved by at least 10% in 7 of 16 (44%), whereas it declined by at least 10% in 4 of 16 (25%). Spirometric evidence of bronchiolitis obliterans syndrome developed within 3 mo of the treated rejection episode in at least 20 of 47 transplants (43%). We conclude that treatment with augmented systemic steroids for presumed and histologically proven acute rejection beyond 6 mo after transplant is often ineffective in improving spirometry.

Acute Disease↗
PubMed1995

Gas trapping as a predictor of positive methacholine challenge in patients with normal spirometry results.

Methacholine challenge studies are often conducted to diagnose asthma in patients with mild or intermittent respiratory symptoms when screening spirometry results are normal. We hypothesized that in patients with increased nonspecific bronchial hyperreactivity (NSB-HR), gas trapping might be present and that this information could be a factor in clinical decision making. To assess the relationship between gas trapping and NSBHR, we conducted a retrospective chart review of 500 patients who had undergone pulmonary function testing, including lung volume measurement and methacholine challenge. Measurements of airflow, lung volumes, and methacholine PC20 values were compiled and analyzed. FRC was determined by body plethysmography (FRCB) and by helium dilution (FRC-He). FRCB-FRC-He, RV (percent of predicted) RV/TLC, and RV/TLC (percent of predicted) were used as measures of gas trapping. RV% and RV/TLC% were the best predictors of a PC20 < or = 8 mg/mL. In the subset of 169 patients who had FEV1/FVC > or = 90% of pred, an RV/TLC% value of 125% of predicted or greater had a positive predictive value of 62.5% and a negative predictive value of 62.0%. RV/TLC% was the only measure of gas trapping that was associated with a PC20 < or = 8 mg/mL (p < 0.05). Linear regression revealed no correlation between any measure of gas trapping and quantified PC20 value (< or = 16 mg/mL). These results suggest that patients with a normal FEV1/FVC who show gas trapping have an increased likelihood of a positive methacholine challenge study. Furthermore, in these patients, RV/TLC (percent of predicted) is the best predictor of a positive methacholine challenge and this parameter may be useful in raising the clinical suspicion of asthma in the large population of patients presenting with respiratory symptoms and normal flow rates.

Adolescent↗
PubMed1995

Health-care utilization after near-fatal asthma.

Near-fatal asthma has been repeatedly associated with an increased risk of premature death. Despite a higher risk, death after near-fatal asthma remains infrequent. Few studies have examined the long-term outcome of those who experience a near-fatal event but do not succumb to asthma. We therefore contacted patients who had an episode of near-fatal asthma 5 to 10 years earlier and documented their use of health-care services for asthma. Each index case was compared with two age-matched controls who had been hospitalized for severe but not near-fatal asthma within 2 years of the index case admission. Thirty-seven index cases and 74 control subjects were assessed. Demographics did not distinguish the two groups. Availability of primary care physicians and asthma specialists were similar. There was no difference in the frequency of hospitalizations, emergency room visits, or visits to physicians for asthma between the two groups. ICU admissions were extremely infrequent. Although the mean number of ICU admissions per subject were similar in the year preceding our contact (0.03 +/- 0.16 in each group), there was a trend toward ICU admissions occurring more often in the near-fatal group (0.62 +/- 1.67 vs 0.31 +/- 0.91 admissions/subject). Days away from work were more frequent in the control group (3.5 +/- 5.5 vs 1.6 +/- 3.3 d/yr) including days away from work in the year preceding our contact (8.9 +/- 43 vs 1.8 +/- 6.1 d). The data suggests that with regards to characteristics and health-care utilization, it may not be possible to distinguish people with near-fatal asthma from those who are hospitalized without a near-fatal event.

Acute Disease↗
PubMed1995

Air quality and the frequency of emergency room visits for asthma.

BACKGROUND: Atmospheric pollution has been proposed as one of the possible factors responsible for increases in asthma mortality and morbidity. OBJECTIVE: We sought to examine whether we could demonstrate a relationship between emergency room visits for asthma and alterations in environmental conditions. METHODS: Over a 1-year period, the frequency of emergency room visits for asthma in a large urban hospital were documented and compared to outdoor concentrations of SO2, NO2, and ozone in addition to two overall measures of air quality (air pollution index and air quality index). RESULTS: A total of 854 emergency room visits were noted with the highest number of visits occurring in May and between September and December. Significant variations in the frequency of visits as well as environmental conditions could be seen on a daily basis. Despite comparisons of results on a daily, weekly, and monthly basis, no significant relationships could be found between any of the pollution indices and emergency room visits. Staggering visits by 1 and 7 days, however, revealed a relationship between emergency room visits and air pollution index and air quality index. An association between emergency room visits and NO2 and ozone was seen when visits were staggered by 7 but not by 1 day. CONCLUSIONS: We conclude the fluctuations in overall air quality are associated with increased frequency of emergency room visits but only when data are lagged by a predefined period.

Air Pollutants↗
PubMed1994

Regular vs as-needed inhaled salbutamol in asthma control.

Recent studies have suggested that regular use of inhaled beta 2 agonists cause loss of asthma control as measured by worsening peak-flow rates, increased asthma symptoms, and more frequent need for supplementary bronchodilators. However, the magnitude of this effect and the reliability of investigator-originated definitions of control is unknown. We studied 341 people with asthma in a four-week, randomised, crossover trial of regular salbutamol (2 puffs--200 micrograms--four times daily) for two weeks and as needed for two weeks. There were no significant differences in morning and evening peak-flow rates between treatments but asthma symptoms and supplementary bronchodilator use were significantly less frequent when salbutamol was given regularly. Asthma episodes occurred 1.39 (1.52) times per day during regular treatment and 2.44 (1.75) times per day during as-needed treatment (p < 0.0001) and 0.50 (0.56) vs 0.65 (0.66) times per night (p < 0.0001). Daytime use of supplementary salbutamol was 1.14 (1.40) vs 2.35 (1.71) puffs per day, (p < 0.0001); night-time use was 0.45 (0.55) vs 0.64 (0.66) puffs per night (p < 0.0001). When control endpoints were compared between treatment periods for each individual by two blinded investigators and control judged by six different sets of criteria, in 70 asthmatics there was no difference in symptom control between periods but in the remainder, control was achieved more often by regular than by as-needed salbutamol (166 vs 69, p < 0.0001). In asthma of moderate severity, regularly administered salbutamol does not produce lower peak flow rates than as-needed salbutamol and is associated with less frequent asthma symptoms.

Administration, Inhalation↗
PubMed1994

Medical personnel's knowledge of and ability to use inhaling devices. Metered-dose inhalers, spacing chambers, and breath-actuated dry powder inhalers.

BACKGROUND: Current treatment strategies for asthma and chronic obstructive pulmonary disease (COPD) emphasize the inhalation route, yet patients often misuse metered-dose inhalers (MDI). To address this problem, patient education by medical personnel has been recommended and a variety of alternate inhaler devices have been developed. METHODS: We surveyed medical personnel to assess their knowledge of and ability to use three widely used inhaler devices; MDI, MDI with a spacing chamber (Aerochamber, Trudell Medical, Canada), and a breath-actuated multidose dry powder inhaler (Turbuhaler, Astra Pharmacy, Inc., Conada). Thirty respiratory therapists (RT), 30 registered nurses (RN), and 30 medical house staff physicians (MD) were asked to demonstrate the use of each device using placebo inhalers and to answer 11 clinically relevant questions related to the use and maintenance of the tested devices. RESULTS: The RT's percent mean knowledge score (67 +/- 5 percent) was significantly higher than those achieved by either the RNs (39 +/- 7 percent) or the MDs (48 +/- 7 percent) (for all p < 0.0001). Similarly, percent mean demonstration scores for each device were significantly higher for RTs than either RN or MD groups; for MDI, 97 +/- 3 percent versus 82 +/- 13 percent and 69 +/- 24 percent, respectively (p < 0.0001); for the Aerochamber, 98 +/- 2 percent versus 78 +/- 20 percent and 57 +/- 31 percent (p < 0.0001); and for the Turbuhaler, 60 +/- 30 percent versus 12 +/- 23 percent and 21 +/- 30 percent (p < 0.0001). Knowledge of and practical skills with the devices were roughly proportional to the length of time the device had been in clinical use, Turbuhaler demonstration scores being lower than either MDI or Aerochamber scores (p = 0.05 and p = 0.09, respectively). More RTs (77 percent) had received formal instruction on the use of devices at school than either RNs (30 percent) or MDS (43 percent) (p < 0.05). CONCLUSION: We conclude that (1) many medical personnel responsible for monitoring and instructing patients in optimal inhaler use lack rudimentary skills with these devices, (2) nurses and physicians seldom receive formal training in the use of inhaling devices, and (3) newer inhaling devices designed to obviate problems of technique are at present less likely to be used well by medical personnel soon after their introduction.

Clinical Competence↗
PubMed1994

Is the short-term response to inhaled beta-adrenergic agonist sensitive or specific for distinguishing between asthma and COPD?

In view of the ubiquitous practice of using bronchodilator responsiveness to determine suitable patients for clinical trials, we wanted to know whether changes in FEV1 or forced vital capacity (FVC) really were useful in differentiating COPD from asthma. Pulmonary function test results from 450 patients were documented by two technicians who had been asked to select consecutive studies in which flow-volume loops showed an obstructive pattern. The respirologist responsible for the care of each patient was asked to record the clinical diagnosis from the existing outpatient chart using clinical judgment based on American Thoracic Society criteria. In 395 cases, a single, unambiguous diagnosis of asthma or COPD was recorded; this diagnosis then formed the database for subsequent analysis. While the mean change in FEV1 in patients judged to have asthma was different from that found in COPD patients (16.4 vs 10.6 percent, p < 0.01), the change in FVC was similar (9.8 vs 10.3 percent, p > 0.06). However the sensitivities and specificities of postbronchodilator changes in FEV1 (dFEV1) for the diagnosis of asthma were not generally sufficient to diagnose or exclude asthma reliably. The FEV1 correlated better with residual volume (RV) in COPD (r = -0.55 vs r = -0.31), but with total lung capacity (TLC) in asthma (r = 0.51 vs r = -0.09). However, FEV1 correlated better with the RV-TLC ratio than RV or TLC alone in both groups, the correlation in each being similar (asthma, r = -0.72; COPD, r = -0.78). We conclude that acute responses of FEV1 and FVC following a standard dose of inhaled bronchodilator are neither sufficiently sensitive nor sufficiently specific to differentiate asthma from COPD purely on spirometric grounds. Furthermore, neither RV nor TLC reflected degrees of airflow limitation as well as did the RV-TLC ratio.

Administration, Inhalation↗
PubMed1994

Patient handling of a multidose dry powder inhalation device for albuterol.

BACKGROUND: Studies have suggested that novel inhaling devices may be misused by patients and medical personnel in the clinical setting soon after their introduction. to assess the adequacy of patient handling of a newer multidose dry powder albuterol inhaler, we conducted a comprehensive survey of use in primary and respiratory practices. METHODS: Patients 6 years of age and older and requiring inhaled beta 2-agonist for the treatment of stable obstructive airways disease were recruited from the practices of primary care and specialist physicians. After instruction from their physician or clinic staff in the use of a multidose dry powder albuterol inhalation device (Diskhaler), patients used the device in unblinded fashion for 2 weeks instead of their usual beta 2-agonist. After 2 weeks, patient use of the device was assessed at a return clinic visit. RESULTS: A total of 4,529 patients with reversible airways obstruction participated in a 2-week assessment of the device and compared it with their previous beta 2-agonist delivery system. Significantly more patients preferred the dry powder device (54 percent) over their previous device (29 percent) (p < 0.001), with 17 percent expressing no preference. After instruction, 98.5 percent of patients could demonstrate adequate use at the initial visit. Performance difficulties at the initial visit resulting in exclusion from the trial were infrequent but more common in the elderly (3 percent vs 0.2 percent for all other age groups combined, p < 0.001). Despite adequate use at the initial visit, at the conclusion of the trial, incorrect use of the device was noted in 10.2 percent of the elderly vs 3.2 percent of all other age groups combined (p < 0.001). Albuterol delivered by Diskhaler was well tolerated in all patient groups. CONCLUSIONS: A majority of patients are able to use a multidose dry powder albuterol inhaler device in the clinical setting, and prefer the device to previously used beta 2-agonist inhalation devices. However, follow-up shows that problems with device handling may become apparent in as little as 2 weeks after initial instruction, thereby mandating the need for periodic follow-up and reinstruction.

Administration, Inhalation↗
PubMed1994

Assessment of an ambulatory care asthma program.

In response to rising asthma morbidity and mortality, numerous comprehensive asthma programs have been developed. However, few studies have examined critically the effectiveness of such programs or the means by which treatment or outcome is altered. To assess the role of a specialized ambulatory asthma care program, we reviewed the interventions recommended to 344 patients referred for the assessment of asthma. A subset of 127 made return visits 6-12 months following their initial assessment, thereby allowing assessment of behavioral and physiological outcomes. At the initial consultation, the recommended medication changes were: inhaled beta-agonists +6% (p < 0.01), inhaled steroids +58% (p < 0.001), intranasal steroids +8% (p < 0.001), dry powdered formulations +13% (p < 0.01), theophylline -7% (p < 0.001). The percentage of patients using spacer devices increased 8% (p < 0.001). Comparing preassessment values to those at a visit at 6-12 months following assessment, a further 25% of patients taking inhaled steroids at the initial assessment had a change to either the dose, device, or frequency of administration. Mean FEV1 improved from 2.41 +/- 0.08 liters at the initial assessment to 2.64 +/- 0.09 liters at the 6-12-month visit (p < 0.001). There was an increase in the number of patients considered mild and not obstructed, with a corresponding decrease in the number considered moderately and severely obstructed (p < 0.05). The number of emergency room visits was reduced by more than 60% (p < 0.001) in patients followed for at least 6 months. We conclude that an ambulatory asthma program marked by increased use of inhaled anti-inflammatory medications and decreased use of theophylline can produce significant decreases in asthma exacerbations requiring hospital care, emergency room care, or systemic steroids while reducing the prevalence and severity of airflow limitation.

Administration, Inhalation↗
PubMed1993

Trends in asthma and chronic obstructive pulmonary disease therapy in Canada, 1985 to 1990.

BACKGROUND: In the mid and late 1980s, numerous changes were recommended in the management of obstructive lung diseases. We analyzed drug sales to determine whether these recommendations have resulted in recent changes in prescription drugs used in airway management. METHODS: Data on prescription sales in Canada from 1985 to 1990 were obtained from an international pharmaceutical market research organization. Data from a random sampling of physicians that reported patients seen along with the diagnosis and prescriptions given were also reviewed. RESULTS: From 1985 to 1990, there was a 38% increase in prescriptions of all airway drugs. Prescriptions increased significantly for inhaled drugs as follows: inhaled beta 2-agonists, 70%; inhaled steroids, 139%; cromoglycate, 88%; and ipratropium bromide, 204%. Theophylline prescriptions, by contrast, fell significantly, by 19%. Although theophylline was the most commonly prescribed airway medication in 1985, inhaled beta 2-agonists were the most commonly prescribed drug in 1990, and these changes in proportional use were significant. Increases in ipratropium bromide usage was accounted for by increases in prescriptions for chronic obstructive pulmonary disease. Increases in nonsteroidal antiinflammatory drugs were accounted for by asthma prescriptions. CONCLUSIONS: The increase in airway medication prescriptions dispensed in Canada is consistent with an increase in the number of patients treated, an increase in the severity of disease treated, or both.

Anti-Inflammatory Agents↗
PubMed1993

Evaluation of fluticasone propionate (500 micrograms day-1) administered either as dry powder via a Diskhaler inhaler or pressurized inhaler and compared with beclomethasone dipropionate (1000 micrograms day-1) administered by pressurized inhaler.

Five hundred and eighty-five patients with moderate asthma, currently receiving 400-1000 micrograms day-1 of an inhaled corticosteroid, were treated for 6 weeks in a double-blind, randomized, parallel group study with either 500 micrograms day-1 fluticasone propionate as a dry powder via a Diskhaler inhaler, 500 micrograms day-1 fluticasone propionate via a pressurized inhaler or 1000 micrograms day-1 beclomethasone dipropionate via a pressurized inhaler. For all three treatment groups, mean morning and evening peak expiratory flow rates (PEFRs) increased within 1 week of the start of treatment. There were also improvements in clinic lung function, daytime and night-time asthma symptoms and a reduction in daytime and night-time rescue bronchodilator medication in all three groups. There were no statistically significant differences between the two formulations of fluticasone propionate in any of the efficacy parameters. Fluticasone propionate via the Diskhaler was significantly more effective than beclomethasone dipropionate over the 6 week study period in reducing diurnal variation (mean difference--4 l min-1, 95% CI--8 to 0 l min-1: P = 0.03). Fluticasone propionate via the Diskhaler produced a statistically significant improvement in night-time symptoms when compared to beclomethasone dipropionate whereas, beclomethasone dipropionate 1000 micrograms day-1 was statistically significantly more effective than both formulations of fluticasone propionate in improving daytime symptoms (P < 0.05). However, these statistical differences must be viewed together with the fact that very few patients recorded a score of 2 or more for both daytime or night-time symptoms. There was a similarly low incidence of adverse events with all three treatments with no evidence of hypothalamic pituitary adrenal (HPA)-axis suppression. The results of the 6-week comparative study showed that 500 micrograms day-1 fluticasone propionate whether administered via pressurized inhaler or Diskhaler is as effective and as safe as 1000 micrograms day-1 beclomethasone dipropionate administered via a pressurized inhaler in the treatment of moderate asthma. Over 12 months fluticasone propionate 500 micrograms day-1 via a pressurized inhaler was at least as effective and as well tolerated as beclomethasone dipropionate 1000 micrograms day-1.

Adolescent↗
PubMed1993

Miliary pulmonary cryptococcosis in a patient with the acquired immunodeficiency syndrome.

A 33 year old man with AIDS presented with fever, dyspnoea, cough and a miliary pattern on the chest radiograph. Cryptococcus neoformans infection was diagnosed from bronchoalveolar lavage bronchoscopy. This case supports the principle that, in patients with AIDS, pulmonary infections can exhibit variable radiographic features and that definitive diagnosis should always be considered.

AIDS-Related Opportunistic Infections↗