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Biomedical subjects

S L Spector

Publications and source records attributed to S L Spector.

At least 73 records · Page 4Linked to original sources
PubMed1989

Acute respiratory emergencies in emergency treatment of the injured athlete.

Exercise and physical fitness are becoming increasingly popular in our society. As a result there are more individuals who are at risk for the development of acute respiratory emergencies associated with sports and athletics. EIB is a common feature of asthma and is characterized by a postexercise fall in FEV1 of more than 10 per cent. Although a variety of medications have been used for the prevention of EIB, cromolyn sodium and inhaled adrenergic agonists have been shown to be the most effective. EIA and cholinergic urticaria are two physical allergies in which hypotension can be brought on by exercise. In some individuals, EIA develops only in association with the ingestion of a particular food. Associated with sports and recreational activities in alpine areas is the risk of developing acute high-altitude medical problems. One of the most dramatic and potentially life threatening is high-altitude pulmonary edema. The management of this condition can be problematic, particularly if rapid descent to lower elevations is not possible. Although rare, spontaneous pneumothorax and pulmonary emboli do develop in the otherwise well-conditioned athlete. These entities must be considered when the physician evaluates any athlete in whom acute cough and dyspnea develop.

Acute Disease↗
PubMed1989

Outpatient treatment of asthma.

The proper management of the patient with asthma demands consideration of both medical and social factors. Although a nonpharmacologic approach is preferred, it is often necessary to prescribe medication for the treatment of asthma. Although theophylline remains a highly effective medication, corticosteroid aerosols and cromolyn are gaining in popularity and beta adrenergic agonists with longer and longer duration of action continue to be of major importance for first line treatment. Oral corticosteroids remain invaluable in the treatment of severe asthma. The role of other agents such as anticholinergics, antihistamines and products undergoing development might serve to change our therapy in the future. Physicians should not be hesitant to adapt if new concepts regarding pharmacologic or nonpharmacologic management suggests need for a modification of our present conceptualization of what's best for our patients.

Ambulatory Care↗
PubMed1988

Double-blind comparison of terfenadine, chlorpheniramine, and placebo in the treatment of chronic idiopathic urticaria.

The efficacy of terfenadine, a nonsedating H1 antihistamine, in the management of chronic idiopathic urticaria was compared with chlorpheniramine and placebo in a parallel multicenter trial. Subjects with symptoms of hives for 3 days per week for at least 6 weeks were initially screened and admitted if no identifiable cause for symptoms could be determined. Patients entered a single-blind placebo period, and if hives of moderate severity were present for at least 3 days during the week, they were randomly assigned in a double-blind fashion to take terfenadine, 60 mg twice daily, chlorpheniramine, 4 mg three times a day, or placebo for 6 weeks. Data were analyzed for 122 patients. Those patients receiving both active treatments noted significant improvement in symptoms: pruritus, redness, number of hives, and waking hours during which hives were present, at the end of the first day of therapy. Symptom control by terfenadine was statistically superior to placebo during all 6 weeks, as rated by both patients and investigators. However, statistical significance was not achieved for chlorpheniramine at all observation points. Diphenhydramine was permitted as a relief medication for refractory symptoms and was taken by 52% of subjects receiving placebo, 26% taking chlorpheniramine, and only 9% of patients who were receiving terfenadine. In addition to providing superior symptom control, terfenadine caused less drowsiness and fatigue than chlorpheniramine. Terfenadine is a useful therapeutic agent for primary management of chronic idiopathic urticaria.

Adolescent↗
PubMed1987

A dose-response study of the bronchodilator action of azelastine in asthma.

Azelastine is an orally effective inhibitor of mediator activity in allergic reactions and has also been demonstrated to have bronchodilator activity. In this randomized, double-blind, placebo-controlled, multicenter study, 150 patients, aged 12 to 60 years, with moderate to severe asthma, received a single oral dose of 2, 4, 8, 12, or 16 mg of azelastine or placebo. Theophylline was stopped 24 hours and other bronchodilators at least 8 hours before the study day. Patients were evaluated for 8 hours after dose by spirometry and were monitored for adverse effects. All doses of azelastine produced bronchodilation with 4 mg greater than 2 mg greater than placebo; higher doses did not increase magnitude or duration of effect. We conclude that azelastine produces significant bronchodilation of long duration. The optimal dose appears to be 4 mg for adolescent and adult patients with asthma.

Adolescent↗
PubMed1987

Pharmacodynamic evaluation of azelastine in subjects with asthma.

A broad antiallergic compound called azelastine was studied pharmacodynamically in 34 subjects to correlate bronchodilator effect with blood levels of azelastine and desmethyl azelastine, its major metabolic product in man. Despite azelastine and desmethyl azelastine blood levels that were proportionate to the dosage range, the bronchodilator effect as measured by FEV1 and forced expiratory flow rate between 25% and 75% of FVC was proportionately greater with 4 mg of azelastine during the 8-hour study period than the anticipated bronchodilator response with the 8 and 16 mg doses. Azelastine, already proven effective in allergic rhinitis, has a bronchodilator effect at doses that do not produce intolerable side effects.

Adolescent↗
PubMed1987

A comparison of inhaled albuterol and cromolyn in the prophylaxis of exercise-induced bronchospasm.

Inhaled albuterol and cromolyn by spinhaler have both been shown to be effective in the treatment of exercise-induced bronchospasm. Eighty subjects with exercise-induced bronchospasm participated in a randomized parallel group study comparing albuterol (180 microgram) and cromolyn (20 mg) administered 15 minutes prior to a standardized treadmill challenge. The cromolyn group was restudied after 2 and 4 weeks of 4 times/day cromolyn therapy. The albuterol group was also studied at 2 and 4 weeks, but they only used their inhaler as needed between study visits. The mean maximum FEV1 drop post-exercise in the albuterol group improved from 33% (screening visit) to 6% (treatment day 1). The cromolyn group showed significantly less (P less than .01) improvement than the albuterol group (31% drop at the screening visit to 14% drop at treatment day 1). When 2 or 4 weeks of continuous cromolyn therapy was given in addition to a dosage 15 minutes prior to exercise, there was no significant difference compared with acute cromolyn administration alone. In summary, acute administration of albuterol was better prophylaxis for exercise-induced bronchospasm than acute or chronic cromolyn treatment.

Administration, Inhalation↗
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

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

Optimum management of asthma in pregnancy.

In pregnancy complicated by asthma, the greatest risk to the fetus is severe and uncontrolled bronchospasm resulting in hypoxia. For this reason, the priority in management of the pregnant asthmatic should be effective control of asthma symptoms with an appropriate amount of asthma medication to accomplish this goal. In general, the management of the pregnant asthmatic does not differ greatly from that of the non-pregnant asthmatic. Virtually none of the commonly used asthma medications are totally contraindicated in pregnancy if their use is justified by the severity of the asthma in pregnancy. These include optimising non-pharmacological means of controlling symptoms, using the smallest doses of antiasthma drugs necessary to control symptoms, basing the decision to use a drug on its benefit-to-risk ratio, avoiding recently introduced drugs (for which safety in pregnancy has not been adequately established), and using the inhaled route in preference to the oral route of administration. Ideally any changes in management should be made before the anticipated pregnancy. Well-controlled asthma appears to pose little risk to either the pregnant mother or the fetus and a favourable outcome of the pregnancy should be anticipated. The patient's justifiable anxiety can often be alleviated by ensuring that she fully understands the objectives of her management and participates in it.

Asthma↗
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

Advantages and disadvantages of 24-hour theophylline.

The general trend in medical therapy toward once-daily administration has not escaped theophylline preparations. Rapid metabolizers, as are found especially among children and smoking adults, may require a more frequent interval than once-a-day dosing, and greater fluctuations in theophylline levels should be expected. An interaction with food has been seen with once- and twice-daily theophylline preparations. Some products release their contents more rapidly while others do so more slowly in association with a high-fat diet. The food effect is of little concern if the theophylline is taken 1 hour before the meal. The greatest anticipated value of once-daily theophylline medications would be improved patient compliance.

Adrenergic beta-Agonists↗