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Biomedical subjects

V Backer

Publications and source records attributed to V Backer.

70 records · Page 4Linked to original sources
PubMed1992

Time-related decrease in diffusion capacity in HIV-infected patients with impaired immune function.

The purpose of this study was to investigate acute and time-related changes in lung function, i.e. forced expiratory volume in 1 second (FEV1), vital capacity (VC) and transfer factor (KCO) in HIV-infected patients with CD4 cell counts less than 400 x 10(6)/l. 66 males with no history of HIV-related pulmonary symptoms participated in a prospective lung function study for 9 months with 3-month intervals between examinations. 15/66 patients (23%) developed acute pulmonary symptoms, i.e. dyspnea (n = 12), cough (n = 13), fever greater than 38 degrees C (n = 13) and interstitial infiltrates on the X-ray (n = 9). Among the 51 asymptomatic patients, a significant time-related decrease in KCO (median decrease of 7%) was found, whereas no significant change in FEV1 or VC was observed during the study. Baseline KCO, i.e. KCO at entry, was found to be significantly higher in the asymptomatic patients (102% predicted (pred.) than in those patients who developed pneumonia (88% pred.). Development of pulmonary symptoms was both followed by a significant decrease in KCO (median decrease 17%), FEV1 and VC. We therefore conclude that HIV-infected patients with impaired immune function have in the absence of pulmonary symptoms a decrease in KCO. In case of pneumonia an acute decrease in both KCO, FEV1 and VC occurs.

Adult↗
PubMed1992

Development of lung function in relation to increased degree of bronchial responsiveness.

To study the relationship between development of lung function and bronchial responsiveness, we examined 106 subjects recruited from a random sample of 527 subjects, aged 8-18 years, from Copenhagen. Lung function and bronchial responsiveness to inhaled histamine were measured at two occasions, in 1986 and 1988. The participating subjects (n = 106) were divided into three groups: (a) 20 asthmatics with bronchial hyperresponsiveness (BHR), (b) 42 nonasthmatic subjects with BHR in 1986, and (c) 44 controls without BHR. In 1986, FEV1 expressed as percentage of predicted value, was found to be similar in the three groups (91%, 94%, and 99%, respectively). The increase in height during the observation period was found to be 5, 6, and 6 cm, respectively, in the three groups. However, at the second examination, in 1988, FEV1 was found to be significantly reduced in both asthmatics (87%) and nonasthmatic subjects (85%) compared with the controls (103%). In 1988, 16 asthmatics (80%) and 24 (57%) nonasthmatic subjects were found to have BHR, whereas none of the controls were found to have BHR. A multiple regression analysis was used to determine the correlation between change in FEV1 and potential factors of importance. The change in FEV1 was highly correlated with the presence of BHR in 1986, however, no correlation was found between change in FEV1 and change in bronchial responsiveness. In conclusion, nonasthmatic subjects with former BHR showed signs of airflow obstruction and less increase in lung function during growth irrespective of the change in level of bronchial responsiveness, which may suggest a risk for subsequent development of obstructive lung disease.

Adolescent↗
PubMed1992

Mortality and decline in lung function in 213 adults with bronchial asthma: a ten-year follow up.

The purpose of this longitudinal study was to describe mortality and change in lung function in adults with bronchial asthma, and furthermore to investigate a potential difference in the prognosis for patients with intrinsic and extrinsic asthma. Out of 213 asthmatics admitted to our hospital, 170 (82%) participated in a 10-year follow-up examination; according to the tests for extrinsic asthma at the first examination, the patients were divided into 117 patients with intrinsic asthma and 53 subjects with extrinsic asthma. Twenty-seven (13%) patients, 23 with intrinsic and 4 with extrinsic asthma, died during the observation period, which was almost twice the number expected in both intrinsic and extrinsic asthmatics, but because of the small number of patients with extrinsic asthma, the findings were statistically significant for the intrinsic asthmatics only (p less than 0.05). Seventeen (8.2%) died of pulmonary diseases, of whom 9 (6 patients with intrinsic asthma) died in an acute attack of bronchial asthma. After a questionnaire concerning respiratory symptoms had been answered, a lung function test was performed in all subjects in both 1976-1979 and 1988. A histamine challenge test was performed at the examination in 1988. Of the 143 subjects who were re-examined in 1988, 96% still had respiratory symptoms. The first lung function test in 1976-1979 showed no difference in FEV1 (% predicted) between the two groups, whereas the annual mean loss of FEV1 during the observation period for the intrinsic and extrinsic asthmatics was 50 ml and 22.5 ml, respectively (p less than 0.0001). Decline in FEV1 was found to be independent of smoking habits in both patient groups. We found that the decline in lung function increased with increasing age in both intrinsic and extrinsic asthmatics (p less than 0.001 and p less than 0.05, respectively). The so-called "horse-racing effect" could be demonstrated for the patients with extrinsic asthma (p less than 0.003); whereas no significant relation was found between FEV1 at the time of enrollment and decline of FEV1 for the intrinsic asthmatics. We conclude that asthmatic subjects have an excess mortality and that the prognosis for intrinsic asthma is worse than that of extrinsic asthma with regard to rate of decline in lung function.

Adolescent↗
PubMed1992

Atopy and bronchial responsiveness in random population sample of 527 children and adolescents.

The relationship between bronchial responsiveness, lung function, and results of skin prick testing was studied in 527 children and adolescents from Copenhagen. All participants completed a questionnaire concerning allergic symptoms (asthma, rhinitis, atopic dermatitis, and urticaria). Furthermore, skin prick test reactivity to nine common aeroallergens, lung function, serum IgE and bronchial responsiveness to histamine and exercise were measured. A total of 53 subjects were atopic, (skin prick 3+), 105 subjects had moderate skin reactivity (1-2+), and 366 subjects had no signs of atopic disease (prick test negative); 58% of the subjects with skin test reactivity (1-3+) were asymptomatic. Increasing degree of atopy was correlated significantly with symptoms such as asthma, rhinitis, dermatitis, and urticaria (P less than .001); increasing level of IgE (P less than .001); month of birth (P = .001); and family history of allergic diseases (P less than .05). The most important markers for the degree of bronchial responsiveness to inhaled histamine were the presence of respiratory symptoms (P less than .001), the degree of atopy (P = .001), a history of asthma in at least two first degree relatives (P less than .01), and the skin reactivity to house dust mites (P = .001), horse epithelium (P = .01), Alternaria iridis, and dog epithelium (P less than .05). In contrast, the degree of bronchial responsiveness to exercise was significantly correlated with asthma (P less than .001), the level of IgE (P less than .05), month of birth (P less than .001), and birth weight (P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Spontaneous changes in bronchial responsiveness in children and adolescents: an 18-month follow-up.

The purpose of this study was to investigate spontaneous changes in bronchial responsiveness to inhaled histamine over a period of 18 months. The first measurements in 495 subjects, 7 to 16 years of age, were made in 1986. Bronchial hyperresponsiveness (BHR), i.e., PC-20 FEV1 less than or equal to 8.0 mg/mL, was found in 79 (16%) individuals, of whom 28 (35%) had symptoms of asthma. Twenty asthmatic and 42 non-asthmatic subjects who had BHR (78%) were re-examined 18 months later. The asthmatics had a modest change in BHR, while in the non-asthmatics bronchial response to inhaled histamine and exercise was significantly decreased. In twenty-two subjects (36%) bronchial response was within the normal range; of these 18 were non-asthmatic. Six asthmatics (30%) and two non-asthmatics (5%) had an increased BHR at follow-up. Two subjects (5%) developed symptoms of asthma by the time of follow-up, with an unchanged degree of BHR. Sex, age, atopic symptoms, and viral respiratory infections at the first examination were unrelated to changes in bronchial responsiveness. However, changes of BHR in the non-asthmatic subjects were significantly correlated to changes in bronchial response to exercise. Although spontaneous changes in bronchial responsiveness occur in asthmatic, as well as non-asthmatic subjects, asthmatics persistently have hyperresponsive airways. Development of asthma was found to occur among subjects with persistent BHR.

Adolescent↗
PubMed1991

The distribution of bronchial responsiveness to histamine and exercise in 527 children and adolescents.

The aim of the study was to describe the bronchial responsiveness to inhaled histamine and exercise in a randomly selected group of 527 children and adolescents from Copenhagen, aged between 7 to 16 years. The distribution of the bronchial responsiveness was described as (1) the provoking concentration that causes a 20% reduction in FEV1 (2) the dose-response slope (DRS), that is, the linear slope of the dose-response curve, and (3) reduction in FEV1 after 6 minutes of exercise on a treadmill. The distribution of the concentration that causes a 20% reduction in FEV1 in the responsive range was not significantly different from a unimodal distribution, although the findings were skewed toward the less responsive end of the range (p greater than 0.05). The subjects with asthma represented a subgroup within the responsive distribution tail rather than a separate distribution peak. In asymptomatic individuals, the values of DRS were distributed symmetrically on a logarithmic scale. The deviation from normal was such that the standard deviation only slightly underestimated the "normal" range. The distribution of the bronchial response to exercise was found to be significantly different from a normal distribution. However, a significant relationship was found between the bronchial response to inhaled histamine and exercise (p less than 0.0001). We conclude that there is a log-normal distribution of the bronchial response to inhaled histamine in a random sample of children and adolescents.

Adolescent↗
PubMed1991

Sensitivity and specificity of the histamine challenge test for the diagnosis of asthma in an unselected sample of children and adolescents.

The purpose of this investigation was to study factors of importance for the degree of bronchial responsiveness and, furthermore, to evaluate the sensitivity, specificity and predictive value of a bronchial challenge test with histamine for the diagnosis of asthma in 495 randomly selected children and adolescents, aged 7-16 yrs, from Copenhagen, Rigshospitalet. Detailed history about allergic symptoms, physical examination and bronchial histamine challenge tests were performed at the out-patient clinic. Asthma, atopic disease and height were found to be of great importance for the degree of bronchial responsiveness, whereas the age, sex and smoking habits were of no significance. The percentage of asthmatics with bronchial hyperresponsiveness, i.e. sensitivity to the test, increased towards 100% on inhaling increasing concentrations of histamine, but this was accompanied by a decrease in specificity and predictive values of positive test in regard to the diagnosis of asthma. However, lower concentrations of histamine may be preferable in order to distinguish between asthma and non-asthma in population samples, as inhalation of 2.4 mg.ml-1 and provocative concentration producing a 20% fall in forced expiratory volume in one second (FEV1) (PC20) provided an acceptable sensitivity (57%), specificity (98%), and predictive value of a positive test (60%). We conclude that as regards the diagnosis of asthma, a low predictive value confirms that the bronchial challenge test plays only a supplementary, but valuable, role in detecting the disease in population samples.

Adolescent↗
PubMed1990

A follow-up study of pulmonary function in patients with primary Sjögren's syndrome.

Twenty-seven patients (25 women, 2 men) with primary Sjögren's syndrome, previously reported to have reduced pulmonary diffusing capacities were reexamined in a 7-year follow-up in order to evaluate longitudinal alterations in pulmonary function. Primary Sjögren's syndrome was diagnosed according to the Copenhagen criteria. The present examination revealed normal and unchanged values for vital capacity, forced expiratory volume in 1 s, maximal expiratory flow at 50% of expired vital capacity (MEF50), and diffusing capacity per liter alveolar volume. Total diffusing capacity (P less than 0.01) and MEF75 (P less than 0.05), were, however, significantly reduced compared with the predicted values, indicating pulmonary involvement primarily affecting the small airways. The longitudinal examination, furthermore, showed increasing values for total diffusing capacity (P less than 0.02), diffusing capacity per liter alveolar volume (P less than 0.001), and MEF75 (P less than 0.02), suggesting an improvement in lung status in the course of time. No correlation was found between MEF75 and diffusing capacities, nor between alterations in pulmonary function and complaints of dyspnoea, tiredness, cough, expectoration, tobacco smoking, or medical treatment with bromhexine, glucocorticosteroids, essential fatty acids, or nonsteroid antiinflammatory drugs.

Adult↗
PubMed1990

Pulmonary pathogens in HIV-infected patients.

On well defined criteria a total of 102 fiberoptic bronchoscopies (FB) were done on HIV-infected patients with pulmonary symptoms. A microbiological agent was identified in 85 patients (83%). Pneumocystis carinii (PC) was histologically verified in 61 patients, bacteria cultured in 22 patients, and cytomegalovirus (CMV) cultured in 17 patients. A histological diagnosis of CMV was only established in 2/17 patients. In the present study, a CMV positive culture from bronchial lavage fluid did not appear related to the clinical picture. Patients with P. carinii pneumonia (PCP) had significantly higher IgA, lower CD4-count, more commonly dyspnea and an X-ray showing diffuse interstitial infiltration than patients without PCP. Patients with bacterial pneumonia had significantly higher CD4-count, lower IgA, more commonly productive cough and an X-ray showing focal infiltration. In more than 75% of the patients, microorganisms identified were responsible for the pulmonary symptoms leading to bronchoscopy. Mainly PC and bacterial pathogens, both of which are treatable, were responsible for these infections. Pulmonary infections of clinical relevance besides PCP and bacterial infections were rare (3%, 95% confidence limit 1-8%).

Adolescent↗
PubMed1990

Prevention of Pneumocystis carinii pneumonia relapse by aerosolised pentamidine, 60 mg biweekly, using an Acorn System 22 nebuliser.

The effectiveness of biweekly administration of 60 mg aerosolised pentamidine (AP) as secondary prophylaxis against relapse of Pneumocystis carinii pneumonia (PCP) was investigated in 45 male AIDS patients. The nebuliser used was an Acorn System 22. In total the patients received AP for a mean period of 13.8 months (3.4-28.8). Six episodes of recurrent PCP were recorded. Relapse per full year of treatment on AP was 12%.

Acquired Immunodeficiency Syndrome↗
PubMed1989

The effect of astemizole on bronchial hyperresponsiveness and exercise-induced asthma in children.

The ability of the new generation H1-receptor antagonist, astemizole, to prevent histamine-induced airway obstruction and exercise-induced asthma (EIA) was studied in 20 children with asthma. The study was a randomised clinically controlled trial of oral astemizole versus placebo in a cross-over study. In each of the two treatment periods the children were tested at days 0, 6, 15 and 22 of therapy. The two treatment periods were separated by a washout period of 50 days, and at each visit a bronchial challenge with increasing concentrations of histamine followed by an exercise test was performed, and peak flow and asthmatic symptom score were recorded daily. The children tolerated significantly higher mean concentrations of histamine when treated with astemizole compared with placebo (P less than 0.001). Astemizole postponed the response to exercise, but no change in the maximal response was found. No differences between the treatment periods were found regarding frequency of asthmatic symptoms or the daily recording of peak flow.

Administration, Oral↗
PubMed1989

Prevalence and predictors of bronchial hyperresponsiveness in children aged 7-16 years.

To study the prevalence and possible predictors of bronchial responsiveness we examined a cross-section of 527 children aged 7-16 years from Copenhagen. The method used included an interview with the child and the parents, skin prick test with common allergens and se-IgE. Bronchial responsiveness was measured by a histamine inhalation test. We found that 79 (16%) of the children had bronchial hyperresponsiveness (BH), defined as a 20% fall in FEV1 with a provoking concentration of histamine (PC20) at 8 mg/ml or less. Atopic symptoms defined as asthma, rhinitis or eczema were significantly (P less than 0.001) correlated to BH both in prevalence and degree of BH. None of the children with urticaria had BH. The degree of bronchial responsiveness was also significantly influenced (P less than 0.001) by family disposition to atopy, whereas we found no correlation between BH and "passive" smoking, specific skin test in unselected children, or elevation of IgE in children without atopic symptoms. We conclude that BH is severest in children with asthma, independent of elevated IgE or positive skin prick test. Children with rhinitis, dermatitis, or asymptomatic BH have the same degree of BH; this differed from that in children with asthma.

Adolescent↗
PubMed1986

Intravenous magnesium in acute myocardial infarction.

In a double-blind, placebo-controlled study, 273 patients with suspected acute myocardial infarction (AMI) were randomised to receive either magnesium intravenously or placebo immediately on admission to hospital. Of 130 patients with proven AMI 56 received magnesium and 74 received placebo. During the first 4 weeks after treatment mortality was 7% in the magnesium group and 19% in the placebo group. In the magnesium group 21% of patients had arrhythmias that needed treatment, compared with 47% in the placebo group. No adverse effects of intravenous magnesium were observed.

Aged↗
PubMedDate not supplied

Salmeterol and fluticasone propionate (50/250 microg) administered via combination Diskus inhaler: as effective as when given via separate Diskus inhalers.

OBJECTIVE: To compare the efficacy and safety of a new combination Diskus inhaler containing both salmeterol 50 mg and fluticasone propionate 250 mg (Seretide) with the two drugs delivered via separate Diskus inhalers. DESIGN: A multicentre, double-blind, double-dummy study. Three hundred and seventy-one symptomatic asthma patients (age range 13 to 75 years, mean 42 years) receiving inhaled corticosteroids were randomly assigned to two treatment groups: 28 weeks' treatment with either salmeterol/fluticasone propionate (50/250 microg bid) via a single Diskus inhaler (combination) and placebo bid via another Diskus inhaler, or salmeterol 50 microg bid via one Diskus inhaler and fluticasone propionate 250 microg bid via another (concurrent). Morning peak expiratory flow rate (PEFR) and symptoms were measured for the first 12 weeks and safety data were collected throughout the study. RESULTS: Over weeks 1 to 12, adjusted mean improvements in morning PEFR were 43 and 36 L/min for combination and concurrent therapies, respectively. The difference between the two treatment arms was 6 L/min (90% CI -13 to 0 L/min; P=0.114), which was within the predefined criteria for clinical equivalence. Adjusted mean improvements in forced expiratory volume in 1 s from baseline for week 28 were also similar between the two therapies. Thirty-five per cent of patients receiving combination inhaler and 31% of those receiving concurrent therapy had a mean daytime symptom score of zero over weeks 1 to 12 compared with 1% and 2%, respectively, at baseline. There was no difference in the incidence of adverse events between the two treatment arms. Mean serum cortisol levels were similar, and no differences in frequency of abnormal results were noted between the two groups. CONCLUSIONS: This study shows that the combination of salmeterol and fluticasone propionate in a single inhaler is as efficacious in achieving asthma control and as well tolerated over a 28-week period as the two drugs administered individually.

Adolescent↗