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Biomedical subjects

W E Pierson

Publications and source records attributed to W E Pierson.

At least 73 records · Page 4Linked to original sources
PubMed1983

Risk factors for persistent middle-ear effusions. Otitis media, catarrh, cigarette smoke exposure, and atopy.

To ascertain risk factors for persistent middle-ear effusions (PMEE), we interviewed the parents of two groups of children. The first consisted of 76 children with PMEE who were admitted to the hospital for tympanostomy-tube insertion. The second, a control group, consisted of 76 children admitted for other types of surgery, who were matched for age, sex, season, and surgical ward. Nearly all (97%) of the children admitted for insertion of tympanostomy tubes had one or more episodes of suppurative otitis media. Only 59% of the control children had previous ear infections. Frequent ear infections sharply increased the risk for persistent effusions. Catarrh, household cigarette smoke exposure, and atopy also occurred more frequently in children with PMEE. The risk for middle-ear effusions was greatest when these three factors were all present. The avoidance of daily exposure to domestic tobacco smoke and, if atopic, of specific allergens should be included in the medical treatment of children with PMEE.

Age Factors↗
PubMed1983

Dyphylline versus theophylline: a double-blind comparative evaluation.

This study was a randomized double-blind evaluation of three doses of dyphylline, theophylline, and placebo for blocking exercise-induced bronchospasm (EIB). Twenty patients aged 12 to 17 years took one of the following on five separate days prior to an exercise challenge: 10, 15, or 20 mg/kg dyphylline; 6 mg/kg anhydrous theophylline; or placebo. Linear relationships were found between the log of dyphylline doses and per cent changes from baseline for PEFR, FEV1 and FEF25-75%. The 15 and 20 mg/kg doses differed significantly from placebo in preventing declines in PEFR, FEV1, and FEF25-75%. While significant, these changes were one half to one third those found with 6 mg/kg theophylline. Tremor was twice as common with theophylline. While dyphylline has therapeutic effectiveness compared to placebo for blocking EIB, its benefit is small. Further evaluations are needed to elucidate optimal dosaging for maximal effectiveness.

Adolescent↗
PubMed1983

A comparison of the pulmonary effects of 0.5 ppm versus 1.0 ppm sulfur dioxide plus sodium chloride droplets in asthmatic adolescents.

The effects of inhaled sulfur dioxide (SO2) on pulmonary function in nine adolescent subjects with extrinsic asthma were studied. The exposure modes, inhaled via a mouthpiece, were (1) 1 mg/m3 sodium chloride solution droplet aerosol (NaCl); (2) 0.5 ppm SO2 + NaCl; or (3) 1.0 ppm SO2 + NaCl. All exposures were at greater than or equal to 75% relative humidity and approximately 22 degrees C. The following pulmonary functional measurements, with the subject seated in a body plethysmograph, were recorded: total respiratory resistance (RT), functional residual capacity (FRC), maximal flow at 50% and 75% expired vital capacity (Vmax50 and Vmax75), and forced expiratory volume in one second (FEV1). Following 10 min of exposure to either SO2 mode during moderate exercise on a treadmill, statistically significant changes in all pulmonary functional measurements except FRC were seen. There were no statistically significant changes following 10 min of exposure during moderate exercise to the NaCl droplet aerosol alone. Since the average pulmonary changes following exposure to 0.5 ppm SO2 mixture during moderate exercise ranged from 8 to 47%, we conclude that this dose of SO2 is above the response threshold for these subjects. To explore the effects of nasal (or oronasal) inhalation on the SO2-induced pulmonary functional changes, 7 of the 9 subjects inhaled 0.5 ppm SO2 + NaCl via a face mask with no nose clips. The average percentage changes in pulmonary functional values seen after exposure via face mask were similar to those seen after exposure via mouthpiece. However, the changes seen after exposure via face mask were not as consistent as following inhalation via mouthpiece and not statistically different from baseline. We conclude that oral, and to a lesser degree oronasal, inhalation of 0.5 ppm of SO2 elicits SO2-induced changes in pulmonary function in these subjects.

Adolescent↗
PubMed1983

The effects of inhaled sulfuric acid on pulmonary function in adolescent asthmatics.

Ten adolescent subjects with extrinsic asthma and exercise-induced bronchospasm were studied. The subjects were exposed for 30 min at rest followed by 10 min during moderate exercise on a treadmill to either 100 micrograms/m3 sodium chloride (NaCl) or 100 micrograms/m3 sulfuric acid (H2SO4) droplet aerosols. All exposures were at approximately 75% relative humidity and 22 degrees C. Pulmonary functional measurements were recorded before, during, and after exposure while the subject was seated in a body plethysmograph. Exposure to the NaCl aerosol during exercise produced a small (12%) but significant drop in maximal expiratory flow (Vmax75) (p less than 0.05). However, exposure to the H2SO4 aerosol produced larger reductions in Vmax75 (29%; p less than 0.01) and also significant changes in 3 other parameters of pulmonary function: Vmax50, FEV1, and total respiratory resistance (RT). The changes were similar to those reported for exposure to 0.5 ppm of sulfur dioxide in a similar group of adolescents with extrinsic asthma. Our results are the first report of reversible pulmonary functional changes after H2SO4 exposure in a group of adolescent asthmatic subjects.

Adolescent↗
PubMed1983

Double-blind evaluation of methylprednisolone versus placebo for acute asthma episodes.

Twenty-eight children with persistent bronchospasm after outpatient therapy were treated for eight days with methylprednisolone or placebo in a prerandomized double-blind manner, in addition to treatment with optimal oral bronchodilators. At follow-up visits 1, 7, and 14 days after onset of therapy, a history was taken and physical examination and pulmonary function tests were performed. Initially and on the 14th day, patients underwent cosyntropin tests of adrenal function. Patients kept daily peak flow charts. Both groups improved with time. However, by 24 hours after starting methylprednisolone therapy, the placebo group continued to show reversibility after isoproterenol inhalation whereas the methylprednisolone group did not. By day 7 there were significantly more patients with normal 1-second forced expiratory volume (FEV1) and forced expiratory flow in the middle half of the forced vital capacity (FEF25-75%) in the methylprednisolone group and mean FEF25-75% was significantly higher for this group (P less than .02). By day 14, six days after finishing treatment with the study drugs, more patients in the placebo group had residual wheezing, but pulmonary function tests were now similar for the two groups. Although both groups showed a decline in cosyntropin responsiveness on day 14 compared with day 1, there was no difference between the steroid- and placebo-treated patients. This study proves that short-term corticosteroid therapy will accelerate resolution of moderately severe and severe-acute attacks of asthma without significant suppression of adrenal function.

Adrenal Glands↗
PubMed1982

Bronchoconstrictor responses to sulfur dioxide or sulfur dioxide plus sodium chloride droplets in allergic, nonasthmatic adolescent.

Eight atopic adolescent subjects without diagnosis of clinical asthma but with signs of hyperactive airways were studied. The subjects were exposed for 30 min at rest followed by 10 min during moderate exercise on a treadmill to the following: (1) filtered air, (2) 1 mg/m3 NaCl droplet aerosol, (3) 1 ppm SO2 and NaCl droplet aerosol, or (4) 1 ppm SO2. All exposures were at 75% relative humidity and 22 degrees C. Exposures to either SO2 mode produced statistically significant changes in pulmonary function, whereas sham exposures to air on NaCl did not. These results are similar to those seen earlier in a group of extrinsic asthmatic adolescent subjects and are three to 22 times greater than changes we saw in a group of normal adolescent subjects. The changes seen after inhalation of SO2 were not statistically different from those seen after inhalation of SO2 and NaCl droplet aerosol. Our results indicate that inhalation of 1 ppm SO2 by a group of atopic adolescents can produce exercise-induced bronchospasm at a level of exercise that has no effect by itself.

Adolescent↗
PubMed1982

Methacholine bronchial challenge in children.

Methacholine sensitivity was evaluated in 166 young subjects who had normal resting spirometric values but who presented problems suggesting lower airways hyperreactivity. Fifty-eight patients (35%) did not have significant sensitivity. The diagnosis of asthma was excluded in this subgroup. Forty-one patients (25%) had mild methacholine sensitivity, 49 (30%) had moderate sensitivity, and 18 (11%) had extreme methacholine sensitivity. Many patients who reacted had chief complaints of cough, bronchitis, or other low respiratory-tract symptoms and did not complain of wheezing. Methacholine challenge helped to clarify appropriate therapy in these individuals. One-year follow-up of these patients showed most patients to be continuing the therapeutic regimen that had been prescribed initially. Methacholine bronchoprovocation was a useful adjunct to management of this large outpatient population of children and young adults and deserves attention as a procedure relevant to patients care, not solely as an investigational test.

Adolescent↗
PubMed1982

Individualization of theophylline dosage using a single serum sample following a test dose.

Because formulas for theophylline requirement based on weight alone carry the risk of overdosing and toxicity, this study was designed to test a clearance nomogram for determining daily theophylline requirement after a known initial dose of theophylline. Twenty asthmatic children who had not taken theophylline for at least 36 hours fasted and were given one dose of anhydrous theophylline (5 mg/kg). Six hours later the serum level was measured and the appropriate dosage of sustained-release theophylline to achieve a serum level of 10 micrograms/ml was selected from the clearance nomogram. Three to seven days later a six-hour theophylline level was obtained. Of 20 patients, therapeutic levels of 10 to 30 micrograms/ml were achieved in 15, and the remaining five patients had levels close to this (range 6.2 to 16.0 micrograms/ml). The dosage requirement per 24 hours ranged from 10 to 32 mg/kg/24 hr. This method of determining theophylline requirements for children required measurement of the serum theophylline level only once for the determination of a safe and effective daily dose. It is especially valuable when follow-up is difficult and is a safe way to avoid serious overdosing while being certain of effective dosing.

Asthma↗
PubMed1982

Altered theophylline clearance during an influenza B outbreak.

During the 1980 influenza B outbreak in King County, Washington, 11 children whose asthma had previously been controlled with a stable theophylline dose, developed theophylline toxicity on this same dose. Two had seizures, eight had nausea and vomiting, and three had headaches. All had clinical evidence of a febrile viral illness. The toxicity appeared to be related to decreased theophylline clearance, which gradually returned to preillness levels over a period of one to three months. Six of ten children had serologic evidence of influenza B, which is presumed to be the cause of the altered clearance. In children receiving chronic theophylline therapy, symptoms of vomiting, headaches, or seizures during a viral illness may be due to theophylline toxicity rather than the virus. Such patients should have an immediate serum theophylline determination, even if previous levels have been in the therapeutic range.

Asthma↗
PubMed1982

Treatment of persistent eustachian tube dysfunction in children with aerosolized nasal dexamethasone phosphate versus placebo.

Forty-five children aged two to 10 years with persistent eustachian tube dysfunction received a three-week course of aerosolized nasal dexamethasone phosphate or placebo. Patients were randomly assigned to the drug or placebo group and received one spray in each nostril three times a day for three weeks. Middle ear pressure and gradient were assessed with tympanometry. Tympanic membrane mobility, position and presence of middle ear fluid were assessed by the investigators initially and at weekly intervals during the study. Fasting morning plasma cortisol levels were obtained prior to starting the study and at its conclusion. The dexamethasone-treated group showed a significant increase in patients with normal middle ear pressure compared to placebo after one week and a significant increase in the number of patients with normal middle ear gradient at the second week. By the conclusion of the study there were no significant differences between the groups. Within the dexamethasone group, however, there were statistically significant increases in patients achieving normal middle ear pressure, tympanic membrane mobility and position in one or both ears. Plasma cortisol levels fluctuated widely from one determination to another and did not show an over-all declining trend for the dexamethasone group. However, two dexamethasone patients had a transient fall in cortisol level to below the normal range. These results support some therapeutic efficacy for nasal aerosolized dexamethasone but also point out the therapeutic value of time alone. The observation that most improvement occurred in the first two weeks and that some worrisome cortisol changes occurred suggests that dexamethasone therapy should be limited to two weeks and be undertaken with caution.

Administration, Intranasal↗
PubMed1981

Short-term double-blind evaluation of flunisolide aerosol for steroid-dependent asthmatic children and adolescents.

The purpose of this study was to compare the effectiveness of flunisolide aerosol prescribed as .5 mg (two inhalations) twice daily and placebo in terms of oral steroid sparing ability in a population of 32 known steroid-dependent children and adolescents. Patients were stabilized on the lowest tolerated dose of daily AM or alternate AM oral corticosteroid for at least one month before entering the study. They were randomly assigned to either flunisolide or placebo treatment for the 12-week, double-blind trial. Patients were seen every two weeks for symptom assessment, physical examination, and pulmonary function testing. Tests of adrenal function were done initially and at the study's conclusion. The flunisolide group had improved asthma control compared with the placebo group. The daily oral steroid requirement decreased in 100 percent of the flunisolide group compared with 53 percent of the placebo group (P less than .01). Pulmonary function and endocrine function remained stable for both groups. There were no adverse effects. Flunisolide aerosol in doses of .5 mg twice daily appears to be topically active and to have oral steroid potential without apparent adverse effects.

Adolescent↗
PubMed1981

Effectiveness of terbutaline and theophylline alone and in combination in exercise-induced bronchospasm.

Theophylline and terbutaline, alone and in combination, were evaluated for effectiveness in treating exercise-induced bronchospasm (EIB) when used at doses that should be tolerated by adolescents taking them intermittently: theophylline, 250 mg (fast release) and terbutaline, 2.5 mg. Twenty-one subjects, 12 to 19 years of age, with EIB performed standardized exercise tests on four separate days and received either theophylline, terbutaline, the combination, or placebo in a prerandomized double-blind manner prior to exercise. Exercise tests were performed two and five hours after each study drug administration. Blood samples were drawn before and again two and five hours after drug administration for theophylline level. Pulmonary function [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and forced expiratory flow rate (FEF 25% to 75%)] was recorded before and after exercise. All of the active treatments were better than placebo in diminishing EIB. The combination was statistically better than terbutaline or theophylline alone. The effect of theophylline was not significantly different from that of terbutaline. The combination induced significantly more tremor than either agent individually. Either drug alone or the two in combination is effective for diminishing EIB. Although the combination may have additive properties for some patients, the increased incidence of tremor may diminish its appeal. Either drug alone or in combination is effective in decreasing EIB for at least five hours, which makes them practical choices for treatment of school-aged children.

Adolescent↗
PubMed1979

Cloprednol therapy in steroid-dependent asthma.

Cloprednol is a new oral corticosteroid with a short half-life that is presently under investigation for use in asthma. Seventeen steroid-dependent children and adolescents were switched from daily treatment with prednisone to cloprednol for a one-year study. Patients showed a statistically significant improvement in symptoms while receiving cloprednol therapy. Two patients had extraordinarily good responses. Growth trends, bone age, and chest roentgenograms were not remarkably changed by cloprednol. Pulmonary function was stable. There was a significant improvement in fasting morning cortisol levels and ability to respond to metyrapone and adrenocorticotropic hormone (ACTH) challenge. Cloprednol appears to be a promising drug for steroid-dependent patients who require oral corticosteroid therapy.

Adolescent↗