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Biomedical subjects

W E Pierson

Publications and source records attributed to W E Pierson.

At least 91 records · Page 5Linked to original sources
PubMed1978

Pulmonary and endocrine function before and after therapy with cromolyn sodium in asthma. Studies in steroid-dependent and nonsteroid-dependent asthmatic children and adolescents.

This study evaluated growth, chest radiographic manifestations, pulmonary function, and function of the pituitary-adrenal axis before and after therapy with cromolyn sodium in two groups of asthmatic youngsters, ie, 18 steroid-dependent patients and ten nonsteroid-dependent patients. The following three groups evolved: (1) steroid-dependent patients; (2) patients weaned from therapy with steroids; and (3) nonsteroid-dependent patients. Growth failure and cataracts were limited to the steroid-dependent group, while abnormalities of the lungs and pituitary-adrenal axis occurred in all three groups. Symptomatic benefits from therapy with cromolyn were striking for all groups. Chest x-ray films and the distribution of alveolar ventilation were more likely to reflect this clinical improvement than tests of pulmonary function and analyses of blood gas levels. Endocrine abnormalities in the steroid-dependent group were significant and were not quickly reversed by withdrawal of therapy with steroids. Even nonsteroid-dependent patients had abnormalities which may be related to having chronic asthma. Therapy with cromolyn seemed to promote some restoration of the function of the pituitary-adrenal axis, as indicated by better responsiveness to administration of metyrapone, which correlated with improved symptomatic control of asthma.

Adolescent↗
PubMed1978

Pharmacokinetics of theophylline in acute asthma.

Serum theophylline concentrations were measured in 17 children and adolescents with acute asthma who received an aminophylline loading dose of 7 mg/kg and a constant infusion of 15 mg/kg/24 hours. The mean total theophylline clearance rate was 1.32 +/- S.D. 0.66 ml/min/kg. Hypoxia, and in two patients, acidosis, did not appear to significantly influence theophylline clearance rates. Inter-individual differences in clearance rates were great. No child experienced symptoms or signs of theophylline toxicity during the study. If serum theophylline concentrations cannot be monitored readily, an aminophylline infusion rate of 15 mg/kg/24 hours can be used safely in patients with acute asthma, but in most patients this infusion rate will not provide serum theophylline concentrations in the desired therapeutic range of 10-20 microgram/ml. Monitoring of serum theophylline concentrations during aminophylline infusion is desirable in order to individualize infusion rates, and achieve optimal bronchodilation without toxicity.

Acute Disease↗
PubMed1978

Exercise, induced bronchospasm in asthmatic children as a dose-response model for theophylline.

Efficacy and dose-response activity of oral theophylline were evaluated in 21 asthmatic children, using inhibition of exercise-induced bronchospasm (EIB) as a therapeutic marker. An aqueous theophylline suspension free of alcohol, sugar, and dye was found to be effective for prevention of EIB when given in usual maintenance doses of 4 to 6 mg/kg every 6 hours for 3 weeks, following single loading doses of 8 mg/kg. Pulmonary function measurements (FEV1, FEF25%-75%, PEFR) following standardized treadmill exercise stress were signifcantly improved during both acute and chronic theophylline administration compared to pre-drug control evaluations. There were no signs of developing tolerance to theophylline. The drug produced at least 50% inhibition of EIB in 16 to 21 patients treated. Individualized adjustment of maintenance dosage resulted in optimal theophylline serum concentrations of 10 to 18 microgram/ml in 17 patients. Signs of drug toxicity were observed only when serum levels exceeded 20 microgram/ml following loading doses in 6 patients. Although some children required higher maintenance dosage because of variability in theophylline pharmacokinetics, no child experienced adverse effects after dosage adjustment. Serum half-life ranged between 86 and 351 minutes (mean, 259 minutes); mean peak serum concentration of theophylline after 3 weeks of treatment was 14.9 microgram/ml.

Adolescent↗
PubMed1977

Respiratory failure in childhood status asthmaticus.

Thirteen of 356 children consecutively admitted for treatment of status asthmaticus in a 37-month period experienced 19 episodes of respiratory failure, an incidence of 5.3%. In this retrospective study, all children received similar pharmacologic therapy after admission, and all were treated with nasotracheal intubation and controlled ventilation with a volume-cycled ventilator. Mean duration of mechanical ventilation was 54 hours and mean duration of hospital stay was 7.5 days. Complications occurred in nine of 19 episodes and there was one death not directly related to acute asthma. It is possible that 12 of the 19 episodes of respiratory failure might have been prevented by more prompt or more appropriate treatment of the child with acute asthma.

Acute Disease↗
PubMed1977

A double-blind evaluation of the use of nebulized metaproterenol and isoproterenol in hospitalized asthmatic children and adolescents.

This study compared two beta-adrenergic agents in the treatment of severe asthma of children and adolescents. Thirty patients admitted to Children's Orthopedic Hospital and Medical Center with acute asthma were treated with either isoproterenol 0.05% (iso) or metaproterenol 0.5% (meta) nebulized in physiologic saline and delivered with O2 in addition to intravenous hydration, aminophylline, and corticosteroids. Vital signs, blood gases, and pulmonary function were monitored frequently. No adverse reactions to the study drugs were encountered. Pulse rates increased similarly after treatments with both drugs. Patients treated with meta had somewhat higher rates than those treated with iso. Diastolic blood pressure decreased significantly from admission in the meta group compared to the iso group. For FVC and FEV1, the meta group had greater percentage increases from admission than the iso group at all times, with the difference being significant (p less than 0.05) at 1 and 12 hr. The same trend occurred for FEF 25%-75%. Though iso seemed to cause greater increases in flow immediately after administrations, these changes were transient compared to improvement caused by meta. Thus, meta seemed to be more effective than iso in reversing bronchospasm as measured by certain pulmonary function parameters.

Adolescent↗
PubMed1977

Safety of influenza vaccination in allergic children.

One hundred forty-two allergic children aged three to 18 years were studied for evaluation of the usefulness of skin testing with influenza vaccine as a means of identifying those children who could be immunized safely despite their allergies to chickens, eggs, or feathers. One hundred twenty-eight children were fully immunized with bivalent influenza A/New Jersey/76-A/Victoria/75 vaccine. Twelve children had positive skin tests and were not immunized, and two developed positive skin tests after their first injection. One child had urticaria 8 hr later, one had a nonspecific reaction, and one had a self-limited erythema multiforme reaction eight days after the second injection. All others tolerated the procedure well. History of sensitivity to eggs was not as reliable an indication of vaccine sensitivity as skin testing with vaccine. A negative result of an intradermal skin test with a 1:100 dilution of the vaccine in saline appeared to be a reliable indicator of allergic subjects who could be immunized against influenza without fear of life-threatening acute allergic reactions.

Adolescent↗
PubMed1977

Acute and chronic theophylline therapy in exercise-induced bronchospasm.

This study examined the effectiveness of theophylline therapy in modifying exercise-induced bronchospasm (EIB) in children with perennial asthma and evaluated whether tolerance to theophylline developed with prolonged use. Twenty-one children between 7 and 16 years of age were studied by a standardized treadmill exercise test carried out before administration of theophylline, 90 minutes after administration of theophylline, and again after three weeks of round-the-clock theophylline treatment. Changes in forced expiratory volume at one second, forced expiratory flow between 25% and 75% of vital capacity, and peak expiratory flow rate were measured before and after each exercise test. Theophylline inhibited EIB in 20 of 21 subjects. There was considerable intersubject variation in the response to theophylline, however, ranging from complete inhibition in five subjects to no inhibition at all in one subject, even though theophylline controlled perennial asthma in all subjects, and all but one had theophylline levels between 10 and 22 microgram/ml when tested. On repeated testing after three weeks of therapy, no tolerance developed to theophylline. These findings suggest that EIB and perennial asthma may result from different causes and tha theophylline's ability to control asthma will not predict its effect on EIB. Subjects who have severe EIB should be retested after theophylline pretreatment of evaluate the effectiveness of therapy.

Acute Disease↗
PubMed1977

Physiology of steroid dependent and non-steroid dependent asthmatic youths.

This study was designed to compare physical findings, pulmonary function and pituitary-adrenal function in steroid dependent (SD) and non-steroid dependent (NSD) children and adolescents in order to clarify similarities and differences between these groups. Study patients included 20 steroid dependent and 14 non-steroid dependent subjects. Abnormalities confined to the SD group included growth suppression, bone age retardation and cataracts. Pulmonary function abnormalities were severe in both groups. While the SD group also showed a degree of pituitary-adrenal abnormality. This suggests that chronic pulmonary disease may have physiologic consequences extending beyond the pulmonary tree.

Adolescent↗
PubMed1976

Growth, pulmonary, and endocrine function in chronic asthma patients on daily and alternate-day adrenocorticosteroid therapy.

Growth, pulmonary, and adrenal-pituitary function were assessed in 20 steroid-dependent asthmatic children and adolescents while they were on daily prednisone therapy. The patients were then switched to equivalent daily methylprednisolone or twice equivalent alternate-day methylprednisolone for a 3-mo period, after which time studies were repeated. The steroid regimens were then crossed so that those patients taking daily methylprednisolone were switched to alternate-day therapy and the alternate-day therapy patients were switched to daily medication for another 3-mo interval, after which studies were repeated again. Abnormal growth, bone maturation, and cataracts were identified. Mean symptom scores at each evaluation were similar. Pulmonary function tests and shunt studies showed little difference between methylprednisolone and prednisone. Endocrine function tests showed a high incidence of disturbed pituitary and adrenal function. A 3-mo period of alternate-day therapy did not alter this.

17-Hydroxycorticosteroids↗
PubMed1976

Incidence of exercise-induced asthma in children.

The incidence of exercise-induced asthma (EIA) was studied in 134 asthmatic and 102 nonasthmatic atopic children and compared to that in 56 nonatopic children. Pulmonary function tests measuring forced vital capacity (FVC) and 1-sec forced expiratory volume (FEV1) were performed on each child prior to and serially for 20 min following free running exercise. The incidences of EIA among the asthmatic and atopic nonasthmatic children were 63% and 41%, respectively. This phenomenon is widespread among allergic children and cannot be accurately predicted from the history. A simple and easily performed outpatient procedure is described for the diagnosis of EIA.

Adolescent↗
PubMed1975

Exercise-induced asthma. Pharmacological assessment of single drugs and drug combinations.

The relative effectiveness of ephedrine, theophylline, and hydroxyzine hydrochloride and their combinations was studied in a two-part investigation of 16 youths who has asthma and exercise-induced asthma. The beneficial and adverse effects of the drugs in the control of asthma were studied in the first part of the investigation. Both theophylline and ephedrine were judged superior to placebo when given alone. When combined they were somewhat more effective than either agent alone, although adverse effects precluded their use in almost half of the subjects. The addition of hydroxyzine diminished the side effects sufficiently to make the combination acceptable to four subjects who refused to take ephedrine/theophylline. In the second part of the study, the relief of exercise-induced asthma was evaluated. Ephedrine had no effect, hydroxyzine had a weak effect on hastening recovery, but theophylline modified the postexercise response significantly. The three drugs together produced an additive effect superior to that of theophylline alone.

Adolescent↗
PubMed1975

The pharmacological assessment of single drugs and drug combinations in exercise-induced asthma.

The relative effectiveness of ephedrine, theophylline, hydroxyzine, and their combinations in relieving cycloergometer exercise-induced asthma were studied in 16 children and adolescents. Ephedrine had no effect on post-exercise asthma, hydroxyzine had weak effect on hastening recovery, while theophylline modified on the post-exercise response significantly. The three drugs together produced an additive effect superior to that of theohylline alone.

Adolescent↗
PubMed1975

Incidence of exercise-induced asthma in children.

The incidence of exercise-induced asthma (EIA) was studied in 134 asthmatic, 102 nonasthmatic atopic, and 56 nonatopic children. Pulmonary function tests measuring forced vital capacity (FVC) and one-second forced expiratory volume (FEV1) were performed on each child prior to and serially for 20 minutes following free running exercise. The incidence of the EIA among the asthmatic and atopic nonasthmatic children was 63% and 41% respectively, and 7% among control subjects. Airway function was studied prior to and after a standardized free running exercise test. Forty-one percent of the nonasthmatic and 63% ofthe asthmatic atopic children had a significant decrease in airway function as compared to 5% of the nonallergic subjects.

Adolescent↗
PubMed1975

Free running test for exercise-induced bronchospasm.

The free running test has been successfully carried out in patients from 5 to 21 years old. It has the following advantages: (1) it simulates normal exercise pattern; (2) it is readily performed in any health care setting; (3) it is simple to perform and noninvasive in nature; and (4) it reveals a maximum decrease in forced expiratory volume at one second at five minutes after the exercise period. There seems to be a seasonal variation that may alter outcome of tests.

Adolescent↗