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PubMed1993

Environmental factors precipitating bronchial asthma exacerbations in southern Puerto Rico: a pilot study.

The purpose of the study was to correlate environmental factors that may play a role in triggering asthma attacks requiring admissions. A retrospective analysis of 320 asthmatic admissions from January 1987 to December 1989 was conducted in two community hospitals in our area. Information from the U.S. Weather Bureau pertaining to temperature, barometric pressure, wind velocity, and precipitation was analyzed. The readings from the Puerto Rican Environmental Agency for Total Suspended Particles (TSP-10) during that period were also reviewed. Our results indicate that the female patients accounted for the majority of the asthmatic admissions: 74.3% versus 26% in males. Eighty-four percent of the patients had a history of asthma attacks and 67% had previous hospitalizations due to asthma exacerbations. Correlation between asthma family history and age was found in only two age groups, 31-40 and 71-80 years. Rhinitis and asthma exacerbations were strongly linked only in the age group of 31-40 years. Active cigarette smoking was strongly associated with asthma exacerbations only in the age group of 61-70 years. Environmental data indicated that there was not a consistent pattern of monthly admissions; however, there was a significant association between admissions and increased precipitation, high counts of annual TSP-10, and decreased wind velocity. In view of our findings, asthmatics living on islands such as Puerto Rico might be affected by an additive effect of pollutants, by local and mainland emissions that are transported by the air currents, leading to a higher incidence of asthma exacerbations.

Adolescent↗
PubMedDate not supplied

Comparison of ketorolac-chlorpromazine with meperidine-promethazine for treatment of exacerbations of chronic pain.

BACKGROUND: The aim was to compare the efficacy and safety of a combination of intramuscular ketorolac and chlorpromazine for the treatment of acute exacerbations of chronic pain with the more commonly used regimen of intramuscular meperidine and promethazine. METHODS: Use-effective case series were drawn from a real-life, rural emergency department practice, in which 200 consecutive patients coming to a rural emergency department with acute exacerbations of chronic pain syndromes were assigned on an every-other basis in a single-blind fashion to one of the two treatment conditions. Patients were given intramuscular doses of either 60 mg of ketorolac plus 50 mg of chlorpromazine (75 mg of chlorpromazine for patients weighing more than 100 kg), or 50 mg of meperidine plus 25 mg of promethazine (50 mg of promethazine for patients weighing more than 75 kg); patients weighing more than 100 kg were given 1.5 doses. Patients older than 65 years or whose blood pressure at the time of injection was less than 110/70 mmHg were given half-doses. Patients could receive one additional half-dose injection if they had no results within 30 to 60 minutes after the first injection. Patients were assessed on self-report and on a verbal and visual analog scale of pain rating. Temperature, blood pressure, heart rate, and respirations were monitored every 15 minutes. RESULTS: Both regimens performed well, with more than 90 percent of patients reporting good or excellent improvement on acute exacerbations of chronic pain. Ketorolac-chlorpromazine offered significant advantages compared with meperidine-promethazine when patients rated their pain on a visual analog pain scale (P < 0.05) but not on a verbal scale. Adverse reactions were minimal and consisted of more respiratory tract depression with meperidine and more vertigo or dizziness with chlorpromazine. There was no difference in incidence of hypotension between the two groups. CONCLUSIONS: The combination of ketorolac and chlorpromazine is a safe and efficacious alternative to meperidine plus promethazine for the treatment of exacerbations of chronic pain in the rural emergency department setting.

Adolescent↗
PubMed1993

[Two elderly cases with acute exacerbation of interstitial pneumonia].

We studied two cases of the elderly with acute exacerbation of interstitial pneumonia to elucidate a prognostic role of super oxide generation in peripheral whole blood. The first case was a 70-year-old man, who presented with acute exacerbation of interstitial pneumonia and was hospitalized. Following steroid-pulse therapy, CRP, ESR, blood-gas and his physical condition improved, resulting in successful discharge. In this case, super oxide generation standardized by the number of neutrophils (K) decreased to less than 1.0 in association with the improvement of physical condition. The second case was a 92-year-old woman in whom acute exacerbation of interstitial pneumonia was diagnosed. While the pulse therapy, CRP, LDH and blood-gas temporarily improved, K was continuously greater than 1.0 and the physical condition worsened, resulting in her death. These cases suggest that the measurement of super oxide generation in peripheral whole blood may play a useful role in assessing the prognosis of the elderly with acute exacerbation of interstitial pneumonia.

Acute Disease↗
PubMed2000

Effects of prednisolone on eosinophils, IL-5, eosinophil cationic protein, EG2+ eosinophils, and nitric oxide metabolites in the sputum of patients with exacerbated asthma.

Corticosteroids are considered to be one of the most effective medicine for asthma by suppressing airway inflammation. This study was carried out to investigate the effects of prednisolone in the sputum of exacerbated asthmatics. Clinical severity, cell differentials, levels of interleukin (IL)-5, eosinophil cationic protein (ECP), EG2+ eosinophils, and nitric oxide (NO) metabolites were measured. Sputum was examined 2 weeks apart in 13 exacerbated asthmatics before and after prednisolone treatment, and once in 12 stable asthmatics. We used a sandwich ELISA for IL-5, fluoroimmunoassay for ECP, immunohistochemical staining for EG2+ eosinophils, a NO metabolites assay using modified Griess reaction. Exacerbated asthmatics, in comparison with stable asthmatics, had significantly higher proportion of eosinophils, higher level of ECP, higher percentage of EG2+ eosinophils, and NO metabolites. Exacerbated asthmatics after treatment with prednisolone had reduced the proportions of eosinophils, reduced level of IL-5, ECP and percentage of EG2+ eosinophils. FEV1 was correlated with the proportion of eosinophils, ECP, and IL-5 respectively. These findings suggest that prednisolone is considered to be effective medicine for asthma by suppressing eosinophil activation through IL-5.

Administration, Oral↗
PubMed2006

[Comparison of different vehicles for nebulized salbutamol in treatment of bronchial asthma exacerbations: a Meta-analysis].

OBJECTIVE: To assess the efficacy of two vehicles for nebulized salbutamol in treatment of asthma exacerbations with Meta-analysis. METHODS: All relevant randomized controlled clinical trials (RCT) with isotonic magnesium sulphate and saline as vehicles for inhaled salbutamol in treatment of asthma exacerbations were searched. A Meta-analysis was performed to evaluate the results of the two therapies. RESULT: Five relevant RCTs from literature were collected and total 219 cases were included for analysis. The meta-analysis indicated that the significant improvements were obtained from isotonic magnesium sulphate as a vehicle for nebulized salbutamol, in comparison with saline [pooled standardized mean difference (SMD)=0.55(95% CI 0.28 - 0.83), P <0.001]. By further subgroup analysis, this change was properly significant in the subgroup of severe patients with their baseline FEV1% <30% [FEV1 weighted mean difference (WMD)=0.72 L(95% CI 0.30 L - 1.14 L), P <0.01]. The pooled results of vital signs between two vehicles did not demonstrate statistical significance. Overall, the risk of admission to hospital was not statistically reduced in patients using magnesium sulphate, who presented to the emergency department with an asthma exacerbation [pooled RR=0.64(95% CI 0.38 - 1.08), P >0.05]. CONCLUSION: Compared with saline,the use of isotonic magnesium sulfate as an adjuvant to nebulize salbutamol is a beneficial therapy with improving spirometric airway function in the severe asthma exacerbation.

Adrenergic beta-Agonists↗
PubMed2003

Acute exacerbations of COPD.

Acute exacerbations of COPD (AECOPD) are a common cause of morbidity and mortality. There is a need for a standardised definition of an exacerbation of COPD. The common aetiological factors are bacterial, viral infection and air pollutants. Exacerbations of COPD may adversely affect the natural history of COPD. Several strategies are available now to prevent or reduce exacerbations of COPD including immunisation against influenza and inhaled corticosteroids in patients with moderate/severe disease. The mainstay of treatment involves increasing bronchodilator therapy, systemic glucocorticoids which have now been shown to have a beneficial effect. The circumstances for the use of antibiotic therapy is now established in patients with increased breathlessness, increased sputum production and/or sputum purulence. In those with respiratory failure, noninvasive ventilation has been shown to reduce intubation rates, shorten lengths of hospitalisation, and improve mortality. Early or immediate supported discharge for selected patients has been shown to be effective in the management of patients with COPD.

Acute Disease↗
PubMed2001

Management of acute exacerbations of chronic obstructive pulmonary disease: a summary and appraisal of published evidence.

PURPOSE: To review critically the available data on diagnostic evaluation, risk stratification, and therapeutic management of patients with acute exacerbations of chronic obstructive pulmonary disease (COPD). DATA SOURCES: English-language articles were identified by searching MEDLINE (1966 to 2000, week 5), EMBASE (1974 to 2000, week 18), HealthStar (1975 to June 2000), and the Cochrane Controlled Trials Register (2000, Issue 1). STUDY SELECTION: The best available evidence on each subtopic was selected for analysis. Randomized trials, sometimes buttressed by cohort studies, were used to evaluate therapeutic interventions. Cohort studies were used to evaluate diagnostic tests and risk stratification. DATA EXTRACTION: Study design and results were summarized in evidence tables. Individual studies were rated by internal validity, external validity, and quality of design. Statistical analyses of combined data were not performed. DATA SYNTHESIS: Data on the utility of most diagnostic tests are limited. However, chest radiography and arterial blood gas sampling seem useful while acute spirometry does not. Identifiable clinical variables are associated with risk for relapse and risk for death after hospitalization for an acute exacerbation. Evidence of efficacy was found for bronchodilators, corticosteroids, and noninvasive positive-pressure ventilation. There is also support for the use of antibiotics in patients with more severe exacerbations. On the basis of limited data, mucolytics and chest physiotherapy do not seem to be of benefit, and oxygen supplementation seems to increase the risk for respiratory failure only in an identifiable subgroup of patients. CONCLUSIONS: Although suggestions for appropriate management can be made on the basis of available evidence, the supporting literature is scarce and further high-quality research is necessary. Such research will require an improved, generally acceptable, and transportable definition of acute exacerbation of COPD, as well as improved methods for observing and measuring outcomes.

Acute Disease↗
PubMed2006

Quality of care for patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease.

BACKGROUND: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is 1 of the 10 leading causes of hospitalization among adults in the United States. OBJECTIVE: To evaluate the quality of care provided to patients hospitalized for acute exacerbations of COPD and to determine whether hospital or patient characteristics influence treatment. DESIGN: Retrospective cohort study. SETTING: 360 hospitals throughout the United States. PATIENTS: 69,820 patients hospitalized for acute exacerbations of COPD. MEASUREMENTS: Adherence to diagnosis and treatment recommendations contained in guidelines produced by the American College of Physicians and the American College of Chest Physicians; analyses of associations between hospital and patient characteristics and composite measures of performance. RESULTS: Of the 69,820 patients, 66,276 (95%) underwent chest radiography, 63,715 (91%) received supplemental oxygen, 67 515 (97%) received bronchodilators, 59,240 (85%) received systemic steroids, and 59,053 (85%) were given antibiotics. In total, 45,800 (66%) received this entire set of recommended care processes. Numerous participants received tests or treatments that were not beneficial: 16,607 (24%) were treated with methylxanthine bronchodilators, 10,051 (14%) had sputum testing, 8354 (12%) underwent acute spirometry, 4299 (6%) had chest physiotherapy, and 1409 (2%) were treated with mucolytic medications. Overall, 31,519 patients (45%) received at least 1 of these nonrecommended care elements, and 22,929 (33%) received ideal care, defined as all of the recommended care processes and none of the nonrecommended ones. Individual hospital performance varied widely; whereas older patients and women were more likely to receive ideal care than their counterparts, a higher annual volume of admissions for COPD was not associated with improved hospital performance. LIMITATIONS: The study used administrative data, not chart review, and was limited to the inpatient management of COPD. CONCLUSIONS: The quality of care for patients hospitalized for acute exacerbations of COPD may be improved by increasing the use of systemic corticosteroid and antibiotic therapy, decreasing the use of unnecessary and potentially harmful treatments, and reducing variation in practice across hospitals.

Adult↗
PubMed1999

[Relevance of deep venous thrombosis of the leg in patients with acute exacerbated COPD].

BACKGROUND: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with dyspnoea and, consequently, reduced mobility. Immobility is a recognised risk factor for deep venous thrombosis (DVT), but few data exist regarding the prevalence of DVT in acute exacerbation of COPD. Real-time B-mode ultrasonography (US) is a noninvasive screening-method for the diagnosis of DVT. We therefore used US to investigate the prevalence of DVT in patients with an acute exacerbation of COPD. METHODS: In a prospective cohort study 196 patients with COPD were studied (110 men, 86 female, age: 66.9 +/- 9.1 years, weight: 63.5 +/- 12.7 kg, forced expiratory volume in 1 second [FEV1]: 0.7 +/- 0.21, FEV1% of vital capacity [VC]: 37 +/- 6) in a respiratory intensive care unit on the day of admission. Patients with reduced mobility due to other diseases were excluded. All US were performed by one experienced person with a 5 MHz linear scanner. The veins of the lower extremity were subdivided into 3 segments: 1. The common femoral, 2. superficial femoral veins including the long saphenous vein and 3. the popliteal vein. RESULTS: In 21 of 196 COPD patients (10.7%) DVT were demonstrated; 18 of these were asymptomatic. Bilateral DVT were not found. In 6 patients additional diagnoses were obtained. There was no difference between patient with and without DVT with respect to age, hemoglobin, PO2, PCO2, pH, FEV1, VC or dyspnoea scale. CONCLUSIONS: DVT in the lower extremity, which was not detectable on clinical examination, was relatively common in patients with an acute exacerbation of COPD. All measured clinical variables (age, weight, dyspnoe-scale, lung function, hemoglobin and hematocrit and blood gases) failed to predict patients more likely to have DVT.

Acute Disease↗
PubMed1999

Infectious exacerbations of chronic bronchitis. ORIONE Board.

Approximately 50% of chronic bronchitis exacerbations are caused by bacteria and 25-50% by viruses. Streptococcus pneumoniae and Haemophilus influenzae are traditionally considered leading pathogens. In Italy, S. pneumoniae and H. influenzae resistance to beta-lactams is low but resistance to macrolides is more widespread. Pathogenic bacteria are isolated in the airways of most chronic bronchitis patients, impairing host respiratory defences, further predisposing towards infection and, thus, establishing a vicious circle, fuelled by damage due to cigarette smoking. The diagnosis of an exacerbation is essentially clinical. Lung function testing may show no modification, or indicate worsening airway obstruction. Blood gas analysis is performed in severe cases. The utility of culture is lessened by evidence of airway bacterial contamination in clinically stable periods. Quantitative thresholds have been identified over and above which bacterial exacerbation is considered probable. General preventative measures include the adoption of hygiene-behavioural standards. Antibiotic prophylaxis is not advisable. Prophylaxis by means of vaccination is indicated against influenza. Vaccination against S. pneumoniae is available but is seldom employed. The principal form of treatment is antibiotic therapy, but there is an ongoing debate regarding the objective criteria for its use. A recent meta-analysis showed a small but statistically significant difference in favour of antibiotic treatment. The antibiotic cost-benefit ratio is favourable in patients with severe functional impairment. Oral administration is to be preferred as more practical and less costly for equal efficacy. In selecting an antibiotic, pharmacokinetic considerations (bioavailability, tissue diffusion, half-life) must be kept in mind. Prescription should be oriented towards drugs active against the most commonly occurring pathogens. In more severe cases coverage against Gram-negative bacteria is considered. Complementary medical treatment includes bronchodilators corticosteroids, diuretics, and oxygen therapy. Chest physiotherapy may be beneficial. Ventilatory support treatment may be necessary, noninvasive ventilatory assistance being preferable early in the course of the acute episode. In a high number of cases endotracheal intubation may be avoided. Most exacerbations may be treated on an outpatient basis, but in some cases admission to hospital is indicated.

Acute Disease↗
PubMed2000

The role of infection in acute exacerbations of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States and the second leading cause of work disability. Extensive data indicate that bacterial infection has an important role in acute exacerbations of COPD. Antibiotic therapy has been shown to benefit patients with exacerbations of COPD by improving clinical outcomes and hastening clinical and physiologic recovery. Antibiotics also provide long-term benefits such as preventing the progression of disease, minimizing secondary colonization with resistant organisms, and prolonging the time between exacerbations. Classifying an episode of COPD as uncomplicated, complicated, or at risk for Pseudomonas is useful in determining antibiotic therapy for patients with an acute exacerbation. Although patients with less severe uncomplicated disease can be treated with older antimicrobial agents, those with serious comorbid conditions or advanced structural lung disease require treatment with new more potent agents. Knowing the patterns of antimicrobial resistance in the respiratory pathogens, antibiotic pharmacokinetics, and factors influencing patient compliance is necessary to prevent treatment failures.

Anti-Bacterial Agents↗
PubMed2000

Acute exacerbations in chronic obstructive pulmonary disease (COPD)--microbial patterns and risk factors.

Around 25% of patients with stable chronic obstructive pulmonary disease (COPD) show some evidence of tracheobronchial colonization. It is, however, probable that the vast majority of patients become colonized at some time during the course of the disease. A variety of factors including current smoking and viral infections predispose to bacterial colonization and subsequently acute exacerbations. In fact, infectious aetiologies account for around 50-75% of acute COPD exacerbations. Bacterial pathogens are present in around 50% of patients, Haemophilus influenzae and Streptococcus pneumoniae being the most frequently encountered pathogens. Pseudomonas aeruginosa and probably also Gram-negative enteric bacilli are more frequently found in patients with more severe airflow limitation. Viral infections are present in around 10-20%, with Influenzavirus representing the most frequent viral pathogen. Only recently, evidence for infection by Chlamydia pneumoniae has been found in 5-20% of patients. Predictors of distinct aetiologies have only infrequently been studied so far. Thus, it currently remains difficult to make adequate predictions on clinical grounds in the individual patient. Nevertheless, we would advocate to tentatively stratify the initial antimicrobial treatment according to the severity of the acute exacerbation episode and the presence of individual risk factors. The validation of such an approach may result in significant progress in our understanding of the role of infection and infectious agents in different subgroups of patients with acute exacerbations.

Humans↗
PubMed2001

Exhaled nitric oxide levels in exacerbations of asthma, chronic obstructive pulmonary disease and pneumonia.

OBJECTIVE: Nitric oxide is known to be present in the exhaled air of normal subjects and at higher concentrations in asthmatics. The aim of this study was to measure exhaled nitric oxide levels in patients admitted to hospital with acute exacerbations of asthma, or chronic obstructive pulmonary disease, or with pneumonia. METHODS: Within 24 hours of admission exhaled nitric oxide levels were measured by a chemiluminescent analyzer in 11 patients with acute sever asthma, 19 patients with acute exacerbation of chronic obstructive pulmonary disease, and in 12 patients with pneumonia. In asthmatics measurements were made on 3 occasions, at day 1, 4, and 28 and were related to changes in peak expiratory flow rate. RESULTS: On admission median exhaled nitric oxide levels (range) were significantly higher in asthmatics 22 (9.3-74) parts per billion in comparison to patients with chronic obstructive pulmonary disease 10.3 (2.7-34) parts per billion; p < 0.01, pneumonia 7 (4-17) parts per billion; p<0.001, and normal subjects 8.7 (5-13.3) parts per billion; p < 0.001. Following treatment the asthmatics had a significant reduction in their exhaled nitric oxide levels from 22 (9.3-74) parts per billion on day 1 to 9.7 (5.7-18.3) parts per billion on day 28; p = 0.005. Peak expiratory flow rate measurements increased from 200 (120-280) l/min on day 1 to 280 (150-475) l/min on day 4; p < 0.05 and to 390 (150-530) l/min on day 28; p < 0.01. A strong negative correlation existed between peak expiratory flow rate measurements and exhaled nitric oxide levels in asthmatics on day 28 (r = -0.70; p = 0.017). CONCLUSION: Acute exacerbations of asthma are associated with increased levels of exhaled nitric oxide in contrast to exacerbations of chronic obstructive pulmonary disease and acute pneumonia. Exhaled nitric oxide may be a useful indirect marker of asthmatic airway inflammation. The differing time course of response of nitric oxide to peak flow measures suggests that these two measures are reflecting differing airway events.

Adolescent↗
PubMedDate not supplied

Foreign accent-like syndrome during psychotic exacerbations.

OBJECTIVE: The goal of this investigation was to describe the neurologic and psychiatric findings in a patient with foreign accent-like syndrome occurring during episodes of psychotic exacerbation. BACKGROUND: Foreign accent syndrome has been reported in several patients with disorders such as cerebral infarction, cerebral hemorrhage, and head trauma but not in a patient whose primary problem was psychosis. Most patients with this syndrome exhibit some degree of aphasia, and some are dysarthric. METHOD: A schizophrenic patient with foreign accent-like syndrome occurring during a psychotic exacerbation was evaluated by examination and interview, language testing, magnetic resonance imaging, electroencephalography, and other investigative methods. RESULTS: The patient exhibited a prominent British accent, which persisted throughout the duration of his psychotic exacerbation and resolved with improvement of his psychosis. Magnetic resonance imaging revealed no lesions, and no abnormality of language or articulation was present. A single-photon emission computed tomography scan could not be obtained. CONCLUSIONS: This represents the first reported case of a patient with foreign accent-like syndrome during psychotic exacerbations.

Aged↗
PubMed2001

COPD: management of acute exacerbations and chronic stable disease.

Acute exacerbations of chronic obstructive pulmonary disease (COPD) are treated with oxygen (in hypoxemic patients), inhaled beta2 agonists, inhaled anticholinergics, antibiotics and systemic corticosteroids. Methylxanthine therapy may be considered in patients who do not respond to other bronchodilators. Antibiotic therapy is directed at the most common pathogens, including Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. Mild to moderate exacerbations of COPD are usually treated with older broad-spectrum antibiotics such as doxycycline, trimethoprim-sulfamethoxazole and amoxicillin-clavulanate potassium. Treatment with augmented penicillins, fluoroquinolones, third-generation cephalosporins or aminoglycosides may be considered in patients with more severe exacerbations. The management of chronic stable COPD always includes smoking cessation and oxygen therapy. Inhaled beta2 agonists, inhaled anticholinergics and systemic corticosteroids provide short-term benefits in patients with chronic stable disease. Inhaled corticosteroids decrease airway reactivity and reduce the use of health care services for management of respiratory symptoms. Preventing acute exacerbations helps to reduce long-term complications. Long-term oxygen therapy, regular monitoring of pulmonary function and referral for pulmonary rehabilitation are often indicated. Influenza and pneumococcal vaccines should be given. Patients who do not respond to standard therapies may benefit from surgery.

Acute Disease↗
PubMed2002

[Systemic inflammation during exacerbations of chronic obstructive pulmonary disease].

OBJECTIVE: The circulating blood levels of several inflammatory cytokines and acute phase proteins are higher in patients with stable chronic obstructive pulmonary disease (COPD). However, whether or not these inflammatory markers increase during COPD exacerbation or are modified by corticosteroid treatment has not been investigated. The objective of this study was therefore 1) to describe changes in several inflammatory markers in systemic circulation during COPD exacerbation, and 2) to assess the potential effects of corticosteroid treatment during exacerbation. METHODS: Serum levels of tumor necrosis factor-alpha (TNF-alpha), interleukin 6 (IL-6), interleukin 8 (IL-8) and C-reactive protein (CRP) were determined for 10 patients (65 2 years old) with severe COPD (FEV1 35 4% reference) who were hospitalized for acute respiratory failure (PaO2 57 2 mm Hg; PaCO2 48 3 mm Hg). Blood samples were obtained in the emergency room (before starting intravenous corticosteroid treatment), during the first 24 hours of admission, upon discharge and two months later. Eight healthy non-smokers of a similar age (54 3 years) were also studied as control subjects. RESULTS: The COPD patients had higher concentrations of IL-6 (5.1 1.6 vs. 1.8 0.5 pg/mL, p < 0.05) and CRP (2.2 0.4 vs. 0.6 0.2 mg/dL, p < 0.005) than did controls, but the concentrations of IL-8 were similar (29 11.3 vs. 34.7 10.3 pg/mL, p = ns). No statistically significant changes were seen either during recovery, in spite of intravenous corticosteroid treatment, or two months after discharge.The ELISA test used was unable to detect TNF-alpha in any of the samples obtained from either patients or controls. CONCLUSION: The results show that 1) there is evidence of systemic inflammation during exacerbation of COPD, and 2) such systemic inflammation does not appear to be influenced significantly by intravenous corticosteroid treatment.

Adrenal Cortex Hormones↗
PubMed2002

[The efficacy of intravenous theophylline injection for treatment of acute exacerbations of bronchial asthma].

The efficacy of the intravenous injection of aminophylline for treatment of acute exacerbations of bronchial asthma has been recognized since 60 years ago by many reports. It has been published on the "Asthma Prevention and Management Guidelines 1998, Japan" as one of important treatment for acute exacerbations of bronchial asthma. An intravenously Administered Theophylline (IAT) was newly developed in Japan in 2000. Different from aminophylline, the theophylline is not combined with ethylenediamine. We investigated efficacy and safety of IAT. In the present study, subjects were 16 asthmatic patients with mild acute exacerbations of bronchial asthma. They were administered IAT (200 mg theophylline with 200 ml saline) intravenously for two hours. After administration of the IAT, PEF and FEV1 were increased significantly. And severity of asthma, Borg scale, wheezing and breath sound were improved significantly. It should be emphasized that none of the patients treated in this study had any adverse symptom. The present study suggested that IAT is useful for patients with acute exacerbations of bronchial asthma.

Aged↗
PubMed2002

Increased proliferative response of peripheral blood mononuclear cells and T cells to Streptococcus mutans and glucosyltransferase D antigens in the exacerbation stage of recurrent aphthous ulcerations.

BACKGROUND AND PURPOSE: Cytotoxic T lymphocyte-induced lysis of virus-infected oral epithelial cells has been shown to be a cause of early ulcer formation in recurrent aphthous ulcerations (RAU). To test whether bacteria and their associated antigens are involved in the disease process of RAU, the proliferative response (PR) to different streptococcal species in peripheral blood mononuclear cells (PBMC) and T cells isolated from RAU patients at the exacerbation stage was determined. METHODS: PBMC and T cells were isolated from 39 patients with RAU, 21 patients with erosive oral lichen plaus (EOLP, disease control group), and 22 healthy subjects (normal control group). Streptococcus mutans, Streptococcus sanguis, Streptococcus oralis, Streptococcus gordonii, Streptococcus mitis and their associated antigen, glucosyltransferase D (GtfD), were used to stimulate isolated PBMC and T cells in in vitro proliferation assays. RESULTS: PBMC and T cells isolated from RAU patients at the exacerbation stage showed a significantly higher PR to S. mutans antigen and GtfD than those isolated from EOLP patients or healthy control subjects (p < 0.05). GtfD was a more potent stimulation antigen than S. mutans. However, elevated PRs to S. mutans antigen and GtfD were transient and present only in the exacerbation stage of RAU. These elevated PRs declined to normal levels in the postexacerbation and convalescence stages of RAU. Furthermore, the GtfD-stimulated PR in PBMC and T cells was correlated with the severity of RAU. CONCLUSION: In addition to viral infections, streptococci and their associated antigen, GtfD, may be involved in the disease process of RAU, especially in the exacerbation stage.

Adolescent↗