In a double-blind study of 2 parallel groups of 15 allergic asthmatic patients each, we investigated whether treatment with inhaled budesonide has a dose- and time-dependent effect on the degree of bronchial hyperreactivity. The patients were randomly allocated to treatment with either 200 or 800 micrograms budesonide per day for a period of 8 wk. The active treatment period was preceded by a selection period of 3 wk, and a single-blind placebo period of 2 wk. During these initial 5 wk the maintenance treatment of the patients, including cromolyn sodium and inhaled corticosteroids, was withheld. Spirometry and inhalation provocation tests with methacholine were carried out, and the symptom score was recorded every 2 wk. The methacholine provocation concentrations (geometric mean) causing a decrease in FEV1 of 20% (PC20) in the 200 and 800 micrograms/day treatment groups just before the active treatment period were 0.90 and 0.91 mg/ml, respectively. These values increased significantly to 1.21 and 1.84 mg/ml after 2 wk of treatment (p less than 0.05 and p less than 0.001, respectively) and to 1.55 and 2.74 mg/ml after 8 wk of treatment (p less than 0.01 and p less than 0.001). During the whole study period budesonide in a dosage of 800 micrograms/day induced a significantly larger change in PC20 than in a dosage of 200 micrograms/day. The FEV1 before treatment was 91 +/- 3% (SEM) and 84 +/- 2% of the predicted value in the 200 and 800 micrograms/day treatment groups, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
In a double-blind, double-placebo, randomized crossover study, we compared the effects of 6 wk of treatment with the anti-inflammatory drug nedocromil sodium (16 mg/day) with 6 wk of treatment with the bronchodilator drug albuterol (800 micrograms/day) in 29 adults with allergic asthma. After 3 and 6 wk of treatment with nedocromil sodium, patients were significantly less hyperresponsive to propranolol (p = 0.002 and p = 0.02) and almost significantly less hyperresponsive to histamine (p = 0.071 and p = 0.065). FEV1 and FVC percent predicted tended to be higher, morning PEF values increased significantly (p = 0.038 and p = 0.03), and diurnal and day-to-day PEF variation decreased (p = 0.03 and p = 0.093, p = 0.005 and p = 0.096, respectively) with nedocromil sodium treatment compared with albuterol treatment. Almost all symptoms (daytime and nighttime asthma, wheezing, shortness of breath) and the additional bronchodilator use were significantly reduced with nedocromil sodium treatment compared with albuterol treatment. Treatment with the anti-inflammatory drug nedocromil sodium was shown to be superior to treatment with the bronchodilator drug albuterol. The patient's clinical situation may deteriorate when beta 2-agonists are used continuously. Nedocromil sodium has good clinical effect, and it may serve as a first-line choice for antiinflammatory therapy in asthma.
Nitric oxide (NO) is produced by many inflammatory cells [1]. Asthma is a disease in which inflammation plays an important role. Nitric oxide can easily be measured in the exhaled air of asthmatics and is used in research settings as a marker for inflammation [2]. Several studies, starting with ALVING et al. [3] in 1993, have shown increased amounts of NO in the exhaled air of asthmatic patients and normal values after treatment with corticosteroids. NO in exhaled air is measured by chemiluminescence.We measure NO by having the patient inhale air with very low NO concentrations (1-3 parts per billion (ppb)). Values of NO measured in exhaled air by this method range approximately 5-40 ppb [4]. By chance we found a problem with the NO measurement after cleaning the breathing system with an alcohol containing disinfectant. We observed a sharp rise in NO readings and even more in NO 2 values. We tested the influence of ethanol by administering a gas mixture containing about 5 vol% of ethanol vapour to the analyser. This resulted in a reading of 22 ppb NO, while ambient concentrations were only 2 ppb NO. A similar result was observed with a second brand of chemiluminescence analyser. Additionally, we mimicked a small spill of disinfectant by spraying 0.5 mL of cleaning substance (chlorhexidine 0.5% in 70% ethanol) into the tube leading to the collecting bag for exhaled air, while performing a normal procedure for measuring NO in four subjects. Between every measurement, the system was totally dried with air for 10 min. A mean (range) baseline NO concentration of 19.7 (12-24) ppb was recorded, which increased to 24.3 (18-28) ppb after adding the disinfectant. One subject even showed an increase of 51% in NO reading.The explanation is probably that ethanol disintegrates in the reacting chamber into water and ethane, which is a known source of interference in chemiluminescence measurement [5]. Other organic fluids frequently used in a hospital environment (acetone, ether, methanol) did not influence the NO measurement, even when administered in high concentrations.Since NO 2 measurements showed a much larger percentual increase when adding ethanol-containing substances to the system, simultaneous measurements of NO and NO 2 can therefore be used to monitor contaminating substances, such as ethanol.Because the rise in NO readings with alcohol is only slightly smaller than the rise during mild asthma exacerbations, we consider this influence of important clinical interest. To our knowledge, alternative non-alcohol-containing disinfectant fluids with sufficient bactericidal activity are not available. Therefore, we advise that only the mouthpiece should be changed between subsequent measurements and, furthermore, that the complete breathing system should be cleaned with alcohol-containing substances only at the end of the day, so that ethanol can evaporate completely before the next day's measurements.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.