Autoimmune diseases and sarcoidosis may be related and, especially, the association between sarcoidosis and autoimmune thyroid disease has long been recognized. The frequency and type of endocrine autoimmunity was examined in a series of Swedish patients with sarcoidosis. Of all patients (N = 89) with documented sarcoidosis attending the Department of Pulmonary Medicine between January 1980 and December 1991, 78 patients (44 males and 34 females; median age at the time of the study 48 years. range 22-81 years) were examined at the Department of Endocrinology, Malmö University Hospital, in the present study. Fifteen patients (19.2%) had clinical or serological evidence of endocrine autoimmunity. Two patients had Addison's disease, both with polyglandular autoimmune (PGA) syndrome type II: evidence of thyroid autoimmunity was found in 13 patients, eight with clinical autoimmune thyroid disease (ATD) (two with Graves' disease and six with autoimmune thyroiditis), of whom two had PGA syndrome type III, and five with isolated positive thyroid serology; two patients had insulin-dependent diabetes mellitus and one had premature ovarian failure. The frequencies of Addison's disease, clinical ATD and PGA syndrome type II were significantly higher compared with the frequencies found in the general population. In conclusion, a high frequency of endocrine autoimmunity in patients with sarcoidosis, occurring in about 20% of the cases, was demonstrated. Thyroid autoimmunity and polyglandular autoimmune syndromes occurred most frequently. Complex immunological and genetic mechanisms might explain the association of sarcoidosis and endocrine autoimmune diseases.

Patients with asthma and/or rhinitis, when using inhalers or nasal sprays containing corticosteroids, may experience mucosal symptoms, such as congestion of the nose, itching, nose bleeding and worsening of rhinitis, but also eczema of the face sometimes spreading to flexures, and sometimes the corticosteroid simply does not help. Few patients with such symptoms have been found to be allergic to their inhaled corticosteroids (1), and no report on whether contact allergy to corticosteroids could explain treatment failures is available. This issue was investigated in 2 ways: (i) by testing asthma/rhinitis patients for corticosteroid allergy, (ii) by looking at the prevalence of tixocortol pivalate allergy among dermatitis patients with and without asthma/rhinitis, respectively.

Two studies are presented, with the aim of establishing the dose potency ratio for salbutamol given via Turbuhaler® and via a pressurized metereddose inhaler (pMDI). Both studies were of a double-blind, randomized design. Outpatients with mild-to-moderate chronic reversible airway obstruction were given single doses of salbutamol administered via Turbuhaler and via pMDI. Efficacy and safety variables were measured before and during 6 h after each dose.The first study was a four-way crossover study including 12 patients. The salbutamol doses given were: 50, 100 and 2×100 µg via Turbuhaler and 2×100 µg via pMDI (Ventolin®). The study showed that 2×100 µg of salbutamol inhaled via Turbuhaler is more potent than 2×100 µg salbutamol inhaled via a pMDI, and that 100 µg salbutamol via Turbuhaler is at least as potent as 2×100 µg salbutamol inhaled via a pMDI.The second study including 50 patients was a placebo-controlled five-way crossover, study. Two doses of salbutamol via Turbuhaler, 50 and 2×100 µg, and via pMDI, 100 and 2×200 µg, were given. There was a dose-dependent response in forced expiratory volume in one second (FEV1) for both inhalers. Adjusted for differences in baseline FEV1 values, the estimated relative dose potency for Turbuhaler versus pMDI was 1.98:1 (95% confidence interval 1.2-3.2).These studies showed that the same bronchodilating effect can be achieved when half the dose of salbutamol given via a conventional pressurized metered-dose inhaler is given via Turbuhaler. Eur Respir J 1997; 10: 2474-2478 The pressurized metered-dose inhaler (pMDI) is the most widely used device for administering inhaled salbutamol, although dry-powder formulations dominate in a few countries. A substantial number of patients do not use their pMDIs optimally, the main problem being difficulties with co-ordination between the actuation of the dose and inhalation [1]. In addition, the chlorofluorocarbons (CFCs) used as propellants and lubricants are suspected of causing bronchoconstriction in some asthmatic individuals [2,3]. Furthermore, CFC propellants are harmful to the environment. Restrictions on the use of pMDIs are currently being implemented in several countries.To overcome co-ordination problems and other drawbacks with pMDIs, inspiratory flow-driven, dry-powder inhalers (DPIs), e.g. Rotahaler® and Diskhaler® (both Glaxo Wellcome Operations, Greenford, Middlesex, UK), have been developed. Turbuhaler® (Astra Pharmaceutical Production AB, Södertalje, Sweden) is an inspiratory flow-driven multidose DPI [4]. Studies have shown that Turbuhaler deposits a higher fraction of the dose in the lung than do pMDIs or the earlier DPIs [5][6][7][8][9]. Results from a cumulative dose-response study indicated that salbutamol inhaled via Turbuhaler gives better bronchodilating effect than salbutamol inhaled via a pMDI [10].The aim of the two single-dose studies presented here was to establish the dose potency ratio for salbutamol given via Turbuhaler compared with via a pMDI. In the first study, the lower dose of salbu...

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