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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The cardiopulmonary effects of epinephrine and terbutaline were compared in a doubleblind crossover study in 23 subjects with chronic obstructive airway disease. On each of three days each subject received a single subcutaneous dose of saline, 0.25 mg of epinephrine or 0.5 mg of terbutaline. Treatment with epinephrine produced significant increases in forced vital capacity (FVC), forced expiratory volume in one second (FEV-1), maximal expiratory flow rate (MEFR) and maximal mid-expiratory flow (MMEF). Terbutaline caused even more pronounced increases in all four parameters and exhibited a longer duration of action. Neither drug altered arterial pH, arterial oxygen pressure (PaO-2), or arterial carbon dioxide pressure (PaCO-2). With regard to cardiovascular effects, no alterations in either systolic or diastolic pressure were observed. Administration of epinephrine and terbutaline caused statistically significant increases in heart rate. The effect of terbutaline was more pronounced that that of epinephrine. In addition, terbutaline caused a heart rate-related depression of the T-wave of the lead 2 ECG. Neither drug altered any of the hematologic, hemochemical or urinary parameters monitored before and after treatment. Side effects were seen in eight subjects after administration of saline solution, in 13 subjects after epinephrine and in 19 subjects after terbutaline. None of these side effects was considered clinically serious and none required treatment. It is concluded from this study that subcutaneously administered terbutaline is a more effective bronchodilator than epinephrine.
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PMID:Comparison of the cardiopulmonary effects of subcutaneously administered epinephrine and terbutaline in patients with reversible airway obstruction. 23 63

Terbutaline, a new bronchodilator acting on beta-adrenergic receptors, was given to 10 asthmatic patients, who received on separate days 5 mg orally, 10 mg orally, and 0.25 mg subcutaneously. The ventilatory response was assessed by measurement of the FEV(1) before and at intervals after administration. The cardiovascular response was assessed by measurement of the heart rate and blood pressure and by electrocardiography at the same times as spirometry was performed.The ventilatory response to all three doses and by both routes was satisfactory. The maximal increase in FEV(1) after 5 mg orally was only slightly less than that after 10 mg. The maximal increase in heart rate after 5 mg orally was about half that which occurred after 10 mg. It is concluded that 5 mg orally and 0.25 mg subcutaneously are suitable doses.In general a modest fall in blood pressure affected the diastolic more than the systolic. On E.C.G. the T wave was often depressed, and in one patient, it was inverted. A trough-like depression of the QRS baseline occurred several times. The significance of the E.C.G. changes is uncertain.
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PMID:Trial of new bronchodilator, terbutaline, in asthma. 439 85

Since the postoperative long-term evaluation for thoracic esophageal carcinoma had not been sufficient by a conventional respiratory function test alone, investigation was carried out by observing the changes in motor tolerance. The subjects were selected of 50 cases who elapsed more than 3 months before and after the operation among the cases who had been undergone radical operations with right thoracotomy and laparotomy for thoracic esophageal carcinoma; and then all of the subjects were subjected to a conventional respiratory function test and a respiratory movement loading test. Furthermore, investigation by use of multivariate analysis (Quantification: Class 1) was conducted for the factors relating to the depression of respiratory movement. For loading the movement, bicycle-type ergometer were employed, and a graded gradual-increase loading method was adopted. With the general respiratory function test, vital capacity was depressed from a preoperative average value of 2.1 +/- 0.4 (1/m2) to a postoperative average value of 1.6 +/- 0.3 (1/m2) showing a depressing trend being significant to a postoperative condition (p < 0.0001), and no significant postoperative difference was observed for FEV 1.0%. Even in such a condition, no significant depression was observed for oxygen intake at resting, but the maximum oxygen intake showed a significant depression (p < 0.0001) from a preoperative average value of 22.3 +/- 5.0 to a postoperative average value of 19.3 +/- 4.1 ml/min/kg. The maximum carbon oxide evacuation showed a significant depression (p < 0.0001) after operation. The ventilation quantity in a course of movement showed a depressing trend after operation, with be number of respiration in an increasing trend, showing a shallow-but-quick respiratory pattern. Mobility restriction due to circulation factors was not observed, and also the nutrition before and after operation did not show any significant difference in the blood examination. But the lactic acid during movement showed a significant increase after operation. As described above, it is considered that a pattern of restrictive impairment at resting increased an oxygen equivalent resulted from depression of oxygen intake by the movement, an increase in dead space ventilation rate for minute ventilation at movement, and a shallow-but-quick respiratory pattern have caused aggravation of the ventilation efficiency, which finally led to the interruption of movement. In a long-term period, as clinical factors relating to those, cigarette smoking, nutrition before operation, age, and postoperative radiation therapy are concerned, which were thus considered the key factors in considering the postoperative long-term QOL. Nutrition and rehabilitation by continuous muscle training is necessary to improve the long-term QOL, after radical esophagectomy.
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PMID:[Pulmonary function during exercise before and after radical esophagectomy for esophageal cancer]. 902 16

We aimed to assess whether partially reversible and fixed airway obstructions are associated with different health status profiles of chronic obstructive pulmonary disease (COPD) patients. We characterized health status profiles of outpatients over 64 years suffering from COPD with fixed (n = 181) or partially reversible obstruction (n = 95) and from chronic bronchitis with forced expiratory volume in the first second (FEV1) > 69% of that predicted (n = 109) on the basis of the Saint George Respiratory Questionnaire (SGRQ) and indexes assessing cognitive (Mini Mental State), affective (15-item Geriatric Depression Scale) and physical status (Index of Barthel, six-minute walking test) and quality of sleep (Index of disturbed sleep). The degree of group-specificity of health status profiles was assessed by discriminant analysis. The 54.1% of COPD patients with partially reversible obstruction were recognized to have a distinctive health status profile characterized by a moderate to severe impairment of all components ('Symptoms', 'Activity', 'Impacts') of the SGRQ and of select indexes of performance. According to logistic regression analysis, this health status profile was associated with FEV < 46% of that predicted (odds ratio (OR): 1.6, 95% confidence interval (CI): 1.07-2.38), the use of at least three respiratory drugs (OR: 2.28, CI: 1.46-3.57) and living alone (OR: 2.01, 95% CI: 1.3-2.29). COPD patients with fixed obstruction had a very heterogeneous health status. Research is needed to verify whether the unfavorable health status profile typical of a subset of COPD patients is associated with a distinctive prognosis and can be improved by dedicated therapeutic interventions.
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PMID:Reversible bronchial obstruction and disease-related health status in COPD. 1220 72

This study assessed the impact of a randomized trial of nursing-based case management for patients with chronic obstructive pulmonary disease, their caregivers, and nursing and medical staff. Sixty-six patients were matched by FEV on admission to hospital, and randomized into an intervention or control group. Intervention group patients reported significantly less anxiety at 1 month postdischarge; however, this effect was not sustained. There was little difference between groups in terms of unplanned readmissions, depression, symptoms, support, and subjective well being. Interviews with patients and caregivers found that the case management improved access to resources and staff-patient communication. Interviews with nursing and medical staff found that case management improved communication between staff and enhanced patient care.(1)
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PMID:A randomized control trial of nursing-based case management for patients with chronic obstructive pulmonary disease. 1239 55

BACKGROUND: Asthma is a sometimes severe respiratory illness with an increased prevalence, especially in low-income, minority, and inner-city populations, over the past 2 decades. Prior reports have suggested a link between depression and asthma deaths. However, no studies have examined the relationship between objective measures of asthma severity and clinician-rated depressive symptom severity. METHOD: In this pilot study, 46 children receiving treatment at an inner-city asthma clinic were assessed with the Children's Depression Rating Scale, Revised (CDRS-R). The current percentage of forced expiratory volume in 1 second (FEV(1)%) predicted and the inhaled steroid dose were recorded, as were oral steroid use, emergency room visits, and hospitalizations in the preceding year. RESULTS: Depressive symptoms were common in this sample, with 30% (N = 14) of the participants having CDRS-R scores consistent with likely, very likely, or almost certain major depressive disorder. When mean CDRS-R scores were compared between the sample divided by these asthma severity measures, only hospitalizations in the past year was associated with higher depressive symptom scores (p =.03). CONCLUSION: These findings suggest that in the patient sample studied, depressive symptoms appear to be common. However, depressive symptom severity is related only to hospitalization, not other measures of asthma severity. Larger studies are needed to confirm these findings and determine if other variables such as family history of depression or subjective assessment of asthma severity explain the high prevalence of depressive symptoms in these patients.
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PMID:Depressive Symptoms in Inner-City Children With Asthma. 1501 4

Dyspnea, the clinical term for shortness of breath, is the primary symptom and an important outcome measure in evaluations of patients with lung disease. It is a subjective symptom that has proved difficult to quantify. Many dyspnea measures are available, yet it is difficult, based on the existing literature, to determine the most reliable and valid. In this study, we evaluated 6 measures of dyspnea for reliability and validity: (a) Baseline Dyspnea Index (BDI) and Transition Dyspnea Index, (b) UCSD Shortness of Breath Questionnaire (SOBQ),(c) American Thoracic Society Dyspnea Scale, (d) Oxygen Cost Diagram, (e) Visual Analog Scale, and (f) Borg Scale. Subjects were 143 patients (74 women) and 69 men) with obstructive lung disease, ages 40 to 86, FEV(1.0) 0.36 to 3.53 L, FVC 1.07 to 5.74 L. Dyspnea measures were assessed for test-retest reliability internal consistency, interrater reliability, and construct validity (i.e., correlations among dyspnea measures and correlations of dyspnea measures with exercise tolerance, health-related quality of life, lung function, anxiety, and depression). Results suggest that the SOBQ and BDI demonstrated the highest levels of reliability and validity among the dyspnea measures examined.
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PMID:Reliability and validity of dyspnea measures in patients with obstructive lung disease. 1625 Jul 81

Goals of effective management of patients with chronic obstructive pulmonary disease (COPD) include relieving their symptoms and improving their health status. We examined how such patient reported outcomes would change longitudinally in comparison to physiological outcomes in COPD. One hundred thirty-seven male outpatients with stable COPD were recruited for the study. The subjects health status was evaluated using the St. George's Respiratory Questionnaire (SGRQ) and the Chronic Respiratory Disease Questionnaire (CRQ). Their dyspnoea using the modified Medical Research Council (MRC) scale and their psychological status using the Hospital Anxiety and Depression Scale (HADS) were assessed upon entry and every 6 months thereafter over a 5-year period. Pulmonary function and exercise capacity as evaluated by peak oxygen uptake (VO2) on progressive cycle ergometry were also followed over the same time. Using mixed effects models to estimate the slopes for the changes, scores on the SGRQ, the CRQ, the MRC and the HADS worsened in a statistically significant manner over time. However, changes only weakly correlated with changes in forced expiratory volume in 1s (FEV(1)) and peak (VO2). We demonstrated that although changes in pulmonary function and exercise capacity are well known in patients with COPD, patient reported outcomes such as health status, dyspnoea and psychological status also deteriorated significantly over time. In addition, deteriorations in patient reported outcomes only weakly correlated to changes in physiological indices. To capture the overall deterioration of COPD from the subjective viewpoints of the patients, patient reported outcomes should be followed separately from physiological outcomes.
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PMID:Longitudinal deteriorations in patient reported outcomes in patients with COPD. 1671 25

Non-compliance or euphoria may limit the usefulness of prednisolone tablets in assessing steroid-responsiveness in chronic obstructive pulmonary disease (COPD). Depot intra-muscular methyl-prednisolone (imMP), producing a plateau steroid effect over two weeks, may be more reliable. Following two weeks of placebo, twenty-seven COPD patients (mean FEV 1 43% predicted) participated in a two-week randomised, double-blind, placebo-controlled, parallel-design trial taking either 120 mg imMP with placebo tablets or placebo injection with prednisolone 30 mg daily. After each period, post-bronchodilator FEV 1, forced vital capacity (FVC), inspiratory capacity (IC) and six-minute walking distance (6MWD) were assessed and patients completed both quality-of-life scores (St. George's 30 and Short Form 36) and mood scores (Hospital Anxiety and Depression scores and Altman's Self-rating Mania Scale). There were no significant changes in 6MWD, quality of life or mood scores after either type of steroids and no change in lung function after imMP. By contrast, there were small mean improvements in lung function on oral prednisolone (mean FEV 1, FVC and IC increased by 100, 320 and 150 ml, respectively). Only the improvement in FVC was significantly greater after prednisolone compared with imMP. Single depot intra-muscular injections of steroids have no advantage over oral daily prednisolone in testing steroid-responsiveness in COPD patients.
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PMID:Comparison of oral and depot intra-muscular steroids in assessing steroid-responsiveness in COPD. 1699 37

Symptoms of asthma can be intensified and/or mixed with depression since depression can cause asthmatic symptoms like complaints even in normal people. In the present study, depression index and its influencing parameters were examined in asthmatic patients. A questionnaire including sociodemografic features was applied to 120 patients, accepted as asthmatic according to the Thoracic Society Guidelines, who were following up in our asthma and allergy outpatient clinic. There were 98 female and 22 male patients and the mean age was 38.19 +/- 10.99. Physical examination, PEF and spirometric measures were made in all patients. Also daytime and nighttime symptom score, Q score, Beck depression score were applied to patients. Beck Depression Index (BDI) was in range of 0 and 37 and the mean was 11.26 +/- 8.54 (mild). According to the cut-off values, BDI scores were obtained as absent, mild, moderate and severe, 59%, 27%, 9%, 7% respectively. The mean BDI score was higher in female patients (12.32 +/- 8.77) than in male patients (6.55 +/- 5.41) and in married patients (11.91 +/- 8.77) than in unmarried ones (7.56 +/- 6.00). According to the results of FEV(1) values, PEF changes, there were no significant difference obtained between groups (p> 0.05). The mean value of BDI was found to be significantly high in patients with moderate and high daytime and nighttime score and Q score (p< 0.05). In conclusion, we think that, while evaluating the severity of asthma, if the spirometric results are not correlated with the symptoms then psychological conditions of the patients should be taken into consideration.
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PMID:[The factors affecting Beck depression scale in asthmatic patients]. 1740 89


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