Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The Asthma Symptom Checklist (ASC), describing the subjective symptoms reported to occur during asthmatic attacks, has been developed previously. In the present study, the ASC key cluster solution was replicated and refined within a sample of 374 asthmatic inpatients. All of the original symptom categories were reporduced, including two mood categories, Panic-Fear and Irritability, a Fatigue category, and two somatic categories. Hyperventilation-Hypocapnia and Airway Obstruction. Two refinements were notable: (1) The Airway Obstruction category was empirically divided into two conceptually clear components, Dyspnea anc Congestion, and (2) three secondary mood categories, Worry, Loneliness, and Anger, were identified, which describe a continuum of mood between the polar extremes of panic and irritability. Of the symptom categories, only Panic-Fear was related to the intensity of the discharge drug regimens recommended 2 to 6 mouths after ASC administration. Panic-Fear scores were independent of pulmonary function measurements. A combined index based on pulmonary functions and panic-fear yielded the best prediction of discharge steroid regiments. Finally, those physicians rated highest in "sensitivity" to their patients by their supervisors prescribed less steroids overall, but most frequently prescribed discharge steriod regimens in relation to their patients' Panic-Fear scores. In contrast, physicians rated lower on sensitivity prescribed higher steroid regimens overall, but based these drug recommendations more cleary on objective pulmonary functioning, and not in relation to their patients' Panic-Fear scores. The results strongly suggest that the ASC Panic-Fear scale is associated with coping behaviors that importantly affect the patient's overall clinical picture by increasing the apparent severity of the asthma, thereby leading to intensified treatment. The findings stress the need to evaluate independently the objective medical condition and subjective symptomatology with its related coping behavior, in order to direct appropriate modes of therapy to each.
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PMID:Obervations on subjective symptomatology, coping behavior, and medical decisions is asthma. 40 66

The results and side effects of immunotherapy in atopic dermatitis, bronchial asthma and/or allergic rhinitis are evaluated in 460 patients. The findings are listed in terms of diagnosis, age, sex and preparations as well as duration and number of incorporated allergens of immunotherapy-vaccine. In 82% a good result was reported, while in 18% no improvement could be seen. The results increase gradually from atopic dermatitis to bronchial asthma and allergic rhinitis, although the differences fail to be significant statistically. Males respond better than females. However, in bronchial asthma only, the differences are significant (p less than 0.01). According to the preparations used (Bencard, Novo-Helisen, Allpyral), no differences could be seen. The percentage of side effects is higher than 50%, but is mainly restricted to local swelling, tiredness and itching. Again no significant differences could be seen between the vaccines used.
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PMID:[Immunotherapy of allergic disease. Studies on 460 patients]. 47 57

Dyspnea is the medical term for the patient's or subject's complaint of shortness of breath. It encompasses the respiratory discomfort experienced in many different diease states as well as the shortness of breath felt by a normal subject during or after strenuous exercise. Several parameters which have been shown to correlate with the onset or severity of dyspnea are described, including reduced vital capacity, the ratio of minute ventilation to vital capacity, reduced breathing reserve, the work of breathing, and the oxygen cost of breathing. Attempts at quantitation of dyspnea have usually consisted of measuring physiological parameters associated with the sensation, such as the "dyspneic index". The direct measurement of respiratory sensations using modern psycho-physical methods is at an early stage of development. Since the observation that the existence of dyspnea is often unrelated to any disturbance of arterial blood gas composition, it has been generally held that the mechanism of dyspnea is primarily neurophysiological. The neural pathways may conceptually be divided into those which transmit the "dyspnea message" from the respiratory apparatus to integrating centers in the brain, and those concerned with subsequently bringing the sensation to the level of consciousness. It seems likely that there is no single sensing mechanism and neural pathway which will be able to explain dyspnea in the diverse populations of patients and subjects who experience unpleasant respiratory sensations. Three theories concerning mechanisms of dyspnea are briefly described: "length-tension inappropriateness", vagal afferent activity especially from the J-receptors, and the recent concept of diaphragmatic fatigue. Some specific characteristics of the shortness of breath experienced in certain disease states are described, including chronic bronchitis and emphysema, bronchial asthma, pulmonary fibrosis and congestive heart disease.
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PMID:Dyspnea. 50 81

Conventional formulations of metoprolol have become well established in cardiovascular medicine and are particularly useful in the management of hypertension and ischaemic heart disease. Recently developed controlled release metoprolol delivery systems (metoprolol CR/ZOK and metoprolol OROS) were designed to overcome the drug delivery problems of matrix-based sustained release forms by releasing the drug at a relatively constant rate over a 24-hour period, and thus producing sustained and consistent metoprolol plasma concentrations and beta 1-blockade while retaining the convenience of once daily administration. Clinically and statistically significant reductions in blood pressure have been observed with metoprolol CR/ZOK and metoprolol OROS 24 hours after administration in mildly or moderately hypertensive patients. Studies in patients with mild to moderate hypertension have demonstrated that a similar or higher percentage of patients achieved a goal response with metoprolol CR/ZOK compared with matrix-based sustained release formulations of metoprolol, or conventional atenolol or bisoprolol, while metoprolol OROS achieved an equal or greater response rate compared with conventional or matrix-based sustained release metoprolol preparations. In patients with stable effort angina pectoris, once daily administration of metoprolol CR/ZOK provided at least equal antianginal efficacy as conventional metoprolol in divided doses, while metoprolol OROS reduced the mean number of anginal attacks by the same margin as atenolol. Controlled release metoprolol formulations have been well tolerated in clinical trials. Metoprolol CR/ZOK was associated with a similar or lesser degree of adverse effects related to the central nervous system compared with atenolol or long acting propranolol. Metoprolol CR/ZOK also demonstrated less pronounced beta 2-mediated bronchoconstrictor effects than atenolol in asthmatics, and less general fatigue and leg fatigue in healthy subjects. Metoprolol OROS produced less pronounced bronchoconstrictor effects than atenolol, matrix-based sustained release metoprolol or long acting propranolol in patients with asthma or obstructive airways disease, and healthy volunteers. These results are presumably due to the beta 1-selectivity of metoprolol in addition to the relatively low plasma concentrations maintained by metoprolol CR/ZOK and metoprolol OROS, and the avoidance of high peak plasma concentrations with these agents. Despite the relative safety of the controlled release forms of metoprolol, the use of all beta-adrenoceptor antagonists should be avoided in patients with a history of bronchospasm. Thus, controlled release metoprolol formulations offer the potential to maximise the confirmed benefits of this agent in the management of hypertension and angina, by maintaining clinically effective plasma concentrations within a narrow therapeutic range over a 24-hour dose interval.
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PMID:Controlled release metoprolol formulations. A review of their pharmacodynamic and pharmacokinetic properties, and therapeutic use in hypertension and ischaemic heart disease. 137 20

Markers of a heavy increase in training were examined in ten highly trained distance runners (mean(s.d.) age 29.8(1.7) years, maximal oxygen intake 65.3 ml kg-1 min-1, personal best 10-km time 31 min 4 s) who undertook a deliberate 38% increment of training over a 3-week period. Their running performance did not improve, and six of the ten subjects developed sustained fatigue, suggesting that training was excessive, although the full clinical picture of overtraining did not develop. The Profile of Mood States was the best single marker of disturbed function, indicating increased fatigue and decreased vigour. There were no useful changes of resting heart rate or perceived exertion during submaximal running, sleep was undisturbed, and there were no orthopaedic injuries. Two subjects developed rhinoviral infections following the heavy training, and a third complained of symptoms that were diagnosed 2 weeks later as exercise-induced asthma. The increase of serum cortisol normally induced by 30 min of submaximal exercise was no longer seen when the same acute exercise was performed after heavy training. Resting lymphocyte proliferation tended to increase in response to phytohaematoglutinin (PHA) and concanavalin A (Con A), the ratio of helper to suppressor cells (H/S) decreased, and pokeweed mitogen induced smaller increases in IgG and IgM synthesis. Whereas before heavy training, PHA-stimulated lymphocyte proliferation was unchanged by 30 min of acute submaximal exercise, after 3 weeks of heavy training the same bout of exercise caused an 18% suppression of proliferation. Likewise, heavy training brought about a decrease of T-lymphocytes in response to acute submaximal exercise, but an abolition of the acute exercise-induced decrease in the H/S ratio. The previously observed exercise-induced decrease of IgG synthesis did not occur when the same acute bout of exercise was performed after heavy training. We conclude that such minor and transient changes of immune function may possibly be a warning that training is becoming excessive, but they have only a limited significance for overall immune function.
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PMID:Potential markers of heavy training in highly trained distance runners. 142 53

Thirty-three asthmatic subjects were told they were receiving, alternately, an inhaled bronchoconstrictor and inhaled bronchodilator, although they actually were only breathing room air. No subjects showed suggestion-produced effects on FEV1, although two (of the 19 on whom FEF50 was measured) showed effects of greater than 20% on measures of maximal midexpiratory flow. The incidence of the effect is smaller than reported previously, possibly because some subjects in previous studies inhaled saline, a mild bronchoconstrictor, and reversal of effect was not required for classification as a reactor. Higher percentages of subjects in this study showed decreased MMEF in response to the 'bronchoconstrictor', but this appeared to reflect fatigue rather than suggestion effects. However, the fact that the effect occurred in a relatively non-effort-dependent measure suggests that real changes occurred in bronchial caliber, not just in test effort. Suggestion had a significant effect on perception of bronchial changes, but the correlation between actual and perceived changes was minimal. There was an increase in FVC prior to administration of the 'bronchoconstrictor', possibly reflecting a preparatory response to the expected drug. Correlations among self-report variables suggested the existence of three personality dimensions among our population related to suggestion and asthma: cognitive susceptibility to suggestion of bronchial change; feeling of physical vulnerability; and anxiety. However, there was no significant relationship between airway response to suggested changes and hypnotic susceptibility, as measured by the Harvard Group Scale of Hypnotic Susceptibility.
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PMID:The effects of suggestion on airways of asthmatic subjects breathing room air as a suggested bronchoconstrictor and bronchodilator. 143 67

We initiated a program to evaluate patient reasons for refusing immunization in an allergy clinic. A general medicine clinic was studied for comparison. For the Northwestern University Allergy Service (NUAS) there were five full-time salaried and seven voluntary physicians. In the general medicine clinic there was one part-time salaried physician. Four hundred eighty-eight NUAS patients and 48 general medicine patients were evaluated. Ninety-five percent of the patients agreed to vaccination. Egg allergy, the only valid contraindication to influenza vaccination, was reported by three (< 1%) patients. Transient mild symptoms consisting of fatigue, myalgias, rhinitis and/or diarrhea were reported in 20% of the patients who received vaccination. No severe systemic reactions were reported. No significant difference in the vaccination acceptance rate was noted between the subspecialty and primary care outpatient clinics. The importance of influenza immunization in patients with asthma and in other high-risk populations deserves emphasis, and high success rates are achievable when emphasized by physicians.
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PMID:Influenza vaccination: a successful outpatient program. 149 Jun 24

A group of seven asthmatics were identified from family practice, following administration of a questionnaire, as expressing feelings of stigma or pessimism concerning their condition. They were interviewed in depth, using interpretive research methods, concerning their experience of asthma. Interpretive research uses qualitative methods to explore the emotions, feelings and meaning of the event of interest. All the interviews were transcribed verbatim by the principal researcher and analyzed by the technique of immersion and crystallization. The picture of asthma that emerged for the participants in this study gave rise to the concept of a dynamic model to illustrate their asthma experience. The model showed asthma as a continuum from diagnosis to final acceptance. The transition phase included a need to integrate knowledge, experience and self-awareness before progressing to acceptance and control. A mentoring relationship greatly facilitated resolution of the transition phase. Progress along the continuum was accompanied by diminishing fear. Another important theme to emerge was the fact that tiredness and physical limitations were common feelings, irrespective of the severity of the asthma in medical terms. The implications of this research for health workers is that they have much to contribute in assisting asthmatics to gain control over their condition, particularly in respect to understanding what knowledge concerning their condition is relevant to asthmatics and in understanding the potential benefit to asthmatics of a mentoring relationship.
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PMID:The experience of asthma. 152 73

An 11-year-old boy with asthma had been receiving a controlled release theophylline preparation. He was prescribed fluvoxamine for a depressive disorder and within a week complained of severe headaches, tiredness and vomiting. His serum theophylline concentration had increased from 14.2 mg/L (shortly before fluvoxamine was started) to 27.4 mg/L. Fluvoxamine was withdrawn and theophylline concentrations decreased. Clomipramine was substituted for fluvoxamine with no further problems, and a later theophylline concentration was 13.7 mg/L. Competitive inhibition of hepatic microsomal enzymes by fluvoxamine may have been responsible for the elevated theophylline concentrations and toxicity observed in this case.
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PMID:Toxic interaction between fluvoxamine and sustained release theophylline in an 11-year-old boy. 179 25

Asthma increases the load on the ventilatory pump by causing simultaneous increases in airway resistance, lung volume, and minute ventilation. The inspiratory muscles bear the majority of this load, whereas expiratory muscle recruitment is relatively minor. Respiratory muscle strength and endurance appear to be normal in stable asthmatics. During acute attacks, airway closure and expiratory airflow limitation result in a dynamic increase in end-expiratory lung volume. In turn, hyperinflation compromises the function of inspiratory muscles, especially that of the diaphragm, by reducing their force-generating capacity (muscle shortening) and impairing their mechanical advantage on the chest wall. Thus, exacerbations of asthma cause an acute increase in mechanical load together with decreased ventilatory capacity, thereby predisposing to inspiratory muscle fatigue and precipitating hypercapnic respiratory failure in severe cases. Management of ventilatory failure in asthma consists of mechanical unloading of the inspiratory muscles by positive pressure ventilation together with pharmacotherapy (anti-inflammatory and bronchodilating agents) to improve airway function. The strategy of mechanical ventilation is aimed at minimizing dynamic hyperinflation, which increases inspiratory muscle load as well as promotes barotrauma.
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PMID:Respiratory muscle function in asthma. 180 52


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