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This study examines the efficacy and side effects of 15-methyl-prostaglandins F2alpha (PGF2a) free acid administered intramuscularly for midtrimester abortion. 50 healthy women aged 14 to 37 years and between 12 to 18 weeks gestation were randomly selected from the abortion clinic at the Los Angeles County/USC Medical Center, Women's Hospital to participate in the study. The prostaglandin preparation was supplied in ampules containing 1.1 mg. in 2.2 ml. of aqueous solution. The injection was given every 2 hours until the fetus was expelled or for a maximum of 12 injections. Vital signs of the patients were closely monitored. 46% (23) of the subjects aborted within 12 hours and 90% within 27 hours. Mean injection-abortion time was 13.5 hours (range, 5 3/4 to 27 hours). The effectiveness and rapidity of abortion was related with gestational age: the lower the gestational age, the shorter the abortion time. Women with more than 17 weeks gestation had a higher failure rate. Mean number of injections was 7.5. 5 patients failed to abort with prostaglandin alone, all of them primigravidas and weighing in excess of 150 lbs; supplemental therapy was provided. Side effects and complications associated with 15-methyl-PGF2a included: emesis (66%); diarrhea (76%); flushing (12%); chills (4%); fever of 100 degrees Fahrenheit (12%); pain requiring medication (16%); and blood loss (6%). The success of this method appears to be related to dosage; parity; gestational age; weight of patient; and frequency of administration. Although there were side effects, these were outweighed by rapid abortion time, mild contractions, and ease of administration. Asthma is the only medical contraindication to prostaglandin therapy.
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PMID:Midtrimester abortion with intramuscular injection of 15-methyl-prostaglandin F2alpha. 113 40

Records from 2 of the 8 primary health care clinics (PHCs) in Pondicherry, India, were surveyed one day per month in 1988 by medical graduates to determine drug utilization. 2953 patients treated during the morning hours received 8021 prescriptions, an average of 2.71 each. The most commonly prescribed drugs were vitamins (24.7% of total drugs), antimicrobials (24.3% of drugs, 66.2% of patients), analgesics (19.9% of drugs) and antihistamines (10.3%). The most prevalent diagnoses were would infection (20.5%), myalgia (11.3%), urinary tract infections (10.2%), pain, skin diseases, cold and diarrhea. Asthma, worms and fever of unknown origin were found in 5% or fewer patients. Among antimicrobials, the most commonly prescribed were sulfonamides, tetracycline, and cotrimoxazole. Children received more antibiotics than adults. Chloramphenicol was given to 42 patients, 28 of them children. Penicillin made up only 6.4% of the antibiotics given. 32.8% of the antibiotics were administered intramuscularly, including 355 tetracycline injections. B-vitamin complex was also injected intramuscularly in 474 patients. Both consumers and practitioners in developing locales must be informed that injections, particularly of agents such as tetracycline and vitamins which are safer and cheaper to give orally, are not the administration route of choice for all medications. A safer antibiotic than chloramphenicol should be chosen for serious infections, especially in pediatrics.
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PMID:Drug utilization at primary health care level in southern India. 145 22

Asthma is a clinically complex condition but at present the pathologist recognises only one disease process. The airways in fatal asthma are occluded by tenacious plugs of exudate, mucus and cells. There is fragility of the airway surface epithelium and thickening of epithelial reticular basement membrane. Bronchial vessel dilation, congestion and oedema, an intense inflammatory cell infiltrate and enlargement of the mass of bronchial smooth muscle, and mucus-secreting gland each contribute to thickening of the airway wall. These changes contribute to the cardinal signs of inflammation (i.e. redness, heat, pain, swelling and secretion of mucus) and can profoundly modify the effects of airway contracture on airflow. The fragility and loss of surface epithelium, thickening of its underlying reticular layer and the presence of an inflammatory infiltrate, comprising activated T lymphocytes together with 'activated' and secreting eosinophils, are early events seen in biopsies of subjects with mild stable atopic asthma.
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PMID:Pathology of asthma. 161 92

The purpose of this paper is to discuss a unique, integrated combination of various psychological methods that can be used in the treatment of asthma during an acute episode, as well as in long-term management. Illustrated by a case presentation, the therapeutic approach, totaling 14 treatment sessions for the patient and his wife, included: a psychological evaluation, the use of pain behavior-modification procedures usually performed conjointly with the patient's wife, the analytical use of dreams, the desensitization of anxiety present in dream material, and autogenic therapy combined with thermal biofeedback (i.e., using digital temperature to measure relaxation) both at the medical center and at home. Electromyography (EMG)--a measurement of tension--and electrodermal (EDR)--a measurement of galvanic skin response--biofeedback instruments were used nosologically and therapeutically to measure psychophysiological changes, as well as to reduce emotional stresses related to the patient's asthmatic condition.
J Asthma 1988
PMID:Psychological treatment of an asthmatic patient in crisis. Dreams, biofeedback, and pain behavior modification. 318 87

We have come a long way since 1882 when Dr. Henry Salter published his treatise, On Asthma: Its Pathology and Treatment. His task then was even more complex than ours is today. He not only worked alone in a medical void, providing care for over 200 patients with chronic asthma, but he also suffered from the same disease. But not only is asthma not an uncommon disease, but it is one of the direst suffering; the horrors of the asthmatic paroxysm far exceed any acute bodily pain; the sense of impending suffocation, the agonizing struggle for the breath of life, are so terrible, that they cannot even be witnessed without sharing in the sufferer's distress. With a face expressive of the intensest anxiety, unable to move, speak, or even make signs, the chest distended and fixed, the head throne back between the elevated shoulders, the muscles of respiration ridged and tightened like cords, and tugging and straining for every breath that is drawn, the surface pallid or livid, cold and sweating--such are signs by which this dreadful suffering manifests itself. And, even in the intervals of health the asthmatic's sufferings do not cease; he seems well, he goes about like his fellows and among them, but he knows that he is altogether different from them; he bears about his disease within him wherever he goes; he knows he is struck; he is conscious that he is not sound--he cannot be warranted; he is not certain of a days, perhaps not of an hours health; he only knows that a certain percentage of his future life must be dedicated to suffering; he cannot make an engagement except with a proviso, and from any of the occupations of life he is cut-off; the recreations, the enjoyments, the indulgences of others are not for him; his usefulness is crippled, his life is marred; and if he knows anything of the nature of his complaint he knows that his sufferings may terminate in a closing scene worse only than the present. Today, this need not be the case.
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PMID:Children with chronic asthma: care by the generalist and the specialist. 670 Oct 29

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of agents with similar actions but diverse chemical structures. Aspirin (acetylsalicylic acid) and sodium salicylate were the first drugs of this type to be used clinically. However, over the past 3 decades there has been a dramatic increase in the number of NSAIDs available for the treatment of postoperative pain. Tissue injury, such as occurs with surgical intervention, is associated with the release of numerous inflammatory mediators including prostaglandins. Prostaglandins derived from the arachidonic acid cascade are implicated in the production of inflammatory pain, and in sensitising nociceptors to the actions of other mediators. They are synthesised from arachidonic acid via the endoperoxide biosynthesis pathway, the initial step of which is catalysed by the enzyme cyclo-oxygenase. Two forms of the cyclo-oxygenase enzyme (COX-1 and COX-2) have been characterised. COX-1 is important in circumstances where prostaglandins have a protective effect such as gastric mucus production and renal blood flow maintenance. NSAIDs inhibit the synthesis of prostaglandins at 1 or more points in the endoperoxide pathway. Three mechanisms of inhibition of the biosynthetic enzymes have been proposed: (i) rapid, reversible competitive inhibition; (ii) irreversible, time-dependent inhibition; and (iii) rapid, reversible noncompetitive (free radical trapping) inhibition. In addition, there is evidence that NSAIDs have a central antinociceptive mechanism of action that augments the peripheral effect. This may involve inhibition of central nervous system prostaglandins or inhibition of excitatory amino acids or bradykinins. There is considerable variability in the pain relief obtained from NSAIDs. Such variability in drug response may be explained in terms of differences between agents with respect to either pharmacodynamic actions or pharmacokinetic parameters or a combination of both. Stereoisomerism, where preparations exist as racemic mixtures and where only 1 enantiomer is active, may also be important. However, chiral inversion from inactive to active enantiomer may occur and may be rapid or slow. NSAIDs have numerous adverse effects. Gastrointestinal disturbances including ulceration are the commonest adverse responses to NSAIDs and carry the greatest risk of death. Also significant are renal impairment and an increased risk of postoperative haemorrhage. Asthma and allergic reactions are uncommon.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Nonsteroidal anti-inflammatory drugs in perisurgical pain management. Mechanisms of action and rationale for optimum use. 770 16

A study was carried out in an inner-city emergency department (ED) of patients returning for related complaints within 48 h of discharge. The incidence was around 0.7% and the majority (82%) of patients presented with persistence or progression of the original symptoms. Patient-related factors accounted for 13% of returns and only 5% were found to be the result of doctor-related factors. Of the returnees, 54% were discharged and 36% were admitted. The most common initial complaint was pain (31%) which, in 23% of patients, was localized to the abdomen. Injury (14%) and febrile illnesses (13%) came second and third. Asthma and chronic obstructive airway diseases (COAD) also accounted for 8% of cases. Children of less than 10 years of age were more likely to return within 48 h. About 18% of cases were thought to be potentially avoidable. Better patient education and an improvement in primary health care services were thought to be important in decreasing such avoidable reattendance. Reattendance audit was a useful tool in the continuous quality improvement programme of emergency department.
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PMID:Reattendance audit in an inner-city emergency department. 789 4

Asthma is a chronic disease in which social life is altered. The importance of restrictions on social life may be greater in severe asthma or when symptoms are not adequately controlled. General scales of quality-of-life (QOL) may be used to detect the importance of social life impairment, but it is not yet known whether the scores of such QOL measures are reliable and valid in asthmatic patients. A study was carried out in 252 patients with asthma of variable severity (FEV1 ranging from 25 to 131% of predicted) to assess the validity of a general QOL scale, the first French version of the SF-36 health status questionnaire (SF-36). This is based on 36 items selected to represent nine health concepts (physical, social, and role functioning; mental health; health perceptions; energy or fatigue; pain; and general health). All nine SF-36 category scores were highly significantly correlated with the severity of asthma assessed by the clinical score of Aas (p < 0.0007 to p < 0.0001). Eight SF-36 category scores were highly significantly correlated with FEV1 (p < 0.003 to p < 0.0001). A high internal reliability of SF-36 was found using the alpha coefficient of Cronbach (0.91 for the whole questionnaire). The SF-36 questionnaire is valid and reliable in asthma and can therefore be used to examine QOL in asthmatic and nonasthmatic patients and to determine to what extent asthma impairs social life.
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PMID:Quality of life in asthma. I. Internal consistency and validity of the SF-36 questionnaire. 830 32

It has been recommended that allergist-immunologists use quality of life (QOL) surveys to document their "added value" in patient care. There are little cross-sectional or prospective data regarding longer term follow-up of patients using QOL assessments and none associated with prospective use of an asthma severity index (ASI). Our objective was to identify clinical and psychological correlates of adverse asthma outcomes as assessed using the ASI survey. A 12 item QOL and a nine item ASI survey, spirometry, and history and physical were obtained from patients initially and then every 3 months for a year. The ASI was calculated as follows: one point for each emergency treatment of asthma if not in status asthmaticus, three points for each hospitalization for status asthmaticus, and six points for each intensive care admission or intubation. Patients were 56 adults between ages 18 and 45 with asthma enrolled between May 1994 and February 1996 with the intention to be reassessed quarterly for a year. At enrollment the 56 patients had ASI scores for the previous 12 months ranging from zero to 30. The patient with an ASI of 30 did not return after the initial visit. Of the 13 patients who completed the study, 12 patients had a zero ASI score over a 12-month period; one patient who had an initial score of 26 finished with a score of one. There were no deaths throughout the follow-up period. Of the 43 patients who did not complete the study only six (13.9%) cited local managed care or primary care physician as taking over their care. Initial ASI scores were dichotomized (zero versus greater-than-zero) due to skewness. The forced expiratory volume in one second (FEV1), % predicted FEV1 and peak flow were not related significantly to the dichotomized ASI score. The strongest univariate predictor was the self-assessment of asthma burden using a 78 mm visual analog scale. A two variable model included a query about bodily pain in the last 4 weeks and a self-assessment of general health. The dropout rate was high but only 13.9% of such patients reported that managed care or primary care physicians were responsible. A two variable model was a strong predictor of asthma severity. The single best predictor of asthma severity was a visual analog scale based on the question "How do you think your asthma is?"
Allergy Asthma Proc
PMID:An attempted prospective testing of an asthma severity index and a quality of life survey for 1 year in ambulatory patients with asthma. 1007 7

This case illustrates the importance of considering a wide range of diagnoses in patients complaining of rib, flank, and pleuritic pain. Further, additional evaluation is warranted when "pneumonia" does not respond to conventional treatment.
Ann Allergy Asthma Immunol 2001 Jan
PMID:Rib pain in a 23-year-old woman with severe asthma. 1120 31


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