(9R)-9-chloro-11-17-dihydroxy-17-(2-hydroxy-1-oxoethyl)-10-13-16-trimethyl-6-7-8-11-12-14-15-16-octahydrocyclopenta[a]phenanthren-3-one and Airway-Obstruction

Topics: Aerosols; Airway Obstruction; Anti-Bacterial Agents; Asthma; Bacteria; Bacterial Infections; Beclomethasone; Carbenicillin; Child; Clinical Trials as Topic; Colistin; Corticosterone; Dexamethasone; Gentamicins; Humans; Hydrocortisone; Kanamycin; Lung Diseases, Fungal; Placebos; Polymyxins; Respiratory Therapy; Triamcinolone Acetonide

Topics: Administration, Inhalation; Adrenergic beta-2 Receptor Antagonists; Adult; Aged; Airway Obstruction; Anti-Asthmatic Agents; Asthma; Beclomethasone; Drug Administration Schedule; Drug Combinations; Ethanolamines; Female; Formoterol Fumarate; Germany; Humans; Lung Volume Measurements; Male; Metered Dose Inhalers; Middle Aged

Air trapping reflects small airway obstruction in asthma and can be assessed quantitatively by high-resolution computed tomography (HRCT). Hydrofluoroalkane-beclomethasone dipropionate (HFA-BDP) is deposited across all sizes of airways, including the small ones. However, its long-term effect on air trapping remains unknown in uncontrolled asthma.. To compare the effect of inhaled corticosteroids of different particle size - HFA-BDP and fluticasone propionate (FP) - on lung attenuation in mild-to-moderate uncontrolled asthma.. A randomized study was performed to analyze the effect of HFA-BDP (400 microg/d) or FP (500 microg/d) given over a period of 3 months to patients with uncontrolled mild-to-moderate asthma. HRCT was performed with spirometric gating, and lung attenuation was measured at residual volume and at pulmonary total capacity. The difference between inspiratory and expiratory attenuation was calculated as an air trapping index.. Twenty-five out of 58 patients had abnormal air trapping and could be included in the study. Lung attenuation significantly diminished in the posterior zones of the lung after a 3-month treatment with HFA-BDP or FP, but the difference between the groups was not significant. Adjusted mean variations of the air trapping index from baseline to treatment completion were 34.3 (11.2, 57.3) and 27.3 (6.4, 48.2) for the HFA-BDP and FP groups, respectively. However, the reduction of air trapping area was more pronounced in the group treated with HFA-BDP.. Inhaled corticosteroids decrease air trapping in uncontrolled asthma regardless of their particle size.. In mild-to-moderate asthma, air trapping assessed by HRCT may be a new outcome related to the control of the disease.

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Adult; Airway Obstruction; Anti-Asthmatic Agents; Asthma; Beclomethasone; Bronchospirometry; Female; Humans; Lung; Male; Particle Size; Tomography, X-Ray Computed; Treatment Outcome

Inhaled corticosteroid therapy has proven efficacy for asthmatics, but the benefit for patients with chronic obstructive pulmonary disease (COPD) is less well supported. We hypothesized that withdrawal of inhaled steroids in elderly patients with severe irreversible airway obstruction would not lead to a deterioration in respiratory function. We designed a prospective, double-blind, randomized, placebo-controlled, crossover study to follow spirometry, quality of life questionnaire, six-minute (6-min) walk test, and sputum markers of inflammation during a 6-wk placebo treatment period and a 6-wk treatment period with beclomethasone dipropionate (BDP), 336 microg/d. There were 24 men receiving BDP who entered the study; 15 completed the study. Their mean age was 66.9 +/- 1.9 yr, and mean FEV(1) was 1.61 +/- 0.1 L (47% of predicted). There was a significant decrease in the mean FEV(1 )while using the placebo inhaler (1.70 L versus 1.60 L, baseline versus placebo: 95% CI, 0.002 to 0.195; p < 0.05). There was a decrease in the mean percentage change in FEV(1) for the study subjects during the placebo treatment period as compared with the BDP treatment period (-6.28 versus 5.03%, placebo versus BDP: 95% CI, -23.38 to 0.76; p = 0.06). Six-minute walk test results and sputum analysis for cell count and differential were not significantly different during placebo and BDP treatment periods. Borg scale assessment of dyspnea after exercise was increased while using the placebo inhaler as compared with baseline, and decreased during the BDP treatment period. Chronic Respiratory Disease Questionnaire (CRQ) scores revealed no significant difference between placebo and BDP. This study has demonstrated that in elderly patients with severe irreversible airway obstruction, withdrawal of inhaled corticosteroid therapy leads to a deterioration in ventilatory function and increased exercise-induced dyspnea.

Topics: Administration, Inhalation; Adult; Aged; Airway Obstruction; Anti-Asthmatic Agents; Beclomethasone; Cross-Over Studies; Double-Blind Method; Dyspnea; Exercise Test; Forced Expiratory Volume; Humans; Lung Diseases, Obstructive; Male; Middle Aged

To evaluate clinical response, pulmonary function, and adrenal gland response to incremental doses of beclomethasone dipropionate in horses with recurrent airway obstruction.. Crossover trial.. 8 horses with recurrent airway obstruction.. Horses randomly assigned to 4 groups were treated twice daily via aerosol administration of placebo or 500, 1,000, or 1,500 micrograms of beclomethasone dipropionate in a crossover design with a 10-day minimum washout period. Subjective assessment of airway obstruction, serum cortisol concentration, and maximum change in pleural pressure during tidal breathing (delta Pplmax) were determined daily prior to morning drug administration, and delta Pplmax was reevaluated 15 minutes after morning drug administration. Pulmonary resistance and dynamic compliance were determined at baseline and approximately 12 hours after the final treatment.. An immediate treatment effect was not identified. Within 24 hours, delta Pplmax and airway obstruction were lower in horses receiving beclomethasone. Onset and magnitude of response was similar among the 3 beclomethasone dose regimens. Pulmonary resistance was improved only after administration of all 3 doses of beclomethasone, whereas dynamic compliance was improved after administration of 1,000 micrograms and 1,500 micrograms of beclomethasone. Reduction in serum cortisol concentration occurred with all 3 beclomethasone dose regimens; however, the magnitude of adrenal gland suppression was greater in horses receiving 1,000 or 1,500 micrograms of beclomethasone.. Low-dose (500 micrograms) beclomethasone administration caused similar, improvement in pulmonary function, compared with high-dose beclomethasone (1,000 and 1,500 micrograms), with the exception of dynamic compliance, and caused less suppression of endogenous cortisol production.

Topics: Administration, Topical; Adrenal Glands; Aerosols; Airway Obstruction; Animals; Anti-Inflammatory Agents; Beclomethasone; Cross-Over Studies; Female; Horse Diseases; Horses; Hydrocortisone; Lung; Male; Respiratory Function Tests

To determine changes in clinical signs of disease and response to pulmonary function testing in horses with recurrent airway obstruction (heaves) after aerosol and parenteral administration of beclomethasone dipropionate and dexamethasone, respectively.. 6 horses with inducible and reversible heaves.. Episodes of heaves were induced by exposure (challenge) to moldy hay and straw for 7 days. Horses were assigned to treatment groups (aerosolized beclomethasone dipropionate, parenterally administered dexamethasone, aerosolized propellant [control]), and respiratory frequency and subjective assessment of respiratory effect were determined twice daily. Maximal change in pleural pressure (delta-Pplmax), pulmonary resistance (RL), and dynamic compliance (Cdyn) was determined on days 0, 7, 10, 14, and 21.. The RL and delta Pplmax were increased, and Cdyn was decreased in all horses in response to natural challenge. Beclomethasone reduced RL on day 10, reduced delta Pplmax on days 14 and 21 and increased Cdyn on day 14. Dexamethasone reduced RL and delta Pplmax on days 10, 14, and 21 and increased Cdyn on days 10 and 14. Respiratory effort (subjective assessment) improved after 2 and 3 days of beclomethasone and dexamethasone administration but rebounded to pretreatment values 1 and 3 days after discontinuation of drugs.. Pulmonary function testing responses and clinical signs of airway obstruction were improved by administration of beclomethasone. The magnitude of response to aerosolized beclomethasone generally was less marked than the response to parenterally administered dexamethasone. Higher or more frequent dosing of aerosolized beclomethasone may be necessary to achieve the anti-inflammatory response to parenterally administered dexamethasone.

Topics: Administration, Inhalation; Aerosols; Airway Obstruction; Animal Feed; Animals; Anti-Inflammatory Agents; Beclomethasone; Cross-Over Studies; Dexamethasone; Double-Blind Method; Female; Food Microbiology; Horse Diseases; Horses; Injections, Intravenous; Male; Recurrence; Respiration; Respiratory Function Tests

To determine cytologic changes in horses with recurrent airway obstruction (heaves) after administration of aerosolized beclomethasone dipropionate and dexamethasone parenterally.. 6 horses with inducible and reversible heaves.. Episodes of heaves were induced by exposure to moldy hay and straw for 7 days. Horses were assigned to treatment groups (aerosolized beclomethasone, parenterally administered dexamethasone, aerosolized propellant), and pulmonary inflammation was evaluated by serial cytologic examination of bronchoalveolar lavage (BAL) fluid samples obtained on days 0, 7, 10, 14, and 21. Total and differential cell counting and phenotypic analysis of lymphocyte subpopulations in BAL fluid were performed.. 7 days of natural challenge induced neutrophilic inflammation. Neutrophil counts in BAL fluid were reduced in beclomethasone- and dexamethasone-treated horses on days 10 and 14 but rebounded to pretreatment values on day 21. The proportion of proinflammatory lymphocyte subpopulations (CD4+ and B+) and MHC class-II antigen expression were increased on days 14 and 21 in propellant-treated horses, compared with beclomethasone- and dexamethasone-treated horses.. Aerosolized beclomethasone attenuated neutrophilic pulmonary inflammation and prevented alteration in lymphocyte subpopulations in horses with heaves. Results were similar to the response associated with parenterally administered dexamethasone. Short-term administration of aerosolized beclomethasone without minimizing environmental allergen exposure is not expected to provide prolonged anti-inflammatory benefit for horses with heaves.

Topics: Administration, Inhalation; Aerosols; Airway Obstruction; Animal Feed; Animals; Anti-Inflammatory Agents; Beclomethasone; Bronchoalveolar Lavage; Bronchoalveolar Lavage Fluid; Cross-Over Studies; Dexamethasone; Double-Blind Method; Female; Food Microbiology; Histocompatibility Antigens Class II; Horse Diseases; Horses; Injections, Intravenous; Lymphocytes; Male; Recurrence

To determine alteration in adrenocortical function in horses with recurrent airway obstruction (heaves) after aerosol and parenteral administration of beclomethasone dipropionate and dexamethasone, respectively.. 6 horses with inducible and reversible heaves.. Episodes of heaves were induced by exposure to moldy hay and straw for 7 days (natural challenge). Horses then underwent treatment (aerosolized beclomethasone, parenterally administered dexamethasone, and aerosolized propellant) for 7 days. Horses remained in the mold-contaminated environment for 7 days after discontinuation of drugs. Adrenocortical function was determine by serial evaluation of cortisol concentration in serum obtained on days 0, 7, 9, 12, 14, 16, 19, and 21. Adrenocorticotropic hormone stimulation testing was performed in 4 horses/treatment group on days 0, 7, 14, and 21.. Endogenous cortisol production was suppressed in beclomethasone- and dexamethasone-treated horses within 2 days of treatment but recovered to values similar to those in propellant-treated horses approximately 2 and 4 days after discontinuation of drugs. Serum cortisol concentration in propellant-treated horses gradually decreased during the study and was significantly lower than baseline on days 14, 16, 19, and 21. Mean increase in serum cortisol concentration in response to ACTH stimulation testing after beclomethasone and dexamethasone administration did not differ significantly from the response observed in propellant-treated horses.. Aerosol and parenteral administration of beclomethasone and dexamethasone, respectively, suppressed adrenocortical function; however, endogenous cortisol production resumed approximately 2 and 4 days after discontinuation of drugs. Responsiveness to ACTH stimulation testing was not affected by the 7-day treatment period.

Topics: Administration, Inhalation; Adrenal Cortex; Adrenocorticotropic Hormone; Aerosols; Airway Obstruction; Animal Feed; Animals; Anti-Inflammatory Agents; Beclomethasone; Cross-Over Studies; Dexamethasone; Double-Blind Method; Female; Food Microbiology; Horse Diseases; Horses; Hydrocortisone; Injections, Intravenous; Male; Recurrence; Time Factors

Chronic bronchitis is associated with airways obstruction and inflammation. In order to determine whether aerosolized beclomethasone can modulate airway inflammation and diminish airway obstruction, subjects with chronic bronchitis performed spirometry and underwent bronchoalveolar lavage (BAL) before and after receiving 6 wk of therapy (five puffs four times a day) with either aerosolized beclomethasone (n = 20) or placebo (n = 10) in a double-blinded, randomized fashion. All subjects received aerosolized albuterol before each use of the study medications. Before BAL, the airways were visually assessed for the appearance of inflammation and assigned a score, the bronchitis index. BAL was performed by instilling five 20-ml aliquots of saline into each of three sites and pooling and separately analyzing the returns from the first aliquots to yield a "bronchial sample." The bronchial lavages were repeated in an additional three sites to increase the volume of fluid available for analysis. The fluid was prepared for cytologic examination by cytocentrifugation. Albumin (as a measure of epithelium permeability) and lactoferrin and lysozyme (as measures of serous cell activity) were measured in unconcentrated BAL fluid by enzyme-linked immunosorbent assay, and concentrations in epithelial lining fluid were estimated using urea as an internal marker for dilution. After treatment, the beclomethasone group, but not the placebo group, showed improvement in FVC (p = 0.02), FEV1 (p = 0.002), and 25 to 75% forced expiratory flow (p = 0.006). Associated with the improvement in spirometry, the bronchitis index fell (13.5 +/- 1.0 versus 10.75 +/- 1.1, p = 0.02) in the beclomethasone-treated group, but not the placebo-treated group.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Inhalation; Adult; Aerosols; Airway Obstruction; Albumins; Beclomethasone; Blood Gas Analysis; Bronchitis; Bronchoalveolar Lavage Fluid; Bronchoscopy; Chronic Disease; Double-Blind Method; Female; Forced Expiratory Volume; Humans; Inflammation; Lactoferrin; Male; Middle Aged; Muramidase; Smoking; Transferrin; Vital Capacity

The diagnosis and treatment of non-purulent rhinitis in the pediatric population poses a challenge to the clinician. In this randomized double blind study, the authors conclude that rhinometry is more effective than cytologic or symptomologic assessment in children with non-purulent rhinitis treated with either intranasal beclomethasone or placebo spray. Intranasal beclomethasone spray produced significant reductions in nasal airflow resistance values compared to the placebo-treated group.

Topics: Administration, Intranasal; Adolescent; Airway Obstruction; Airway Resistance; Beclomethasone; Child; Double-Blind Method; Evaluation Studies as Topic; Female; Humans; Male; Manometry; Nasal Mucosa; Nose; Placebos; Random Allocation; Rhinitis

A double-blind cross-over study of the effect of insufflation of beclomethasone dipropionate 400 microgram per day for four weeks showed favourable results, as verified statistically, concerning nasal blockage at the end of the treatment period. Rhinomanometry also showed that the nasal patency was significantly improved during the beclomethasone period. There was also a tendency, though not statistically significant, for nasal secretion to react favourable. The polyps did not disappear during the active treatment period and short-term treatment with beclomethasone aerosol can thus only be used as an adjuvant to other models of therapy, whether medical or surgical, in nasal polyps. No clinical side-effects of any importance were observed during the study.

Topics: Administration, Intranasal; Adult; Aerosols; Aged; Airway Obstruction; Beclomethasone; Clinical Trials as Topic; Double-Blind Method; Evaluation Studies as Topic; Humans; Manometry; Middle Aged; Nasal Polyps

Seven patients with reversible obstructive airways disease, who were unsatisfactorily relieved by conventional bronchodilating drugs, were admitted to a 1-year-long therapeutic trial with beclomethasone dipropionate aerosol, 400 mug a day. After 3 weeks of treatment the mean values of VC, FEV, and PEFR were increased by about 100 per cent of the pretreatmetn values, and the consumption of self-administered bronchodilators was markedly diminished. Throughout the trial the occupationa diability and need for hospitalization were negligible compared with the previous year. Development of tolerance to the drug was not observed during the trial. The adrenocortical function remained unaffected, as judged by the plasma cortisol levels and adrenocortical stimulation tests. Continuously low normal levels of excreted urinary 17-ketogenic-steroids might indicate a very slight adrenal suppression.

Topics: 17-Ketosteroids; Adult; Aerosols; Airway Obstruction; Beclomethasone; Clinical Trials as Topic; Disability Evaluation; Drug Evaluation; Female; Follow-Up Studies; Forced Expiratory Volume; Hospitalization; Humans; Hydrocortisone; Male; Methylprednisolone; Middle Aged; Peak Expiratory Flow Rate; Time Factors; Vital Capacity

Topics: Aerosols; Airway Obstruction; Anti-Bacterial Agents; Asthma; Bacteria; Bacterial Infections; Beclomethasone; Carbenicillin; Child; Clinical Trials as Topic; Colistin; Corticosterone; Dexamethasone; Gentamicins; Humans; Hydrocortisone; Kanamycin; Lung Diseases, Fungal; Placebos; Polymyxins; Respiratory Therapy; Triamcinolone Acetonide

Topics: Administration, Topical; Adult; Aerosols; Aged; Airway Obstruction; Anti-Inflammatory Agents; Asthma; Beclomethasone; Chronic Disease; Clinical Trials as Topic; Female; Humans; Hydrocortisone; Male; Methylprednisolone; Middle Aged; Placebos; Spirometry; Time Factors

COPD patients prescribed inhaled corticosteroids (ICS) outside guidelines should be targeted for ICS withdrawal. Within a primary care population of 209,618 we used a combination of digital search algorithm, individual record review, and clinical review to identify COPD patients suitable for a trial of ICS withdrawal. At most, 39% of COPD patients with mild or moderate airflow limitation prescribed ICS were suitable for withdrawal according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Recurrent exacerbations and reversible airway obstruction were the main reasons for patients' unsuitability for withdrawal. Identifying COPD patients in whom ICS withdrawal should be considered presents a challenge to primary care clinicians.

Topics: Administration, Inhalation; Airway Obstruction; Beclomethasone; Glucocorticoids; Humans; Pulmonary Disease, Chronic Obstructive; Severity of Illness Index; Withholding Treatment

Topics: Adrenal Cortex Hormones; Aged; Airway Obstruction; Asthma; Beclomethasone; Bronchodilator Agents; Clinical Trials as Topic; Female; Forced Expiratory Volume; Humans; Male; Middle Aged; Oscillometry; Prednisolone; Reproducibility of Results; Surveys and Questionnaires

Topics: Administration, Inhalation; Adult; Airway Obstruction; Beclomethasone; Bronchoalveolar Lavage; Bronchoscopy; Female; Humans; Middle Aged; Recurrence; Sarcoidosis, Pulmonary; Tomography, X-Ray Computed; Treatment Failure

Endogenously released nitric oxide (NO) has been detected in the exhaled air of humans. Exhaled NO (NOexh) levels have been significantly increased in patients with inflammatory airways disorders such as asthma, and NOexh has been suggested to be a usable marker of airway inflammation. In the present study, NOexh levels were measured both in steroid-treated and untreated subjects with mild asthma, and were correlated with the degree of airway hyperresponsiveness (AHR), measured as the dose of histamine that produced a 20% decrease in FEV1 (PC20histamine). NOexh levels, which were significantly increased in steroid-naive patients (Group A1: NOexh = 21 +/- 11 ppb; n = 56) in comparison with levels in control subjects (Group B: NOexh = 10 +/- 2 ppb; n = 20; p < 0.001), correlated significantly with the PC20histamine (r = -0.65; p < 0.0001). The NOexh level was significantly lower in patients with chronic cough of other causes than bronchial asthma (Group A2: NOexh = 11 +/- 3 ppb; n = 18) when compared with the level in subjects with mild asthma (Group A1: p < 0.001). Therefore, the noninvasive measurement of NOexh allowed us to discriminate, among patients with respiratory complaints, between those with and without AHR. In asthmatic subjects treated with inhaled steroids, the NOexh levels were significantly lower (Group A3: NOexh = 13 +/- 5 ppb; n = 25) than in untreated subjects (Group A1; p < 0.01), and there was no relationship with the PC20histamine (r = -0.18, p = NS). These findings confirm that NOexh reflects AHR in patients with mild asthma who have not already been treated with inhaled steroids. Patients treated with inhaled steroids had an NOexh level comparable to levels in control subjects, although AHR could still be demonstrated.

Topics: Adrenergic beta-Agonists; Adult; Airway Obstruction; Anti-Asthmatic Agents; Anti-Inflammatory Agents; Asthma; Beclomethasone; Biomarkers; Bronchial Hyperreactivity; Bronchial Provocation Tests; Chronic Disease; Cough; Dyspnea; Female; Forced Expiratory Volume; Glucocorticoids; Histamine; Humans; Male; Nitric Oxide; Respiration; Respiratory Sounds

Nitric oxide (NO) is known to be present in measurable quantities in the exhaled air of normal subjects and at higher concentrations in asthmatic subjects not treated with glucocorticoids. We confirmed these findings by analyzing the mean mixed expired NO concentrations of 43 stable asthmatics and 90 normal subjects; NO levels were higher in the asthmatic population (13.9 parts per billion [ppb] versus 6.2 ppb, p < 0.001). Although the effects of glucocorticoids on the NO content of mixed expired air are known, it is not known if beginning systemic glucocorticoid therapy reduces exhaled NO levels in a given individual. To examine this question, seven patients needing emergency therapy for asthma underwent repeated measurements of mixed expired NO levels during their course of treatment with glucocorticoids. All patients had a reduction in mixed expired NO concentration (p = 0.002) and an accompanying improvement in airway obstruction. The decrease in exhaled NO was evident as early as 48 h after the initiation of therapy (p = 0.05). These data suggest mixed expired NO concentrations may prove useful as an index of asthma severity and treatment efficacy for an individual patient.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Airway Obstruction; Asthma; Beclomethasone; Case-Control Studies; Cohort Studies; Emergencies; Female; Forced Expiratory Volume; Glucocorticoids; Humans; Male; Methylprednisolone; Middle Aged; Nitric Oxide; Peak Expiratory Flow Rate; Prednisone; Respiration; Smoking; Triamcinolone

The effect of medication on peripheral airway obstruction was examined in cases of bronchial asthma. Subjects were 1) patients with exercise-induced asthma, 2) an animal model of hyperventilation-induced asthma and 3) patients with chronic asthma. Peripheral airway obstruction was induced in 30 of 51 patients with exercise-induced asthma. Induction of peripheral airway obstruction was protected significantly by procaterol. Cromoglycate was effective in 12 of 17 patients but ipratropium was not effective against induction of peripheral airway obstruction. In the animal model, humid air inhalation, procaterol and ipratropium completely prevented hyperventilation-induced bronchoconstriction, but cromoglycate caused only partial prevention. In cases of chronic asthma with peripheral airway obstruction, beclomethasone inhalation reduced the symptom rating rapidly, but no changes were observed in pulmonary function and threshold of airway responsiveness. Cromoglycate was started in patients with chronic asthma who had been treated with beclomethasone. After cromoglycate administration, therapeutic rating decreased, but increased again after 8 weeks of cromoglycate therapy. Peripheral airway obstruction induced by exercise or hyperventilation could be prevented by adequate premedication, but chronic peripheral airway obstruction was difficult to treat.

Topics: Administration, Inhalation; Airway Obstruction; Animals; Asthma; Asthma, Exercise-Induced; Beclomethasone; Cromolyn Sodium; Histamine; Humans; Ipratropium; Procaterol; Rabbits

The aim of the study was to find out whether asthma patients whose airways obstruction is sensitive (CS) or resistant (CR) to corticosteroid treatment also differ in their cutaneous vasoconstrictor response to a potent topical glucocorticoid. Corticosteroid resistance was defined by failure of forced expiratory volume in 1 s (FEV1) and peak expiratory flow rate to improve by at least 15% after a 2-week trial of corticosteroids (prednisolone 20 mg daily for 1 week, then 40 mg daily for 1 week) despite more than 15% improvement with inhaled beta agonists. Beclomethasone dipropionate in concentrations of 3 micrograms/ml, 10 micrograms/ml, 30 micrograms/ml, and 100 micrograms/ml was applied to forearm skin; the site was occluded under plastic and the degree of blanching assessed after 18 h. CS asthmatic subjects (n = 31), asthma patients with mild airways obstruction (n = 26), asthma patients taking long-term prednisolone (n = 13), and healthy volunteers showed similar vasoconstrictor responses. In CR asthmatic subjects (n = 15), the response (expressed in terms of either blanching intensity or the proportion of patients showing a positive response) was significantly lower than that in the CS group at concentrations of 3 micrograms/ml (p less than 0.01), 10 micrograms/ml (p less than 0.01), and 30 micrograms/ml (p less than 0.05), but not at 100 micrograms/ml. This resistance to glucocorticoids in the skin, together with reported evidence of glucocorticoid resistance in peripheral blood leucocytes, suggests a general defect in the ability of tissues to respond to glucocorticoids in CR asthma.

Topics: Administration, Oral; Administration, Topical; Adult; Aged; Airway Obstruction; Anti-Inflammatory Agents; Asthma; Beclomethasone; Bronchodilator Agents; Budesonide; Drug Administration Schedule; Female; Glucocorticoids; Humans; Male; Middle Aged; Prednisolone; Pregnenediones; Skin; Vasoconstriction

Posterior rhinometric measurements of nasal resistance were conducted on two groups of patients with perennial rhinitis: those whose symptom of nasal stuffiness responded to a topical steroid spray and those in whom it did not. The anterior ends of the inferior turbinates in 48 patients were treated with either cryosurgery or cautery, and in half of the subjects the erectile tissue of the septum was also thermally ablated. Measurements were made before and 10-16 weeks after therapy. It is concluded from statistical comparison that there is no benefit to treating the septum, and that cryosurgery is more effective in those whose symptoms respond to topical steroids, while cautery works better in those who do not. Histology showed no change in the capacitance vessels (sinusoids) after either modality, and xylometazoline caused a marked decrease in nasal resistance, suggesting that vascular smooth muscle function was intact. Irrespective of the change in airway resistance, most subjects felt that there had been an improvement. The mechanism is discussed.

Topics: Adult; Airway Obstruction; Airway Resistance; Beclomethasone; Cryosurgery; Electrocoagulation; Female; Humans; Male; Manometry; Nasal Septum; Nose; Pulmonary Ventilation; Rhinitis, Allergic, Perennial; Turbinates

Some types of pneumoconiosis, such as asbestosis, are characterized by marked restrictive functional patterns. Treatment is begun when definite arterial hypoxemia appears, since the inhalation of oxygen clearly lowers pulmonary artery pressure. It is also important that the onset of concomitant airway obstruction is recognized promptly. From the sociomedical standpoint the most significant pneumoconiosis continues to be the miner's anthracosilicosis. The functional pattern of this pneumoconiosis is clearly airway obstruction, and such anthracosilicotic airway obstruction responds like all other forms of airway obstruction to antiobstructive therapy. The fundamentals of this therapy, which is based on the use of bronchodilators, adrenal cortical hormones and antibiotics, are described.

Topics: Airway Obstruction; Anthracosilicosis; Anti-Bacterial Agents; Beclomethasone; Bronchodilator Agents; Drug Therapy, Combination; Humans; Pneumoconiosis

A double-blind crossover trial comparing the clinical efficacy of intranasal beclomethasone dipropionate and intranasal sodium cromoglycate was carried out in fourteen patients with perennial rhinitis due to animal danders. Intranasal beclomethasone dipropionate was significantly more effective than intranasal sodium cromoglycate in relieving nasal obstruction, nasal discharge and sneezing. Eleven patients reported preference for beclomethasone dipropionate and three had no preference for either drug.

Topics: Adolescent; Adult; Airway Obstruction; Beclomethasone; Cough; Cromolyn Sodium; Double-Blind Method; Female; Humans; Male; Middle Aged; Nasal Mucosa; Rhinitis, Allergic, Perennial; Sneezing

Topics: Airway Obstruction; Albuterol; Beclomethasone; Bronchoscopy; Emergencies; Female; Fiber Optic Technology; Foreign Bodies; Humans; Intubation, Intratracheal; Middle Aged; Pulmonary Atelectasis; Pulmonary Edema; Therapeutic Irrigation

Emphysema, chronic bronchitis, asthma, and cystic fibrosis are often cited as examples of chronic airways obstruction, while sarcoidosis is typically restrictive. Approximately 15 percent of sarcoidosis patients, however, have airways obstruction clinically characterized by wheezing with granulomatous involvement of airways. Since the majority have Stage IV disease by chest radiograph, their lungs usually have honey-combining with pulmonary fibrosis, adhesions, cavities, and mediastinal distortion.Patients had a mixed ventilatory defect, but obstruction of large airways was present as shown by decreased specific airways conductances. Small airways obstruction was also present as shown by low instantaneous flows at the terminal portion of the maximum expiratory flow-volume curve and diminished helium response of this curve. The closing volume, however, was not very sensitive. Radioactive xenon washout from ventilation lung scans and N2 washout from the lungs were prolonged in patients with worse disease.The authors conclude that the obstructive type of physiologic pattern is more frequent than recognized in sarcoidosis, which like that of cystic fibrosis has some restrictive element and is characterized by poor reversibility to bronchodilators. A trial period of beclomethasone dipropionate aerosol was not helpful in two patients. Relief of this distressing airways obstruction continues to pose a challenging problem in management.

Topics: Adult; Airway Obstruction; Beclomethasone; Bronchodilator Agents; Female; Humans; Male; Respiratory Function Tests; Sarcoidosis; Smoking

Topics: Administration, Intranasal; Adult; Aged; Airway Obstruction; Asthma; Beclomethasone; Humans; Middle Aged; Peak Expiratory Flow Rate; Rhinitis, Allergic, Seasonal; Seasons

Topics: Aerosols; Airway Obstruction; Asthma; Beclomethasone; Humans; Methylprednisolone

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Aged; Airway Obstruction; Aspergillosis; Beclomethasone; Bronchodilator Agents; Female; Humans; Male; Methylprednisolone; Middle Aged; Respiratory Function Tests; Respiratory Tract Infections

The effect of atropine on sputum production has been studied in patients with asthama, chronic bronchitis, and bronchiectasis in some of whom there was bronchorrhoea. In three patients a reduction in sputum volume was observed after atropine but it would seem that the decrease was mainly due to the inhibitory effect on salivary secretion which facilitates spitting. The one patient treated with long-term oral atropine showed a marked reduction in sputum volume although chemical constituents and viscosity levels remained unchanged, suggesting that in this case atropine had an inhibitory effect on bronchial gland secretion.

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Aged; Airway Obstruction; Asthma; Atropine; Beclomethasone; Bronchi; Bronchiectasis; Bronchitis; Fucose; Humans; Male; Middle Aged; Neuraminic Acids; Prednisone; Saliva; Salivation; Sputum; Viscosity

Topics: Administration, Topical; Adult; Aerosols; Aged; Airway Obstruction; Anti-Inflammatory Agents; Asthma; Beclomethasone; Female; Humans; Hydrocortisone; Male; Methylprednisolone; Middle Aged; Spirometry