(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 Bronchitis

Topics: Administration, Inhalation; Adrenergic beta-Agonists; Albuterol; Anti-Asthmatic Agents; Anti-Inflammatory Agents; Asthma; Beclomethasone; Bronchi; Bronchial Diseases; Bronchial Hyperreactivity; Bronchitis; Constriction, Pathologic; Drug Therapy, Combination; Eosinophilia; Glucocorticoids; Humans; Salmeterol Xinafoate; Theophylline

Topics: Adult; Aerosols; Asthma; Beclomethasone; Bronchitis; Child; Clinical Trials as Topic; Double-Blind Method; Humans; Placebos; Respiratory Hypersensitivity; Rhinitis, Allergic, Seasonal; Time Factors

In a first chapter the author reviews the mechanisms of action of corticoids in respiratory diseases. Moreover the causes and the prevalence of unwanted side-effects are discussed. The advantages of synthetic glucocorticoids with short half-life time in pneumology are stressed. In the following chapters, the rationale of long-term corticoid treatments of asthma, in non allergic obstructive chronic lung diseases, in sarcoidosis and in the thoracic localisations of some collagen diseases is presented in detail. Regarding the treatment of asthma the author discusses the advantages of the alternate-day therapy, the use of corticoids in aerosols and the ratioale of ACTH. The usefulness of alternate-day therapy in sarcoidosis is also advocated.

Topics: Adrenocorticotropic Hormone; Aerosols; Asthma; Beclomethasone; Bronchitis; Chemical Phenomena; Chemistry; Chronic Disease; Collagen Diseases; Glucocorticoids; Humans; Lung Diseases, Obstructive; Respiratory Tract Diseases; Sarcoidosis; Time Factors

We hypothesized that regular use of long-acting beta-agonists could delay recognition of ("mask") increasing airway inflammation. We studied steroid-sparing and "masking" effects of salmeterol versus placebo in 13 asthmatic individuals requiring >= 1,500 microgram inhaled corticosteroid daily. Corticosteroid doses were reduced weekly until criteria were met for an exacerbation or the corticosteroid was fully withdrawn. Subjects were restabilized on their original dose of inhaled corticosteroid for 4 wk before crossover to the alternative treatment. Subjects maintained symptom and peak expiratory flow (PEF) diaries, and underwent weekly spirometric, methacholine challenge, sputum eosinophil, and serum eosinophil cationic protein (ECP) measurements. Mean corticosteroid dose was reduced by 87% during salmeterol treatment, versus 69% with placebo (p = 0.04). Sputum eosinophils increased before exacerbation despite stable symptoms, FEV1, and PEF. In the week before clinical exacerbation, sputum eosinophil counts were higher in the salmeterol-treatment arm (19.9 +/- 29.8% [mean +/- SD], versus placebo 9.3 +/- 17.6%; p = 0.006). Five subjects showed > 10% sputum eosinophilia before exacerbation during salmeterol treatment, as compared with two receiving placebo. In this model, salmeterol controlled symptoms and lung function until inflammation became significantly more advanced. We conclude that the bronchodilating and symptom-relieving effects of salmeterol can mask increasing inflammation and delay awareness of worsening asthma.

Topics: Administration, Inhalation; Adrenergic beta-Agonists; Adult; Albuterol; Anti-Asthmatic Agents; Asthma; Beclomethasone; Blood Proteins; Bronchial Provocation Tests; Bronchitis; Bronchoconstrictor Agents; Bronchodilator Agents; Budesonide; Cross-Over Studies; Disease Progression; Eosinophil Granule Proteins; Eosinophils; Female; Glucocorticoids; Humans; Inflammation Mediators; Leukocyte Count; Male; Methacholine Chloride; Middle Aged; Peak Expiratory Flow Rate; Placebos; Ribonucleases; Salmeterol Xinafoate; Spirometry; Sputum

Topics: Administration, Inhalation; Beclomethasone; Bronchitis; Bronchodilator Agents; Female; Glucocorticoids; Humans; Ipratropium; Lung Diseases, Obstructive; Male; Maximal Expiratory Flow Rate; Middle Aged; Mucus; Prednisolone; Pulmonary Emphysema; Smoking; Smoking Cessation; Smoking Prevention; Vital Capacity

The efficacy of beclomethasone dipropionate (CAS 5534-09-8, BDP, beclomethasone) inhalation therapy over the course of 12 months were evaluated in 42 patients with established chronic silicosis. Their pulmonary functions were monitored every 3 months and volume of sputum production was established daily. Subjects were divided randomly into two groups; 21 patients (BDP group) were treated with BDP (400 micrograms/day) by way of a metered-dose inhaler, while the 21 controls did not receive the BDP inhalation therapy. Although FVC (forced vital capacity), FEV1 (forced expiratory volume in 1 s), MMEF (maximal mean expiratory flow) and arterial blood oxygen tension did not improve significantly, sputum production significantly decreased in the BDP group. The patients who responded most dramatically to the treatment presented with sputum eosinophilia and elevated serum IgE levels prior to therapy. Pulmonary tuberculosis or exacerbation of chronic airway infection was not observed in any of the patients. These results suggest that corticosteroid inhalation therapy is helpful in the management of chronic silicosis, especially in patients with sputum eosinophilia. Positive atopic factors may be related to the pathogenesis of eosinophilic bronchitis, a complication of chronic silicosis.

Topics: Aged; Anti-Asthmatic Agents; Beclomethasone; Bronchitis; Eosinophils; Follow-Up Studies; Forced Expiratory Volume; Humans; Hypersensitivity, Immediate; Male; Mining; Occupational Exposure; Respiratory Function Tests; Silicosis; Sputum

The physiopathology of chronic cough remains obscure. We evaluated the possibility that chronic cough in nonasthmatic subjects is associated with airway inflammation, and if this is so, what the relationship between this inflammation and the possible etiology of cough might be, as well as its response to inhaled steroids. Nineteen nonsmoking, nonasthmatic subjects referred for a persistent cough (mean: 3.8 yr) were evaluated and compared with 10 normal subjects. The evaluation included a respiratory questionnaire, a physical examination, allergy skin-prick tests, chest and sinus radiographs, esophageal pH monitoring, measurements of expiratory flows, methacholine and citric acid challenges, and flexible bronchoscopy for bronchoalveolar lavage (BAL) and bronchial biopsies. Fourteen subjects further accepted participation in a randomized, double-blind crossover trial of inhaled beclomethasone (500 micrograms four times daily) and a placebo for 1 mo each. Four groups of subjects were identified according to the presence of postnasal discharge (n = 4), gastroesophageal reflux (n = 6), both conditions (n = 5), or neither (n = 4). Subjects with chronic cough had an increased number of inflammatory cells in their bronchoalveolar lavage fluid (BALF), but there was no significant difference between the four subgroups of coughers. As compared with control subjects, the bronchial biopsies of subjects with chronic cough showed increased epithelial desquamation (p = 0.004) and inflammatory cells (p = 0.005), particularly mononuclear cells (p < 0.01), in addition to submucosal fibrosis, squamous-cell metaplasia, and loss of cilia. These findings were not significantly different between the different etiologic groups. In subjects with chronic cough, basement-membrane thickness was normal and not different from that of control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Asthma; Beclomethasone; Bronchi; Bronchitis; Bronchoalveolar Lavage Fluid; Chronic Disease; Cough; Double-Blind Method; Female; Humans; Male

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

Aerosolized steroids may be implicated in the increased incidence of chest infections. To evaluate such a possibility, we utilized a double-blind study to investigate the acute effect of inhaled beclomethasone dipropionate on mucociliary clearance in 10 patients with chronic obstructive lung disease (5 receiving the drug and 5 placebo). Mucociliary clearance was measured by inhalation of a 99mTc-labelled albumin aerosol. The resulting radioactivity was recorded externally by a large-field gamma camera and dedicated computer for 3 consecutive hours without patient repositioning. After 1-hour baseline recording, the subjects inhaled from a commercial pressurized canister either beclomethasone dipropionate (250 micrograms) or vehicle alone. The recording was then continued for 2 more hours. No statistically significant difference was found in clearance rates throughout the entire period of observation between patients receiving beclomethasone and controls. The data suggest that mechanisms other than mucociliary function impairment are responsible for the increased incidence of chest infections which may accompany steroid treatment by the inhalatory route.

Topics: Adult; Aerosols; Aged; Beclomethasone; Bronchitis; Cilia; Female; Humans; Lung; Male; Middle Aged; Mucus; Respiratory Tract Infections

From the start of the Astemizole clinical investigations, until now the results of 39 trials including more than 2300 patients are available. These results show that Astemizole is an effective and safe Histamine-H1-antagonist for the therapy of hayfever, chronic allergic rhinitis, allergic conjunctivitis, chronic urticaria and allergic bronchitis in adults and children. Astemizole was superior to placebo and the classical antihistamines like Clemastine, Terfenadine, Ketotifen, Mequitazine, pheniramine and Chlorphenamine.

Topics: Astemizole; Beclomethasone; Benzimidazoles; Bronchitis; Clinical Trials as Topic; Conjunctivitis; Double-Blind Method; Drug Therapy, Combination; Histamine H1 Antagonists; Humans; Hypersensitivity; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Urticaria

A randomized multicentre trial was done to investigate the protective effects of ketotifen and disodium cromoglycate (DSCG) in the therapy of bronchial asthma. 236 patients with seasonal asthmatic symptoms were treated and controlled in the summer of 1978. Both drugs showed a significant improvement of the lung function and a marked reduction of asthmatic symptoms, cough and expectoration.

Topics: Adrenergic beta-Agonists; Asthma; Beclomethasone; Bronchitis; Clinical Trials as Topic; Cromolyn Sodium; Histamine H1 Antagonists; Humans; Ketotifen; Piperidines; Random Allocation; Seasons; Spirometry; Theophylline; Thiophenes

Topics: Adult; Aerosols; Asthma; Beclomethasone; Bronchitis; Child; Clinical Trials as Topic; Double-Blind Method; Humans; Placebos; Respiratory Hypersensitivity; Rhinitis, Allergic, Seasonal; Time Factors

Topics: Adrenal Cortex Hormones; Aerosols; Asthma; Beclomethasone; Bronchitis; Chronic Disease; Clinical Trials as Topic; Cough; Humans; Spasm

Topics: Aerosols; Asthma; Beclomethasone; Bronchitis; Candida albicans; Child; Female; Humans; Male; Pharynx; Respiratory Therapy

Topics: Adult; Asthma; Beclomethasone; Bronchitis; Chronic Disease; Clinical Trials as Topic; Female; Humans; Male; Middle Aged

Topics: Adrenal Cortex Hormones; Adrenal Glands; Aerosols; Asthma; Beclomethasone; Body Weight; Bronchitis; Clinical Trials as Topic; Female; Humans; Male; Methylprednisolone; Middle Aged; Substance-Related Disorders

Topics: Administration, Intranasal; Adult; Aerosols; Aged; Asthma; Beclomethasone; Bronchitis; Chronic Disease; Clinical Trials as Topic; Cough; Female; Humans; Male; Methylprednisolone; Middle Aged; Rhinitis; Rhinitis, Allergic, Seasonal

Topics: Aerosols; Asthma; Beclomethasone; Bronchitis; Chronic Disease; Clinical Trials as Topic; Humans; Methylprednisolone; Middle Aged; Prednisone

In asthmatic patients with eosinophilic inflammation of the peripheral airways, appropriate drug delivery to the affected area is required.. It was the aim of this study to assess persistent eosinophilic inflammation of the peripheral airways in asthmatic patients, stabilized by the long-term use of dry powder type inhaled steroids, and to evaluate the clinical efficacy of hydrofluoroalkane-beclomethasone dipropionate (HFA-BDP) over 1 year.. Seventy-four outpatients with moderate stable asthma were studied for at least 6 months, 37 treated with fluticasone propionate Diskus (FP-DK) and 37 with budesonide Turbuhaler (BUD-TH). The eosinophil count, eosinophil cationic protein (ECP), eotaxin and RANTES levels in 10% hypertonic saline-induced sputum were examined before treatment, as well as 4 weeks, 8 weeks, 6 months and 1 year after switching patients to HFA-BDP.. Fifteen patients (40.5%) in the FP-DK group and 12 (32.4%) in the BUD-TH group had eosinophils in induced sputum. The sputum ECP in the eosinophil-positive and the eosinophil-negative groups was 1,510.1 +/- 2,009.3 versus 426.6 +/- 464.1 microg/l (p = 0.037) in the FP-DK group, and 3,850.0 +/- 5,486.2 versus 492.0 +/- 1,150.7 microg/l (p = 0.011) in the BUD-TH group, respectively. Four weeks after the switch to HFA-BDP, the number of eosinophil-positive patients decreased in both groups. Significant reductions in sputum ECP and eotaxin were observed at 8 weeks, and their concentrations continued decreasing for 1 year.. There is a certain proportion of asthmatic patients for whom long-term treatment with dry powder type steroids may not be suitable; however, their peripheral airway inflammation improved after switching them to HFA-BDP, suggesting its excellent delivery.

Topics: Administration, Inhalation; Aerosol Propellants; Aged; Asthma; Beclomethasone; Bronchitis; Eosinophilia; Eosinophils; Female; Follow-Up Studies; Glucocorticoids; Humans; Hydrocarbons, Fluorinated; Leukocyte Count; Male; Middle Aged; Sputum; Time Factors; Treatment Outcome; Vital Capacity

To determine the value of inhaled corticosteroids in the management of chronic inflammatory airway disease in dogs.. Medical records of dogs that were presented for the investigation of respiratory disease were reviewed retrospectively. Criteria for inclusion were knowledge of previous medical treatment including side effects, diagnosis of the underlying disease, use of inhaled corticosteroids and at least two-months follow-up data.. Thirteen dogs that fulfilled the criteria were identified. Ten dogs were diagnosed with chronic bronchitis and three with eosinophilic bronchopneumopathy. Four dogs had not previously received corticosteroid treatment for their respiratory disease, and all these showed a reduction or a resolution of clinical signs without obvious side effects after inhaled corticosteroid therapy. Nine dogs had previously received oral or parenteral corticosteroids for treatment of their respiratory disease, and all had exhibited side effects. Five of these dogs were treated with inhaled corticosteroids alone, and all exhibited an improvement in clinical signs without observable side effects. The remaining four dogs were treated with a combination of inhaled and oral corticosteroids, and all showed improvement in clinical signs and reduction in side effects. Inhaled medication was well tolerated in all dogs.. Inhaled corticosteroids were used for the management of chronic bronchitis and eosinophilic bronchopneumopathy in 13 dogs, and these may have the advantage of reducing side effects associated with oral corticosteroids.

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Androstadienes; Animals; Anti-Inflammatory Agents; Beclomethasone; Bronchitis; Bronchopneumonia; Chronic Disease; Dog Diseases; Dogs; Female; Fluticasone; Male; Pulmonary Eosinophilia; Respiratory Tract Diseases; Retrospective Studies; Treatment Outcome

Asthma and eosinophilic bronchitis are characterized by a similar type of eosinophilic inflammation. However, eosinophilic bronchitis differs from asthma in that there is no variable airflow obstruction or airway hyperresponsiveness. We evaluated the roles of vascular endothelial growth factor (VEGF) and microvascular permeability in causing these differences between the two diseases. Inflammatory indexes in induced sputum, exhaled nitric oxide levels, and vascular permeability index were examined in 11 normal control subjects, 19 beclomethasone dipropionate (BDP)-treated subjects with asthma, 20 non-BDP-treated subjects with asthma, and 17 patients with eosinophilic bronchitis. The percentage of eosinophils in sputum and exhaled nitric oxide levels were significantly higher in non-BDP-treated subjects with asthma and patients with eosinophilic bronchitis than in other two groups; however, VEGF levels and vascular permeability index were significantly higher in non-BDP-treated (VEGF: mean; 4,710 [SD; 1,150] pg/ml, p < 0.0001; vascular permeability index: 0.028 [0.009], p < 0.0001) and BDP-treated (2,560 [1,070] pg/ml, p = 0.0002; 0.016 [0.006], p = 0.004) subjects with asthma than in patients with eosinophilic bronchitis (1,120 [800] pg/ml; 0.01 [0.005]) and normal control subjects (1,390 [1,280] pg/ml; 0.008 [0.003]). We found significant correlations between the VEGF level and the airway vascular permeability index in all patient groups. Thus, interaction between airway microcirculation and VEGF may be a key element in differences in airway function between asthma and eosinophilic bronchitis.

Topics: Adult; Analysis of Variance; Asthma; Beclomethasone; Bronchial Provocation Tests; Bronchitis; Capillary Permeability; Case-Control Studies; Eosinophilia; Female; Humans; Male; Middle Aged; Nitric Oxide; Probability; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Sputum; Vascular Endothelial Growth Factor A

The relationship between airway inflammation and asthma severity in corticosteroid-treated asthma is unclear.. Our purpose was to characterize the inflammatory cell profile of the airway lumen and epithelium in corticosteroid-treated asthma and to relate these findings to clinical and physiologic markers of asthma severity.. Adults (n = 20) with asthma received standardized high-dose inhaled corticosteroid therapy with beclomethasone 2000 microgram per day for 8 weeks. Airway responsiveness to methacholine and hypertonic (4.5%) saline solution was then assessed, followed by sputum induction and, 1 week later, bronchoscopy with bronchoalveolar lavage and bronchial brush biopsy to assess inflammatory cells.. Clinical asthma severity was associated with airway hyperresponsiveness. Metachromatic cells were the main granulocyte present in bronchial brush biopsy specimens and correlated with airway responsiveness to saline solution (r = -0.75), methacholine (r = -0.74), peak flow variability (r = 0.59), and clinical asthma severity (r = 0.57). Eosinophils were the main granulocyte present in sputum and correlated with airway responsiveness to saline solution (r = -0.63) but not with other clinical markers of asthma severity. Bronchoalveolar lavage cell counts were not related to clinical asthma severity.. In asthmatic patients treated with cortico-steroids, the dominant inflammatory effector cell in the epithelium is the metachromatic cell, and in sputum it is the eosinophil. These cells correlate with the degree of airway hyperresponsiveness. Clinical asthma severity correlates with airway responsiveness and epithelial metachromatic cells. Induced sputum eosinophils and airway responsiveness to hypertonic saline solution may be useful markers of airway inflammation for clinical practice.

Topics: Adult; Asthma; Beclomethasone; Bronchi; Bronchial Hyperreactivity; Bronchitis; Bronchoalveolar Lavage Fluid; Dose-Response Relationship, Drug; Eosinophils; Female; Glucocorticoids; Humans; Male; Mast Cells; Peak Expiratory Flow Rate; Severity of Illness Index

We tried to use eosinophil counts in induced sputum samples as a marker of airway inflammation, and as a guide for reducing inhaled corticosteroids in patients with well-controlled persistent asthma. The eosinophil count in induced sputum smears was defined as follows: Eos%; eosinophil percentage of 200-400 leukocytes in properly cell-separated fields, TEC; total eosinophil counts in the 5 most eosinophil-dense high power view fields (x 400). First, the eosinophil count in induced sputum samples was compared between 29 asthmatic subjects treated with inhaled corticosteroid and 15 age- and sex-matched healthy controls. Second, inhaled corticosteroid was reduced by 50% in 20 patients with green-zone asthma (morning PEF > 80% of patient's best PEF). PEF measurements were followed prospectively for 12 weeks thereafter. Once PEF decreased below 70% of their best PEF, subjects were considered as treatment "failures". Both Eos% and TEC were significantly higher than in the controls, even in well-controlled (morning PEF > 80% of their best) asthmatic patients (p = 0.001, 0.03). The chance of treatment "failure" was significantly higher in those having more eosinophils (Eos% > 10%, TEC > 100) in their initial induced sputum sample (p = 0.03, 0.001). Airway inflammation still persists in many well-controlled chronic asthmatic patients, and induced sputum eosinophilia predicts an early decrease of PEF after reduction of inhaled corticosteroids.

Topics: Administration, Inhalation; Adult; Aged; Anti-Asthmatic Agents; Anti-Inflammatory Agents; Asthma; Beclomethasone; Biomarkers; Bronchitis; Eosinophils; Female; Humans; Leukocyte Count; Male; Middle Aged; Peak Expiratory Flow Rate; Sputum

Neuropeptides act on most of the components of the bronchial environment. They influence bronchomotor tone and bronchial vascular caliber and permeability. To investigate the nonadrenergic, noncholinergic system within the airways in asthma and chronic bronchitis, we performed endobronchial biopsies in 16 normal human volunteers, 49 patients with asthma of varying severity, including 16 patients treated with oral corticosteroids, and 13 patients with chronic bronchitis. Frozen sections of biopsies stained with specific antibodies against the neural marker PGP 9.5, vasoactive intestinal peptide (VIP), substance P (SP), calcitonin gene-related peptide (CGRP), and neuropeptide Y (NPY) were analyzed for the presence of nerves through indirect immunofluorescence. Nerves were present in most of the biopsies and were found within and below the epithelium and adjacent to smooth muscle, glands, and blood vessels. By comparison with those in normal subjects, the numbers of VIP-immunoreactive nerves were not significantly decreased in patients with asthma and chronic bronchitis, but NPY-immunoreactive nerves were significantly decreased in the smooth muscle of these latter two groups of patients (p < 0.005). There was no correlation between disease severity and the number of nerves found in the biopsies. This study does not confirm previous findings in autopsy material of some defects in sensory and VIP-containing nerves in severe asthma.

Topics: Administration, Oral; Adolescent; Adult; Aged; Asthma; Beclomethasone; Biomarkers; Biopsy; Bronchi; Bronchitis; Bronchoconstriction; Calcitonin Gene-Related Peptide; Capillary Permeability; Chronic Disease; Epithelium; Female; Fluorescent Antibody Technique, Direct; Glucocorticoids; Humans; Male; Middle Aged; Mucous Membrane; Muscle, Smooth; Nerve Tissue Proteins; Neuropeptide Y; Neuropeptides; Prednisone; Substance P; Thiolester Hydrolases; Ubiquitin Thiolesterase; Vasoactive Intestinal Peptide; Vasomotor System

The purpose of the study is to investigate the relationship between inhaled or intranasal adrenergic agonists and corticosteroids and the development of central serous chorioretinopathy (CSC).. The medical records of three patients with CSC who were found to use inhaled adrenergic agents or corticosteroids or both were identified prospectively. A survey of members of the Retina, Macula, and Vitreous societies and the National Registry of Drug-Induced Ocular Side Effects identified three additional cases.. Six patients with CSC were found to be chronic users of corticosteroid (four patients) or both beta adrenergic agonist and corticosteroid (two patients) metered dose inhalers or nasal sprays. In three cases, there was a close temporal correlation between the use of a corticosteroid nasal spray and the development of CSC.. These findings suggest that, in patients who are susceptible, the periocular or systemic absorption of inhaled corticosteroids may be sufficient to produce CSC in humans, supporting previous hypotheses regarding the pathogenesis of the disorder. Further studies are needed to confirm this association and to determine whether inhaled adrenergic agents also contribute to the development of this disorder. Patients in whom CSC develops while using corticosteroid inhalers or nasal sprays should be alerted to the possible relationship between CSC and these agents.

Topics: Administration, Inhalation; Adrenergic beta-Agonists; Adult; Albuterol; Androstadienes; Asthma; Beclomethasone; Bronchitis; Choroid Diseases; Exudates and Transudates; Female; Fluorescein Angiography; Fluticasone; Fundus Oculi; Glucocorticoids; Humans; Male; Middle Aged; Pigment Epithelium of Eye; Prospective Studies; Retinal Detachment; Retinal Diseases; Rhinitis; Risk Factors; Triamcinolone Acetonide; Visual Acuity

The transcription factor Fos is involved in cell proliferation and differentiation. Its expression in normal and pathological adult human tissues and cells has rarely been studied. We therefore studied bronchial biopsies obtained from 14 normal subjects (NS), 18 non-steroid-treated asthmatics, 10 corticosteroid-treated asthmatics and 10 patients with chronic bronchitis (CB), in addition to 34 patients with lung cancer (LC), by immunofluorescence for Fos immunoreactivity, using a highly specific polyclonal antibody. Bronchial tissue of 0/10 NS, 11/18 non-steroid-treated asthmatics, 1/10 steroid-treated asthmatics, 0/10 CB and 1/34 LC expressed Fos. In asthmatic patients, the expression was heterogeneous, localized to epithelial cells and correlated with the epithelium shedding (tau = 0.45, P = 0.0001). Corticosteroid-treated patients rarely expressed Fos, suggesting a role for this proto-oncogene in asthmatic bronchial inflammation. Fos was rarely expressed in the normal and pathological (CB, LC) proliferative compartment of the human bronchi, suggesting its low role in cell proliferation of the large airways.

Topics: Adenocarcinoma; Adolescent; Adult; Aged; Aged, 80 and over; Asthma; Beclomethasone; Bronchi; Bronchitis; Budesonide; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Chronic Disease; Female; Fluorescent Antibody Technique; Humans; Lung Neoplasms; Male; Middle Aged; Pregnenediones; Proto-Oncogene Mas; Proto-Oncogene Proteins c-fos

Two men with severe ulcerative colitis developed ulcerative tracheobronchitis 4 and 8 years after total colectomy. Intense plasma cell infiltration of tracheal mucosa and submucosa and destruction of mucous glands occurred, with partial relief of symptoms with corticosteroids. We compare them with the only other case reported, also years after colectomy.

Topics: Beclomethasone; Bronchitis; Colectomy; Colitis, Ulcerative; Humans; Male; Middle Aged; Prednisolone; Time Factors; Tracheitis

Forty-one children, aged six to 36 months (mean, 23.3 months), with a past history of acute bronchiolitis with or without recurrent wheezing episodes were treated with either a beclomethasone dipropionate metered dose inhaler 150 microgram twice daily, or a placebo for 12 weeks. Aerosols were inhaled through an AeroChamber (Trudell, Canada) using a mask. The patients were followed up biweekly. The two groups were well matched in anthropometric data and frequency of wheezing prior to the study being undertaken. At the end of four to six weeks, the beclomethasone dipropionate treatment group showed a significant improvement in both wheezing and sleep patterns, and systemic steroid therapy was able to be tapered. No significant side effect could be ascribed to this treatment.

Topics: Acute Disease; Administration, Inhalation; Adolescent; Beclomethasone; Bronchitis; Child, Preschool; Female; Humans; Male; Recurrence; Respiratory Sounds

The main goal of asthma treatment has usually been to maintain normal air potency with bronchodilators. A prompt improvement in physiologic measures of expiratory flow can be observed after administration beta-2-agonists or steroids. The present study aimed to assay the influence of fenoterol or beclomethasone therapy on the pulmonary ventilation (VC, FEV1, FEV1%), the heart action (heart rate, QT interval, 24 hours ECG) and the potassium balance in examined group. 20 patients with chronic asthmatic bronchitis were divided on two group (A and B). Group A consisted 10 subjects and patients were treated with fenoterol, the second group (Group B) consisted 10 subjects too, and patients were treated with beclomethasone. After five days treatment in all subjects an increase VC, FEV1 and FEV1% were observed. In group A (inhalation of fenoterol) we observed: 1--the significant increase of heart rate, QT interval, and frequency of cardiac arrhythmias and 2--significant decrease plasma potassium levels. In group B we didn't observed a significant changes in heart function and potassium levels. We concluded that nebulization of fenoterol, even in low doses, required control of the plasma potassium concentration and the evaluation of the heart action.

Topics: Asthma; Beclomethasone; Bronchitis; Chronic Disease; Female; Fenoterol; Forced Expiratory Volume; Heart; Humans; Male; Middle Aged; Potassium; Respiratory Function Tests

100 cases, of which sixty four bronchial asthma patients and forty two asthmatic bronchitis patients sufficiently severe to be treated with inhaled corticosteroids, were investigated. All were treated with high dose beclomethasone dipropionate (BDP) inhaler aerosol (1500-2000 micrograms/day) for three months. The results showed the total effective rate was 98.4% in bronchial asthma patients and 62.5% in asthmatic bronchitis patients. The pulmonary functions and bronchial hyperresponsiveness of most bronchial asthmatic patients were improved significantly after 1-2 weeks treatment. It is recommendable to treat the oral cortisone-depending patients with BDP inhaler. After 3 months treatment, the adrenocortical secretive ability and reserve power of the patients could be slightly damaged. The investigation also showed 8 percent subjects complained of dysphonia and 25 percent suffered from oropharyngeal candidiasis. Finally, the asthmatic relapse rate was high after cessation of the therapy.

Topics: Administration, Inhalation; Adult; Aerosols; Asthma; Beclomethasone; Bronchitis; Female; Humans; Male; Middle Aged

We investigated compliance and inhaler technique in 50 patients with airway obstruction (26 asthma, 24 chronic bronchitis) being treated with inhaled steroid (beclomethasone dipropionate, BDP) via a dry powder inhaler (Rotahaler omega). Patients had already participated for one year in a 2-year trial of BDP in general practice. They were treated daily with two dry powder inhalations of 400 micrograms BDP in combination with a bronchodilator. Compliance with BDP was measured by counting capsules (single-blind) at the end of a 4-month period and through a questionnaire. Counting capsules revealed non-compliance in 46% of the patients. Compliance was not related to age, sex, diagnosis or side-effects of BDP. In chronic bronchitis, but not in asthma, compliance was related to the outcome parameters of steroid treatment (pulmonary symptoms, change in lung function and non-specific bronchial responsiveness). The inhaler technique was judged insufficient in 27% of the patients. This study stresses the importance of regular instruction in inhaler technique and proper information about prophylactic steroid treatment by the general practitioner during the treatment of asthma and chronic bronchitis.

Topics: Administration, Inhalation; Adult; Aged; Asthma; Beclomethasone; Bronchitis; Chronic Disease; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Patient Compliance; Patient Education as Topic; Treatment Outcome

Forty patients suffering from chronic bronchitis with basal forced expiratory volume in one second (FEV1) values at least 20% below ECSC (European Community Steel and Coal) predicted values were treated with a combination of salbutamol plus beclomethasone dipropionate or with theophylline for a period of 4 weeks. Methacholine bronchial inhalation challenges were performed before and after treatment. Both treatments produced significant increases in FEV1, forced vital capacity (FVC) and FEV1 100/FVC, while only the salbutamol plus beclomethasone dipropionate combination significantly reduced the decrease in FEV1 values after bronchial inhalation challenge.

Topics: Adult; Albuterol; Beclomethasone; Bronchial Provocation Tests; Bronchial Spasm; Bronchitis; Chronic Disease; Drug Therapy, Combination; Female; Forced Expiratory Volume; Humans; Male; Methacholine Compounds; Middle Aged; Theophylline

The authors provide comparative data derived during study of the time-course of changes in IgM, IgG and IgA and cellular eosinophilic and basophilic allergic reactions during application of pentoxyl and becotide alone and combined in multiple modality treatment of 161 patients with chronic obstructive bronchitis. Application of pentoxyl was accompanied mainly by quantitative increment of immunoglobulins, particularly IgA and IgG, and moderately pronounced desensitization effect that manifested by attenuation of the eosinophilic reaction and spontaneous degranulation of basophils. Application of becotide in multiple modality treatment led primarily to attenuation of the cellular allergic reactions under study and less marked increment of immunoglobulins. The combined use of the drugs for bronchitis exacerbation produced maximally pronounced desensitization (according to the eosinophilic reaction and basophil degranulation data) as compared to the effect of these drugs used alone on the patients' allergic status. It is recommended that patients with chronic bronchitis exacerbation should receive pentoxyl (during immunoglobulin deficiency and proneness to allergy), becotide inhalations to obtain primarily desensitization effect, and combined pentoxyl and becotide (in patients with high risk of sensitization).

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Aged; Basophils; Beclomethasone; Bronchitis; Chronic Disease; Drug Therapy, Combination; Eosinophils; Female; Histamine; Humans; Immunity; Immunoglobulins; Male; Middle Aged; Pentoxyl; Time Factors; Uracil

Topics: Adolescent; Adult; Beclomethasone; Bronchitis; Chronic Disease; Combined Modality Therapy; Female; Humans; Male; Middle Aged

Sputum samples from patients with chronic bronchitis were assayed for histamine content using a bioassay, and/or fluorometric assay and single or double radioenzymatic techniques. Comparison showed that all the assays produced significant differences in the measurement of sputum histamine. Similarly, it was observed that the assays all showed significant differences in the measurement of histamine released from human basophils. In general the fluorometric assay give the highest values for histamine in sputum and the double-isotope radioenzymatic assay the lowest. In contrast, no differences were found between the bioassay, fluorometric assay and the single-isotope radioenzymatic assay for the measurement of histamine added to Tyrode's solution. These results suggest that in biological samples some of the assays may additionally be measuring metabolites of histamine or other components present in the samples and underline the need to measure the levels of histamine and its metabolites separately in sputum.

Topics: Albuterol; Ampicillin; Basophils; Beclomethasone; Bronchitis; Carbon Radioisotopes; Histamine; Humans; Sputum; Tritium

Topics: Adult; Atropine Derivatives; Beclomethasone; Bronchi; Bronchial Provocation Tests; Bronchial Spasm; Bronchitis; Chronic Disease; Ethanolamines; Fenoterol; Histamine; Histamine Antagonists; Humans; Ipratropium; Male; Middle Aged

Topics: Aerosols; Asthma; Beclomethasone; Bronchitis; Glucocorticoids; Humans; Lung Diseases, Obstructive; Respiratory Therapy

Topics: Alveolitis, Extrinsic Allergic; Asthma; Beclomethasone; Bronchitis; Humans; Hydrocortisone; Lung Neoplasms; Prednisolone; Pulmonary Eosinophilia; Pulmonary Fibrosis; Respiratory Tract Diseases; Sarcoidosis; Steroids; Tuberculosis, Pulmonary

Topics: Aged; Anti-Bacterial Agents; Beclomethasone; Bronchitis; Bronchodilator Agents; Diagnosis, Differential; Diuretics; Evaluation Studies as Topic; Expectorants; Humans; Hypoxia; Lung Diseases, Obstructive; Middle Aged; Oxygen Inhalation Therapy; Prednisone; Pulmonary Emphysema

Topics: Adolescent; Adult; Aged; Asthma; Beclomethasone; Bronchitis; Drug Evaluation; Female; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Respiratory Function Tests

Topics: Beclomethasone; Bronchitis; Humans; Psychoses, Substance-Induced; Respiratory Therapy

Topics: Adolescent; Asthma; Beclomethasone; Bronchi; Bronchial Diseases; Bronchitis; Child; Child, Preschool; Cough; Drug Tolerance; Female; Follow-Up Studies; Humans; Male; Nasal Cavity; Rhinitis, Allergic, Seasonal; Spasm

Topics: Aerosols; Beclomethasone; Bronchitis; Child; Chronic Disease; Female; Humans; Pulmonary Eosinophilia

142 patients suffering from chronic obstructive lung disease were treated with 9-chloro-11beta,17,21-trihydroxy-16beta-methyl-pregna-4,4-diene-3,20-dione-17,21-dipropionate (beclometasone) metered aerosal. Between 3 subgroups: chronic infectious obstructive lung disease, allergic obstructive lung disease and chronic bronchitis without airway obstruction, there was no difference in the results. Three times per day three puffs of the metered aerosol can substitute about 6 mg prednisolone p.o. The systemic effects of the beclometasone therapy with metered aerosols are clearly less than those which are seen with a comparable oral dosage. Side effects are seen dose dependently as hoarseness and as relatively harmless Candida infection of the throat. For most of the patients with obstructive lung disease who are dependent on glucocorticosteroids beclometasone as metered aerosol should be given as basic therapy. In case higher dosages are necessary they should be given orally or parenterally.

Topics: Aerosols; Asthma; Beclomethasone; Bronchitis; Humans; Lung Diseases, Obstructive

Topics: Aerosols; Asthma; Beclomethasone; Bronchitis; Chronic Disease; Female; Humans; Male; Methylprednisolone

Topics: Adolescent; Adult; Aged; Asthma; Beclomethasone; Bronchitis; Child; Chronic Disease; Drug Evaluation; Female; Humans; Long-Term Care; Male; Methylprednisolone; Middle Aged

Topics: Aerosols; Beclomethasone; Blood Gas Analysis; Bronchitis; Chronic Disease; Humans; Hydrocortisone; Lung Diseases, Obstructive; Methylprednisolone; Pulmonary Emphysema; Respiratory Function Tests

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; Aged; Anti-Inflammatory Agents; Asthma; Beclomethasone; Biopsy; Bronchi; Bronchitis; Bronchoscopy; Cilia; Eosinophils; Epithelium; Female; Glucocorticoids; Humans; Lymphocytes; Male; Middle Aged; Mucous Membrane; Time Factors