piperidines and Respiratory-Tract-Diseases

The antitussive Libexin was synthesized in the Research Laboratory of CHINOIN Pharmaceutical and Chemical Works Ltd., Budapest. Observations of the drug in different disease groups have been surveyed on the basis of data published over more than twenty years. According to the unanimous opinion of the authors the drug does not depress respiration, it rather improves the values of the respiratory function. The majority of the examining physicians are on the opinion that it does not hinder expectoration. The drug proved to be of high value in alleviating nocturnal coughing controlling spastic bronchitis in children, as a pretreatment before bronchological examinations and their anaesthesia. It may successfully be used in both acute and chronic bronchitises in preoperative and postoperative cases, in cardiology, otorhinolaryngology and paediatrics.

Topics: Antitussive Agents; Humans; Hungary; Piperidines; Respiratory Tract Diseases; Tablets

Antihistaminic drugs may interfere with ion and water transport across bronchial epithelium, decreasing the water content of the bronchial mucus and thus adversely affecting mucociliary clearance. A double-blind trial was therefore undertaken to study the short-term effects of ketotifen, a new antiasthmatic drug with antianaphylactic and antihistaminic properties, on the physicochemical properties of sputum in 16 patients with clinically stable chronic reversible airway diseases. The study lasted 5 weeks, during which the patients received 2 mg ketotifen daily for two or three weeks and placebo for the remaining weeks; thus, all patients received both the active drug and a placebo. The patients were evaluated weekly and different measurements, including graded clinical observations, ventilatory tests and blood studies were carried out. Objective sputum measurements included 24-hour volume, dry weight, "apparent" viscosity (at a shear rate of 900 s-1), content of fucose, neuraminic acid, immunoglobulin A and acid mucus glycoprotein fibers. Of the sputum characteristics the daily volume decreased slightly after ketotifen. In contrast, sputum dry weight appeared to increase. The "apparent" viscosity showed a tendency to decrease. Fucose, neuraminic acid and immunoglobulin A content varied slightly, as did the percentage of acid mucus glycoprotein fibers. Since none of the sputum characteristics changed significantly during short-term therapy with ketotifen, this drug probably does not alter either the water content or the mucus biopolymers--both of which are responsible for the flow properties of bronchial mucus--thus presumably leaving mucociliary transport unchanged in patients with chronic reversible airway diseases.

Topics: Adult; Aged; Drug Administration Schedule; Female; Fucose; Glycoproteins; Humans; Immunoglobulin A; Ketotifen; Male; Middle Aged; Piperidines; Respiratory Tract Diseases; Sialic Acids; Sputum; Thiophenes; Viscosity

Topics: Aged; Antitussive Agents; Cough; Female; Humans; Male; Piperidines; Placebos; Respiratory Tract Diseases

Topics: Adolescent; Adult; Aged; Animals; Benzilates; Biliary Tract Diseases; Blood Circulation; Cardiovascular System; Cats; Central Nervous System; Child; Child, Preschool; Clinical Trials as Topic; Dogs; Female; Gastrointestinal Diseases; Genital Diseases, Female; Guinea Pigs; Humans; Infant; Infant, Newborn; Male; Mice; Middle Aged; Muscle Contraction; Muscles; Muscular Diseases; Neoplasms; Piperidines; Pupil; Rabbits; Rats; Respiration; Respiratory Tract Diseases; Salivation; Urologic Diseases

Flexible bronchoscopy has been more and more used for diagnosis and management diseases of respiratory system in pediatrics. Previous studies have reported that remifentanil (RF) and propofol are safe and effective for flexible bronchoscopy in adults, however, there have no trials evaluate the efficacy of DEX-RF versus dexmedetomidine-propofol in children undergoing flexible bronchoscopy.We divided 123 children undergoing flexible bronchoscopy with DEX-RF or dexmedetomidine-propofol into 2 groups: Group DR (n = 63, DEX infusion at 1.0 μg kg for 10 minutes, then adjusted to 0.5-0.7 μg kg h; RF infusion at 1.0 μg kg for 5 minutes, then adjusted to 0.05-0.2 μg kg min), Group DP (n = 60, DEX infusion at 1.0 μg kg for 10 minutes, then adjusted to 0.5-0.7 μg kg h; propofol infusion at 10 μg kg for 5 minutes, then adjusted to 0.05-0.1 μg kg min). Ramsay sedation scale of the 2 groups was maintained at 3. Anesthesia onset time; total number of intraoperative patient movements; hemodynamics; total cumulative dose of DEX; amount of and time to first-dose rescue midazolam and lidocaine; postoperative recovery time; adverse events; and bronchoscopist satisfaction score were recorded.Anesthesia onset time was significantly shorter in DP (8.22 ± 2.48 vs 12.25 ± 6.43 minutes, respectively, for DP, DR, P = 0.015). The perioperative hemodynamic profile was more stable in DR than DP group. More children moved during flexible bronchoscopy in DP group (P = 0.009). Total dose of rescue midazolam and lidocaine was significantly higher in DR than in DP (P < 0.001). Similarly, the time to first dose of rescue midazolam and lidocaine was significantly longer in DP than in DR (P < 0.001). Total cumulative dose of DEX was more in DR than DP group (P < 0.001). The time to recovery for discharge from the postanesthesia care unit (PACU) was significantly shorter in DP than in DR group (P < 0.001). The bronchoscopist-satisfaction scores were higher for DR than DP (P = 0.036). There were significant differences between the 2 groups in terms of the overall incidence of hypertension, tachycardia, and hypoxemia (P < 0.05).Although underwent longer recovery time and more incidence of rescue scheme, DEX-RF resulted in more stable hemodynamic profiles and bronchoscopist-satisfaction scores, lesser patient movements, and can hence be more effectively used in children undergoing flexible bronchoscopy than dexmedetomidine-propofol.

Topics: Anesthesia; Anesthesia Recovery Period; Blood Pressure; Bronchoscopy; Child; China; Dexmedetomidine; Dose-Response Relationship, Drug; Drug Monitoring; Female; Heart Rate; Hemodynamics; Humans; Hypnotics and Sedatives; Male; Piperidines; Propofol; Remifentanil; Respiratory Tract Diseases; Retrospective Studies; Treatment Outcome

Topics: Adolescent; Analgesics, Opioid; Anesthesia, General; Anesthesia, Inhalation; Anesthetics, Inhalation; Child; Child, Preschool; Desflurane; Female; Humans; Infant; Infusions, Intravenous; Isoflurane; Laryngeal Masks; Male; Piperidines; Remifentanil; Respiratory Tract Diseases

Acetylcholinesterase inhibitors (AChEIs), commonly prescribed in Alzheimer's disease, may trigger complications of chronic airways disorders. The aim of this study was to determine whether initiation of therapy with AChEIs contributes to complications of chronic airways disorders in an elderly population.. Sequence-symmetry analysis was used to assess two cohorts of patients, both with a history of chronic airways disorders. Both cohorts comprised Medicare beneficiaries who received drug coverage through the Pennsylvania Pharmaceutical Assistance Contract for the Elderly, between 1997 and 2002. One cohort of 922 patients initiated treatment with an AChEI; the other cohort of 2819 patients initiated treatment with a beta-adrenoceptor antagonist (beta-blocker), a comparator drug also contraindicated in chronic airways disorders. The occurrence of the following four outcomes in claims data was assessed: (i) emergency room visits for complications of chronic airways disorders; (ii) hospitalisations for complications of chronic airways disorders; (iii) physician visits for complications of chronic airways disorders; and (iv) dispensing of an antibacterial and an oral corticosteroid on the same day. Rate ratios (RRs) were adjusted for age, sex, race, nursing home residence, cognitive status, severity of chronic airways disorders, comorbid illnesses and all other patient characteristics that can be assumed to remain constant over the study period.. Initiators of AChEIs had no detectable increased rate of complications of chronic airways disorders. Adjusted RRs of the four outcomes ranged from 1.00 (95% CI 0.61, 1.62; p = 0.99) for physician visits to 1.64 (95% CI 0.55, 4.89; p = 0.37) for emergency room visits, none reaching statistical significance. In contrast, beta-blocker initiators had significantly increased rates of all four outcomes after treatment, with adjusted RRs ranging from 1.97 (95% CI 1.18, 3.29; p = 0.009) for emergency room visits to 2.76 (95% CI 1.71, 4.45; p < 0.0001) for dispensing of an antibacterial and oral corticosteroid on the same day.. These results suggest that, in current clinical practice, physicians can prescribe AChEIs safely to elderly patients with chronic airways disorders, while beta-blocker prescribing continues to result in adverse health outcomes.

Topics: Aged; Aged, 80 and over; Cholinesterase Inhibitors; Chronic Disease; Cross-Over Studies; Donepezil; Female; Galantamine; Humans; Indans; Logistic Models; Male; Phenylcarbamates; Piperidines; Respiratory Tract Diseases; Rivastigmine

To report a case of lower respiratory tract obstruction occurring in a patient with primary pulmonary amyloidosis and discuss anesthetic management.. A 53-yr-old man was referred to our institution for microlaryngoscopy and laser treatment of the larynx. He presented with a five-year history of primary laryngo-tracheo-bronchial amyloidosis and symptoms consistent with narrowing of the conducting airways. General anesthesia was induced with iv propofol 150 mg and remifentanil 50 microg. Mivacurium 20 mg provided muscle relaxation for endotracheal intubation. Following endotracheal intubation, the airway became obstructed and patient ventilation impossible. The endotracheal tube was removed and a Dedo laryngoscope inserted. Gas exchange was maintained using supraglottic jet ventilation via a distal port of the laryngoscope. Rigid bronchoscopy showed tissue partially obstructing the lumen of the lower trachea. This was removed and the airway appeared patent. At the end of the case, a further episode of lower airway obstruction occurred requiring reinsertion of the laryngoscope and resumption of jet ventilation. Extensive debridement through the bronchoscope was required before adequate ventilation could be restored. Some days later when the patient's condition deteriorated again and he required further debridement of the trachea and insertion of a tracheostomy, guide wires were positioned in the femoral vessels in the event that cardiopulmonary bypass was required for gas exchange.. Primary laryngo-tracheo-bronchial amyloidosis is a recurrent disease, requiring repetitive surgical procedures. Airway compromise can be a persistent problem. Awareness of this uncommon disease process and its presentation may serve to caution the anesthesiologist presented with this type of case.

Topics: Amyloidosis; Anesthesia, General; Anesthetics, Intravenous; Bronchial Diseases; High-Frequency Jet Ventilation; Humans; Intubation, Intratracheal; Isoquinolines; Laryngoscopy; Laryngostenosis; Lung Diseases; Male; Middle Aged; Mivacurium; Neuromuscular Nondepolarizing Agents; Piperidines; Propofol; Remifentanil; Reoperation; Respiratory Tract Diseases; Tracheal Stenosis

We have developed a guinea pig model for cough related to allergic airway inflammation. Unanesthetized animals were exposed to capsaicin aerosols for 10 min, and cough frequency was counted during this period. The cough evaluation was performed by the following three methods: visual observation, acoustic analysis, and monitoring of pressure changes in the body chamber. These analyses clearly differentiated a cough from a sneeze. To elucidate the relationship between cough response and airway inflammation, animals were immunosensitized and multiple challenged. Sensitized guinea pigs presented no specific changes microscopically, but multiple-challenged animals showed an increased infiltration of inflammatory cells into the airway. Cough number in response to capsaicin increased significantly from 4.7 +/- 1.4 coughs/10 min in normal animals to 10.6 +/- 2.0 coughs/10 min in sensitized animals and further to 22.8 +/- 1.3 coughs/10 min in multiple-challenged animals. This augmented cough frequency was significantly inhibited by the inhalation of tachykinin-receptor antagonists and by oral ingestion, but not inhalation, of codeine phosphate. The results suggest that airway inflammation potentiates an elevation of cough sensitivity in this model.

Topics: Animals; Antitussive Agents; Benzamides; Bronchoalveolar Lavage Fluid; Capsaicin; Codeine; Cough; Dipeptides; Female; Guinea Pigs; Indoles; Inflammation; Peptides, Cyclic; Piperidines; Quinuclidines; Receptors, Neurokinin-2; Receptors, Tachykinin; Respiratory Hypersensitivity; Respiratory Tract Diseases

It is not known whether antireflux surgery is more effective than medical therapy to control respiratory symptoms (RS) in gastroesophageal reflux disease (GERD).. In 21 GERD patients with RS, reflux was assessed by endoscopy, manometry, and pH monitoring. Patients had proton pump inhibitor therapy and cisapride for 6 months. After GERD relapsed following withdrawal of medical therapy, 7 patients with normal esophageal peristalsis had a laparoscopic Nissen fundoplication and 14 with impaired peristalsis a Toupet fundoplication. Respiratory symptoms were scored prior to treatment, at 6 months following medical therapy, and at 6 months after surgery.. Heartburn and esophagitis were effectively treated by medical and surgical therapy. Only surgery improved regurgitation. Respiratory symptoms improved in 18 patients (85.7%) following surgery and in only 3 patients (14.3%) following medical therapy (P <0.05). Esophageal peristalsis improved following the Toupet fundoplication.. Medical therapy fails to control reflux since it does not inhibit regurgitation. Surgery controls reflux and improves esophageal peristalsis, which contributes to its superiority over medical therapy in the treatment of RS associated with GERD.

Topics: Adult; Aged; Anti-Ulcer Agents; Cisapride; Drug Therapy, Combination; Female; Gastroesophageal Reflux; Humans; Male; Middle Aged; Omeprazole; Piperidines; Respiratory Tract Diseases

Gastro-oesophageal reflux (GOR) has been implicated in such clinical phenomena as aspiration pneumonia, bronchospasm or wheezing, apnea, stridor, and hoarseness. Various tests have been used as an aid to diagnosing patients with chronic respiratory disease where GOR is a causal factor. Different forms of conservative treatment have been tried for GOR, including cisapride. Several studies have evaluated its effect on the pH profile and respiratory symptoms in patients with chronic respiratory disease and have demonstrated improvement of nocturnal wheezing, cough, and irritability. Our experience with cisapride is positive in children with GOR. Patients refractory to medical treatment have been surgically treated with good results.

Topics: Anti-Ulcer Agents; Asthma; Child; Child, Preschool; Chronic Disease; Cisapride; Gastroesophageal Reflux; Humans; Infant; Piperidines; Pneumonia, Aspiration; Respiratory Sounds; Respiratory Tract Diseases

We studied the effect of neurogenic inflammation on airway blood flow in anesthetized F-344 rats. Three successive determinations of blood flow were made by injecting radionuclide-labeled microspheres suspended in 70% dextrose into the left ventricle. A selective agonist of the tachykinin receptor neurokinin 1 (NK1) increased airway blood flow, but NK2- and NK3-selective agonists were without effect. The natural agonist of NK1 receptors, substance P (1 micrograms/kg), increased airway blood flow, an effect that was abolished by the selective NK1 receptor antagonist CP-99,994 [(+)-(2S,3S)-3-(2-methoxybenzylamino)-2-phenylpiperidine] but not by the (2R,3R)-enantiomer CP-100,263. Capsaicin (25 micrograms/kg), a drug that releases tachykinins and calcitonin gene-related peptide from sensory nerves, increased airway blood flow, and again this effect was abolished by CP-99,994. We also studied the effect of a selective inhibitor (captopril, 2.5 mg/kg) of the tachykinin-degrading enzyme kininase II [or angiotensin-converting enzyme (ACE)] on substance P-induced airway vasodilation. Captopril potentiated and prolonged the vasodilator effect of substance P. We conclude that neurogenic vasodilation in rat airways is due to the release of substance P, acts via NK1 receptors, and may be modulated by ACE.

Topics: Animals; Capsaicin; Inflammation; Male; Microspheres; Neurons, Afferent; Peptidyl-Dipeptidase A; Piperidines; Rats; Rats, Inbred F344; Receptors, Neurokinin-2; Receptors, Neurotransmitter; Regional Blood Flow; Respiratory System; Respiratory Tract Diseases; Substance P; Tachykinins; Vasodilation

Topics: Adolescent; Adult; Antitussive Agents; Chronic Disease; Female; Humans; Male; Middle Aged; Oxadiazoles; Piperidines; Respiratory Tract Diseases

The artificially induced cough reflex in experimental animals should necessarily be similar to the cough which occurs naturally in humans. The curve demonstrated during a cough of each patient with respiratory disease was characteristic. Compared with the curve of a cough-like reflex (CLR) induced by DMPP, the curve of a cough induced by electrical stimulation of the tracheal mucosa was similar to that of a cough in humans. In dogs and cats anesthetized with alpha-chloralose (80 similar to 100 mg/kg i.p.), the number of CLR with DMPP was dose dependent. Tachphylaxis did not occur despite repeated administration of DMPP. DMPP (5 similar to 10 mug/kg i.v.) did not affect airway resistance. CLR with DMPP was depressed not only by morphine, codeine, oxymethebanol, picoperidamine, piclobetol and hexacol but also by hexamethonium. Thus, it appears that the mechanism of CLR with DMPP is different from that in the cough reflex. This CLR may be utilized for determining the physiology of cough reflex and the site of action of antitussives.

Topics: Airway Resistance; Allyl Compounds; Animals; Antitussive Agents; Benzamides; Cats; Chloralose; Chlorobenzenes; Codeine; Cough; Diethylamines; Dimethylphenylpiperazinium Iodide; Dogs; Electric Stimulation; Electrodes, Implanted; Female; Histamine; Humans; Male; Methyl Ethers; Morphine; Pentobarbital; Piperidines; Pyridines; Reflex; Respiratory Tract Diseases; Thebaine; Trachea

Topics: Bronchitis; Chronic Disease; Humans; Injections, Intravenous; Khellin; Lung Diseases; Lung Diseases, Obstructive; Phenothiazines; Piperidines; Posture; Quaternary Ammonium Compounds; Respiratory Tract Diseases; Theophylline

Topics: Analgesics; Anesthesia, Endotracheal; Anesthetics; Atropine; Diphenhydramine; Ethyl Ethers; Humans; Male; Morpholines; Nitrous Oxide; Phenobarbital; Piperidines; Postoperative Complications; Respiratory Tract Diseases; Thiopental; Tranquilizing Agents

Topics: Anti-Infective Agents; Benzilates; Child; Chloramphenicol; Guaifenesin; Humans; Middle Aged; Piperidines; Respiratory Tract Diseases; Theophylline; Tropanes

Topics: Ammonium Chloride; Cough; Humans; Piperidines; Respiratory Tract Diseases

Topics: Antipyrine; Benzilates; Bronchodilator Agents; Heart Rate; Humans; Muscles; Piperidines; Respiratory Tract Diseases