Evaluation of efficacy and safety of erdosteine in patients affected by chronic bronchitis during an infective exacerbation phase and receiving amoxycillin as basic treatment (ECOBES, European Chronic Obstructive Bronchitis Erdosteine Study).

An international multicentric study was conducted with the aim of demonstrating that erdosteine improves the efficacy of amoxycillin in the treatment of infective exacerbation of chronic bronchitis mainly on the clinical symptomatology (primary objective), on spirometric tests and body temperature, without negatively influencing the tolerance (secondary objectives). The study was conducted as a prospective evaluation, with 2 comparative groups treated with erdosteine (300 mg x 2/day) or placebo in association with amoxycillin (1500 mg/day) for a maximum of 10 days. The design of the trial was double-blind and parallel group with 2 subgroups. The treatments have been assigned randomly to a population of chronic bronchitic patients in exacerbation phase of n = 237 subjects. The study was conducted according to the principles of the Declaration of Helsinki and its amendments (Hong Kong, September 1989). The primary end-point used to determine effectiveness in this study was the global clinical assessment (GCA) which was choosen as a general indication of activity with objective/subjective evaluation of the clinical picture. Secondary endpoints of efficacy are sputum parameters, functional signs of chronic obstructive bronchitis, spirometric tests and overall judgement of efficacy. Safety was evaluated with adverse drug reactions reporting, arterial blood pressure, heart rate and laboratory tests monitoring. The obtained values have been analyzed with two-way and factorial ANOVA, Least Squares Catmod-SAS, Wilcoxon and Chi-square tests. The number of patients included in the effectiveness analysis is of n = 226 subjects, due to the fact that 11 patients were lost due to different reasons. In term of results as far as the primary objective of the study was concerned, erdosteine resulted more active than placebo. The analysis evidenced a very significant difference for treatment, time and interaction time x treatment. No difference on the contrary was observed for center and the interaction center x treatment. Sputum volume, body temperature and spirometric parameters were not significantly influenced by both treatments. Viscosity, appearance as well as functional signs evidenced a modification over time in favour of erdosteine. As safety is concerned the majority of adverse events, both in the erdosteine and in the placebo group, were related to the gastrointestinal area. For erdosteine, of 9/17 side-effects, 3 were epigastralgias, 3 nauseas, 1 diarrhoea, 1 taste loss, 1 hemorrhoids. For placebo of 13/17 related events 3 were epigastralgias, 4 nauseas, 4 diarrhoeas, 1 pyrosis, 1 dry mouth. In terms of severity they have been all defined as mild or moderate degree. Also from a qualitative perspective it is clear that there are no relevant differences between the 2 treatments under evaluation, concerning safety. In conclusion of particular interest is the datum arising from the efficacy/safety evaluation, which indicates that the clinical picture is modified earlier and at deeper degree by the synergistic activity of erdosteine and of the antibiotic without the risk of an augmentation of side-effects incidence.

Effects of MR889, a cyclic thiolic neutrophil elastase inhibitor, on rheologic properties of mucus.

MR889 is a synthetic inhibitor of human neutrophil elastase with potential in clinical conditions characterized by a high load of this proteolytic enzyme, mainly chronic obstructive pulmonary disease. On the basis of its mechanism of inhibition, it has been suggested that MR889, upon reaction with elastase, would generate new free thiol groups. The aim of this study was to investigate whether MR889, upon reaction with elastase, may modify rheologic properties, i.e. apparent viscosity and elasticity, of both human sputum and porcine stomach mucus, in ex-vivo and in vitro experiments. MR889 10(-4) M alone had no effect on rheologic properties of samples, whereas an agent with free thiol group, n-acetylcysteine 10(-4) M reduced both viscosity and elasticity. MR889 10(-4) M upon reaction with elastase 0.03 nMol (giving 83% of elastase inhibition) had no effect on rheologic properties of samples, whereas upon reaction with elastase 0.15 nMol (49% inhibition) yielded a marked decrease in viscosity. This result would suggest that MR889, in the presence of a high load of elastase, may acquire direct mucus modifying capacity, likely because of its greater utilization upon reaction with the enzyme.

Efficacy and tolerability of brodimoprim in respiratory tract infections.

Brodimoprim is a new diaminopyridine derivative suitable for oral therapy which shows good in-vitro activity against most Gram-positive and Gram-negative pathogens. The efficacy and tolerability of brodimoprim in acute lower respiratory tract infections was tested in controlled clinical trials in comparison with different classes of antibiotics. Acute bacterial infections or infective exacerbations of chronic obstructive bronchitis were included in the studies. Brodimoprim in a single dose was compared to different oral treatments which included co-trimoxazole (trimethoprim 160 mg+sulphamethoxazole 800 mg every 12 hours) and erythromycin (600 mg three times a day). In the studies criteria of efficacy such as daily temperature curve, intensity and frequency of cough, degree of dyspnea, intensity of thoracic pain, difficulty of expectoration, sputum production, thoracic semiology were examined. Brodimoprim was more effective than cotrimoxazole and erythromycin at the end of the treatment, induring a more significant and prompt reduction of axillary temperature, daily sputum volume, degree of dyspnea. There was no difference among treatments in the mean period of therapy to obtain the resolution of the infective process (8 days on average). Brodimoprim had a significantly lower percentage of side effects during the treatment in comparison with cotrimoxazole or erythromycin. Hence brodimoprim was better accepted by patients.

[Respiratory insufficiency and cardiac arrhythmia: the rationale of treatment]. / Insufficienza respiratoria e aritmie cardiache: il razionale della terapia.

It is well known that the incidence of cardiac arrhythmia is particularly high in patients with chronic respiratory insufficiency (CRI). This study examines the prevalence, incidence and prognostic clinical importance of arrhythmia occurring during the course of CRI on the basis of data taken from the literature and the authors' personal experience using dynamic electrocardiographic diagnosis (24-hour Holter monitoring). The majority of arrhythmias observed in these patients appeared to take the form of premature ventricular and/or supraventricular beats and less frequently of atrial fibrillation and/or attacks of supraventricular paroxysmal tachycardia. Cardiac rhythm alterations were observed using Holter monitoring in 70-90% of patients. No cardiac rhythm disorder is specific to this pathological condition. The aim of this study was to formulate, as far as was possible, a rational therapeutic approach which took account of the electrogenesis of arrhythmic phenomena, variations in the type of arrhythmia and the hemodynamic conditions under which they occur. The etiopathogenesis of arrhythmias within the framework of CRI is relatively complex and probably multifactorial since there are a number of concomitant pathological conditions able to trigger off arrhythmogenic processes both inducing the onset of reflux circuits and enhancing cardiac automatism centres. Many studies correlate the presence of arrhythmia with hypoxemia, hypercapnia and both respiratory and metabolic alkalosis. Even the combined effect of hypoxia with respiratory acidosis and the integrity or otherwise of cardiac function (chronic pulmonary heart, right ventricular hypertrophy, ischemic cardiopathy) have a notable pro-arrhythmic effect. Hypokalemia induced by both respiratory alkalosis and by drugs used during the course of CRI (eg diuretics and/or steroids) may induce a marked dispersion of refractory periods of the various fibrocells thus encouraging the onset of arrhythmia. With regard to drugs, it has been observed that both digitalis and theophylline and beta-2 stimulants if frequently used during the course of CRI may possibly induce arrhythmia. It is therefore important to underline that they should be used with particular caution. As far as concerns the use of beta-2 adrenergic compounds, it is advised that they be administered using an aerosol rather than systemic route. Digitalis has limited indications; the molecules of the methylxanthine classes require careful pharmacological dose monitoring. Arrhythmic therapy should also be seen in terms of prophylaxis and the correction of predisposing and decisive factors such as hypoxemia, hypercapnia, hemoglobin and electrolyte levels, and alterations in blood pH following the obstruction of small airways.(ABSTRACT TRUNCATED AT 400 WORDS)

Effects of seaprose on sputum biochemical components in chronic bronchitic patients: a double-blind study vs placebo.

Seaprose is a semialkaline proteinase endowed with proteolytic effect and antiinflammatory activity tested in different clinical trials. There is clinical evidence that seaprose reduces sputum viscoelastic properties in chronic hypersecretory bronchitis. The present study evaluated (in a double-blind design vs. placebo) the activity of seaprose on bronchial inflammation, mucus glycoprotein secretion and bronchial humoral defence mechanism in chronic bronchitic patients clinically stable (10 per group). Markers of bronchial inflammation (albumin, albumin/total protein ratio) and bronchial infection (DNA), of mucus glycoproteins (fucose and N-acetylneuraminic acid) and of humoral defence mechanism (secretory-IgA) were tested in sputum. We found that ten-day treatment with seaprose (90 mg/day) reduced sputum albumin during the observation period, the difference being statistically significant at the 18th day. The sputum albumin/total protein ratio also decreased by 50% at the end of the study. In the same group, sputum DNA, secretory-IgA, fucose and N-acetylneuraminic acid remained unchanged after treatment. The placebo group did not show any significant changes in the sputum marker substances. This study provides experimental evidence for the antiinflammatory activity of seaprose on bronchial mucosa in chronic bronchitic patients studied in a stable phase of their disease. Furthermore the drug does not seem to affect mucus glycoprotein secretion or secretory-IgA production.

[Asthma due to Dermatophagoides in children. Peroral desensitization]. / L'asma da Dermatophagoides nel bambino. Desensibilizzazione per via orale.

At present current knowledges on OIT are controversial. We studied the effectiveness and the possible immunological mechanisms of this therapy. We followed a group of 56 children affected by allergic asthma due to Dermatophagoides during their treatment with OIT. Many clinical parameters were investigated and also immunoallergological and spirometric values in a subgroup. We observed a particularly satisfying clinical and respiratory improvement, while immunoallergological parameters did not suffer significant changes.

[Treatment of acute inflammatory pathology of the upper airway with morniflumate]. / Trattamento delle patologie infiammatorie acute delle vie aeree superiori con morniflumato.

Sixty patients, 33 men and 27 women (mean age about 45 years; range 25-60), affected by acute influenza syndrome of the upper airways were admitted to a controlled single-blind study with three drugs under parallel conditions. According to a balanced randomized sequence, the subjects were treated over a 7-10 day period with morniflumate sachets (700 mg bid) or with tiaprofenic acid sachets (300 mg bid) or with paracetamol (10 ml syrup equivalent to 500 mg tid). The efficacy of the test drugs was assessed by determining the local and general signs and symptoms before starting the treatments, in basal conditions, and on the 3rd, 5th and last day of treatment. At the doses and formulations used, morniflumate proved to be equivalent to paracetamol and more effective than tiaprofenic acid as for its antipyretic action in the first days of treatment. On the other hand, both morniflumate and tiaprofenic acid showed a significantly higher antiinflammatory effect compared to paracetamol. Pain was effectively and equally controlled in all the treatment groups. The drugs administered were generally well tolerated. A greater incidence of adverse GI events was reported in the group treated with tiaprofenic acid.

[Efficacy and tolerability of paracetamol-sobrerol combination in patients with hyperpyrexia]. / Efficacia e tollerabilità dell'associazione paracetamolo-sobrerolo nel paziente iperpiretico.

The therapeutic efficacy and tolerability of the association paracetamol-sobrerol in comparison with paracetamol alone, was tested in a double-blind, randomized clinical trial, carried out on 287 out-patients, suffering from diseases of the respiratory tree with fever. The treatment was performed for up to five days. At the end of the treatment, both treatments lead to an important improvement of all considered clinical parameters; furthermore, the association paracetamol-sobrerol showed a statistically important difference versus paracetamol alone as to cough and difficulty to expectorate. As to body temperature, both paracetamol and paracetamol-sobrerol showed a good antipyretic activity; furthermore, the association compared to paracetamol alone obtained a statistically significant differences in times x treatments. These data fully confirm the results obtained from recent studies: the simultaneous administration of paracetamol and sobrerol obtains a better antipyretic action than paracetamol alone. This synergism allows to reduce paracetamol doses and, consequently, to eliminate the already low incidence of adverse reactions, without decreasing the antipyretic activity.

Effects of erdosteine on sputum biochemical and rheologic properties: pharmacokinetics in chronic obstructive lung disease.

Erdosteine is a new thioderivative endowed with mucokinetic, mucolytic, and free-radical-scavenging properties. This study evaluated (in a double-blind design vs. placebo) its efficacy on biochemical and rheologic properties of sputum and on some indices of respiratory function in chronic patients with chronic bronchitis (10 per group), while receiving basic treatment with a controlled-release theophylline preparation. The pharmacokinetics of erdosteine and theophylline were also studied. We found that a 2 week treatment with erdosteine (300 mg 3 times daily) was able to reduce significantly (p less than 0.05) the sputum apparent viscosity, fucose content, and macromolecular dry weight (MDW) with no statistically significant influence on sputum elasticity, DNA, albumin, total proteins, total IgA, lactoferrin, and lysozyme content. The treatment caused a significant increase in the following ratios: total IgA/albumin, lactoferrin/albumin, and lysozyme/albumin. The pharmacokinetics of erdosteine, its metabolites, and theophylline were the same after 1 or 14 days of treatment, evidence both of absence of an enzymatic induction and of an accumulation process. Further confirmation that there was no interference between erdosteine and theophylline was obtained from the data available on the group of patients receiving only theophylline, since its plasma levels and related pharmacokinetic parameters were identical to those obtained in patients receiving both drugs. In conclusion, 2 weeks of therapy with erdosteine reduced the marker of mucus glycoproteins (fucose) in patients with chronic bronchitis but did not interfere with the pharmacokinetics of xanthine derivatives. We also suggest that the significant increment in the IgA/albumin ratio might be related to a sum of other local effects such as reduction of the inflammatory process and enhancement of the humoral defense mechanism.

[Enoxacin in the treatment of bacterial infections of the respiratory system]. / L'enoxacina nel trattamento di infezioni batteriche a carico dell'apparato respiratorio.

The above study was carried out in 30 patients, 22 males, 8 females, aged between 30 and 66 years, average age 57.17 +/- 1.43 years, 19 of whom with flare-ups of chronic or asthmatic bronchitis, 6 suffering from flare-ups of chronic bronchoectasic bronchitis, and 5 with acute tracheobronchitis. Treatment with two 300 mg tablets of enoxacin daily lasted from 10 to 15 days. The clinical result was good in 95% of the cases, and microbiological results were also satisfactory in that the micro-organisms isolated were sensitive to the antibiotic. Tolerance was good both locally and generally, only two patients complained of slight stomach discomfort. Both symptoms and laboratory findings improved progressively, and the result was considered excellent in four cases, good in 25 and only fair in one.

Clinical study on bronchodilation induced by a metered aerosol of fenoterol in combination with ipratropium bromide.

The response to an aerosol preparation containing 100 micrograms fenoterol and 40 micrograms ipratropium bromide per puff (Duovent) was compared with a placebo in 18 asthmatic patients in a double-blind cross-over fashion. We measured changes in lung function tests and pulse rate. Duovent induced a significant improvement in lung tests with statistical relevance for VEMS and Raw in comparison with placebo. The combination of fenoterol and ipratropium bromide also provided a long-lasting bronchodilatation without side effects.

Effects of methylprednisolone on sputum biochemical components in asthmatic bronchitis.

Nineteen patients with chronic mucus hypersecretion and reversible airway obstruction were studied during an acute exacerbation. One group of patients was treated with antibiotics and aminophylline, the other, additionally, with gradually decreasing doses of methylprednisolone, starting with 80 mg/day. The sputum specimens were collected on the day of admission and 2 weeks later. In whole sputum, we examined macromolecular components both transudated from serum and locally secreted: albumin, fucose, N-acetylneuraminic acid, total protein, IgA, IgM, IgG. At the end of the second week albumin (marker of serum transudate), and fucose (marker of mucus glycoproteins), were significantly lower in the group treated with corticosteroids. IgG and albumin behaved in the same way suggesting a marked IgG serum exudation. IgM was partially reduced by corticosteroids while IgA remained unchanged.

[Bilateral primary pulmonary amyloidoma. Diagnostic contribution of subcutaneous needle-biopsy and of the digoxinemia test]. / Amilodoma polmonare primario bilaterale. Apporto diagnostico dell'agobiopsia sottocutanea e del test della digoxinemia.

A case of bilateral neoplastic pulmonary amyloidosis is presented and discussed. The diagnosis was based on the results of a lung biopsy; and laboratory methods of great utility in this pathology were used. Of particular importance are the indications which can be obtained through subcutaneous biopsies and the biochemical test for digoxinemia.