Effects of long-acting bronchodilators and prednisolone on inspiratory lung function parameters in stable COPD.

BACKGROUND: In chronic obstructive pulmonary disease (COPD), there is a poor correlation between forced expiratory volume in 1 s (FEV1) and dyspnea following bronchodilator use. Better correlations have been observed between inspiratory lung function parameters (ILPs) and dyspnea, which drives our interest in ILPs. However, the acute and prolonged effects of long-acting bronchodilators and oral corticosteroids on ILPs have not been well investigated. Therefore, the aim of this study was to investigate the effects of these treatments on the ILPs, FEV1, dyspnea (visual analog scale (VAS)) and clinical COPD questionnaire (CCQ). METHODS: Twenty-eight stable COPD patients had their ILPs and FEV1 measured both before and 2 h after the use of a single dose of 18 mcg bronchodilator tiotropium and 50 mcg salmeterol. Thereafter, the patients were randomized to 2 weeks of treatment with 30 mg oral prednisolone once daily or oral placebo in combination with daily treatment with these two bronchodilators. Four weeks after the cessation of the randomized treatment, the ILPs and FEV1 were again measured. After each intervention, any change in the VAS score was assessed. RESULTS: With both bronchodilators, significant improvements in ILPs were demonstrated (p < 0.005), with the exception of changes in ILPs inspiratory capacity (IC) and forced inspiratory flow at 50% of the vital capacity (FIF50) after tiotropium inhalation. After 2 weeks of treatment with prednisolone, significant differences were found for ILP forced inspiratory volume in 1 s (FIV1) and FEV1 compared with placebo. These differences were no longer present 4 weeks after the cessation of prednisolone. Significant relationships between ILPs and VAS scores were only found after 2 weeks of treatment with prednisolone or placebo. CONCLUSIONS: After a single dose of long-acting bronchodilator salmeterol, significant improvements are observed in all ILPs and in FIV1 and PIF after tiotropium. Two weeks of oral corticosteroid treatment improved the FIV1 and FEV1. The dyspnea VAS score was only significantly correlated with the ILPs after 2 weeks of oral corticosteroid treatment.

The effect of bronchodilators administered via aerochamber or a nebulizer on inspiratory lung function parameters.

BACKGROUND: In chronic obstructive pulmonary disease (COPD) the clinical efficacy of bronchodilator therapy delivered via a nebulizer versus an aerochamber on FEV1 is controversial. No studies comparing changes in inspiratory pulmonary function parameters (ILPs) using these inhaler devices are currently available. This information might be of interest because due to dynamic bronchial compression, the relationship between the ILPs and dyspnea is more reliable than that between FEV1 and dyspnea. Therefore, our study aimed to investigate whether changes in ILPs after use of these inhaler devices were similar to the changes in FEV1 and correlate with VAS (Visual Analogue Scale). METHODS: Forty-one stable COPD patients participated in a crossover trial. Spirometry was performed before and after two puffs Combivent (200 mcg salbutamol and 20 mcg ipratropium per puff) using an aerochamber or 2 mL of Combivent (2.5 mg salbutamol and 250 mcg ipratropium per mL) using a nebulizer. Differences in lung function parameters and changes in VAS were measured. RESULTS: ILP values improved significantly from baseline after Combivent administration using both devices (p ≤ 0.004). With both devices, the mean percent changes were significantly greater for FEV(1) than the ILPs (p ≤ 0.003), except for IC (p = 0.19). The mean VAS score did not differ significantly between the devices (p = 0.33), but significant correlations were found between the VAS and forced inspiratory flow at 50% of the vital capacity (FIF(50)) and peak inspiratory flow (PIF) when a nebulizer was used. With an aerochamber, no significant correlations between lung function parameters and VAS were found. CONCLUSIONS: The present study demonstrates that ILPs improved significantly after using either device. Although significant correlations were found between the VAS and FIF(50) and PIF for the nebulizer, in stable COPD patients, the pMDI plus spacer is a better route of administration than a nebulizer.

Reversibility of inspiratory lung function parameters after short-term bronchodilators in COPD.

BACKGROUND: The responsiveness of short-term bronchodilator use on inspiratory lung function parameters (ILPs), including Forced Inspiratory Volume in one second (FIV(1)), Inspiratory Capacity (IC), Forced Inspiratory Flow at 50% of the vital capacity (FIF(50)), Peak Inspiratory Flow (PIF) and on the relationship between these values and dyspnea in COPD subjects has been examined only sparsely in past studies. The aim of this study was to assess the effects of inhaled salbutamol 400 mcg, ipratropium 80 mcg and a placebo on ILP and FEV(1) and their relationship to dyspnea, as measured with a Visual Analogue Scale (VAS). METHODS: A total of 85 subjects with stable COPD participated in a crossover, randomized, double-blind, placebo-controlled study. Spirometry was performed before and after inhalation of salbutamol, ipratropium or a placebo. The primary analysis was performed using 63 participants with absent reversibility. RESULTS: All ILP and FEV(1) values improved significantly after bronchodilator administration except for FIF(50) after ipratropium administration. After administration of both bronchodilators, the mean percent changes from initial values did not significantly differ between the various ILPs and FEV(1). The mean VAS score showed significant improvements after bronchodilator and placebo inhalation but did not significantly correlate with changes in lung function parameters. For each lung function parameter, patients were further classified as responders if the amount of change was greater than the coefficient of repeatability of the test. Response rates did not differ significantly between the various ILPs. Moreover, no significant differences were found between responders and non-responders with respect to dyspnea after bronchodilator inhalation. This finding applied to all ILP and FEV(1) values. CONCLUSIONS: In subjects with COPD, all ILP, FEV(1) values and VAS scores showed significant improvements after bronchodilator use as well as with placebo. However, ILPs were not more sensitive than FEV(1) for detecting responders after bronchodilator use or changes in the VAS score.

Regression of invasive thymoma following corticosteroid therapy.

A case of invasive thymoma is presented showing tumour regression after palliative treatment with prednisone. Moderate doses of prednisone resulted in a longtime palliation via remarkable anti-tumour effect. The literature of corticosteroid responses of thymomas is reviewed.

Video assisted thoracoscopic treatment of pleuropericardial cysts.

Question of the Study In this study, safety and feasibility of thoracoscopic fenestration of pleuropericardial cysts under local and general anaesthesia is evaluated. Besides, a rare case of a pleural cyst, causing a superior vena cava syndrome, is described.Materials, Patients and Methods In a retrospective study, the results of thoracoscopic treatment of pleuropericardial cysts in three patients are presented. We performed videothoracoscopic fenestration of pleuropericardial cysts. One of these was performed under local anaesthesia. The two other cases were performed under general anaesthesia. After fenestration, talc poudrage of the inner lining of the cysts was performed in one case.Results Thoracoscopic fenestration appeared to be safe and effective. No recurrence was observed. One patient was lost to follow-up.Answer to the Question Thoracoscopic fenestration of pleuropericardial cysts is safe and effective. This procedure can be performed under local anaesthesia in selected cases. The role of talc poudrage of the cysts is unclear and needs further investigation.

In-vitro differentiation of cells of patients with acute undifferentiated leukaemia.

The diagnosis of acute undifferentiated leukaemia (AUL) is made when the cells of patients with acute leukaemias cannot be classified as myeloid or lymphoid by means of morphological, cytochemical and immunological criteria. The mononuclear cells of eight different AUL patients were cultured in suspension for 3 d with or without TPA. After culture, especially in the presence of TPA, the cells of all patients expressed at least one myeloid membrane antigen. It was shown that this antigen expression was dependent on de novo protein synthesis and not influenced by inhibition of proliferation.

Specific expression of a myeloid-associated CMP-NeuAc:Gal beta 1----3GalNAc alpha-R alpha 2----3-sialyltransferase and the sialyl-X determinant in myeloid human-mouse cell hybrids containing human chromosome 11.

Human-murine myeloid somatic cell hybrids were assayed for the expression of the myeloid-associated sialyl-X determinant. This determinant is expressed at the surface of hybrid cells containing human chromosome 11, but its expression could not be correlated with the presence of the sialyltransferase which is involved in the sialyl-X synthesis. The sialyl-X determinant, however, is simultaneously expressed with another alpha 2----3-sialyltransferase activity, which is involved in the sialylation of the O-linked Gal beta 1----3GalNAc alpha-R core structure. Chromosomal analyses and enzymatic data suggest that human chromosome 11 is involved in the expression of both the sialyl-X antigen and this alpha 2----3-sialyltransferase.

A GDP-fucose:[Gal beta 1----4]GlcNAc alpha 1----3-fucosyltransferase activity is correlated with the presence of human chromosome 11 and the expression of the Lex, Ley, and sialyl-Lex antigens in human-mouse cell hybrids.

By fusion of human leukocytes and cells of the murine myeloid cell line WEHI-TG, we produced human-mouse myeloid cell hybrids. Hybrids which contain human chromosome 11 have been demonstrated to express the myeloid-associated carbohydrate antigen Lex (Geurts van Kessel, A. H. M., Tetteroo, P. A. T., Von dem Borne, A. E. G. Kr., Hagemeijer, A., and Bootsma, D. (1983) Proc. Natl. Acad. Sci. U. S. A. 80, 3748-3752). In this paper, we report that the hybrids that contain chromosome 11 also expressed the Lex-related antigens Ley and sialyl-Lex. Glycosyltransferase activities were measured in a panel of six such hybrid cell lines, and the correlation to antigen expression and to the presence of human chromosomes was investigated. GDP-fucose:[Gal beta 1----4]GlcNAc alpha 1----3-fucosyltransferase activity in the hybrids tested correlated with the expression of Lex, Ley, and sialyl-Lex and with the occurrence of chromosome 11. No such correlation was found for several other glycosyltransferases involved in the synthesis of these antigens. These findings suggest that the gene for alpha 3-fucosyltransferase is located on chromosome 11 and that it is through the activity of this enzyme that the expression of Lex, Ley, and sialyl-Lex in human myeloid cells is regulated.

Neutrophil activation detected by monoclonal antibodies.

Monoclonal antibodies have been produced against three neutrophil-associated membrane proteins (p 90, p 170, and p 70) expressed at different maturation stages of the cells. The reactivity of the antibodies against p 90 (B13.9) and p 170 (CLB-gran 10), as measured by quantitative flow cytofluorometry, increased after stimulation of the neutrophils by the calcium ionophore A23187, by phorbol myristate acetate, or by the chemoattractant formylmethionyl-leucyl-phenylalanine in combination with cytochalasin B. This increase is regulated independently of the simultaneously increased expression of the C3bi receptor, because neutrophils of a patient deficient for the C3bi receptor showed a normal increase in membrane expression of p 90 and p 170. Neutrophil cytoplasts were not inducible to increased membrane expression, suggesting that the cytoplasts lack the internal pool of these proteins. The reactivity of the antibody against p 70 (CLB-gram 5) was not affected by activation. The antibodies B13.9 and CLB-gran 10 may be useful to detect neutrophil activation.

Myeloid-associated antigen 3-alpha-fucosyl-N-acetyllactosamine (FAL): location on various granulocyte membrane glycoproteins and masking upon monocytic differentiation.

Seven different granulocyte-reactive murine monoclonal antibodies (mAb) were studied. The antigens recognized by these mAb were immunoprecipitated from lysates of 125I-labeled granulocytes of healthy donors. The isolated antigens were analyzed by electrophoresis on sodium dodecyl sulfate-polyacrylamide gel and autoradiography. All 7 antibodies precipitated the same 6 membrane polypeptides from membrane-iodinated granulocyte lysates: 105 and 150-kDa as most pronounced, together with 260-, 230-, 67- and 52-kDa polypeptides. One of the antibodies studied, B4.3, is directed against 3-alpha-fucosyl-N-acetyllactosamine as shown by absorption with the synthesized carbohydrate molecule. Competition experiments with 125I-labeled B4.3 demonstrated complete inhibition of binding by B4.3 and 3 of the other antibodies (VM D5, UJ308, MI/N1) and partial inhibition by the 3 other antibodies (FMC 10, FMC 12, FMC 13), indicating binding to the same antigenic structure. None of the 7 mAb reacted with monocytes in the immunofluorescence technique, but after neuraminidase treatment of these cells, positive reactions were obtained with all mAb. Immunoprecipitation with lysates of both native and neuraminidase-treated monocytes showed no polypeptide bands. Monocytic differentiation of the cell line HL60 by 12-O-tetradecanoylphorbol-13-acetate (TPA) and of cell line U 937 by dimethylsulfoxide and TPA was accompanied by a decrease in reactivity with these antibodies, which could be recovered by neuraminidase treatment. This indicates that 3-alpha-fucosyl-N-acetyllactosamine is masked for the detection of the antibody upon monocytic differentiation by sialylation.