[Correct inhalation technique--an integral part of rational treatment of bronchial asthma]. / Správná inhalacní technika--nedílná soucást racionální lécby astmatu bronchiálního.

In the rational treatment of asthma bronchiale in recent years a marked increase can be observed as regards prescription of beta-2-agonists and glucocorticoids. They are administered almost exclusively from metered dose inhalers (MDI) with an adjustable valve. Almost half the users do not know the correct inhalation technique. Unless that is used, the effect of drugs is markedly reduced. The author deals therefore in his review in detail with all aspects of a correct inhalation technique; above all he emphasizes slow inhalation with subsequent breath retention which is the only way how to achieve maximum penetration of particles to the final branches of the bronchial tree. The author mentions also spacers which improve in some patients the effectiveness of aerosol treatment.

[Experience with the dipyridamole test in the diagnosis of coronary insufficiency]. / Zkusenosti s dipyridamolovým testem v diagnostice koronární nedostatecnosti.

In 1980-86 263 dipyridamole tests were made before or after ergometry on account of the diagnosis of coronary insufficiency and possible indication for coronarography. The sensitivity and specificity was evaluated in a group of 101 subjects where both examinations had been made. As a reference method the authors used ergometry with more strict criteria of positivity of the two tests (deviations of segment ST 0.2 mV, incl. stenocardia) which are in good agreement with coronarography. The sensitivity was 58.2 and the specificity 96% (in men 61.4 and 100%). On combination of 98 dipyridamole tests with immediately following ergometry of 39 negative ergometries 23 (58.6%) changed to positive. Of 38 coronarographies the dipyridamole test was positive in 73% and in some patients with affections of the three main branches it was negative. There was also one serious complication: a new myocardial infarction. Because of lower sensitivity the dipyridamole test does not replace ergometry, except when the latter cannot be performed. The combination of the two tests sensitizes ergometry. On account of the high specificity ergometry can be omitted when the test is positive, in particular in men. For diagnostic purposes the stricter variant of criteria for evaluation of the test is more reliable and almost specific.

[Maximal dilatation of the coronary bed using dipyridamole in the diagnosis of coronary insufficiency]. / Maximální dilatace koronárního reciste dipyridamolem v diagnostice koronární nedostatecnosti.

The authors give an account of the mechanism of action of dipyridamole. Via adenosine it produces selective and maximal vasodilatation of resisting coronary vessels in the non-ischaemic area. Thus redistribution of the blood flow from the ischaemic to the non-ischaemic portion of the heart muscle occurs along with clinical and electrocardiographic manifestations of cardiac angina which can be used for its diagnosis. The pharmacological dipyridamole test makes detection of myocardial ischaemia possible in a fundamentally different way as compared with other loading tests. The authors mention pharmacodynamic, metabolic, haemodynamic and associated phenomena of the action of dipyridamole and the mechanism of the opposite effect of aminophylline and nitroglycerin.

Treatment of bronchial obstruction in asthma.

The bronchodilator effects of various sympathomimetics given as aerosols have been compared. Hexoprenaline, fenoterol and terbutaline were all effective bronchodilators and their effects lasted far longer than that of isoprenaline. Clenbuterol inhaled at night did not prevent 'morning dip' but the addition of slow-release theophylline was an effective combination. The mechanisms of action of these agents, and also of atropinic drugs such as ipratropium bromide and oxytropium bromide are discussed, and also the benefits of using mixtures of drugs.