Sarcoidosis: a disorder commoner in non-smokers?

The smoking habits of 202 patients presenting with sarcoidosis, as recorded in the clinical case records, were compared with figures from the General Household Surveys (GHS) to determine whether there was any association between smoking habit and sarcoidosis. In 19 there was no record of smoking habit. Of the remaining 183 patients, 40 (21.9%) were smokers, which was significantly less than expected from the GHS figures (p less than 0.001). This association between non-smoking and sarcoidosis persisted despite further analysis by sex and age distribution and socioeconomic grouping. Statistical likelihood models showed that ex-smokers were similar to current smokers with respect to the association between smoking and sarcoidosis. This association was greatest in those patients with stage I sarcoidosis and less for those with other stages of the disease.

Mycobacterium gordonae: a new pathogen?

Mycobacterium gordonae is a slow growing scotochromogenic acid fast bacillus (Runyon group II) with specific cultural and biochemical characteristics. It is a contaminant of water, soil, and raw milk and is usually considered to be saprophytic and non-pathogenic in man. We have recently seen two cases of pulmonary disease that may have been due to M gordonae, and we now report these and review our recent experience of this organism.

Betamethasone valerate in corticosteroid-dependent asthmatics. The integrity of the hypothalamic pituitary adrenal axis.

In a single-blind trial 29 patients with corticosteroid-dependent asthma reduced their daily dose of oral prednisolone by 1 mg/week while using a placebo inhaler until an unacceptable degree of asthma occurred. Betamethasone-17-vlaerate in a dose of 800 mug/day and if necessary 1600 mug/day was then substituted for the placebo inhaler and the reduction of oral prednisolone continued until the prednisolone was withdrawn completely or an unacceptable degree of asthma recurred. In 22 patients (76%) prednisolone was withdrawn completely, 11 on 800 mug and 11 on 1600 mug betamethasone-17-valerate. The mean reduction of prednisolone was 3-8 mg on placebo, 5-4 mg on 800 mug and a further 1-8 mg in patients requiring 1600 mug of betamethasone-17-valerate. The hypothalamic pituitary adrenal (HPA) axis was assessed by tetracosactrin and insulin stress tests at the start of the study and after withdrawal of oral prednisolone. The results indicate that an HPA axis which is completely suppressed by systemic corticosteroids can regain normal integrity when the systemic steroid is replaced by betamethasone-17-valerate in a dose of either 800 mug/day or 1600 mug/day. Candidiasis was observed, but will be reported later.

Comparison of two methods of administering bronchodilator aerosol to asthmatic patients.

In 78 patients with chronic asthma the increase in forced expiratory volume in one second (FEV-1) after the administration by intermittent positive-pressure ventilation (I.P.P.V.) of 10 mg of salbutamol was compared with that recorded after the inhalation of a conventional dose (200 mug) from a pressurized canister. The mean increase was significantly greater after I.P.P.V. administration, and the superiority of this method was greatest in patients with the lowest pretreatment FEV-1.

Bronchodilator effect of oral salbutamol in asthmatics treated with corticosteroids.

In a double-blind trial the effect on ventilatory function of oral salbutamol (in two different doses) and a placebo were studied in 12 patients with chronic asthma receiving regular maintenance treatment with prednisolone. Salbutamol in a dose of 4 mg four times daily, given for a period of four weeks, produced a sustained and statistically significant increase in peak expiratory flow rate over the pretreatment recordings. This effect was not observed with a lower dose of salbutamol (2 mg four times daily) or with a placebo. Salbutamol in the higher dose would seem to be an effective and safe oral bronchodilator that can be recommended for the treatment of mild or moderate asthma. The duration of treatment in this study was, however, limited to four weeks, and it is not known whether effective bronchodilatation would be maintained if the drug were given for longer periods.

Response of asthmatics to isoprenaline and salbutamol aerosols administered by intermittent positive-pressure ventilation.

The bronchodilator and cardiac effects produced by aerosols of 0.5% isoprenaline and of 0.25, 0.5, and 1% salbutamol administered in 40% oxygen by intermittent positive-pressure ventilation were compared in 24 asthmatic patients. Isoprenaline and salbutamol in concentrations of 0.5% were equipotent in peak bronchodilator effect; salbutamol was superior in total bronchodilator effect and duration of average effect, but the peak bronchodilator effect occurred earlier after isoprenaline. Significantly greater tachycardia was produced by 0.5% isoprenaline than by the same concentration of salbutamol. The 0.25, 0.5, and 1% concentrations of salbutamol had about the same peak bronchodilator effect, but there was a stepwise increase in total effect and duration of average effect in relation to the concentration used. A similar stepwise increase in heart rate was also noted, but with all concentrations this was significantly less than with 0.5% isoprenaline. It was concluded that a 0.5% solution of salbutamol, which provided maximal bronchodilatation without important tachycardia, was therapeutically superior to the other three treatments.

Controlled comparison of the bronchodilator effects of three beta-adrenergic stimulant drugs administered by inhalation to patients with asthma.

In a double-blind trial of the effect of inhaling three different beta-adrenergic stimulants (isoprenaline sulphate 1,000 mug., orciprenaline sulphate 1,500 mug., and salbutamol 200 mug.) and a placebo on ventilatory function in 24 patients with chronic asthma salbutamol was found to have a much longer action than isoprenaline, and it produced a slightly more intense and prolonged effect than orciprenaline. In a double-blind subjective assessment 13 of the 24 patients selected salbutamol as the most effective preparation, while only five preferred isoprenaline and three orciprenaline. Hence salbutamol, given by inhalation, may prove to be the most effective drug at present available for the short-term relief of asthmatic symptoms.