Progressive pneumonia complicating steroid-dependent asthma.

We describe a patient who developed pulmonary nocardiosis whilst taking long term oral steroids for asthma. Nocardiosis is more common than is generally appreciated by clinicians, is notoriously difficult to diagnose, and is associated with significant mortality. This patient developed progressive pneumonia despite antibiotic therapy, which is typical of pulmonary nocardiosis. It is important to consider this treatable condition in the differential diagnosis of pneumonia.

A flexible loading dose schedule for warfarin therapy.

A flexible loading dose schedule for inducing anticoagulation with warfarin was assessed in 31 consecutive patients. 55% reached the therapeutic range (prothrombin ratio between 2 and 4:1) by Day 2 (40 hours after the first dose) and this figure rose to 77% on Day 3 and to 87% on Day 4. All patients had a PTR between 1.7 and 4.2 on Day 5. Patients with evidence of cardiac failure and abnormal liver function, and those taking medications known to interact with warfarin required lower doses and ran a higher PTR when compared with the total group of patients. This schedule offers a useful means of safely and rapidly inducing warfarin therapy in all patients.

Effect of prednisolone on theophylline pharmacokinetics in patients with chronic airflow obstruction.

The effect of prednisolone on the elimination kinetics of theophylline was studied in a group of nine patients with chronic airflow obstruction. Volume of distribution, plasma half life, and clearance after a single intravenous dose of aminophylline (5.6 mg/kg) were unchanged by prednisolone treatment (20 mg daily for three weeks). The metabolism of an intravenous bolus of theophylline is not influenced by oral prednisolone.

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.

Polished off: an inhaled dental brush.

Foreign body inhalation is probably the most frequent presentation requiring urgent bronchoscopy. The objects most commonly aspirated by adults are small bones, pieces of dentures, peanuts and metal tacks. We report an unusual case in which the object inhaled was a dental polishing tip.

Pulmonary hypersensitivity in prawn workers.

In a prawn-processing factory, workers were exposed to an aerosol of prawn. Nearly 40% of those exposed developed wheezing and other respiratory symptoms.

Metabolic effects of salbutamol: comparison of aerosol and intravenous administration.

The effects of intravenous salbutamol (4 mug/kg) were compared with those of aerosol salbutamol (200 mug) in 10 asthmatic patients in a double-blind placebo-controlled study. Both methods of administration produced equal bronchodilatation. Intravenous salbutamol caused significant increases in plasma insulin and glucose levels and a fall in serum potassium concentration in addition to tachycardia and tremor, whereas aerosol salbutamol produced only a small transient increase in the plasma glucose level. The initially raised non-esterified fatty acid levels decreased significantly after aerosol and placebo but not after intravenous salbutamol.

Extrinsic allergic alveolitis and contaminated cooling-water in a factory machine.

Symptoms and signs typical of extrinsic allergic alveolitis occurred in 24 workers in a stationery factory. The illness was caused by inhalation of a water aerosol contaminated by microorganisms, and although no specific organism has been incriminated, affected workers had serum precipitins to the contaminated water, and the illness could be reproduced by inhalation challenge tests.

Hyposensitisation with house dust mite vaccine in bronchial asthma.

In a double-blind placebo-controlled trial of tyrosine-absorbed Dermatophagoides pteronyssinus vaccine no improvement was seen in 45 patients with asthma sensitive to house dust mite. In particular there was no significant improvement in symptom scores, spirometry, and skin and nasal challenge test results. Some patients in other studies have benefited from doses of vaccine much stronger than those now commercially available, but the incidence of side effects has also been high.

The effect of intramuscular salbutamol in asthmatics.

1 In a double-blind placebo controlled dose-response experiment in six asthmatic patients with reversible airways obstruction the effect of i.m. salbutamol (4 mug/kg, 8 mug/kg or 12 mug/kg) was assessed by improvement in spirometry and change in pulse rate. 2 Salbutamol (8 mug/kg) resulted in a mean increase in FEV1 of 1 litre and a mean increase in pulse rate of 7 beats/minute. 3 It was concluded that salbutamol (8 mug/kg) was the optimal dose.

Comparison of intravenous AH 5158 (ibidomide) and propranolol in asthma.

The cardiac and bronchial effects of AH 5158 and propranolol were compared in a double-blind, placebocontrolled intravenous study on 10 asthmatics. AH 5158, like propranolol, is a non-cardioselective beta-adrenoceptor-blocking drug, but unlike propranolol it also has an alpha-adrenoceptor-blocking action. Both drugs produced equivalent cardiac(beta1) blockade, but propranolol produced bronchoconstriction, whereas AH 5158 did not. Hence the alpha-blocking action of AH 5158 seems to prevent the bronchoconstrictor effects of propranolol in these patients.