Effects of non-bronchoconstrictive doses of inhaled propranolol on airway responsiveness to methacholine.

OBJECTIVES: The aim of this study was to evaluate the effects of non-bronchoconstrictive doses of propranolol on airway hyperresponsiveness to methacholine. METHODS: Double increasing concentrations (from 0.03 to 64 micrograms/ml) of inhaled propranolol were administered to a study population which included ten patients with mild asthma, ten rhinitics, and ten healthy control subjects. After the baseline bronchial responses to propranolol and methacholine, expressed as the cumulative provocative dose producing a 20% fall in forced expiratory volume in 1 s (PD20FEV1), were assessed, methacholine challenge was repeated after pretreatment with non-bronchoconstrictive doses of propranolol. RESULTS: The pharmacologically induced beta-blockade did not cause any effect in normal individuals, but it worsened airway responsiveness to methacholine in all asthmatics (geometric mean PD20 FEV1: 257 and 87 micrograms, respectively) and some rhinitics (geometric mean PD20 FEV1: 724 and 446 micrograms, respectively). CONCLUSION: Asthmatic patients were extremely sensitive to beta-blockers, whereas we observed a variable response to propranolol within the group of rhinitic subjects. This variability in the latter group is possibly because these individuals had different degrees of airway inflammation, increased parasympathetic activity, and beta-adrenoceptor dysfunction.

Bronchial asthma induced by an antithyroid drug.

We report the case of a 67-year-old woman who suffered from a severe asthma exacerbation as a consequence of an antithyroid drug treatment prescribed for her multinodular, hyperfunctioning goiter. Asthma symptoms were associated with a very significant increase in the number of eosinophils, detected in both blood and induced sputum.

Effect of inhaled heparin on water-induced bronchoconstriction in allergic asthmatics.

OBJECTIVE: The aim of this study was to investigate the effect of inhaled heparin on bronchoconstriction induced by ultrasonically nebulised distilled water (UNDW) in allergic asthmatics. METHODS: Eight atopic asthmatics, hyperresponsive to UNDW, were selected for this randomised, placebo-controlled, crossover double-blind study. On two consecutive days, these subjects underwent a UNDW challenge 45 min after inhaling aerosolised heparin (1000 U/kg) or placebo. RESULTS: Neither heparin nor placebo had a significant effect on base-line forced expiratory volume in 1 s (FEV1), but heparin significantly attenuated UNDW-induced bronchoconstriction, as shown by its efficacy in preventing the decreases in FEV1 produced by all doses of water (in comparison with placebo: P < 0.05 after 2 ml water; P < 0.01 after 4, 8 and 16 ml water). CONCLUSION: Inhaled heparin is able to exert a protective effect against the bronchoconstrictive response to UNDW in allergic asthmatics, and this action is likely due to inhibition of mast cell degranulation.

Effects of specific immunotherapy in allergic rhinitic individuals with bronchial hyperresponsiveness.

Allergic rhinitis can be associated with bronchial hyperresponsiveness (BHR), and carries an increased risk for the development of asthma. The aim of this study was to evaluate the ability of specific immunotherapy (SIT) to reduce the progression of allergic rhinitis to asthma and prevent the associated increase in BHR. Forty-four subjects monosensitized to Dermatophagoides pteronyssinus, with perennial rhinitis and BHR to methacholine, were randomly assigned to receive SIT or placebo in a double-blind study conducted over a period of 2 yr. After 1 yr of treatment, a 2.88-fold increase in the provocative dose of methacholine producing a 20% decrease in FEV(1) (PD(20)FEV(1)) was recorded in the SIT-treated group (95% confidence interval [CI]: 3.98- to 2.09-fold; p < 0.001), with a further increase to fourfold at the end of Year 2 (95% CI: 2.9- to 5.7-fold; p < 0.001). At the end of the study, the methacholine PD(20)FEV(1) was within the normal range in 50% of treated subjects (p < 0.0001), and was significantly higher in this group than in the group receiving placebo (p < 0.0001). In contrast, no changes in methacholine PD(20)FEV(1) were found in the placebo group throughout the study. Although 9% of subjects given placebo developed asthma, none of those treated with SIT did. This study suggests that SIT, when administered to carefully selected, monosensitized patients with perennial allergic rhinitis, reduces airway responsiveness in subjects with rhinitis, and may be an appropriate prophylactic treatment for rhinitic patients with hyperreactive airways.

Transudative right pleural effusion due to compression of the brachiocephalic vein caused by an intrathoracic goitre.

The case presented in this report is of a female patient who suffered recurrent transudative right pleural effusions, due to a giant benign intrathoracic goitre. The latter caused compression of the brachiocephalic vein, which is a very rare cause of pleural fluid accumulation. Magnetic resonance imaging played a crucial diagnostic role.

Short-term cardiovascular effects of salmeterol.

The occurrence of cardiovascular side effects is sometimes associated with the utilization of beta-adrenoceptor agonists. The most important causes of these undesirable pharmacologic actions are as follows: (1) direct stimulation of cardiac beta-adrenoceptors; (2) reflex activation of adrenergic mechanisms due to peripheral vasodilation; (3) hypokalemia; and (4) hypoxemia. The aim of this study was to evaluate the potential short-term, cardiovascular side effects of salmeterol, a long-acting and highly selective beta2-adrenoceptor agonist. Eight volunteer healthy subjects and eight patients with reversible airway obstruction and without cardiovascular alterations were treated with 50 microg of salmeterol twice a day for 3 days and then with 100 microg of salmeterol twice a day for a further 3-day period. The 24-h ECG (Holter) monitoring and measurement of arterial BP, performed on the admission day and on the third and the sixth day of pharmacologic treatment, showed that salmeterol did not produce any significant change in mean heart rate, number of supraventricular and ventricular premature complexes, and BP. Furthermore, no ECG abnormality related to myocardial ischemia was recorded during 24-h Holter monitoring. These data suggest that salmeterol, administered in regular and high doses for a short period, does not cause significant cardiovascular effects in both normal subjects and patients with reversible airway obstruction.

Inflammatory pseudotumour of the lung presenting as an airway obstructive syndrome.

The inflammatory pseudotumour of the lung is a rare and non-malignant neoplasm, which can be asymptomatic or characterized by variable clinical expressions. This report refers to a case occurring in a young woman and presenting as a persistent airway obstructive syndrome. With regard to histopathologic characterization, the present case can be classified as a fibrous histiocytic subtype.

Tracheal rupture secondary to orotracheal intubation.

A case of tracheal rupture due to orotracheal intubation performed for anaesthesiological procedures is described. It is very likely that this rare complication was favoured by some anatomical factors, which were responsible for a difficult intubation. Tracheal rupture was diagnosed by endoscopy and treated by a decompressive tracheostomy.

Effect of ipratropium bromide and/or sodium cromoglycate pretreatment on water-induced bronchoconstriction in asthma.

The mechanisms underlying water-induced bronchoconstriction are still not fully understood. Cholinergic reflexes and mast cell mediator release are currently believed to play an important pathogenetic role. In order to evaluate the relative contribution of each of these mechanisms, we studied the effect of ipratropium bromide (80 micrograms), a muscarinic antagonist, and sodium cromoglycate (20 mg), an inhibitor of mast cell mediator release, administered alone and in combination, in the prevention of bronchospasm induced by ultrasonic mist of distilled water (UMDW). Fifteen patients with documented atopic asthma and hyperresponsiveness to distilled water were selected for this randomized, placebo-controlled, double-blind study. Airway responses to pharmachological agents and bronchial challenge were measured by change in specific airways conductance (sGaw). Sodium cromoglycate had no effect on bronchial calibre, whilst ipratropium bromide and the combination of the two drugs produced a significant bronchodilation 30, 60 and 90 min after treatments. The maximal increase in sGaw (mean % +/- SD) was observed at 90 min: 63 +/- 28% and 58 +/- 22% after ipratropium bromide and the combined drugs respectively. UMDW (2, 4, 8, 16 ml water) caused a -36 +/- 19%, -42 +/- 19%, -49 +/- 18%, -56 +/- 15% mean % +/- SD fall in sGaw after placebo. Pretreatment with sodium cromoglycate abolished the bronchoconstriction to 2 ml (fall sGaw -5 +/- 23% NS) and significantly reduced the effect of 4 (-15 +/- 22%), 8 (-21 +/- 20%) and 16 ml (-24 +/- 18%) water.(ABSTRACT TRUNCATED AT 250 WORDS)