Respiratory-induced hemodynamic changes measured by whole-body multichannel impedance plethysmography.

The cardiovascular system is described by parameters including blood flow, blood distribution, blood pressure, heart rate and pulse wave velocity. Dynamic changes and mutual interactions of these parameters are important for understanding the physiological mechanisms in the cardiovascular system. The main objective of this study is to introduce a new technique based on parallel continuous bioimpedance measurements on different parts of the body along with continuous blood pressure, ECG and heart sound measurement during deep and spontaneous breathing to describe interactions of cardiovascular parameters. Our analysis of 30 healthy young adults shows surprisingly strong deep-breathing linkage of blood distribution in the legs, arms, neck and thorax. We also show that pulse wave velocity is affected by deep breathing differently in the abdominal aorta and extremities. Spontaneous breathing does not induce significant changes in cardiovascular parameters.

Can we hear ventricle dyssynchrony? Yes, we can.

This study introduces a method for detection of ventricular depolarization activity and the transfer of this activity into an audible stereo audio signal. Heart potentials are measured by an ultra-high-frequency high-dynamic-range electrocardiograph (UHF-ECG) with a 25-kHz sampling rate. Averaged and prolonged UHF amplitude envelopes of V1-3 and V4-6 leads at a frequency range of 500-1000 Hz are used as a modulating function for two carrier audio frequencies. The right speaker makes it possible to listen to the depolarization of the septum and right ventricle (V1-3) and the left speaker the left ventricle lateral wall (V4-6). In the healthy heart, both speakers can be heard simultaneously. A delayed L or R speaker represents the dyssynchronous electrical activation of the ventricles. Examples of the normal heart, right bundle branch block and left bundle branch block can be heard at www.medisig.com/uhfecg.

Respiratory induced heart rate and blood pressure variability during mechanical ventilation in critically ill and brain death patients.

UNLABELLED: We analysed respiratory induced heart rate and blood pressure variability in mechanically ventilated patients with different levels of sedation and central nervous system activity. Our aim was to determine whether it is possible to distinguish different levels of sedation or human brain activity from heart rate and blood pressure. We measured 19 critically ill and 15 brain death patients ventilated at various respiratory frequencies - 15, 12, 8 and 6 breaths per minute. Basal and deeper sedation was performed in the critically ill patients. We detected and analysed heart rate and blood pressure parameters induced by ventilation. RESULTS: Respiratory induced heart rate variability is the unique parameter that can differentiate between brain death patients and sedated critically ill patients. Significant differences exist, especially during slow deep breathing with a mean period of 10 seconds. The limit values reflecting brain death are: baroreflex lower than 0.5 ms/mmHg and tidal volume normalised heart rate variability lower than 0.5 ms/ml. Reduced heart rate variability parameters of brain death patients remain unchanged even after normalisation to respiration volume. However, differences between basal and deep sedation do not appear significant on any parameter.

Excitation specificity of repolarization parameters.

UNLABELLED: The excitation specificity of QT dynamic parameters was tested on three groups of subjects: healthy subjects; non-medicated hypertensive subjects with metabolic syndrome; and subjects with essential hypertension. Four different excitations of RR were used: bicycling exercise; tilt with breathing 0.1 and 0.33 Hz; and deep breathing. Linear dynamic feedback model of QT/RR coupling was supposed at the analysis and next repolarization parameters were tested: QTc; gain of QT/RR coupling for slow and fast RR variability; time constant of QT adaptation; and random QT variability. RESULTS: Dynamic repolarization parameters statistically significantly depend on the type of RR excitation. The gain of QT/RR coupling for slow RR variability, the time constant of QT adaptation and QTc are maximal at RR excitation given by the bicycling exercise. The frequency of breathing, i.e. corresponding vagal modulation has no effect on repolarization parameters. The measurements with deep breathing, without any other slow excitation of heart rate, has low signal-to-noise ratio of analyzed data and resulting QT parameters are inaccurate. CONCLUSION: The use of heart rate excitation and all measurements conditions should be defined for the exact analysis of the repolarization dynamic parameters.

Dynamic QT/RR coupling in patients with pacemakers.

The dynamic coupling between heart rate intervals (RR) and ventricular repolarization (QT) is analyzed. The analysis is based on measurements of 11 patients with pacemaker. In each measurement, there are at least 4 abrupt changes of RR preset by the pacemaker. With such a protocol, RR changes are important and well defined while disturbing factors and noise sources (such as those related with motion of patient) are minimized. The QT/RR coupling was described by 3 parameters (a1, b2, b3) transfer function (TRF) selected on the basis of a statistical analysis of performances of different TRF models. We found that our model is by far the best in its class: with more parameters (higher order models) the residuals remain almost the same while the extra parameters display variability much larger than that of our parameters. For all measurements, our TRF model describes more than 70% of QT variability. Within the patient set, we found interesting differences concerning dynamic non-linearity (response times longer with decreasing RR intervals than with increasing RR).

Once-daily dosing with budesonide/formoterol compared with twice-daily budesonide/formoterol and once-daily budesonide in adults with mild to moderate asthma.

Adherence to maintenance therapy is often poor in patients with asthma. Simplifying dosing regimens has the potential to improve both adherence and asthma-related morbidity. In this 12-week, randomized, double-blind, double-dummy, parallel-group study, 617 patients with mild to moderate persistent asthma (mean forced expiratory volume in 1s [FEV1] 78.5% predicted) who were not optimally controlled on inhaled corticosteroids (200-500 microg/day) were randomized to once-daily budesonide/formoterol (80/4.5 microg, 2 inhalations in the evening), twice-daily budesonide/formoterol (80/4.5 microg, 1 inhalation), or a corresponding dose of budesonide once-daily (200 microg, 1 inhalation in the evening). All patients received budesonide (100 microg twice daily) during a 2-week run-in. Changes in mean morning peak expiratory flow (PEF) were similar for od budesonide/formoterol (23.4 l/min) and twice-daily budesonide/formoterol (24.1 l/min), and both were greater than with budesonide (5.5 l/min; both P<0.001). Evening PEF, symptom-free days, reliever-free days, and asthma control days were improved with budesonide/formoterol therapy vs. budesonide (P<0.05 vs. budesonide for all variables). All treatments were well tolerated. Budesonide/formoterol administered once daily in the evening is a convenient treatment regimen that is as effective in improving asthma control as twice-daily dosing in patients with mild to moderate persistent asthma.

Generic versus disease-specific instruments in quality-of-life assessment of chronic obstructive pulmonary disease.

OBJECTIVES: Chronic respiratory diseases may alter a patient's social life and well-being. Measures of health-related quality of life have been proven to bring complementary information to functional assessments. The aim of the study was to describe the questionnaires that are most frequently used to measure this subjective construct in patients with chronic obstructive pulmonary disease (COPD) and to compare the responses obtained via administering one generic (SF-36) and one disease-specific questionnaire (St. George's Respiratory Questionnaire; SGRQ) to patients with COPD. METHODS: One group of patients (46 individuals) was used to evaluate the questionnaire's performance in repeated administrations under unchanged conditions (reproducibility) and to study the correlations of corresponding domains of respective questionnaires. Responsiveness of both questionnaires was tested on another group of 129 patients measured before and after the therapeutic stay at the spa. Methods of correlational analysis (Spearman, intraclass, and canonical correlation coefficients) as well as the Wilcoxon rank test were used for statistical analysis. RESULTS: Both questionnaires seem to be comprehensive outcome measures for patients with COPD, but some particular areas may not be covered with the same intensity (e.g. emotional problems). Reproducibility of both questionnaires was good and only small non-significant shifts were seen, particularly in physical and social functioning domains. In repeated measurement, the SGRQ seemed to be slightly more responsive to change than the SF-36. CONCLUSIONS: The idea of using generic and disease-specific questionnaires together probably represents the best approach to this topic. It may improve our knowledge and explain better the relationship between disease-specific changes in patient status and both disease-specific treatment and general functional status.

[The importance of chronic obstructive pulmonary disease]. / Proc je chronická obstrukcní plicní nemoc (CHOPN) závazná?

COPD mortality is a world-wide growing problem. COPD is the fifth leading cause of mortality among all diseases now and is projected to be the third one in 2020. In the USA died 119,000 inhabitants in 2001. The Czech republic mortality for COPD in the same year was: men 21.3/100,000 inhabitants, women 11.6/100,000; this represents total number of 1666 deaths for COPD. Prevalence of COPD is from 4.5% to 11% in developed countries of Europe and in the USA; prevalence in the Czech republic is 7.7%. Total economic cost of COPD reaches in the USA nearly the same value as cost of lung cancer. The cost is increasing with severity of the disease and with hospitalization, intensive care unit treatment especially. The average length of hospitalization for COPD is in the USA 6.9 days, in Italy 10.6 days, in the Czech republic 15.8 days. Increasing lost of life years by premature death and inability to work (Disability-Adjusted Life Year--DALY system) in developed countries moves COPD from current 12th positron to the 5th one. Quality of life of COPD patients is decreased mainly in domain of physical activity in subjects with respiratory insufficiency on home long term oxygen therapy.

Once-daily budesonide/formoterol in a single inhaler in adults with moderate persistent asthma.

Patients with moderate persistent asthma (n = 523; mean FEV1 77.4%) not fully controlled with inhaled corticosteroids (ICS; 400-1000 microg/day) were randomized to receive either once-daily budesonide/formoterol (160/4.5 microg, two inhalations); or twice-daily budesonide/formoterol (160/4.5 microg, one inhalation); or budesonide (400 microg) once-daily for 12 weeks. Once-daily dosing was administered in the evening and twice-daily dosing was administered in the morning and evening. All patients received twice-daily budesonide (200 microg) during a 2-week run-in. Compared with budesonide alone, change in mean morning and evening peak expiratory flow was greater in the once-daily budesonide/formoterol group (27 and 171 min(-1), respectively; P < 0.001) and twice-daily budesonide/formoterol group (23 and 24 l min(-1), respectively; P < 0.001). Night awakenings, symptom-free days, reliever-use-free days and asthma-control days were all improved during once-daily budesonide/formoterol therapy vs. budesonide (P < or = 0.05). Similar improvements were also seen with twice-daily budesonide/formoterol (P < or = 0.05). The risk of a mild exacerbation was reduced after once- and twice-daily budesonide/formoterol vs. budesonide (38% and 35%, respectively; P < 0.002). All treatments were well tolerated. Budesonide/formoterol, once- or twice-daily, in a single inhaler improved asthma symptoms and exacerbations compared with budesonide. In the majority of patients with moderate persistent asthma requiring ICS and long-acting beta-agonists, once-daily formoterol/budesonide provided sustained efficacy over 24 h, similar to twice-daily dosing.

A new HFA-134a propellant in the administration of inhaled BDP via the Jet spacer: controlled clinical trial vs the conventional CFC.

This study was carried out with the aim of demonstrating the efficacy and tolerability of beclomethasone dipropionate (BDP) aerosol spray 500 microg b.i.d. via a spacer device (Jet, Chiesi Farmaceutici S.p.A.) using a new HFA-134a formulation or chlorofluorocarbon (CFC) propellant. After having completed a 2-week run-in period, 154 adult patients (77 in each group) with mild-to-moderate persistent asthma were randomised into two groups to receive the study treatment for a duration of 12 weeks in a double-blind, multinational, multicentre, parallel-group design. Morning and evening peak expiratory flow rate (PEFR), use of rescue salbutamol, number of day- and night-time asthma attacks, number of night-time awakenings due to asthma and clinical symptoms were recorded daily by patients on diary cards. Pulmonary function tests (FEV1, FVC, PEFR, FEF25-75%, MEF50 and FEF25) and vital signs were measured at the clinic at study entry, at the start of treatment and every 2 weeks thereafter. Morning serum cortisol (8.00-10.00 a.m.) was measured at the start and at the end of the treatment period. Adverse events were recorded throughout the total study period. Significant improvements over baseline were reported in both groups in terms of lung function, symptoms and use of rescue inhaled salbutamol. Equivalence between groups was demonstrated for the primary end-point morning PEFR, as well as for evening PEFR and FEV1. No statistically significant differences in the comparisons between groups, except for FEF25 (P=0.044), were observed in any of the other efficacy variables. Adverse events were reported in 31% of patients in the BDP-HFA group and in 32% in the CFC group. Adverse drug reactions were 4 and 2 in the two groups, respectively. No drug-related serious adverse events were reported in either of the groups. No signs of relevant adrenal suppression were observed in both groups: 2 patients in each group had final values below the normal range. In conclusion, the BDP-HFA-134a formulation proved to be equivalent in efficacy and comparable in safety to the standard BDP-CFC product over 12 weeks in adult patients with mild-to-moderate persistent asthma.

[A statistical method for long-term monitoring of selected causes of death]. / Statistická metodika dlouhodobého sledování úmrtí na vybrané príciny smrti.

The death rate statistics belongs to the essential health parameters and it is therefore frequently analysed. Authors suggest reviewing problems, which could be met, and discussing statistical methods in order to make the comparison and analysis of the development as much corresponding to the actual health state of the population as possible. Authors also discuss methods of the "International classification of diseases" and describe methods of direct data standardisation, including estimation of the variability. Using respiratory diseases as an example, authors illustrate the problems of revision of the code system in the "International classification of diseases" and the give examples of numerical evaluation.

[Budesonide (Turbuhaler) at a dosage of 400 micrograms per day is at least as effective as a double dose of beclomethasone (MDI) in patients with mild to moderately severe bronchial asthma]. / Budesonid (Turbuhaler) v dávce 400 micrograms denne je alespon tak úcinný jako dvojnásobná dávka beclometasonu (MDI) u nemocných s lehkým az stredne tezkým bronchiálním astmatem.

BACKGROUND: Recent investigations revealed that in patients with bronchial asthma the same anti-inflammatory effect is achieved by inhalation of half the dose of budesonide by a Turbuhaler (i.e. by using corticosteroid in powder form) as by a full dose of beclomethasone driven into the lungs by compressed chlorofluorocarbons (i.e. MDI = pressure dosage inhalator). The objective was to assess whether there is a difference between 12-week treatment with budesonide Turbuhaler in a smaller dose of 400 micrograms/day and treatment with beclomethasone dipropionate MDI 800 micrograms/day. METHODS AND RESULTS: After an initial two-week period of the 227 patients with mild or medium severe asthma who had not taken corticosteroids for three months, into the budesonide Turbuhaler group 94 patients were included and into the beclomethasone MDI group 99 patients. Characteristics: group treated with budesonide (46 men, 48 women, mean age 38 years, FEV1 78% of appropriate values). Group treated with beclomethasone (51 men, 48 women, mean age 39 years, FEV1 81.5% of appropriate values). Morning and evening values of the peak expiration rate (PEF) increased significantly after budesonide treatment 2 x 200 micrograms/day) as compared with beclomethasone treatment (2 x 400 micrograms/day). Differences of morning PEF between budesonide and beclomethasone: 47:28 l/min, p < 0.05, differences of evening PEF: 32:10 l/min., p < 0.027. The number of dyspnoic attacks declined after both types of treatment, as well as the amount of inhaled bronchodilatating substances (terbutalin Turbuhaler). The differences between drugs were however not statistically significant. CONCLUSIONS: Budesonide Turbuhaler, 400 micrograms/day when administered to patients with bronchial asthma was at least as effective as beclomethasone MDI, 800 micrograms/day. The increase of morning and evening PEF values was after budesonide significantly higher than after beclomethasone.

[In towns there is a higher prevalence of asthmatic symptoms in children than in rural areas]. / Ve mestech je vetsí prevalence príznaku astmatu detí nez ve venkovských oblastech.

The authors assessed the prevalence of symptoms of bronchial asthma by means of a standardized questionnaire used in the international survey PEACE (Pollution Effect on Asthmatic Children in Europe). The questions about complaints were addressed to children aged 6-13 years (the questionnaires were completed with the parents assistance). In urban areas 5669 children participated from Prague 5, i.e. 35% of all elementary school children, in Teplice 2489 (21% children), in rural areas: in the Benesov district 5619, i.e. 61% children, in the Prachatice district 1983, i.e. 37% children. The response rate of questionnaires in the urban areas was 86-88%, in rural areas 93%. In urban areas the annual prevalence of wheezing in the chest or dyspnoea or possibly both symptoms was within the range of 3.8-13.8% and differed significantly from the prevalence in rural areas where it was 2.4-3.6%. The most frequent symptom was nocturnal dry cough without a cold (in urban areas 14.1-36.7%, in rural areas 6.0-10.6%). Rural areas differed from urban ones by a lower contamination of the atmosphere, a lower density of the population as well as some parameters caused by a different lifestyle.

Influence of digital audio filters on image reconstruction in MRI.

This paper deals with the influence of the transient response and group delay of digital filters on the MRI signal and its aspects in image reconstruction. The consequence of digital filtration on the acquired signal will be shown in the time domain (k-space) for three basic imaging methods-echo scan, radial scan and spiral scan. The influence of the group delay and transient response of filters will be explained and a method will be proposed which compensates both these phenomena while retaining all the advantages of digital filtration. The proposed method is based on applying the principle of signal superposition and on using the consequences of the sampling principle. The method works in the time domain. It is very simple and rapid and does not depend on the properties of the acquired signal or reconstruction algorithm. It will be shown and explained in which cases the transient response can be neglected and in which it has to be compensated. In the end, the results of the proposed methods will be shown for mentioned cases on a simulated signal in the image domain.

[Quality of life in patients with chronic obstructive pulmonary disease and bronchial asthma]. / Kvalita zivota nemocných s chronickou obstrukcní plicní nemocí a s bronchiálním astmatem.

Review of data in the literature on the quality of life and its assessment in chronic obstructive lung disease and in bronchial asthma. The authors mention the most frequently used types of questionnaires and results achieved when using them. General questionnaires include the Sickness Impact Profile or the short version of a very detailed questionnaire which has 36 questions with sub-questions (SF-36 = Short Form-36). Specific questionnaires are focused on certain questions concerning different diseases. These questionnaires include SGRQ (St. George's Respiratory Questionnaire) which is used mainly in chronic obstructive lung disease. For this disease also the CRQ was developed (Chronic Respiratory Questionnaire) but its section on dyspnoea is not standardized. For evaluation of the quality of life of asthmatic patients several questionnaires exist, in particular for children. Several questions call for further standardization. The value of questionnaires is, however, beyond dount. They elucidate the situation which does not ensue even from detailed functional examination of the lungs or immunological examination. It appraises bodily and mental functions of man, restriction of his activity, the sensation of comfort and general evaluation of his health. Thus "classical" evaluation methods are extended by now non-traditional ways of appraisal of diseases which have a high prevalence and thus also great impact in the population.

[What dosage is sufficient in combined inhalation therapy (fenoterol + ipratropium bromide) in patients with exacerbation of chronic obstructive lung disease?]. / Jaká dávka je dostatecná pri kombinované inhalacní lécbe (fenoterol + ipratropium bromid) u nemocných s exacerbací chronické obstrukcní plicní nemoci (CHOPN)?

The authors compared in a prospective study the bronchodilatating and undesirable effects of combined inhalation treatment (phenoterol + ipratropium bromide) in the treatment of patients with exacerbation of chronic obstructive pulmonary disease, using different dosages. The patients were divided at random into two groups--group one inhaled berodual sol 3.5 ml/day (i.e. 1.75 mg phenoteroli + 0.875 mg ipratropii bromidium), the second group had a dose of double size. During the trial the authors monitored the peak expiration rate, the heart and respiration rate, blood gases and the subjective state of dyspnoea, using a 10 cm line. By comparison of bronchodilatating and undesirable effects they reached the conclusion that a daily dose of 3.5 ml berodual sol. is sufficiently effective. Increasing the daily dose to 7 ml did not produce a greater therapeutic effect nor increase the risk of undesirable effects.

Chronic respiratory symptoms, skin test results, and lung function as predictors of peak flow variability.

We examined how chronic respiratory symptoms, reported in a questionnaire, and results of skin prick tests and spirometry predicted variability in peak expiratory flow (PEF) among 6-12-yr-old children (n = 1,854). After characterization with skin tests and spirometry, children were followed for 2-3 mo during the winter of 1993-1994. Peak expiratory flow was measured daily in the morning and evenings. Children with asthmatic symptoms (wheeze and/or attacks of shortness of breath with wheeze in the past 12 mo and/or ever doctor diagnosed asthma) had a greater variation in PEF than children with dry nocturnal cough as their only chronic respiratory symptom. Similarly, doctor-diagnosed asthma was associated with a greater variation in PEF, also among children with asthmatic symptoms. Peak flow variability increased with an increasing number of symptoms reported in the questionnaire. Atopy, positive skin test reactions to house dust mite and cat and lowered level (as % of predicted) in FEV1 and in MMEF were also associated with an increased variation in PEF. All the differences were observed in both diurnal and day-to-day variation in PEF. In conclusion, chronic respiratory symptoms reported in a questionnaire, spirometric lung function and skin prick test results among asthmatic children predicted variation in PEF measured during a 2-3 mo follow-up. The difference in morning PEF coefficient of variation (CV) between children with asthmatic symptoms and children with cough only was somewhat bigger in girls than in boys. The effect of atopy on morning PEF CV was somewhat bigger in young than in older children.

Sequential therapy with cefuroxime followed by cefuroxime axetil in community-acquired pneumonia.

STUDY OBJECTIVES: To compare the efficacy of two sequential therapy regimens of IV cefuroxime followed by oral cefuroxime axetil for the treatment of community-acquired pneumonia (CAP). DESIGN: Prospective, multicenter, randomized, open-label, parallel-group study. SETTING: Sixty-six centers in 11 countries (Belgium, Canada, Czech Republic, Germany, Hungary, Ireland, Israel, Poland, Portugal, South Africa, and the United Kingdom). PATIENTS: Six hundred thirty-six adults with CAP requiring hospitalization and initial IV antibiotic treatment. INTERVENTIONS: Cefuroxime, 1.5 g IV tid or bid for 48 to 72 h followed by oral cefuroxime axetil, 500 mg bid for 7 days. MEASUREMENTS AND RESULTS: For clinically evaluable patients, the clinical response rates were equivalent for cefuroxime tid and bid groups posttreatment (cure/improvement, 79% and 84%, respectively) and at follow-up (maintained cure, 87% and 82%, respectively). All signs and symptoms of pneumonia showed improvement at the time of switch from IV to oral therapy. A total of 111 pathogens were isolated, the most common being Streptococcus pneumoniae (23%), Haemophilus influenzae (18%), and Enterobacteriaceae (15%). Bacteriologic clearance was obtained posttreatment in 47 of 49 and 36 of 42 of bacteriologically evaluable patients in the cefuroxime tid and bid groups, respectively. Both regimens were well tolerated with a low incidence of drug-related adverse events, the most common being GI. CONCLUSIONS: Twice daily IV cefuroxime followed by oral cefuroxime axetil is a simple and effective sequential therapy regimen for the treatment of CAP. It offers potential cost savings and can replace the current tid regimen in this indication.

Sequential therapy with cefuroxime followed by cefuroxime axetil in acute exacerbations of chronic bronchitis.

A prospective, multicentre, randomized, open-label, parallel group study compared the efficacy, safety and tolerability of cefuroxime 750 mg iv administered either twice daily (bd) or three times daily (tds) for 48-72 h, followed by oral cefuroxime axetil 500 mg bd for 5-7 days in a sequential therapy regimen for the treatment of acute exacerbations of chronic bronchitis. A total of 628 adult patients entered the study; 323 in the cefuroxime tds group and 305 in the cefuroxime bd group. For clinically evaluable patients, the post-treatment clinical response rate was 86% and 88% in the cefuroxime tds and bd groups, respectively. Cure was maintained at follow-up (14-28 days after treatment completion) in 85% of the cefuroxime tds group and 84% of patients in the cefuroxime bd group. A total of 189 pathogens was isolated, the most common being Haemophilus influenzae (17%), other Haemophilus spp. (15%), Streptococcus pneumoniae (15%) and Enterobacteriaceae (23%). At the post-treatment assessment, 66% and 70% of pathogens were cleared in the cefuroxime tds and bd groups, respectively. Both treatment regimens were well tolerated. The incidence of drug-related adverse events was 7% in the cefuroxime tds group and 6% in the cefuroxime bd group; the most common side-effects were gastrointestinal. Qualitative and quantitative markers were used to determine the optimal time to switch from iv to oral therapy and, of these, peak expiratory flow rate was shown to be the most useful in the present study. In conclusion, the findings of this study support the use of a bd dosing schedule of cefuroxime in a sequential therapy regimen with oral cefuroxime axetil, demonstrating it to be clinically equivalent to the standard tds dosage currently used, as well as being simpler and more convenient to administer at a lower cost.

[Fundamentals of hospital treatment in exacerbations of chronic obstructive lung disease]. / Zásady nemocnicní lécby exacerbace chronické obstrukcní plicní nemoci.

Treatment of Acute Exacerbations of Chronic Obstructive Lung Disease Involves Administration of O2, beta 2 adrenergic, anticholinergic drugs, corticoids, theophylline, antibiotics, mucolytics and supported ventilation. The objective of oxygen treatment is to increase the oxygen saturation to a minimum of 90%, PaO2 = 8 kPa, without an increase of PaCO2 by more than 1.33 kPa or a reduction of the pH below 7.25. Beta 2 adrenergic substances are the most potent bronchodilatating agents. Inhalation of the preparation in solution is optimal. Neither the interval of administration nor the dosage are uniform. In Europe most frequently the following solutions are recommended: salbutamol (Ventolin) 0.5%-2.5 mg. This dose can be repeated, depending on tolerance, after 30-60 minutes, fenoterol (Berotec) 0.1%, most frequently an initial dose of 0.5-1.25 mg is used. In chronic obstructive lung disease inhalation of ipratropium in solution is preferred (Atrovent) 0.025%. American authors agreed on 0.5 mg after 4-8 hour intervals. A combination of adrenergic and cholinergic agents is useful as each drug acts by a different mechanism. The effect can potentiate while no undesirable effects develop. Views on corticoid administration in chronic obstructive lung disease differ. Some investigations did not prove a positive effect while others did. In the authors' department preference is given to the intravenous administration of 160 mg methylprednisolone divided into two doses per day. Intravenous administration of aminophylline is indicated if inhalation treatment is not effective enough or if inhalation treatment cannot be administered. Aminophylline is administered continually or intermittently in infusion, the dose for adults being 0.5-0.9 mg/kg/hour. Opinions on antibiotics differ. Some authors recommend them, others do not. The objective of antibiotic treatment is to shorten the duration of the exacerbation and to prevent deterioration in a patient with a minimal respiratory reserve. As to mucolytics, most frequently inhalatory forms of Bromhexine, Ambroxol, N-acetylcysteine and Mistabrone are used.