Low dose amiodarone pulmonary toxicity in a patient with a history of pneumonectomy.

A case of amiodarone pulmonary toxicity (APT) is described following a low dosage of amiodarone (200 mg/day) with serious respiratory insufficiency in a patient after right pneumonectomy. The patient was successfully treated by discontinuation of amiodarone, mechanical ventilation and prednisolone (40 mg/day). A literature study indicates that APT is a dose related toxicity. In our opinion a higher pulmonary drug concentration of amiodarone could exist from a change in pharmacokinetics because of a low fat storage in a thin patient and compensatory growth of the remaining lung which occurs after pneumonectomy. Given these findings we suggest that if amiodarone is indicated in such patients both loading and maintenance doses should be adapted.

The effect of positive expiratory pressure versus forced expiration technique on tracheobronchial clearance in chronic bronchitics.

In a randomized cross-over trial, including a control measurement the effect of positive expiratory pressure (PEP) and forced expiration technique (FET) on tracheobronchial clearance was evaluated in eight chronic bronchitics with abundant sputum production (mean, 32 g/day). PEP consisted of PEP-mask breathing interspersed with breathing exercises, huffing, and coughing. FET consisted of postural drainage, breathing exercises, huffing, and coughing. Clearance was measured with a radio-aerosol technique. At 40 min after the start of therapy the mean clearance, expressed as percentage of the amount of radioactivity present at the start of therapy, was 32% after PEP, 53% after FET, and 15% in the control run. The difference between PEP, FET, and control was statistically significant (p less than 0.02). Sputum production during PEP and FET was larger than during the equivalent period of time in the control run. It is concluded that FET is more effective than PEP in enhancing tracheobronchial clearance.

Measurement of tracheobronchial clearance after sauna in subjects with chronic bronchitis.

The effect of sauna on tracheobronchial clearance was studied in five male patients with chronic bronchitis by a radioaerosol technique. No enhancement of tracheobronchial clearance could be detected.

Clinical course in 28 unselected patients with aplastic anaemia treated with anabolic steroids.

Twenty-eight unselected patients with histologically proven aplastic anaemia were electively treated with anabolic steroids (75-150 mg orally q.d.) Additional supportive treatment with blood cell components and antibiotics was given if indicated. Response to therapy was defined as favourable if after 3 months of anabolic therapy overt bleeding tendency had disappeared, there was no need for transfusion therapy, a spontaneous increase of haemoglobin had occurred of greater than 3 g/dl above the initial level, and a platelet rise of twofold the initial count (up to at least greater than 30 x 10(9) /L) had occurred. Of 22 patients evaluable for the results of long-term (greater than 3 months) anabolic treatment, six showed a partial response and eleven responded favourably. These 11 are all alive at the end of the study. Five of these patients proved to be anabolic steroid-dependent. The 50% actuarial survival is approximately 4 years after diagnosis, which compares favourably with the best published results from bone marrow transplantation for aplastic anaemia. It is concluded that anabolic therapy in aplastic anaemia should be tried for 2-3 months before the bone marrow transplantation or immunosuppressive therapy is taken into consideration.

Conventional physiotherapy and forced expiration manoeuvres have similar effects on tracheobronchial clearance.

This study compared the effect of two forms of chest physiotherapy. In the "conventional" form of physiotherapy, postural drainage was combined with percussion and directed coughing. The other, relatively new form of physiotherapy, was the forced expiration technique, i.e. huffing combined with postural drainage, breathing exercises and, if necessary, coughing. Eight patients (six with cystic fibrosis, two with agammaglobulinaemia) took part in the study. No difference was found in tracheobronchial clearance, regional lung clearance, sputum production or lung function between the two forms of treatment. The forced expiration technique can be performed without an assistant. Therefore, it is concluded that in general the forced expiration technique is preferable.

Variability of tracheobronchial clearance in healthy non-smoking subjects.

Tracheobronchial clearance was measured twice in 10 healthy non-smoking volunteers to evaluate inter- and intrasubject variability, using a radio-aerosol technique (5 microns 99mTc-labelled polystyrene particles). By means of two detectors radioactivity in the lungs was measured at regular intervals for 6 h and once more 24 h after inhalation. The decrease in radioactivity after correction for background activity, isotope decay and 24-hour retention was assumed to reflect tracheobronchial clearance. Among other parameters to quantitate the results of these tests, the area under the retention curve up to 6 h after inhalation (AUC-6) was calculated. The intersubject coefficient of variation (COV) using the AUC-6 was 31%. The intrasubject COV of the AUC-6 was 11%. These results compare favourably with those reported by others using different techniques. It is concluded that the intrasubject variability of tracheobronchial clearance as measured by this technique is small.

Effect of positive expiratory pressure mask physiotherapy (PEP) versus forced expiration technique (FET/PD) on regional lung clearance in chronic bronchitics.

On theoretical grounds it is assumed that positive expiratory pressure mask physiotherapy (PEP) as a means of promoting mucus clearance is especially effective in the more distal airways. In a randomized cross-over trial including a control measurement the effect of PEP and of the forced expiration technique combined with postural drainage (FET/PD) on regional lung clearance was evaluated in seven patients with chronic bronchitis and abundant sputum production (mean 32 g.day-1). PEP consisted of positive expiratory pressure mask breathing interspersed with breathing exercises, forced expiration manoeuvres (huffing) and, if necessary, coughing. FET consisted of breathing exercises, huffing and also, if necessary, coughing. FET was combined with PD. Following inhalation of a radio-aerosol regional lung clearance was estimated by means of gamma camera imaging. The results after PEP appeared to be not significantly different from control. The mean clearance in all three lung zones (peripheral, intermediate and inner) was largest after FET/PD as compared with PEP and control. Statistical significance (p less than 0.02) was reached only for clearance in the inner region. It is concluded that PEP has no demonstrable effect on regional lung clearance in these patients.

No effect of oral high frequency oscillation combined with forced expiration manoeuvres on tracheobronchial clearance in chronic bronchitis.

This study compared the effect of oral high frequency oscillation (OHFO) with the effect of the forced expiration technique (FET) on tracheobronchial clearance. Eight patients with chronic bronchitis were investigated (mean age 60 +/- 10 yrs, mean forced expiratory volume in one second (FEV1) 68 +/- 27% predicted, mean sputum production 33 +/- 9 g.day-1). OHFO was applied at the respiratory system resonant frequency of each patient (range 9.2-25 Hz) and combined with huffing. FET included breathing exercises, huffing and postural drainage. Duration of both OHFO and FET was 30 minutes. Tracheobronchial clearance was measured by means of a radio-aerosol technique. At 60 mins after start of the treatment mean tracheobronchial retention was 70 +/- 26% after OHFO, 54 +/- 26% after FET and 76 +/- 18% in the control run, which included huffing only. OHFO was not significantly different from control. FET was significantly different (p less than 0.02) from both OHFO and control. It is concluded that OHFO has no effect on tracheobronchial clearance in chronic bronchitis.