Comparison of the anticholinergic bronchodilator ipratropium bromide with metaproterenol in chronic obstructive pulmonary disease. A 90-day multi-center study.

The short- and long-term efficacy and safety of an inhaled quaternary ammonium anticholinergic agent, ipratropium bromide, and a beta agonist aerosol, metaproterenol, were compared in 261 nonatopic patients with chronic obstructive pulmonary disease (COPD). The study was a randomized, double-blind, 90-day, parallel-group trial. On three test days-one, 45, and 90-mean peak responses for forced expiratory volume in one second and forced vital capacity and mean area under the time-response curve were higher for ipratropium than for metaproterenol. Clinical improvement was noted in both treatment groups, especially during the first treatment month, with persistence of improvement throughout the remainder of the study. Side effects were relatively infrequent and generally mild; tremor, a complication of beta agonists, was not reported by any subject receiving ipratropium. These results support the effectiveness and safety of long-term treatment with inhaled ipratropium in COPD.

Alcohol and the respiratory tract.

Possible mechanisms by which alcohol may adversely affect the respiratory system are considered. Alcohol ingestion impairs glottic reflexes, and alcoholics are predisposed to pneumonias and lung abscesses from aspiration of oropharyngeal bacteria. Alcohol intoxication also increases the frequency of sleep apnea and may result in respiratory failure from oversedation.

Computerized rapid analysis of pulmonary function test: use of a least mean squares correlation for interpretation of data.

Although systems for automated calculation and interpretation of screening pulmonary function tests (PFT) have been discussed by previous investigators, these systems are often unavailable to other users, require large or hybrid computers, or are difficult to modify. The use of a branching decision tree for PFT interpretation may also limit the number of correlations possible and make revision of the program difficult because changes in the proximal branches of the tree require a rewriting of the entire distal program. We have developed a system based on a minicomputer which uses a least mean squares analysis for rapidly analyzing the patient's PFT data. This program considers the following types of PFT data singly and in combination: percentage predicted total lung capacity and/or alveolar volume, forced expiratory volume in one second to forced vital capacity ratio (before and after bronchodilator or 80% helium challenge), and percentage predicted single breath diffusing capacity for carbon monoxide. The interpretation program (IP) then selects the 'best interpretation' for the patient by computing the variance between the patient's data and data from a menu of over 120 interpretation statements. During the past two years we have used this system for screening over 3000 patients. In about 90% of patients the computer selected interpretation statements which were acceptable to a sub-specialty pulmonary physician. The use of this IP for screening purposes has facilitated the efficient use of laboratory personnel and equipment.

Use of laryngeal sound recordings to monitor apnea.

Laryngeal sounds are produced by air flow across the glottis. We found that apnea could be identified by the cessation of laryngeal sounds during continuous monitoring. We recorded laryngeal sounds using a microphone coupled to a stethoscope head taped to the subject's lateral neck. This signal was conditioned using a commercially available amplifier and displayed on a time-based recorder. Laryngeal sound monitoring of apnea could be useful in sleep studies.

T and B lymphocytes in sarcoidosis: a clinical correlation.

Immunological abnormalities in sarcoidosis have been previously described. Cutaneous anergy to a wide variety of antigens first prompted the suggestion that the underlying defect may be of importance in the aetiology or pathogenesis of the disorder. The thymus derived lymphocytes appear to be particularly affected, and both quantitative and qualitative in vitro defects have been described in these cells in sarcoidosis patients. We have quantitatively investigated T and B cells in a series of 52 sarcoidosis patients, and our results indicate that, as a group, sarcoidosis patients have lower mean total lymphocyte counts and lower T cell counts than the control series in agreement and with other reports. We found no difference between B cells in the sarcoidosis and control groups. The quantitative abnormalities detected did not correlate with any of the clinical parameters which were investigated--stage of disease, duration of the disease, treatment regime, and activity of disease--and there was a considerable overlap between the results obtained in sarcoidosis patients and the controls. Our results indicate that these investigations are of little value in the management of sarcoidosis patients.

Lymphocytes in sarcoidosis: a clinical correlation.

The responsiveness of lymphocytes from 40 sarcoidosis patients and 32 control subjects to Phytohaemagglutinin (P.H.A.), P.P.D. and Candida duration and activity of disease or treatment program are analyzed and discussed.

Bioenergetic alterations in cultivated pulmonary artery and aortic endothelial cells exposed to normoxia and hypoxia.

Endothelial cells function under conditions of different oxygen availability under physiologic conditions and a variety of pathologic states. We determined the effect of normal and low O2 tensions on three key bioenergetic enzymes [pyruvate kinase (ATP:pyruvate phosphotransferase, EC 2.7.1.40), phosphofructokinase (ATP:D-fructose-6-phosphate 1-phosphotransferase, EC 27.1.11) and cytochrome aa3] in culture-maintained endothelial cells derived from calf pulmonary artery and aorta. Endothelial cells derived from pulmonary artery and aorta demonstrate similar bioenergetic enzyme activities when exposed to the same PO2 in vitro. Endothelial cells exposed to hypoxia in vitro for 48-96 hr show significantly increase activities of 2 key glycolytic enzymes: pyruvate kinase, and phosphofructokinase. Freshly isolated intimal strips from calf pulmonary artery (normal PO2 = 40 torr) show significantly greater activities of PyKi than aortic intimal strips (normal PO2 = 90 torr), suggesting that a similar pattern occurs in vivo. The data suggest that both cell types have a common bioenergetic pattern which is genetically determined and that this pattern is modified by regulatory mechanisms geared to ambient O2 tension. As endothelial cells of both types are not uncommonly exposed to hypoxic conditions, these regulatory mechanisms may play an important role in maintaining vascular integrity.