Inhaled steroids in asthma

Inhaled steroids are the mainstay of anti-inflammatory treatment of asthma. Topical application of steroids to the asthmatic airway has many benefits as well as potential side effects; however, the side effects are much less prevalent than those caused by the use of chronic oral prednisone.     

Intestinal responses to hyperosmolar glucose infusion in dogs

Physiological and morphological changes of small intestine after hyperosmolar glucose infusions into canine jejunum were studied using in vivo perfusion model. Infusions of 40 ml of 50% and 20% glucose solution into the jejunal loops induced biphasic osmolar degression in the lumen. Osmolarity of jejunal venous blood was rapidly increased and maintained the maximal level (approximately 320 mOM/L). Blood flow to the jejunal loop was significantly increased after 50% glucose infusion compared to 5% glucose infusion. Most characteristic electron microscopic change of jejunal epithelial cell was pseudo-pod like process projected into the jejunal lumen, which was very similar to that of cholera.     

Airway responsiveness to hyperosmolar saline challenge in cystic fibrosis: a pilot study

Hyperosmolar aerosols are used to assess airway responsiveness in subjects with asthma. Using a 10% NaCl aerosol, we investigated airway responsiveness in 23 cystic fibrosis (CF) subjects (12 females, 11 males; 19.1 +/- 3.3 years) who had asthma-like symptoms. The pre-challenge predicted forced expiratory volume in 1 second (FEV1) was 74.7 +/- 21.5. The aerosol was generated by a MistO2gen 143A ultrasonic nebulizer and inhaled for 0.5, 1, 2, 4, 8, 8, and 8 minutes or part thereof. Spirometry was performed before and 1 minute after each inhalation period. The challenge was stopped when a > or = 20% fall from the baseline FEV1 was recorded, after the last inhalation period, or when requested by the subject. We recorded different responses to 10% NaCl among subjects. In 7, the FEV1 fell progressively throughout the challenge in a manner similar to asthmatics. By contrast, in 15 subjects the FEV1 was higher at the completion of challenge compared to during challenge, i.e., the fall in FEV1 was transient. In 7 of these subjects, the final FEV1 at the end of the challenge was higher than the pre-challenge FEV1. We conclude that inhaled 10% hyperosmolar saline causes either progressive and sustained or transient airway narrowing during challenge in the majority of CF subjects. The cause of the transient airway narrowing requires further investigation.     

Inhaled glucocorticosteroids in treatment of bronchial asthma

Studies of bronchial asthma pathogenesis, conducted over many years, have shown that inflammatory process plays a major role in the development of this disease. Glucocorticosteroids are agents with strongest antiinflammatory activity and together with beta 2-agonists are thought of as firstline therapy in the treatment of bronchial asthma. New inhaled glucocorticosteroids are preparations with small systemic activity, despite the fact, that some of them are more lipophyllic than the others, despite the differences in solubility, affinity to lung tissue, different serum concentrations and affinity to receptors. Even with the tremendous progress in increasing efficacy and lowering side effects of inhaled glucocorticosteroids, no ideal preparation was found so far, however the antiinflammatory activity was increased and the dose lowered, which means increasing clinical efficacy and lowering the systemic effects. Only in the future we can hope for developing an ideal preparation of inhaled glucocorticosteroid with common specificity towards lung tissue and direct influence on the target cell, and maybe even on a specific gene.     

Inhaled beta2-agonists and airway responses to allergen

A series of investigations show that the regular use of inhaled beta2-agonists will increase all aspects of the airway response to allergen. The mechanism of this effect is uncertain; however, it appears to be different from the mechanism that produces tolerance to beta2-agonist effects. One possibility is that the regular use of beta2-agonists might induce a mast cell beta-receptor dysfunction that might make mast cells more prone to release mediators. As a result beta2-agonist use plus allergen exposure might cause more mediator release than does allergen exposure alone. The corollary of this is that beta2-agonist use plus allergen exposure might cause more airway inflammation than does allergen exposure alone. These hypotheses are both testable. I believe that this is a clinically important phenomenon and may well be a major reason for beta2-agonist-induced worsened asthma control. Further investigations are indicated to identify the mechanism and the clinical relevance of the phenomenon.     

Inhaled ICI 204,219 blocks antigen-induced bronchoconstriction in subjects with bronchial asthma

Three inhalation formulations of ICI 204,219 were compared for antagonism of antigen-induced bronchoconstriction in 16 subjects with asthma who demonstrated reproducible hypersensitivity to allergen during screening challenges. Each subject received a single 0.2-mg dose of each formulation and was challenged with ragweed 30 min after administration of ICI 204,219 until the forced expiratory volume in 1 s (FEV1) decreased by 20 percent or the maximum allergen concentration (100 micrograms/ml) was reached. The majority of subjects tolerated 100 micrograms/ml of allergen without a 20 percent decrease in FEV1. Inhalation formulations of ICI 204,219 successfully inhibited bronchoconstriction in subjects with reproducible sensitivity to ragweed challenges.     

Use of modeling to modify children's responses to a natural, potentially stressful situation.

Tested whether modeling-i.e., the sight of another person behaving calmly in the presence of a feared stimulus-would reduce later aversive behavior on the part of children experiencing a commonly feared stimulus, i.e., anesthesia induction. Ss were 38 boys and girls, mean age 6 yrs, randomly assigned to an experimental or a control group. Ss exposed to modeling behaved as if they were less afraid of anesthesia induction than did control Ss. Differences between experimental and control Ss were smallest during those phases of anesthesia induction which were not portrayed by modeling. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Severe pneumonia caused by Chlamydia pneumoniae in a patient treated with steroids for bronchial asthma

A case of bilateral severe pneumonia caused by Chlamydia pneumoniae has been described in a female patient with bronchial asthma. Both the clinical course and massive radiological changes, as-well as the fact that pneumonia occurred during the patients hospitalization and the treatment with, among other drugs, prednisone lead to the presumptive diagnosis of hospital acquired pneumonia or tuberculosis. The instituted therapy turned out ineffective. Only when Chlamydia pneumoniae was found in the culture infected by the material from the patient, the appropriate diagnosis could be made. The erythromycin therapy was prescribed which soon resulted in remission od clinical and radiological symptoms.     

Tachyphylaxis to topically applied steroids

Acute tolerance to the vasoconstrictive effect of topically applied glucocorticoids in humans has recently been described. Similar acute tolerance to the antiproliferative properties of topically applied steroids in proliferating and normal hairless mouse epidermis is now shown to occur. Thus, at first, topically applied steroids cause profound inhibition of DNA synthesis and mitosis in the epidermis, but with continued treatment, DNA synthesis and mitosis recover and the tissue becomes insensitive to further stimulation. This suggests that there is an optimum approach to therapy with topically applied steroids that might reduce the incidence of side effects and improve therapeutic efficacy.     

Research note: responses of laying hens on saline drinking water to dietary supplementation with various zinc compounds

Production variables, eggshell defects, eggshell quality, the concentration of calcium-binding protein (CaBP), and the activity of carbonic anhydrase (CA) in the shell gland mucosa were determined in hens receiving town water (10 mg Na/L), or town water supplemented with 2 g NaCl/L (796 mg Na/L). Five treatments were examined. Control hens received town water and a proprietary layer mash containing .17% Na. The remaining four treatments received the water containing NaCl (2 g/L). Hens of Treatment 2 were fed the proprietary layer mash and those of Treatments 3, 4, and 5 received, respectively, the layer mash containing supplements of Zn-methionine (Zinpro-200; .5 g/kg), Zn sulfate (ZnSO4.7H2O; .46 g/kg), or chelated Zn-EDTA (.54 g/kg) to supply the same concentration of Zn (.1 g/kg). The treatments were applied for 6 wk. Hens receiving the saline drinking water without any dietary Zn supplement produced significantly (P < .05) more eggs with shell defects than hens receiving the town water. This increase in the incidence of eggshell defects was associated with significant reductions in eggshell breaking strength, the concentration of CaBP, and the activity of CA. Supplementing the saline drinking water with any of the three Zn compounds significantly reduced the incidence of eggshell defects and in some cases improved shell breaking strength, the concentration of CaBP, and the activity of CA.     

Different responses of morning dipping and nocturnal dipping to inhaled and/or oral steroids in chronic asthmatics

Clinical experiences have suggested distinct differences in responses to anti-asthmatic drugs between patients suffering early morning asthmatic attacks and those experiencing nocturnal ones. However, there has been no report on any difference in the improvement of asthmatic flow dipping after inhaled and/or oral steroid treatment. In this retrospective study, the peak expiratory flow rates (PEF), which had been monitored four times a day, were reviewed in 40 chronic asthmatics. The group consisted of 19 patients with very low PEF (geometrical mean PEF/week [mPEF] < 60% of the personal best PEF), 15 patients with moderately low PEF (mPEF 60% to 70% of personal best PEF), 2 patients with mildly low PEF (mPEF 70% to 80% of personal best PEF) and 4 patients with occasionally low PEF (mPEF > 80% of personal best PEF). Of 40 chronic asthmatics, 22 patients had morning dipping alone and 10 patients had both morning dipping and nocturnal dipping. After inhaled and/or oral steroid treatment at sufficient level, mPEF was improved in all patients. All the dipping disappeared except for morning dipping in five cases. We concluded that there was a difference in responses to inhaled and/or oral steroids during early morning dipping and during nocturnal dipping in chronic asthmatics. There should be further investigation to discriminate between pathophysiological events that may be related to morning dipping and to nocturnal dipping.     

Comparison of bronchial challenge with ultrasonic nebulized distilled water and hypertonic saline in children with mild-to-moderate asthma

There is still controversy about the most suitable method to measure bronchial hyperresponsiveness in children. In epidemiological surveys, nonisotonic aerosols are being used increasingly for bronchial provocation testing. Our aim was to study the acceptability, safety and correlation between two published bronchial challenge tests. Two standardized protocols--the inhalation of hypertonic saline (HS) and ultrasonically-nebulized distilled water (UNDW)--were performed in 36 children: 19 patients with the clinical diagnosis of mild-to-moderate asthma (7-12 yrs of age), and 17 control subjects (8-18 yrs of age). HS challenge involved stepwise inhalation of 4.5% saline (for 0.5, 1, 2, 4 and 8 min), whereas challenge with UNDW was performed as a single step protocol with 10 min inhalation of cold UNDW. Asthma medication was withheld prior to challenge testing. Thirty five subjects completed both challenge tests (one asthmatic patient did not return after UNDW challenge) in random order within a 7 day time interval. For HS a > or = 15% reduction in forced expiratory volume in one second (FEV1) from baseline was considered a positive response, and for UNDW a > or = 10% decrease. In 13 of the 19 asthmatic patients, but in none of the controls, a positive response was observed for UNDW. Fifteen out of 18 patients and one control subject had a positive response to HS. Twelve out of 18 asthmatic children responded to both challenges, three responded only to HS and three had no response to either challenge. There was a negative correlation between log provocative dose causing a 15% reduction in FEV1 (PD15) after HS and the maximum fall in FEV1 after UNDW (rs = -0.63; p < 0.005). The HS challenge had a lower acceptability than challenge with UNDW due to the unpleasant salty taste of HS. However, this did not inhibit the completion of the tests in any subject. The results of this study suggest a good correlation between response to hypertonic saline and ultrasonically-nebulized distilled water in children with mild-to-moderate asthma. A multiple step protocol might be safer when applied in field studies involving children.     

Do psychological factors modify survival of cancer patients? II: Results of an empirical study with bronchial carcinoma patients

The present prospective test study of hypotheses addressed the question whether psychological factors are predictive of survival time in lung cancer patients. The hypotheses were: Emotional distress, depression and depressive coping are associated with shorter survival; hope and active coping with longer survival. The study was based on a sample of n = 103 patients who were investigated post-diagnosis and before the beginning of primary treatment. Emotional distress and hope were assessed by clinical scales (self-reports and interviewer ratings), depression by the Depression Scale of von Zerssen, depressive coping and active coping by the Freiburg Questionnaire on Coping with illness by Muthny. At follow-up, which took place three to five years later, n = 74 patients had died, for n = 29 patients the survival data are censored. The prediction of the survival time was performed applying multivariate analyses (Kaplan-Meier-method, Cox-Regression), adjusting for biological risk factors (histological classification, stage of the disease, type and amount of treatment, Karnofsky performance status, age). Results were as follows: Active coping and hope were associated with longer survival, emotional distress, depression and depressive coping with shorter survival, respectively. These associations were found consistently across assessment methods. The predictive effects of coping and distress were statistically independent of the influence of the somatic risk factors. The best psychological predictor was the interviewer rating of active coping. Its predictive power equalled that of the Karnofsky performance status. However, there was evidence that the effects of the psychological factors varied somewhat in interaction with treatment modalities. The findings are discussed from a methodological perspective. Possible causal models and mechanisms are presented which could account for interactions of psychological measures and the course of the disease: Thus, it can be conceived that psychological effects were mediated by patients' compliance with medical treatment. In addition, it cannot be ruled out that psychological factors themselves were influenced by the physical status of the patients at the time of entry to the study.     

Chronic social stress conditions differentially modify vulnerability to amphetamine self-administration

Using social instability and cohabitation with females as chronic stress, we observed that neuroendocrine systems were differentially activated according to the experimental design. We show here that amphetamine self-administration, a paradigm to study the reinforcing effects of psychostimulants, is also differentially affected by these conditions. Coexistence with females increases amphetamine self-administration and this effect is reduced when social instability is superimposed. On the other hand, locomotor response to amphetamine is not modified by either social factor, suggesting a specific involvement of a subset of dopaminergic neurons.     

Briquettes with nanostructured materials used to modify of cast iron

A method is developed to fabricate briquettes with nanostructured materials aimed at modification of cast iron resulting in the improvement of the physicochemical properties of cast iron and its castings. This improvement is achieved by grain refinement, stable modification, the elimination of pyroelectric effect upon modification, and a decrease in the sensitivity to chilling upon melt solidification.     

The use of observationally presented information to modify hypnotic susceptibility.

Examined the extent to which hypnotic susceptibility could be modified by means of various types of information modeled on a videotape. Of particular interest was the extent to which hypnotizability could be altered for the initially less susceptible S. 2 major informational components were compared: (a) behavioral modeling cues, in which Ss observed a model acquiesce to 7 hypnotic suggestions; and (b) verbal modeling cues, in which information was presented designed to correct misconceptions concerning hypnosis as well as provide concrete methods for experiencing hypnosis. 70 undergraduates completed the Stanford Hypnotic Susceptibility Scale (SHSS) Form B. After the manipulation period, Ss completed the SHSS Form C. Several days later, Ss completed M. Diamond's CP Scale of Hypnotic Susceptibility. Verbal modeling cues (in combination with motivational encouragement) were significantly more effective than the other cues, even for the initially less susceptible Ss. Results are discussed in relation to social learning and cognitive approaches to behavior change. (23 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

NO does not mediate inhibitory neural responses in sheep airway and bronchial vascular smooth muscle

Endogenous nitric oxide (NO) influences acetylcholine-induced bronchovascular dilation in sheep and is a mediator of the airway smooth muscle inhibitory nonadrenergic, noncholinergic neural response in several species. This study was designed to determine the importance of NO as a neurally derived modulator of ovine airway and bronchial vascular smooth muscle. We measured the response of pulmonary resistance (RL) and bronchial blood flow (Qbr) to vagal stimulation in 14 anesthetized, ventilated, open-chest sheep during the following conditions: 1) control; 2) infusion of the alpha-agonist phenylephrine to reduce baseline Qbr by the same amount as would be produced by infusion of Nomega-nitro-L-arginine (L-NNA), a NO synthase inhibitor; 3) infusion of L-NNA (10(-2) M); and 4) after administration of atropine (1.5 mg/kg). The results showed that vagal stimulation produced an increase in RL and Qbr in periods 1, 2, and 3 (P < 0.01) that was not affected by L-NNA. After atropine was administered, there was no increase in Qbr or RL. In vitro experiments on trachealis smooth muscle contracted with carbachol showed no effect of L-NNA on neural relaxation but showed a complete blockade with propranolol (P < 0.01). In conclusion, the vagally induced airway smooth muscle contraction and bronchial vascular dilation are not influenced by NO, and the sheep's trachealis muscle, unlike that in several other species, does not have inhibitory nonadrenergic, noncholinergic innervation.     

Do supervisors modify psychotherapy supervision according to supervisees' levels of experience?

Administered a questionnaire concerning goals, expectations, and procedures of supervision to 10 supervisors who had 1st-yr practicum students, 13 supervisors with 2nd-yr externship students, and 8 supervisors with interns who had at least 2 yrs prior clinical experience as psychotherapists. All Ss had an average of 10 yrs clinical experience and 5 yrs experience as supervisors. Results show no significant differences among the 3 groups of Ss who were supervising trainees with different levels of clinical development and skill, suggesting that supervisors may not modify their manner of providing supervision in accordance with supervisees' levels of experience. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)