Allan Bundgaard

Pulmonary function in patients with primary Sjögren's syndrome

SummaryIn 43 women and 3 men suffering from primary Sjögrens syndrome pulmonary function was correlated to various clinical, haematological and serological disease activity parameters. Primary Sjögrens syndrome was defined as the presence of keratoconjunctivitis sicca and xerostomia, in the absence of other well-defined chronic inflammatory connective tissue diseases. Only objective tests were used in the evaluation of the patients [2]. Total lung capacity, residual volume, vital capacity, functional residual capacity and ventilatory capacity were normal. The diffusion capacities measured for CO were significantly reduced compared with the predicted values. This indicates that pulmonary interstitial disease is a common feature of primary Sjögrens syndrome. There was a statistically significant negative correlation between reduced diffusion capacity and previous pneumonia, previous pleurisy, tiredness, dyspnoea, ESR and p-orosomucoid. No correlation was found to certain other clinical disease parameters, the duration of disease or tobacco smoking.

Maximal oxygen consumption rate in patients with bronchial asthma—the effect of β2-adrenoreceptor stimulation

Five young male patients with exercise-induced asthma (EIA) were subjected to graded bicycle exercise with work loads corresponding to 50%, 75% and 120% of the load necessary to elicit maximal oxygen uptake (Vo2 max). The exercise tests were performed after inhalation of salbutamol (Ventoline) as well as after inhalation of saline as control. Additionally two maximal work tests (bicycling and treadmill) were performed without inhalation on a work load corresponding to 100% Vo2 max. Oxygen uptake (Vo2) heart rate (HR), mean blood pressure (MBP), rating of perceived exertion (RPE) as well as arterial concentration of glucose and acid-base variables were measured. Vo2 max during bicycle exercise averaged 3.16 l/min and no significant difference was disclosed between the beta 2-stimulation and the control situations. The coefficient of variation of a single Vo2 max measurement was 4.7%. The maximal treadmill running revealed a significantly higher Vo2 max (3.42 l/min, P less than 0.05) than during bicycling; no EIA was provoked in any of the experiments. After beta 2-stimulation a higher HR and MBP in relation to Vo2 was observed than in the control experiment; however, the slope of HR/Vo2 and MBP/Vo2 relationships was not affected. Normal relationships were observed between Vo2 and work load, ventilation, RPE and acid-base data and these relations were unaffected of beta 2-stimulation. It is concluded, that Vo2 max seems to be within the normal range in asthmatics, provided they are free from attacks.

Cumulative dose-response study comparing terbutaline pressurized aerosol administered via a pearshaped spacer and terbutaline in a nebulized solution

SummaryThe bronchodilator effects of cumulative doses of terbutaline 0.125 mg, 0.125 mg and 0.250 mg administered as a pressurized aerosol via a pearshaped spacer were compared with those of terbutaline 1.25 mg, 1.25 mg and 2.50 mg administered as a nebulized solution via a PARI-inhaler Boy. FEV1.0 and flow-volume curves in 13 patients were measured. Initial placebo treatment of both groups resulted in a significant increase in FEV1.0, especially when it was given in nebulized form. The increase after active drug was significant after 15 min, with only minor changes during the rest of the trial. The log-dose/increase in FEV1.0 showed that equipotent doses of pressurized and nebulized terbutaline were in the ratio 1 to 4. Administration by nebulization offered no clear advantage over use of a pressurized aerosol with a pearshaped spacer.

Effect of physical training on peak oxygen consumption rate and exercise-induced asthma in adult asthmatics

Sixteen adults with perennial asthma were trained for 2 months using heavy exercise. Eleven comparable subjects performing light exercise with the same frequency and duration served as controls. After the training the peak oxygen consumption rate (Vo2max) was increased by 10% (P = 0.02) in the heavily trained group, whereas no significant change was observed in the control group. The difference in Vo2max between males and females averaged 20% and is thus of the same magnitude as found in healthy subjects. An exercise-induced asthma (EIA) test comprising 6 min of free running was carried out in all participants in both training groups before and after the training period. The post-exercise decrease in pulmonary function assessed by peak expiratory flow (PEF) was 36 + 4% (mean +/- SEM) before heavy training and 33 +/- 2% after two months of training (paired t-test: P = 0.18); for the control group the decrease was 40 +/- 6% and 40 +/- 7% (P = 0.22), respectively, at the pre- and post-training investigation. It is concluded that physical training may increase the Vo2max in asthmatic patients by the same amount as in normal subjects, whereas no influence on the degree of EIA could be detected.

SHORT-TERM PHYSICAL TRAINING IN BRONCHIAL ASTHMA

The effect of two types of physical training on patients with perennial asthma were compared in a blind, controlled, randomized study. Eleven of 27 adults with asthma performed a physical training programme which did not change their oxygen consumption (control group). The remaining 16 asthmatics performed a physical training programme which improved their maximal oxygen consumption (training group). Both of the training programmes were performed for 1 hour, twice a week during a period of 2 months. No complications were reported during the performance of the training programmes. The doses of all medicines apart from beta 2-agonist aerosol were unchanged during the training period. The patients inhaled beta 2-agonist aerosol if their peak expiratory flow (PEF) was less than 60% of their maximal PEF. The training group decreased their use of aerosol from an average of 4.94 puffs per day to 3.41 puffs per day (P less than 0.05). The control group did not change their use of beta 2-agonist aerosol significantly. It is concluded that physical exercise which improves the maximal oxygen consumption decreases the use of beta 2-agonist spray and that heavy exercise is well tolerated by asthmatics.

Pretreatment of Exercise‐Induced Asthma in Adults with Aerosols and Pulverized Tablets

Eighteen adult asthmatics took part in a double‐blind crossover study comparing the effect on exercise‐induced asthma (EIA) of pretreatment with aerosolized 1) disodium cromoglycate (DSCG), 2) ipratropium bromide (IPTB), 3) fenoterol, 4) DSCG + IPTB and 5) saline.

The Importance of Ventilation in Exercise-Induced Asthma

The degree of post treadmill‐running decrease in pulmonary function (Exercise‐Induced Asthma) in 11 adult asthmatics was compared with the decrease in pulmonary function followed by resting isocapnic hyperventilation. It was checked that ventilation during the hyperventilation was kept identical to the ventilation during treadmill‐running by continuous recording of respiratory frequency, minute ventilation, tidal volume and accumulated ventilation. The temperature of the inspired air was identical in the two situations and the relative humidity was 40% during treadmill‐running and 15% during hyperventilation. The average accumulated ventilation during treadmill‐running and hyperventilation was 411 1/6 min in both events. The decrease in peak expiratory flow after treadmill‐running was 25% and after isocapnic hyperventilation 24%. It is concluded that the ventilation is of more importance for the decrease in pulmonary function after exercise, than the work load.

Incidence of Exercise‐Induced Asthma in Adult Asthmatics

One‐hundred and fourteen adults (48 males, 66 females, average age 35.5 years, range 16‐61 years) were tested for bronchial asthma. Eighty‐nine were given the clinical diagnosis asthma bronchiale. Of these 89 patients 68 (76%) had exercise‐induced fall in PEF. Twenty‐one (24%) showed no fall in PEF. The incidence of exercise‐induced fall in PEF was the same among patients with extrinsic as among patients with intrinsic asthma. Out of 25, in whom the clinical diagnosis asthma bronchiale was not confirmed, only one patient had exercise‐induced fall in PEF. This patient had chronic bronchitis. Twelve adults without any disease showed no fall in PEF. after exercise.

Terbutaline depot tablets in asthma. A clinical evaluation.

A sustained release preparation of terbutaline sulphate has been formulated (Bricanyl® depot tablets) in order to extend the duration and accordingly change the dosage regimen to twice a day. This presentation gives a summary of a clinical trial performed in order to study effect and side effects of terbutaline depot tablets 7.5 mg twice a day compared to terbutaline tablets 5 mg three times a day.

Exercise-induced asthma after walking, running and cycling

Bronchial response to 6 min exercise performed as treadmill-walking, treadmill-running, ergometer bicycling and free running were compared in 11 subjects with exercise-induced asthma (EIA). The study was performed under control of air temperature and relative humidity. The three different types of exercise were performed on consecutive days, and the ventilation was monitored using pneumotachography and rating of perceived exertion (RPE). The decrease in peak expiratory flow after treadmill-running was 25.5 +/- 4.5% (mean +/- SEM), after bicycle ergometer exercise 26.0 +/- 3.0%, after treadmill-walking 26.0 +/- 3.0% and after free running 27.0 +/- 3.5%. No statistical difference in bronchial response was demonstrated between the four types of exercise. The total ventilation for the 6 min period of exercise was 421, 411 and 427 litres for treadmill-walking, treadmill-running and bicycle ergometer exercise, respectively. It is concluded that the type of work is of little importance in EIA.