Hylan A. Bickerman

The use of prednisone (meticorten) in respiratory disease: II. Pulmonary emphysema and pulmonary fibrosis☆

Abstract The effect of prednisone was studied in 50 patients with pulmonary emphysema and pulmonary fibrosis. The clinical results differ from those obtained with cortisone and ACTH in the following ways: 1. 1. Moderate to excellent improvement with relief of dyspnea and increased exercise tolerance in 86 per cent of the patients treated with a daily dosage averaging one-quarter that employed with cortisone. 2. 2. The onset of subjective improvement was significantly more rapid than cortisone, usually within forty-eight hours of initiation of therapy. 3. 3. A striking weight loss ranging between 3 to 9 pounds occurred in 12 of the 50 patients during the first week of therapy including cases of cor pulmonale who had not responded favorably to cortisone. Of interest was the finding of loss in body weight in 4 patients with pulmonary fibrosis who had not previously been treated with cortisone. There was a decrease of 8 and 9 pounds, respectively, in 2 of these patients during the first week of treatment. The possible mechanism of this weight loss at a time when appetite and food intake was increased deserves further study. 4. 4. With the exception of salt and water retention, and the decreased incidence of facial mooning or fat deposition, other adverse reactions observed with cortisone have been encountered, especially gastrointestinal disturbances and reactivation of sinobronchial infection. Appropriate measures to counteract or prevent these conditions have been suggested. The case histories of 5 patients who exhibited significant weight loss are reported.

PHYSIOLOGIC FACTORS IN THE TREATMENT OF CHRONIC HYPERTROPHIC PULMONARY EMPHYSEMA

Excerpt The difficulties involved in the treatment of chronic pulmonary emphysema have recently been emphasized, especially the undesirable reactions that may follow the administration of oxygen in...

Original communicationThe use of prednisone (meticorten) in respiratory disease: II. Pulmonary emphysema and pulmonary fibrosis☆

Abstract The effect of prednisone was studied in 50 patients with pulmonary emphysema and pulmonary fibrosis. The clinical results differ from those obtained with cortisone and ACTH in the following ways: 1. 1. Moderate to excellent improvement with relief of dyspnea and increased exercise tolerance in 86 per cent of the patients treated with a daily dosage averaging one-quarter that employed with cortisone. 2. 2. The onset of subjective improvement was significantly more rapid than cortisone, usually within forty-eight hours of initiation of therapy. 3. 3. A striking weight loss ranging between 3 to 9 pounds occurred in 12 of the 50 patients during the first week of therapy including cases of cor pulmonale who had not responded favorably to cortisone. Of interest was the finding of loss in body weight in 4 patients with pulmonary fibrosis who had not previously been treated with cortisone. There was a decrease of 8 and 9 pounds, respectively, in 2 of these patients during the first week of treatment. The possible mechanism of this weight loss at a time when appetite and food intake was increased deserves further study. 4. 4. With the exception of salt and water retention, and the decreased incidence of facial mooning or fat deposition, other adverse reactions observed with cortisone have been encountered, especially gastrointestinal disturbances and reactivation of sinobronchial infection. Appropriate measures to counteract or prevent these conditions have been suggested. The case histories of 5 patients who exhibited significant weight loss are reported.

Comparative results of the use of ACTH, cortisone, and hydrocortisone in the treatment of intractable bronchial asthma and pulmonary emphysema

Abstract A total of 163 patients with intractable asthma and pulmonary emphysema with bronchospasm were given 309 courses of ACTH, cortisone, or hydrocortisone. Complete or partial remission was observed in 82.3 per cent of the ACTH courses. Of the cortisone-treated patients, 86.2 per cent of the courses showed a similar response. Complete or partial relief of bronchospasm and dyspnea was observed in 96 per cent of the courses of hydrocortisone administered at a dosage level averaging 50 to 60 per cent of that employed with cortisone. The duration of remission induced by the short, intensive courses of either ACTH, cortisone, or hydrocortisone was generally short-lived, averaging approximately 2 to 3 weeks. No significant difference in the duration of remission induced by these hormonal agents was found. Patients with bronchial asthma generally manifested a more complete remission than those with the broncho-spastic type of pulmonary emphysema. The effects produced with hydrocortisone differed from that of cortisone in the following manner: (1) a swifter onset of therapeutic benefit, i.e., in 18 to 36 hours with hydrocortisone as compared to 4 to 5 days with cortisone, (2) a decreased dosage requirement of approximately one-half to two-thirds of the cortisone dosage for comparable effect, and (3) a significant reduction in the adverse side reactions, due in all probability to the decreased dosage employed. The best results from the use of hormonal therapy took place in the following two clinical entities: (1) patients in whom persistent bronchospasm was the result of exposure to seasonal factors such as pollen, and (2) patients in whom the asthmatic state had been previously moderately well-controlled but in whom intractable bronchospasm developed following an upper respiratory infection. Although short, intensive courses of ACTH or the steroids seemed preferable to maintenance therapy in these two groups, in 21 of the 30 patients with chronic intractable asthma, pulmonary fibrosis, and advanced pulmonary emphysema, clinical improvement was maintained for 9 to 24 months by a daily dose of 20 to 75 mg. of cortisone or hydrocortisone. The adverse side effects of administration of the corticosteroids and ACTH were generally lessened by a low-sodium diet, administration of potassium chloride, and the use of antibiotic drugs in the presence of bronchial and sinus infections. The effectiveness of hydrocortisone at approximately one-half the dosage level of cortisone was accompanied by a significant reduction in the incidence of adverse side reactions. One patient who took cortisone against advice for 3 months developed bilateral pulmonary tuberculosis. One fatality occurred in a patient with severe bronchial asthma after repeated courses of both ACTH and cortisone. Delirium accompanied by exhaustion, fever, and cardiorespiratory failure suggested an Addisonian-like crisis.

The effect of breathing 100 per cent oxygen in pulmonary emphysema: Correlation of clinical improvement with changes in pulmonary ventilation

Abstract The resting pulmonary ventilations breathing air and 100 per cent oxygen were recorded in 121 patients with chronic pulmonary emphysema, twenty patients with bronchial asthma, and twenty-nine control subjects of whom twentyone were healthy individuals and eight were ambulatory patients who had no evidence of cardiac or pulmonary disease. A significant reduction in the minute ventilation was observed in pulmonary emphysema when oxygen was substituted for air, with the extent of this decrease indicating a positive although rough correlation with the clinical severity of the disease. Insignificant changes in pulmonary ventilation took place in the asthma patients and control subjects under identical testing conditions. Lowering of the minute ventilation also occurred when patients with pulmonary emphysema were placed in the head-down position. The decrease in ventilation expressed as a per cent change from the sitting position was of the same order as the air-oxygen difference, and was probably due to the initiation of diaphragmatic breathing resulting in increased aeration of the lower lobes and more efficient alveolar ventilation. Thirty-three patients with severe pulmonary emphysema were retested after two to six months of treatment designed to train and encourage viscero-diaphragmatic breathing and to ameliorate bronchospasm. The mean per cent change in ventilation between breathing air and oxygen fell from minus 22 to minus 8, and this was paralleled by the clinical improvement in exercise tolerance.

Further studies on the evaluation of antitussive agents employing experimentally induced cough in human subiects

The feasibility of employing experimental cough induced by eitric acid aerosols as a quantitative method for assessing antitussive activity is confirmed in this study. Thirteen coded drugs were tested by the double blind technique on trained healthy subjects. Differences in both degree and duration of effect on the cough response as recorded by pneumotachographic tracings permitted the grouping of these agents into three general categories: ineffective drugs, preparations which had sustained antitussive activity over the 4 hour test period, and those with maximal cough suppression at the second hour with a waning of effect thereafter. Mechanisms responsible for these differences are discussed.

Periarteritis nodosa: Report of a case treated with ACTH and cortisone

Abstract 1.1. A case is presented of a fifty year old male with periarteritis nodosa complicated by bronchial asthma. The patient has been observed for two years. 2.2. Four separate courses of ACTH induced clinical improvement and temporary remissions of his disease processes. 3.3. Prolonged therapy with both oral and intramuscular cortisone in suppressive doses shows promise of maintaining remission.