I.W.B. Grant

Asthmatic pulmonary eosinophilia: A review of 65 cases

In a series of 65 patients with asthma with pulmonary eosinophilia 54 were adequately investigated for allergic aspergillosis and this was present in 32 (59%). Asthma with pulmonary eosinophilia was found to carry a relatively poor prognosis in terms of permanent symptoms, impairment of pulmonary function and residual radiographic abnormality. The prognosis was least favourable when allergic aspergillosis was associated with long-standing asthma. On the other hand there was a group of patients with asthma with pulmonary eosinophilia who had relatively little permanent disability. These were mainly women with asthma of recent onset, and in these evidence of allergy to Aspergillus fumigatus was less apparent. Those patients who received long-term daily corticosteroid therapy were less likely to develop further radiographic opacities than those given intermittent corticosteroid therapy. To prevent recurrent pulmonary infiltrates it is probably necessary to give prednisolone in a daily dosage of at least 10 mg for an indefinite period.

HYPOTHALAMO-PITUITARY-ADRENAL FUNCTION IN ASTHMATIC PATIENTS RECEIVING LONG-TERM CORTICOSTEROID THERAPY

Abstract The diurnal variations of plasmacortisol (11-OHc.s.) on the first and fourth days after withdrawal of corticosteroid therapy, and the response to insulin-induced hypoglycaemia, have been measured in 27 patients with chronic asthma. 16 patients had been taking prednisolone on only three consecutive days per week, while the other 11 had been taking it every day. A control group of chronic asthmatics who had not received corticosteroid therapy was studied in the same way. Significant reductions in plasma 11-OHc.s. concentration were observed in both treatment groups in the morning and evening of the first day after withdrawal of therapy, and also in the morning of the fourth day in patients who had been receiving corticosteroids daily. The response to insulin-induced hypoglycaemia was subnormal in 4 of the 5 patients tested in each group. It is concluded that in patients with chronic asthma intermittent corticosteroid therapy is no more effective than continuous (daily) treatment in preserving the response of the hypothalamo-pituitary-adrenal axis to stress.

NEBULIZED SALBUTAMOL IN LIFE-THREATENING ASTHMA: IS IPPB NECESSARY?

A double-blind crossover trial compared equal doses of nebulized salbutamol delivered with and without intermittent positive pressure breathing (IPPB) in 20 patients admitted to hospital with life-threatening asthma. No significant differences were observed between the two forms of treatment. It was concluded that the use of IPPB to administer nebulized salbutamol in oxygen had no advantage over passive inhalation in the initial treatment of patients with severe acute asthma.

Intrapleural perforation of peptic ulcer in association with diaphragmatic hernia

Two patients with perforation of intrathoracic peptic ulcer in association with paraoesophageal hiatus hernia are described. This unusual complication of hiatus hernia should be considered in the differential diagnosis of patients presenting with spontaneous hydropneumothorax.

Severe acute asthma — a problem patient

Abstract A patient with severe acute episodic asthma is described who has required artificial ventilation as a life-saving procedure on 20 occasions. To obtain easy access to her circulation during attacks, an arteriovenous fistula has been fashioned in her thigh and has been found to be of considerable value.