Irving W. Schiller

Measurement of changes in vital capacity as a means of detecting pulmonary reactions to inhaled aerosolized allergenic extracts in asthmatic subjects.

Abstract 1.1. It was shown that a reduction in vital capacity followed the inhalation of aerosolized extracts of certain pollens and dust in ten asthmatic subjects. 2.2. Tests could be carried out with little discomfort to the subject, although mild asthmatic manifestations usually occurred. 3.3. In some instances a fall in vital capacity was observed in the absence of signs or subjective symptoms of asthma. 4.4. Our limited experience indicates that this method may be helpful in diagnosis. The technique has the advantage that pulmonary reactions inditinguishable from spontaneous asthma may be produced and measured under controlled conditions. 5.5. The possible value of this method in studying the effect of drugs on the asthmalike response is pointed out.

Chronic obstructive pulmonary emphysema; a disease of smokers.

Excerpt During the last two years a number of patients with chronic obstructive emphysema have been observed while under treatment with bronchodilator agents and the adrenal steroids, in the course...

Aerosolized steroids in bronchial asthma

Abstract Preparations of prednisolone and hydrocortisone suspended in a Freon propellant were administered as aerosols to asthmatic patients. Using the double-blind technique, we obtained strong evidence for a topical therapeutic effect of prednisolone in asthma. Clinical experience indicated that this was also true for aerosolized hydrocortisone. The topical therapeutic effect of steroids as given appeared to be approximately equivalent to a daily dose of 40 mg. of hydrocortisone by mouth.

Prolonged treatment of bronchial asthma with cortisone.

Abstract Observations in 19 patients with severe bronchial asthma, treated with cortisone for a year or more in the period from December, 1949, to November, 1952, are described. Although 17 of the 19 patients have maintained a satisfactory state of health, no evidence has been obtained to date that the underlying pulmonary disease of which asthma is the manifestation has been materially influenced by treatment. Two patients who improved initially have developed increasing asthma under treatment and may probably be regarded as failures. The chief side-effects encountered in this group of patients have been gain in weight (10 patients) and hypertension (3 patients), although the latter may be coincidental. Recurrent respiratory infections may be difficult to recognize and are often associated with relapse or exacerbation of the asthma.

Acute allergic reactions induced in subjects with hay fever and asthma by the intravenous administration of allergens with observations on blood clot lysis

Abstract Six patients with allergic disease of the respiratory tract were given intravenous extracts to which they were sensitive both clinically and by skin test. Amounts which were sufficient to evoke respiratory manifestations produced little apparent circulatory or cutaneous change. No change was observed in skin sensitivity or in circulating skin-sensitizing antibody or complement. An unexpected finding was the lysis of clot formed in blood drawn after the induced reactions (fibrinolysis) in three instances.

Estimation of daily changes in the severity of bronchial asthma

S PART of a larger study on asthma,* attempts have been made to improve methods of assessing the screrity of the disease as it waxes and wanes over a period of time. Severity may be measured or estimated in a number of ways : (1) by the intensity and number of musical e (2) by tests of pulmonary function ; (3) by the amount of medicat,ion the patient requires; and (4) by the intensity of symptoms as reported by the patient. Examination of the chest gives some indication of severity, but we have not found this to be reliable, even though the presence of asthma may be detected so very readily by this means. The auscultatory signs of asthma, which are difficult to express quantitatively anyway, are increased when there is increased ventilation for any reason and they are iikewise decreased when the minute volume falls. Furthermore, in the course of giving various drugs for the relief of asthma, we have observed on occasion with the patient at rest, an intensification of the auscultatory signs, even though there was subjective relief and evidence of improvement as judged by an increase in the vital capacit,y. The administration of bronchodilator drugs (isopropylarterenol, aminophylline) may bring about an increase in ventilation,l but it is not clear whether or not this explains the intensification of physical signs just referred to. Tests of pulmonary function not only reveal abnormalities, but also yield data which may be expressed quantitatively in numerical terms. To be sure, many of these tests are cumbersome and cannot be done at frequent intervals. Among the simpler procedures, the timed vital capacity appears to be satisfactor?, 3 and demands little of t.he patient in the way of time, effort, and cooperation. Even this can be done only once or twice weekly in most patients an d, as the intensity of asthma tends to fluctuate from day to day, such measurcments may uot be representative of the intervening periods. If a patient takes medication only for the relief or control of symptoms as they arise, the amount of medication taken will provide an index of the iutensit,y and frequency of asthmatic manifestations. However, the amount of medication taken may be influenced by factors other than the intensity of symptoms. Estimation of severity based on the patient’s answers to questions asked at intervals of days or weeks has been unsatisfactory for our purpose, depend

Pulmonary function in bronchial asthma

Abstract Methods for the study of pulmonary function have been applied by a number of workers in patients with bronchial asthma and have gone far to elucidate the changes which occur during the asthmatic attack. Although valuable information concerning the severity of asthma can usually be obtained with a spirometer, coupled with measurements designed to assess the obstruction to air flow, a much deeper understanding of the functional defect can be derived from tests which also measure abnormalities of distribution of the inspired gas, and the changes which occur in the arterial blood.

The effect of helium-oxygen mixtures on pulmonary function in asthmatic patients

Abstract Eight patients with bronchial asthma were given air and a helium-oxygen mixture to breathe, and spirograms and measurements of speed of flow were obtained. In the severely ill patients, no significant change was observed in the expiratory reserve volume, the inspiratory capacity, the vital capacity, or the speed of flow during the performance of the vital capacity. In some measurements among the less ill patients, slightly larger values were obtained with helium.

Oral cortisone in the treatment of hay fever

Abstract 1.1. Fifty-one patients with hay fever, 10 of whom had seasonal pollen asthma, who had failed to benefit from specific pollen therapy and the antihistaminic drugs or other agents, were treated with one or more four-day courses of oral cortisone. In 42 patients, treatment with cortisone appeared to provide complete to satisfactory relief; 9 patients failed to obtain relief. 2.2. It is concluded that oral cortisone in the dosage used is effective in the treatment of hay fever.

CLINICAL STUDIES WITH CORTISONE'BY MOUTH, CORTISONE BY INJECTION, AND ACTH IN THE TREATMENT OF ASTHMA

Abstract Twnty-five patients with severe bronchial asthma were treated with ACTH or cortisone by injection and cortisone by mouth in the period from December 1949 to January 1951. Treatment of bronchial asthma with these agents appears to be effective and practical. Prolonged continuous treatment of severe chronic bronchial asthma with ACTH and cortisone holds promise but will require careful study.