J. H. Alpers

Survival on long-term oxygen therapy in chronic airflow limitation : from evidence to outcomes in the routine clinical setting

Abstract

The impact of anxiety, depression and living alone in chronic obstructive pulmonary disease

Objective: This prospective longitudinal study examined whether quality of life as measured by the disease specific chronic respiratory questionnaire (CRQ) and living alone, at the time of prescription of long-term oxygen therapy (LTOT), impacted on the mortality of patients with severe chronic obstructive pulmonary disease (COPD). Methods: One-hundred and fifty-seven patients, (male:female, 74:83) with severe COPD, aged under 80 years completed the CRQ at the time of prescription of LTOT. Demographic and physiological parameters were also collected. The patients were followed in outpatient clinics after commencing LTOT. Results: Kaplan–Meier analysis of the data demonstrated a relationship between the emotional function score of the CRQ at the commencement of LTOT and survival on LTOT for female patients. Living with a partner was associated with an additional 12 months of life. When known physiological predictors of survival, the CRQ dimensions and living alone were included in a Coxs proportional hazard model, emotional function, body mass index and forced vital capacity were independent prognostic indicators for females, and arterial partial pressure of oxygen for males. Conclusion: Our results suggest that poor emotional functioning of female patients with severe COPD at the time of prescription of LTOT is associated with increased mortality.

Repeated histamine inhalation tests in asthmatic patients.

Histamine inhalation tests were performed in 12 asthmatic patients using a 2-min tidal breathing inhalation technique. The tests were repeated on separate days with 30-, 60-, and 120-min intervals between inhalation tests. On another day the inhalation tests were repeated four times with 40-min intervals between tests. The geometric mean provocative concentrations of histamine needed to cause a 20% fall in forced expiratory volume in 1 sec (PC20) for the group on the latter study day were 1.67, 1.57, and 1.55 mg/ml (p greater than 0.25) indicating no change in sensitivity to inhaled histamine with repeated testing. The results suggest that cumulative dose-response curves for drugs potentially affecting the airways or antagonizing histamine can be constructed within 1 day using histamine inhalation tests. The data also suggested that an individual PC20 result may be sensitively assessed by comparing it to a +/- 2 SD range from the mean of a series of control or placebo PC20 values.

The MOS SF-36 health survey questionnaire in severe chronic airflow limitation: Comparison with the Nottingham health profile

This study documents the cross-sectional, health-related quality of life (HRQOL) measures obtained at baseline for patients with severe chronic airways limitation (CAL) being assessed for home oxygen therapy (HOT) at the Flinders Medical Centre, Adelaide, South Australia. Two generic quality of life instruments, the Nottingham Health Profile (NHP) and the Medical Outcomes Study (MOS) short form 36-item questionnaire (SF-36), were administered by interview to the same patients to permit comparisons to be made between the two instruments. SF-36 mean scores were also compared with scores obtained in separate studies of a South Australian elderly general population and of groups of Australian subjects with various medical and psychiatric conditions. NHP mean scores were compared with scores from an elderly group of Adelaide residents from a household survey. HRQOL measures were obtained for 60 patients, 32 males and 28 females. At assessment for HOT, patients with severe CAL were experiencing severe impairment in their quality of life in comparison to age-matched South Australian norms, with physical disability the major limitation. There were several significant correlations between the domains of the SF-36 and the NHP which were predominantly gender-specific. Only small decrements in mental health were found with the SF-36 questionnaire. The SF-36 and the NHP appear to provide discrepant information for severely disabled CAL patients for the subjective domains of emotional and mental health.

Inhaled verapamil in histamine-induced bronchoconstriction

Fifteen asthmatic subjects participated in a double-blind trial comparing the protective effects of inhaled verapamil, salbutamol, and saline against inhaled histamine. Inhaling verapamil between four repeated histamine inhalation tests produced no significant protection against histamine-induced bronchoconstriction, while there was significant protection with salbutamol (p less than 0.001). Inhaling verapamil before a single inhalation test produced limited but significant protection (p less than 0.05) compared with a saline control in eight asthmatic subjects. This small protective effect in the two-treatment study of eight asthmatics suggests that either the protective effect of verapamil is variable among subjects or a preceding histamine inhalation test blocks the verapamil effect.

Combination bronchodilator therapy in asthma

This study has compared the short-term bronchodilator effects of inhaled anticholinergic (ipratropium bromide) and sympathomimetic (fenoterol) agents alone and in combination in 18 asthmatic patients. the study was of double-blind, placebo-controlled, crossover design. The combination of 60 micrograms ipratropium bromide and 200 micrograms of fenoterol had a greater bronchodilator effect than lower dose combinations or either drug alone. Small but significant gains may be made with combination inhaled bronchodilator therapy.

The changing prevalence of asthma‐like respiratory symptoms in South Australian rural schoolchildren

Objectives: To describe the changing prevalence of wheezy breathing and doctor‐diagnosed asthma, as obtained by questionnaire data, from the years 1984‐92 in a sample of South Australian rural schoolchildren.

The effect of bucindolol on the airway function of asthmatics

SummaryThe airway and cardiovascular effects of separate single oral doses of 50, 100 and 200 mg of bucindolol were compared to those of placebo in a double-blind trial in 16 patients with mild to moderately severe asthma. Heart rate (HR), blood pressure (BP), forced vital capacity (FVC), forced expired volume in one second (FEV1), maximum expiratory flow at 50% of vital capacity (FEF50) and maximum expiratory flow at 75% of expired vital capacity (FEF75) were measured before and at intervals for 4 h, when salbutamol (200 µg) was inhaled and the measurements repeated 15 min later. There was an interval of at least 4 days between each drug treatment day.Four of the 16 patients developed clinically significant bronchoconstriction with 50 mg (3) or 100 mg (1) of bucindolol and were withdrawn from the study. The remaining patients showed impaired bronchodilator response to salbutamol for each bucindolol dose as compared to placebo. No significant BP or HR effects were measured. Two patients withdrew because of circumstances unrelated to bucindolol induced bronchoconstriction. The development of bucindolol induced bronchoconstriction in this group of mild to moderate asthmatics was not predicted by the level of baseline pulmonary function, or the level of histamine responsiveness. However, there was a weak relationship between bucindolol induced bronchoconstriction and salbutamol induced bronchodilation. There was no definitive asthmatic characteristic to predict the likelihood of significant bucindolol induced bronchoconstriction in this asthmatic population.

Minimum lung function for breath alcohol testing using the Lion Alcolmeter SD-400

The aim of this study was to determine the minimum lung function required by an individual to complete a breath alcohol test successfully using a Lion Alcolmeter SD-400. A total of 331 subjects routinely referred to a busy clinical respiratory function laboratory for assessment of their lung function were tested. A total of 52 (15.7%) of these subjects were unable to provide an adequate sample after two attempts. The majority of the group (86.5%) were female. There was considerable overlap of the minimum lung function parameters between those subjects who were unsuccessful at all attempts and those who were successful. The failure rate of the subjects using the Lion Alcolmeter SD-400 was approximately 50% of that found in a previous study of the Lion SD-2.