Roger C. Bone

Oropharyngeal candidiasis in patients treated with triamcinolone acetonide aerosol

Thirty asthmatic patients participating in a trial of triamcinolone acetonide aerosol were evaluated to determine the relationships among symptons of sore throat or hoarseness, the appearance of the throat on physical examination, and the presence of yeasts on pharyngeal culture. Observations were recorded prior to aerosol therapy and repeated after 2 wk, 4 wk, 6 wk, 4 mo, and 6 mo of therapy. A total of 15 patients (50%) experienced sore throat or hoarseness, 15 (50%) had yeasts cultured from the pharynx on at least one occasion, and 11 (37%) at some point had an abnormal throat examination; however, there was no predictable relationship between symptoms or abnormal physical examinations and the presence of a positive culture. The frequency of positive cultures did not change significantly during the observation period. Twelve patients had positive yeast cultures on 50% or more of their samples. The incidence of symptoms was not sigficantly increased in these chronically colonized patients. Symptoms were usually transient, and discontinuation of the aerosol or antifungal therapy was unnecessary. Triamcinolone aerosol was not associated with significantly increased pharyngeal colonization with yeasts in this 6-mo study. Existing chronic colonization is not necessarily a contraindication to triamcinolone therapy. Sore throat and hoarseness are usually unrelated to yeast infection in patients using triamcinolone acetonide aerosol.

The Oxyhemoglobin Dissociation Curve in Type A and Type B COPD

Patients with chronic obstructive pulmonary disease (COPD) have been clinically separated into Type A and Type B COPD. Type A patients are characterized by the presence of anatomical emphysema or an increased total lung capacity, low sputum production, late onset of cough, rare hypercapnia, rare cor pulmonale and absent polycythemia. In contrast, Type B patients are characterized by roentgenographic evidence of chronic inflammation or smaller total lung capacity, significant sputum production, frequent hypercapnia with cor pulmonale and the presence of polycythemia. We studied whole blood oxygen transport (P50, 2,3-DPG, and ATP) in 11 Type A patients and 13 Type B patients. Whole blood oxygen transport was not different in the two groups of patients. Type A patients with higher hemoglobin values had a lower 2,3-DPG. Type A patients with a higher hemoglobin value also had a higher ATP level. In all patients, Type A and Type B, 2,3-DPG was inversely related to hemoglobin concentration. Despite other distinguishing clinical and laboratory characteristics, whole blood oxygen transport was not different in Type A and Type B patients.