Roger H. L. Wilson

Clinical evaluation of enzymatic therapy in diseases of the chest.

Abstract The initial enthusiasm with which enzyme therapy was greeted must now be tempered with caution. Although excellent results have been obtained with application of various enzymes in diseases of the chest, toxic manifestations both immediate and delayed have become numerous enough to give us pause in the routine use of these agents. The main problems to be resolved in enzyme therapy appear to be the following: 1.1. Enzymes used clinically at present are derived from non-human sources and are applied to sites in which such substances would not normally occur. They may give rise to antibody formation with occasional marked hypersensitivity causing severe local and systemic disturbances. 2.2. The enzymes themselves or the products of lysis produce local and systemic reactions of varying severity in almost all patients, depending upon dosage and route of administration. 3.3. Late toxic effects upon epithelium have been seen in the tracheobronchial tree. 4.4. The dissolution of fibrin plugging a bronchopleural fistula or a vessel gives rise not infrequently to hydropneumothorax or severe hemorrhage. Prediction of success or complication in the therapeutic application of enzymes is not now possible. Serious complications may occur early and it is necessary carefully to calculate the risks when enzyme therapy is proposed. This is not to suggest that enzyme therapy should only rarely be employed, but to emphasize the powerful nature of these agents and the dangers in their indiscriminate use.

Evaluation of a new bronchodilator aerosol and its components in pulmonary emphysema

The effects of nebulized isoproterenol dispensed in the conventional Freon propelled cartridge were studied in a group of emphysematous patients. The components of the study included combination with a surfactant (thonzonium bromide), the surfactant alone, isoproterenol alone, propellant and solvent alone, an isoproterenol analogue, and a simulated preparation of room air. Seventeen patients in the group were completely studied in three separate series. A fourth series with differing concentrations of thonzonium bromide was included. Results show an enhancing effect with prolongation of improvement with the addition of thonzonium bromide, the possible importance of a rebound reaction at 30 minutes, a definite improvement with propellant and solvent, and that the best concentration of thonzonium bromide is at 0.1 per cent. The clinical implications are discussed.

The rational approach in the use of bronchodilators in chronic respiratory disease.

Excerpt Pharmacologic bronchodilators have been used perhaps as long as any known medicinal agent. The use of ephedrine (ma hwang) is shrouded in the mists of Chinese antiquity. The burning of stra...