Sheldon L. Spector

Beneficial effects of propylene and polyethylene glycol and saline in the treatment of perennial rhinitis

Although propylene‐and‐polyethylene‐glycol and saline have been used in clinical studies as placebos, their possible therapeutic role as welling agents in the treatment of perennial rhinitis was investigated. Clinical and laboratory response to these agents was measured in eighteen patients during a 2‐week baseline period and with 4 weeks of active treatment in a double blind randomized study. After 2 and 4 weeks there was a significant improvement compared to baseline in nasal function (P<0.05) and blockage index (P<0.01) combining both groups, with no difference between treatments. Patients had less sneezing at 2 and 4 weeks (P< 0.01), and less stuffiness at 4 weeks (P< 0.01). There was a significant correlation between improvement in blockage index and nasal biopsies when both were judged independently of the other. This study has demonstrated that wetting agents offer both subjective and objective improvement in the treatment of perennial rhinitis and merit consideration prior to (or along with) other agents with known systemic side effects.

Bronchial inhalation challenge with antigens

In the following discussion, we will cover certain aspects of (1) antigen inhalation challenge with emphasis on clinical usefulness and (2) recent observations regarding methacholine and histamine inhalation challenges which have not been discussed by the other speakers at this Workshop. Due to time limitations we will present generalizations and hope that the details of these generalizations will emerge during subsequent sessions.

Clinical and nasal biopsy response to treatment of perennial rhinitis

Nasal biopsies of patients with perennial rhinitis were performed at baseline and compared with biopsies performed 4 wk after active flunisolide, 50 micrograms four times per day, or placebo. An effort was made to relate histologic findings to other subjective and objective parameters as an indication of response to treatment. Although patients admitted to the study had severe subjective nasal symptoms, biopsies varied considerably. Some resembled biopsies from normal individuals, and others showed marked edema and inflammation; the latter findings were more typically present in the biopsies of patients with the most severe disease. A decrease in edema and loss of inflammatory cells on biopsy as well as a corresponding decrease in eosinophils on the nasal smear usually accompanied clinical improvement, which occurred in both the active and placebo groups.

Dose-response effects of albuterol aerosol compared with isoproterenol and placebo aerosols: Response to albuterol, isoproterenol, and placebo aerosols

Albuterol aerosol was an effective bronchodilator as reflected by indices of pulmonary function obtained from spirometry and flow volume curves; Compared with isoproterenol, there were minimal side effects even at the highest doses, and bronchodilation lasted significantly longer. In addition albuterol was successfully used by a patient with idiopathic hypertrophic subaortic stenosis who was unable to tolerate isoproterenol, as well as by some patients with idiosyncratic responses to isoproterenol; A few patients appeared to derive little benefit from either albuterol or isoproterenol.

Comparison between transillumination and the roentgenogram in diagnosing paranasal sinus disease

The reliability of transillumination versus roentgenogram to diagnose maxillary and frontal paranasal sinus disease was assessed in 52 subjects with rhinitis and/or asthma. Two different otolaryngologists transilluminated the sinuses while the roentgenograms were evaluated by a radiologist and a third otolaryngologist. Patients filled in questionnaires of symptoms. There was excellent agreement (p < 0.001) between otolaryngologists regarding transillumination of the frontal sinuses but not the maxillary sinuses. Similarly, transillumination of the frontal sinuses correlated well with the roentgenograms. This was not true for transillumination of the maxillary sinuses. Although pain in the upper teeth related well to the presence of frontal disease, sinus headache was a frequent complaint but not useful as a predictor of sinus disease. Even though transillumination of the frontal paranasal sinus has some predictive value, the technique of transillumination has limited usefulness as a diagnostic tool and is not an adequate substitute for roentgenogram.

The use of cultures and immunologic procedures to predict oropharyngeal candidiasis in patients on steroid aerosols

Sixty‐seven asthmatic individuals treated with either beclomethasone diproprionate or flunisolide were sequentially evaluated for up to 32 months to determine the incidence of oropharyngeal candidiasis as well as laboratory parameters which might be predictive of this complication. Throat cultures and measurements of Candida antibody by immunodiffusion and radioimmunoassay were performed and compared over time and treatment groups. Unlike other studies, pre‐treatment Candida precipitins did not predict increased risk for clinical thrush nor did quantitative determinations of Candida antibody. Those patients with positive cultures pre‐trial, however, had a significantly higher incidence of clinical thrush than those with negative cultures (P < 0.01).

Use of provocation techniques for the evaluation of drug efficacy

The chairman of this round-table discussion, Dr. David Herzig, asked me to address the following three questions. I will respond to them in this order: (1) How does one select patients for bronchial challenge in terms of (a) disease, (b) present therapy, and (c) sample size? (2) What baseline and placebo studies are needed? (3) Does blocking of bronchial challenge with a drug predict actual efficacy of the drug in a double-blind clinical investigation?

More implications of reactivity characteristics to methacholine and histamine in asthmatic patients

In a recent review of the epidemiology and natural history of asthma, Reed’ sites 2 observations made by McNickol and William?. x in his pediatric studies which, at first glance, did not seem to apply to our clinical experience with adult patients, yet with further scrutiny, made some sense. 1. Early onset of asthma carries a risk of increased severity. Thus, in a third of the 14-yr-old asthmatic patients with very frequent or unremitting symptoms, the disease began before 6 mo of age, while only 3% of lCyr-old subjects with mild asthma had their symptoms before age 3 yr. 2. Children with severe asthma more often have hay fever and eczema, have more numerous positive skin tests, and have higher levels of IgE than children with mild asthma. Keeping these 2 observations in mind, we recently related histamine and methacholine reactivity to other observations that reflect on severity of asthma, age of patient at onset, and reagin mediation.