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1. The antitussive properties of bronchodilators were evaluated in a total of 47 normal volunteers. 2. Cough was induced by inhalation of ultrasonically nebulized solutions of distilled water and hypotonic saline. 3. Inhaled fenoterol hydrobromide (360 micrograms; 20 volunteers) and inhaled ipratropium bromide (72 micrograms; 14 volunteers) both significantly reduced couch compared with placebo (P less than 0.01). Oral salbutamol sulphate (4 mg; 11 volunteers) and oral pirenzepine hydrochloride (50 mg; 14 volunteers) had lesser effects. 4. Cough inhibition correlated with a small but statistically significant degree of bronchodilatation as measured by specific airway conductance (sGaw) and forced expiratory volume in one second (FEV1) in six normal subjects studied with each treatment in a placebo controlled, double blind study (r = 0.67, P less than 0.001). 5. Small reductions in airway tone are associated with a reduced cough response elicited by inhaled ultrasonically nebulized distilled water.

In this study is reviewed the experience at Papworth Hospital, Cambridgeshire, and Great Ormond Street Hospital, London, with combined heart-lung transplantation. Between April 1984 and June 1989, 73 patients have undergone heart-lung transplantation. Donors and recipients were carefully matched with regards to serology, morphology and cytomegalovirus compatibility. Heart preservation was based on use of cold St. Thomas' cardioplegic solution; a pulmonary preservation fluid has been developed that allows distant organ procurement with a single pulmonary artery flush technique (Papworth solution). The recipients were: 21 pts with Eisenmenger's syndrome, 15 pts with pulmonary hypertension, 37 pts with pulmonary disease (including 22 cystic fibrosis). The results are: no surgical mortality; no acute cardiac rejection episodes. Twenty-three patients died (16 with infections, 3 with obliterative bronchiolitis, 2 with cerebral embolism and 2 others). The actuarial survival rate at one year is 73.2%; 63% at two years and 47.4% at four years. The use of transbronchial biopsy of the lung has provided accurate early and safe diagnosis of pulmonary rejection. Development in organ preservation and patient management, as well as careful selection of recipients and donors, have led to the effective use of resources and thereby to these good results.

16 patients undergoing coronary artery bypass grafting using cardiopulmonary bypass (CPB) had blood samples taken at various times before, during and up to 1 week after surgery for estimation of beta-thromboglobulin (BTG), alpha-1-antichymotrypsin (ACT), factor VIII procoagulant protein (VIII:C), von Willebrand factor antigen (vWF:Ag) and ristocetin co-factor (vWF:RiCoF). vWF:Ag and vWF:RiCoF rose during and following surgery in a different manner to ACT. At 1 week there was a significantly disproportionate rise in vWF:Ag compared to vWF:RiCoF which suggested a degree of pulmonary endothelial damage. Prostacyclin, which was administered to 8 of the patients during CPB, reduced platelet activation as measured by a reduction in the release of BTG and also attenuated the consumption of VIII:C. It had no effect on pulmonary endothelial damage as measured by the ratio of vWF:Ag to vWF:RiCoF.

Coughing is one of the most common of respiratory systems, and yet few anti-tussives are wholly effective and safe. Centrally acting anti-tussives not only inhibit coughing, but also depress ventilation. As an alternative approach, therapies acting on the afferent limb of the cough reflex are explored. Coughing can be reflexly induced in man by reducing the chloride ion content of airway surface lining liquid (ASL). This can be achieved by inhaling aerosols of hypochloride aqueous solutions nebulized ultrasonically. The cough reflex so provoked may be an important protective mechanism to prevent wide excursions of ionic content of ASL. We have demonstrated that pretreatment with inhaled beta-sympathomimetic and anti-muscarinic drugs inhibit this cough reflex whilst oral beta-sympathomimetics and anti-muscarinics have less effect. It is unlikely that either group of drugs directly affect the vagal epithelial receptors responsible for the cough reflex induced by hypochloride solutions. We hypothesize that these agents may act by limiting the communication between the ASL and the paracellular channels, where the receptors lie between the epithelial cells, by tightening the junctions between cells. This may also explain why beta-sympathomimetic agents inhibit the cough of viral infections and the cough of asthma.

Twenty patients were studied to assess the value of aerosol ventilation scintigraphy, using 99Tcm diethylene triamine penta-acetic acid (DTPA) as a screening test for bronchiectasis. All patients had previously undergone bronchography for suspected bronchiectasis. Nine had cylindrical bronchiectasis and 11 had no demonstrable abnormality. Only two of the 20 patients had features suggestive of bronchiectasis on their chest radiographs. Segmental defects in ventilation were demonstrated by scintigraphy in five of the nine patients with bronchiectasis (56%). Regional ventilation appeared normal in 26 of the 27 lungs which were bronchographically normal (96%). Whilst the sensitivity of aerosol ventilation scintigraphy in detecting bronchiectasis is low (56%), it compares favourably with that of the chest radiograph (22%) in this group of patients with mild disease and non-specific symptoms. Thus, in some, it may obviate the need for bronchography.