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The diagnosis of COPD can easily be made on the basis of history, physical findings, and simple laboratory procedures. Treatment is aimed at symptoms and is individualized to the patient's needs. Therapy must be given on a long-term basis. The patient should be educated in the basic nature of his disease and encouraged to return to as normal a life as possible. Patients with COPD often are severely restricted in their earning ability, and treatment can cause a severe financial drain. Thus the physician should carefully consider costs--especially the cost of medications. Finally, the correct choice and use of the many therapeutic measures available can yield marked symptomatic relief and improvement in lifestyle--often allowing the patient to return to productive employment.

Twenty-three patients with severe hemophilia were given single or multiple doses of diphenhydramine hydrochloride, chlorpromazine hydrochloride, or guaifenesin to test their effects on hemostasis. In contrast with earlier studies with aspirin, bleeding times were not prolonged after ingestion of these three drugs. No patient had hemorrhage because of the drugs, and none recalled excessive bleeding following drug ingestion. These results greatly extend the clinical implications of prior observations carried out in normal subjects demonstrating that many antiplatelet drugs have no effects on in vivo hemostasis. We conclude that these drugs are probably safe for patients with bleeding disorders like hemophilia.

The results obtained in a single blind controlled study using a new preparation, guacetisal, and an already available similar product based on dimethylaminophenazone guaiacolglycolate and calcium ethylcamphorate, are reported. The drugs were administered to 28 elderly patients of both sexes suffering from bronchopneumopathies for a period of 7 consecutive days with 2 suppositories/day. The results generally favoured the new product. Tolerance was very good at all levels.

The physical and chemical properties, administration, biotransformation, pharmacological effects, clinical applications, side-effects, toxicity and contraindications of glyceryl guaiacolate ether in the horse are reviewed.

An understanding of the anatomic, physiologic, and pathophysiologic aspects of cough is necessary to appropriately diagnose and treat patients with cough. In the majority of persons, cough that is acute and self-limiting is usually secondary to a viral upper respiratory tract infection; cough that is chronic and persistent is usually due to chronic bronchitis or postnasal drip. In the remaining persons, to determine the cause of cough, it is necessary to systematically consider anatomic locations were receptors and afferent nervous pathways are located. Definitive treatment of cough depends on determining its precise cause and then initiating specific therapy for the underlying disorder. Only when the cause of cough remains unknown or when cough performs no useful function and its complications represent a potential hazard to the patient, should symptomatic treatment be considered. Combination cough preparations should not be prescribed.

The efficacy of guaifenesin in reducing cough frequency in young adults with acute respiratory disease was evaluated by both an objective cough counting system and a questionnaire. A guaifenesin cough preparation and the syrup vehicle were administered in a double-blind manner. Coughs were recorded on tape over a 24-hour baseline evaluation period and a 36-hour treatment period for 42 patients. A pronounced diurnal variation in cough frequency was observed. The evaluation of efficacy was based upon comparisons between equivalent six-hour time periods of successive days. No antitussive effect of guaifenesin was demonstrated. The questionnaire was administered to 65 patients, including the 42 whose coughs were recorded. Of 26 patients with productive cough receiving guaifenesin, 25 (96 percent) reported a decrease in sputum thickness compared to 13 (54 percent) of 24 patients receiving the vehicle (p = 0.01, Fisher exact test). Twenty-three of 26 (88 percent) patients receiving guaifenesin also reported reduction in sputum quantity compared to 15 of 24 (62.5 percent) receiving the vehicle (p = 0.07, Fisher exact test). The diurnal variation in cough frequency measured by the tape recording was not apparent from the subjective cough frequency estimates obtained by the questionnaire.

The defenses of the lung against inhaled gases and particles include aerodynamic filtration mechanisms of the tracheobronchial tree, mechanical clearance and local detoxification. Cough, mucociliary transport, alveolo-bronchiolar fluid flow and clearance to lymph and blood participate in the mechanical excretory mechanisms whereas phagocytosis, immunologic and secretory mechanisms, and tissue reaction represent in-situ detoxification. Impaired mucociliary transport causes obstruction of the airways, the pathophysiologic hallmark of chronic nonspecific lung diseases. The clearance of diseases airways is not easy. It may be accomplished either by changing primarily the physicochemical properties of the mucus or by stimulating ciliary activity. By means of doublebind-crossover studies in patients with stable chronic nonspecific lung diseases, it is shown how drugs which presumably improve the clearance of diseased airways do affect the various physicochemical properties of the tracheobronchial mucus.

Thirty-four patients, 21 male and 13 female, with chronic asthma and tenacious mucoid expectoration were studied regarding clinical parameters, PEF, airway resistance and sputum viscosity measured according to the n.m.r. method (nuclear magnetic resonance); a technique for determination of the water phase viscosity. Using double-blind cross-over technique, oral treatment with the two drugs and placebo was given during three consecutive 12-day periods with 48-h intervals free of test drug. No significant improvement in clinical state, PEF or airway resistance could be demonstrated. Nor did the sputum viscosity show any significant change after treatment with the different preparations. However, regarding the patients' own preference of drug as to mucolytic effect, a significant difference in favour of bromhexine at the 0.1% level was shown.

The investigations presented were undertaken to find out whether a long-term treatment of chronic bronchitis with a combination of tetracycline, theophylline, doxylamine succinate, etafedrine, phenylephrine and guaifenesine could reduce the frequency of recurrent infections of the respiratory system. Out of 57 patients who all had suffered from at least one exacerbation in the year preceding the trial only 12 showed clinical signs of an ixacerbation during the study. 12 exacerbations occurred during the placebo phase, 6 during the treatment with Ditenate Tetra. It is specified why such a long-term treatment with an antibiotic should be reserved only for patients who are especially endangered by the exacerbation. The results of numerous microbiological investigations of sputa, nose and throat swabs before and during the long-term study are interpreted under certain aspects and questioning.

A double-blind placebo-controlled crossover study was done to evaluate the efficacy of an oral decongestant preparation in the treatment of rhinitis. The preparation consisted of 5 mg of phenylephrine hydrochloride, 45 mg of phenylpropanolamine hydrochloride, and 200 mg of guaifenesin (Rymed). Subjects were selected for participation in the study on the basis of history, physical examination, and immediate hypersensitivity skin testing. Fourteen of 20 subjects (P less than .05) observed a reduction in the severity of nasal symptoms while taking the drug. The mean symptom score of the 20 subjects while taking the drug was 31.344 and while taking placebo, 42.979. This is a statistically significant difference (P = .009717). Side effects were minimal. We concluded that the oral decongestant preparation used in this study is effective in controlling symptoms of rhinitis.

Lotussin and linctus diphenhydramine were compared for efficacy and patient preference in fifty patients suffering from post-infective cough. The trial was a single-blind randomized crossover one which was subjected to sequential analysis based on patient preferences. Under the conditions of the trial there appeared to be a significant difference in favour of Lotussin (p less than 0-01).

The results of the implementation of Myoscain E/Holzinger in the treatment of the "pseudocroup syndrome" (laryngitis catarrhalis) are reported. The generally prompt action of the drug is stressed. It is pointed out that non-response to the compound suggests a more serious form of the disease necessitating close observation. A list of diseases involved in the differential diagnosis is added.