Search

We studied the bronchodilator effects of inhaled fenoterol, a relatively selective beta-2 adrenergic agent, and ipratropium an anticholinergic drug, singly and in combination in 10 patients with asthma. The period of observation was 6 hr after aerosol administration. The six drug regimens used were fenoterol 100 micrograms, fenoterol 200 micrograms fenoterol 50 micrograms combined with 20 micrograms of ipratropium, fenoterol 100 micrograms combined with 40 micrograms of ipratropium, 40 micrograms of ipratropium, and placebo. Measurements consisted of spirometry with determination of forced expiratory volume in one second (FEV1), maximal expiratory flow at 50% of vital capacity (V50), specific airway conductance, lung volumes, and heart rate. Bronchodilation with regimens containing fenoterol was rapid, with 75% of the maximum response achieved by 5 min, while the peak effect of ipratropium was delayed for 1 to 2 hr. Fenoterol 100 micrograms produced approximately half the degree of improvement in FEV1 and V50 compared with 200 micrograms of fenoterol. The addition of 40 micrograms of ipratropium to 100 micrograms of fenoterol resulted in bronchodilation equivalent to 200 micrograms fenoterol and was associated with a more prolonged effect than fenoterol 100 micrograms. Tremor was observed in two-subjects inhaling fenoterol 200 micrograms but was not observed with any other regimen. It is concluded that the combination of inhaled ipratropium and fenoterol is an effective bronchodilator in asthma, achieving efficacy similar to that of fenoterol alone but with fewer side effects.

Protease-antiprotease imbalance in the lung is considered a likely pathogenetic mechanism in the development of emphysema. To assess whether differences in enzyme release from stimulated neutrophils could be a factor leading to increased elastase release in the lung, we compared the in vitro release of elastase and a lysosomal enzyme, β-glucosaminidase, from neutrophils of nonsmokers and smokers. Neutrophils were stimulated in vitro by zymosan as a phagocytic stimulus, and the synthetic polypeptide, N-formyl-methionyl-leucyl-phenyl-alanine (FMLP) as chemotactic factor. We studied 54 male subjects, 24 nonsmokers (mean age, 39.5 ± SD 14.4 yr) and 30 smokers (mean age, 45.4 ± SD 8.2 yr). Smokers were divided into 2 groups according to results of their lung function, 17 with normal and 13 with abnormal lung function. Smokers with abnormal lung function were older (59.8 ± SD 11.8 yr) and had smoked more (45.6 ± SD 18.2 pack-years) than smokers with normal lung function (mean age, 39.8 ± SD 11.0 yr; smoking, 22...

The clinical features of 81 cases of abdominal tuberculosis (TB) are presented. The peritoneum was involved in 41 patients, the ileocecal area in 17, the anorectal area in 16, and mesenteric glands in 8. There was one case each involving the liver and sigmoid colon. Most patients were young women. The tuberculin reaction was significant in 83% of patients tested, and 54% had evidence of TB elsewhere. Tuberculous peritonitis was more common in native North American Indians and presented as an acute abdomen, abdominal tumor, or cirrhosis. Asians developed the majority of ileocecal and mesenteric lymph node disease and were frequently diagnosed as having Crohn's disease, appendicitis, or cancer. Anorectal cases presented with fistulae or abscesses and usually had concomitant pulmonary TB. The disease was fatal in five patients (6%), four of whom were diagnosed only after death. One noncompliant patient had a relapse. All other patients were cured after receiving treatment.