bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of oral prednisolone on the bronchoprotective effect of formoterol in patients with persistent asthma
Authors: Grootendorst D.C. , Sterk P.J. , Heijerman H.G.M. 
Published: July 2002

Tolerance to the bronchoprotective effects by long-acting β2‐agonists (LAB) in patients with asthma is not prevented by inhaled corticosteroids (ICS). This study examined whether oral prednisolone can restore the bronchoprotective effects of formoterol in 24 patients with persistent asthma already treated with ICS (at least 800 μg budesonide·day−1or equivalent) and LAB, using a parallel-group design.During a 2‐week run-in period and during the study, patients used formoterol 12 μg twice daily by Turbuhaler®, instead of their own LAB. At baseline and at the end of 7‐days treatment with oral placebo or prednisolone (30 mg·day−1), provocative concentration of histamine causing a 20% fall in forced expiratory volume in one second (PC20histamine) was measured on two separate days after randomized single-dose inhalation of placebo (postP) or formoterol (postF). In addition, PC20postF was measured 24 h after starting oral treatment. The protective effect by formoterol at baseline and during treatment was calculated as the difference between the logs of PC20postP and PC20postF.The mean±sem in doubling dose (DD) bronchoprotective effect at baseline was 0.8±0.4 DD in the placebo group and 1.0±0.4 DD in the prednisolone group. At the end of the treatment period, the protective effect changed to 1.0±0.5 DD and 0.8±0.6 DD in the placebo and prednisolone treated groups, respectively. This change was not different between the groups (p>0.4).In conclusion, the bronchoprotective effect by formoterol is not influenced by 1 week prednisolone treatment in patients with asthma who are using regular inhaled corticosteroids and long-acting β2‐agonists. These findings indicate that tolerance to long-acting β2‐agonists cannot be restored by oral steroid therapy.
Significance of lymphocytosis in bronchoalveolar lavage in suspected ocular sarcoidosis
Authors: Takahashi T. , Azuma A. , Abe S. , Kawanami O. , Ohara K. , Kudoh S. 
Published: July 2002

Ocular sarcoidosis is frequent in Japan, but in many cases the condition remains undiagnosed in patients with suspected ocular sarcoidosis. Bronchoalveolar lavage (BAL) was performed in order to study the clinical implications of lymphocytosis of BAL fluid in such patients with characteristic ocular manifestations.The subjects included in this study were 39 patients with suspected ocular sarcoidosis. The patients were divided into four types based on high-resolution computed tomography (HRCT) findings; no lung involvement (HRCT-0), bilateral hilar lymphadenopathy (BHL) without lung involvement (HRCT-I), lung involvement and BHL (HRCT-II), and lung involvement and no BHL (HRCT-III). Transbronchial lung biopsy (TBLB) and BAL were conducted after examining serum angiotensin-converting enzyme and serum lysozyme values, skin test for purified protein derivative chest radiograph, HRCT, and gallium scintigram.Twenty patients were histologically diagnosed as having sarcoidosis, and 19 patients remained undiagnosed. Granuloma was identified by TBLB in 19 of 20 patients in type HRCT-II but in only one of 19 patients in types HRCT-0 and HRCT-I (p<0.0001). Lymphocytosis in BAL (>15%) was identified in all patients who showed lung field involvement (type HRCT-II) and in 16 of 19 patients without lung field involvement (types HRCT-0 and HRCT-I). There were 10 patients whose only relevant findings were lymphocytosis in BAL. Among these 10 patients, an increased CD4+/CD8+ ratio (>3.5) in BAL was seen in 60%.The authors conclude that high-resolution computed tomography results yield the same degree of diagnostic accuracy as transbronchial lung biopsy in ocular sarcoidosis suspects. However, bronchoalveolar lavage revealed significant lymphocytosis in patients with negative high-resolution computed tomography results. It should be kept in mind that a diagnostic group of patients with sarcoidosis who manifest ocular involvement and lymphocytosis in bronchoalveolar lavage exists.
Serum surfactant proteins‐A and ‐D as biomarkers in idiopathic pulmonary fibrosis
Authors: Greene K.E. , King T.E. , Kuroki Y. , Bucher-Bartelson B. , Hunninghake G.W. , Newman L.S. , Nagae H. , Mason R.J. 
Published: July 2002

Idiopathic pulmonary fibrosis (IPF) has a high mortality rate, and current therapies are only marginally effective. A serum biomarker that predicts clinical outcome would be useful to stage disease, indicate prognosis and the need for aggressive therapy, and help stratify patients for clinical trials.The goals of this study were to determine whether serum levels of surfactant protein‐A (SP‐A) or surfactant protein‐D (SP‐D) would distinguish between IPF and other types of interstitial lung disease and whether serum SP‐A or SP‐D levels predict outcome in patients with IPF.The authors found that serum SP‐A and SP‐D levels were significantly elevated in patients with IPF and systemic sclerosis compared to sarcoidosis, beryllium disease and normal controls, and that SP‐D correlated with radiographic abnormalities in patients with IPF. In addition, the authors found that both serum SP‐A and SP‐D levels were highly predictive of survival in patients with IPF.This is the largest North American data set of surfactant protein measurements in idiopathic pulmonary fibrosis and the first report using multivariate analysis comparing serum surfactant proteins‐A and ‐D to other commonly measured predictors of survival in idiopathic pulmonary fibrosis. Based on these results, the authors propose that serum surfactant proteins may prove to be useful biomarkers in patients with idiopathic pulmonary fibrosis.
Management of lower respiratory tract infections by French general practitioners: the AIR II study
Authors: Raherison C. , Peray P. , Poirier R. , Romand P. , Grignet J-P. , Arsac P. , Taytard A. , Daures J-P. 
Published: July 2002

The Analyse Infections Respiratoires (AIR) II study is a prospective, multicentre survey of the management of lower respiratory tract infections in patients aged 15–65 yrs by general practitioners (GPs) in France.To obtain real-time data recording, practitioners were required to submit an anonymous copy of their drug prescriptions. They were then interviewed over the telephone about the patients' sociodemographic data, signs and symptoms, as well as their presumptive diagnosis and the investigations they had decided upon.GPs (n=3,144) reported 5,469 evaluable cases. Pneumonia accounted for 9.6% of diagnoses, acute exacerbations of chronic bronchitis 14.9% and acute bronchitis 72.5%. The symptomatology covered an extremely wide range of clinical features, which, although statistically different in terms of incidence, overlapped to a large extent across diagnoses. By contrast, hospitalization, investigations or referral to a specialist were much more prevalent in pneumonia, although still very infrequent in general terms (0.5, 1.2 and 10.8%, respectively). Antibiotics were prescribed in 96.5% of patients, with minor differences between diagnoses. However, other medications such as nonsteroid, anti-inflammatory drugs, steroids, nonspecific antitussives and bronchial liquefiers accounted for two-thirds of the prescriptions.This study demonstrates the lower respiratory tract infections encountered by general practitioners are usually mild. However, antibiotic prescription was more systematic than in previous studies and the prescription of nonspecific symptomatic treatments was twice as frequent. General practitioners did not perform additional examinations or refer on a regular basis. There was a high prescription rate for symptomatic treatment.
Bronchial bacterial colonization in patients with resectable lung carcinoma
Authors: Ioanas M. , Angrill J. , Baldo X. , Arancibia F. , Gonzalez J. , Bauer T. , Canalis E. , Torres A. 
Published: July 2002

The pattern and clinical implications of bronchial bacterial colonization have been widely investigated in patients with chronic lung disease, particularly chronic obstructive pulmonary disease. The main aim of this study was to determine the frequency and risk factors for bronchial colonization in lung cancer patients who have undergone surgical resection.Forty-one patients with resectable lung cancer (22 (54%) active smokers, 52±23 pack-yrs) with a mean forced expiratory volume in one second of 80±16% predicted, were studied with bilateral protected specimen brush and lung tissue biopsy during the surgical procedure. Quantitative bacterial culture, susceptibility tests and histological examination of samples were performed.Bronchial colonization with ⩾1 potential pathogenic micro-organism was found in 17 of 41 (41%) patients. The most frequent strains isolated were:Haemophilus influenzae(35%),Streptococcus pneumoniae(13%) andPseudomonasspp. (9%). The risk factors for bronchial colonization were central location of the tumour (odds ratio (OR)=9.2, confidence interval (CI) 95%=2.1–39.6, p=0.003) and increased body mass index (OR=1.6, CI 95%=1.2–2.2, p=0.005). The frequency of postoperative infectious pulmonary complications was low (five cases (12%)) and no relationship was observed with bronchial colonization.Patients with resectable lung carcinoma had a high rate of bronchial colonization (41%), mainly with potential pathogenic microorganisms. The independent risk factors for colonization in these patients were central location of the tumour and a high body mass index.
Pharmacodynamic steady state of tiotropium in patients with chronic obstructive pulmonary disease
Authors: van Noord J.A. , Smeets J.J. , Custers F.L.J. , Korducki L. , Cornelissen P.J.G. 
Published: July 2002

Tiotropium (Spiriva®) is a new once-daily inhaled anticholinergic that has its effect through prolonged muscarinic (M)3receptor antagonism. It has a clinically documented, long duration of action with once-daily dosing in chronic obstructive pulmonary disease (COPD). A single-centre, double-blind, ipratropium-controlled study was conducted in order to characterize the onset of pharmacodynamic steady state of tiotropium in patients with COPD. Thirty-one patients (25 male, six female) with a mean age of 62 yrs and a mean forced expiratory volume in one second (FEV1) of 1.13 L (38% of predicted) were randomly assigned to receive either tiotropium 18 µg once-daily from a dry-powder inhaler (HandiHaler®, 20 patients), or ipratropium 40 µg four-times daily from a pressurized metered-dose inhaler (11 patients) for a period of 1 week. FEV1and forced vital capacity (FVC) were measured 1 h prior to, and just before inhalation (mean value of the two measurements on test-day 1 was the baseline value, while on all other test days it was the trough value), and 0.5, 1, 2, 3, 4, 5, and 6 h after inhalation of the morning dose of the study drug (one capsule and two puffs) on days 1, 2, 3, and 8.Trough FEV1following 8 days of tiotropium was 0.19 L (18%) above baseline. Approximately 90% of this increase was achieved within 24 h of the first dose (0.17 L, 16%). Trough FVC increased 0.67 L (27%) on test-day 8. Approximately 70% of the improvement was observed after two tiotropium doses (0.47 L, 19%). Achievement of FVC steady state was delayed compared to FEV1. Ipratropium performed typically with an onset of action within 30 min, a peak response between 1–2 h postdosing and a duration of action of ∼4 h. It was concluded that forced expiratory volume in one second steady state with tiotropium is reached within 48 h, while continued improvements in forced vital capacity can be expected over or beyond the first week of therapy. The continued increases in forced vital capacity beyond 48 h suggests that maintenance bronchodilator therapy is required to achieve maximal changes in hyperinflation.
Haemorrhagic hypersensitivity pneumonitis due to naphthylene-1,5-diisocyanate
Authors: Merget R. , Marczynski B. , Chen Z. , Remberger K. , Raulf-Heimsoth M. , Willroth P.O. , Baur X. 
Published: July 2002

Symptoms of hypersensitivity pneumonitis and massive pulmonary haemorrhage occurred in a 24-yr-old male shortly after occupational exposure to naphthylene-1,5-diisocyanate (NDI).The present examination was performed ∼1-yr after the initial life-threatening haemoptysis and following an uneventful recovery after resection of the middle lobe, which had been identified bronchoscopically as the bleeding source. Histological re-examination of the lung was compatible with hypersensitivity pneumonitis.After a chamber challenge with NDI (5 parts per billion (ppb) for 10 min, 10 ppb for 110 min), rales were heard in both lungs, and a fall in vital capacity and partial pressure of arterial oxygen as well as a rise in body temperature were documented. Isocyanate-specific immunoglobulin-G antibodies could not be detected in the patient's serum, possibly due to the long period without exposure to isocyanates.The authors conclude that naphthylene-1,5-diisocyanate may cause immunological pulmonary haemorrhage. The underlying disease is consistent with hypersensitivity pneumonitis and may be triggered by low concentrations of the diisocyanate.
Respiratory viral infections as promoters of allergic sensitization and asthma in animal models
Authors: Schwarze J. , Gelfand E.W. 
Published: July 2002

Respiratory virus infections can trigger exacerbations of asthma and may also contribute to allergic sensitization to aeroallergens and the development of asthma. Conversely, atopy may predispose to more severe virus-induced airway disease. The animal models reviewed in this article support the hypothesis that respiratory virus infections can promote allergic sensitization and the development of asthma. Respiratory viruses can prevent induction of tolerance and enhance sensitization to inhaled allergens resulting in increased airway inflammation and airway hyperresponsiveness.Probable mechanisms involved in this enhanced sensitization are increased permeability of the airway mucosa to allergens and recruitment of dendritic cells to the respiratory epithelium during acute infection. Factors involved in augmenting the consequences of allergic airway sensitization appear to be T-cells, especially CD8+ T-cells as regulators of this process, interleukin-5 as a pivotal cytokine for eosinophilic airway inflammation and eosinophils themselves as effector cells triggering airway hyperresponsiveness. Depending on the timing of allergen exposure, respiratory virus infections which elicit a significant type 1 T-helper cell cytokine response may also downregulate allergic sensitization.Respiratory virus infections in animals previously sensitized to aeroallergens result in prolonged increases in inflammation and airway responsiveness, indicating that critical interactions between immune responses to allergen sensitization and the responses to infection can lead to more severe disease.Taken together, animal models have proved valuable in generating a number of plausible pathogenetic concepts, and can be used to address a host of unresolved questions regarding the immunology of respiratory virus infections, allergic sensitization and asthma.
Role of persistent infection in the control and severity of asthma: focus onChlamydia pneumoniae
Authors: von Hertzen L.C. 
Published: July 2002

Conventional risk factors have been unable to explain most of the substantial increase in the prevalence of asthma observed in many countries during the last few decades. Much attention has been directed at the “hygiene hypothesis”, the apparent inverse relationship between intense systemic childhood infections and the subsequent development of asthma and atopy. However, it is not only the absence or scarcity of infections, but the prolonged presence of certain microorganisms in the lungs that may be involved in the development of asthma.Accumulating evidence suggests thatChlamydia pneumoniae, an intracellular ubiquitous pathogen with an innate propensity to persist and cause chronic infections, may be associated with asthma. This microorganism can achieve a state of “latency” in which it is viable but dormant and does not multiply. During this state, however, chlamydia continues to synthesize the “stress” protein, a 60‐kDa heat shock protein (hsp60). This protein is able to elicit a strong host inflammatory response at sites of its production and appears to be involved in tissue injury and scarring processes.As inflammation has been found to be present in almost all asthmatics, whatever the severity and aetiology of the disease, inhaled glucocorticoids now have an established position in the treatment of early stages. However, corticosteroids negatively affect many aspects of cell-mediated immunity and favour the shift from a T‐helper‐1‐type response towards a T‐helper‐2‐type response. Corticosteroids may thus severely deteriorate the host's ability to eradicate an intracellular pathogen, such asChlamydia pneumoniae, which requires a properly functioning cell-mediated (T‐helper‐1‐type) immune response to be cleared. These drugs are also able to reactivate persistent Chlamydia to an active growth phase, which, by increasing the production of pro-inflammatory cytokines at the site of infection, can further amplify inflammation in the airways of patients with asthma.
Bedside methodsversusdual energy X‐ray absorptiometry for body composition measurement in COPD
Authors: Steiner M.C. , Barton R.L. , Singh S.J. , Morgan M.D.L. 
Published: July 2002

The measurement of body composition is of value in the nutritional assessment of patients with chronic obstructive pulmonary disease (COPD). The purpose of the present study was to compare two bedside methods for the measurement of body composition using dual energy X‐ray absorptiometry (DEXA) as a reference method.Fat-free mass (FFM) was measured using DEXA, bioelectric impedance analysis (BIA) and skinfold anthropometry (SFA) in a cohort of 85 COPD patients accepted for pulmonary rehabilitation. Patients whose body mass index was >30 were excluded.Relative to DEXA, BIA underestimated FFM, whereas it was overestimated by SFA. There was a systematic increase in bias with mean FFM for both DEXAversusBIA and DEXAversusSFA, but this was almost eliminated when results were expressed as FFM index. Significant sex differences in the bias of BIA and SFA measurements of FFM were found. Forty-two (49.4%) patients were identified as nutritionally depleted using DEXA. Compared to DEXA, the sensitivity for detecting nutritional depletion was 86 and 74% for BIA and SFA, respectively, and the specificity 88 and 98%, respectively.There are significant intermethod differences in the measurement of body composition in chronic obstructive pulmonary disease patients. The choice of measurement method will have implications for nutritional assessment in chronic obstructive pulmonary disease.
Dose-related effects of formoterol on airway responsiveness to adenosine 5′‐monophosphate and histamine
Authors: Ketchell R.I. , Jensen M.W. , Spina D. , O'Connor B.J. 
Published: July 2002

Inhaled short-acting β2‐agonists provide greater protection against airway responsiveness (AR) to the mast-cell stimulus, adenosine 5′‐monophosphate (AMP), than to histamine, a direct spasmogen. Both terbutaline and albuterol exhibit this mast-cell stabilizing property in a dose-dependent manner. A single dose of the long-acting β2‐agonist formoterol has also been reported to have a mast cell-stabilizing effect, whereas salmeterol has not. To explore the dose-related actions of the long-acting β2‐agonist formoterol on AR, the authors compared the acute effects of three doses of formoterol and terbutaline on AR to AMP and histamine.In a double-blind, randomized, placebo-controlled, cross-over study, 25 mild, steroid naive, asthmatic subjects attended on 10 occasions. At each visit, subjects inhaled either a single dose of terbutaline (500 µg), formoterol (6, 12 or 24 µg) or a matched placebo, administeredviaTurbuhaler®, 30 min prior to challenge with both AMP and histamine.Each dose of β2‐agonist reduced AR to AMP and histamine. The bronchoprotective effects of formoterol (6 µg) and terbutaline (500 µg) were similar in magnitude in reducing AR to histamine (mean±sd: 3.6±0.3 and 3.1±0.3 doubling doses (DD)) and AR to AMP (3.5±0.5 and 3.3±0.4 DD, respectively). Overall, formoterol reduced AR to both spasmogens in a dose-dependent manner. In addition, formoterol (12 and 24 µg) provided a significantly greater protective effect against AMP than against histamine challenge. It decreased AR by 5.7±0.6 and 6.3±0.7 DD against AMP and 4.3±0.4 and 4.8±0.43 DD against histamine, respectively.The results of this study indirectly demonstrated anin vivodose-dependent mast-cell stabilizing effect of formoterol, in addition to functional antagonism on airway smooth muscle. This property of β2‐agonists may have clinical benefits in asthma management.
Investigating accommodation in language proficiency interviews using a new measure of lexical diversity
Authors: Malvern David , Richards Brian 
Published: July 2002

Lexical diversity is an important indicator of language learners’ active vocabulary and how it is deployed. Traditionally it has been measured by the Type-Token Ratio (TTR), the ratio of different words to total words used. Unfortunately, TTR is a function of sample size: larger samples of words will give a lower TTR and even commonly used measures derived from TTR which are claimed to be independent of sample size are problematic. To overcome this, the authors have developed an innovative measure of vocabulary diversity, D, based on mathematically modelling how new words are introduced into larger and larger language samples, and have produced software (vocd) to calculate it. Previous research by the authors into language proficiency interviews (Richards and Malvern, 2000) investigated linguistic and discourse accommodation of teacher-testers using a wide range of student and teacher variables. In a study of teenage learners of French, the aspect of teachers’ language in oral interviews that was most responsive to the ability of their students was lexical diversity. The analysis reported here focuses on this finding in greater depth using the new measure, D. The relationship between D and other measures of foreign language proficiency is investigated, the Ds of students and teachers are compared and the correlations between teachers’ D and students’ proficiency are computed. Results firstly demonstrate the validity of D as a measure of vocabulary diversity and the effectiveness of vocd as a tool to analyse language data. Secondly, with regard to accommodation processes in oral testing, the two teachers did not finely tune their vocabulary diversity to the proficiency of individual students. Instead, each teacher roughly adjusted his or her language to the ability of the class they examined.