Proceedings of the British Thoracic Society
Journal: Thorax (1983)

gamma camera images were used to assess lung clearance of 99mTc-labelled aerosol particles before and after four weeks' corticosteroid treatment in 12 stable asthmatics (8 men and 4 women; mean age 43 + SD 13 years; mean FEV, 69.2 + SD 20-1% of predicted).Enteric-coated prednisolone, 15 mg daily for two weeks and then 30 mg daily for two weeks, was given orally as a supplement to the patients' usual bronchodilator therapy.FEV, and PEFR improved significantly (p < 0-05 Wilcoxon matched-pairs test); cough frequency decreased significantly (p < 0-05) and five patients who were initially sputum producers (mean 1-1 g/h) ceased to produce sputum after treatment.Regional mucus clearance was assessed by a newly introduced method (Agnew et al.In: Raymond C, ed.Nuclear medicine and biology, Paris: Per- gamon, 1982: 2533), in which the distribution of inhaled SlmKr gas is used to assess the distribution of aerosol alveo- lar deposition so that clearance can be calculated relative to the amount of aerosol deposited on the ciliated airways.Clearance from inner and intermediate lung zones improved slightly despite a small increase in radioaerosol penetration and despite the reduced cough frequency.Peripheral zone clearance improved significantly (p < 0.01).Erythromydn as a prophylactic agent in chronic bronchitis G ANDERSON, ET PEEL, HV THOMAS Acute infective exacerbations of chronic bronchitis cause considerable morbidity and mortality each winter, and many lost days from work.Prophylaxis of such acute attacks would reduce suffering and make economic savings.We report a study, carried out over two winters, of the prophylactic effect of erythromy- cin on acute exacerbations of chronic bronchitis.In the first winter (study 1) 24 patients with chronic bronchitis (MRC criteria) were randomly allocated to take erythromycin stearate 500 mg or identical placebo for a continuous period of two months from 1 November 1979 to 31 December 1979.In the second study 35 different chronic bronchitics were similarly allocated for a three-month period from 1 December 1981 to 28 February 1982.In both studies patients were given an emergency supply of antibiotic (ampicillin or co-trimoxazole) to take for five days and an acute exacerbation was defined as the necessity to use this emergency supply.Patients recorded their chest infections and morning peak expiratory flow rate (PEFR) on a diary card.Fifty-nine patients entered the study.One on placebo and one on erythromycin died of acute infections during the study; the rest completed it.Among the 32 receiving erythromycin there were 36 exacerbations-that is, 1-13 exacerbations per patient.There were 47 exacerbations among the 27 placebo patients (1.74 per patient).These represent a significant difference (p < 0-05).There was no change in the mean peak flow readings of either group.We conclude that erythromycin does have a prophylactic effect against acute infective exacerbations of chronic bronchitis.Nocturnal hypoxia in obese women MCP APPS, PG KOPELMAN DW EMPEY Sleep apnoea and noc- turnal hypoxia occur in obese men, but are said not to occur in obese women.Some women who are obese have evidence of a hypothalmic disorder of prolactin, with no increase in response to insulin hypoglycaemia (non- responder, obese NR); others increase prolactin secretion with insulin hypoglycaemia (responder, obese R).We studied six obese NR (mean age 25, mean weight 110 + 9 kg) and five obese R women (mean age 30, mean weight 96 + 10 kg).They were observed during sleep for two nights.Airflow at nose and mouth was sensed with thermis- tors and movement of the chest and abdomen with inductance coils; oxygen saturation was measured with a Hew- lett Packard ear lobe oximeter.Sleep staging was by stan- dard methods.There were no apnoeic episodes in any woman.In the obese NR women mean Sao2 was 97% awake, 94-5% asleep.There were episodes of desaturation during sleep, range Sao2 84-90%, time Sao2 S 90% 10 s-65 min.In the obese R women mean awake Sao2 was 98%, asleep 95-5%.There were episodes of desaturation, range Sao2 92-94%.Periods of hypoxia occur during sleep in obese women.The finding of a greater fall in Sao2 in the obese NR women suggests that central factors may be involved. Pneumococcal bacteraemia at Central Middlesex Hospital