Summarized in Table 2 are the spirometric values for all 39 patients in both groups at admission and discharge. Table 3 shows the comparison of subjective patient rating, and Table 4 the duration of hospitalization. Among the more severely ill patients whose FEVi was ^35 percent predicted on admission to the hospital, analysis revealed no difference in any response parameter between the placebo group (n = 7) and aminophylline group (n = 11). The mean serum theophylline concentration was 13.6 ±4.1 |xg/ml during the course of hospitalization for the aminophylline group. Analysis of patients whose serum theophylline concentration was ^15 |xg/ml (n = 9) vs <15 |xg/ml (n = 12) revealed no significant difference in any response parameter. Cheap Diskus Advair
Category Archives: Asthma : Part 6
Given subject variability, our sample size was sufficient to detect a minimum difference of 16 percent between the groups at each time period with beta =.20 and alpha =.05 for the Bonferroni multiple comparisons. Although a repeated measures A NOVA could have been performed with missing data, the analysis would not be as powerful and could possibly have led to invalid conclusions. Of the three patients who were readmitted to the study, one admission for each patient was used in the repeated measures ANO\A because the other three admissions had missing data points during the hospital course (eg, too ill to perform pre- and post-bronchodilator spirometry at every time point early in the course).
Of the 44 patients who entered the study, 39 were followed to the completion of the investigation. Two patients with prior history of intensive care unit admissions for asthma and intubation became severely ill and were transferred to the ICU where they recovered after several days. Both patients had been randomized to the aminophylline group. Three patients were discharged against medical advice. Data analysis was performed for the 39 patients who completed the study. Three of the 39 patients who finished the study were entered twice and crossed over to the opposite treatment on readmission (ie, 36 patients were analyzed for 39 admissions). The mean length of time between admission for these three patients was 5.6 months (range four to eight months).
Each patient received albuterol, 2.5 mg in 3 ml of saline solution nebulized via a mouthpiece from a hand held jet nebulizer, driven by 100 percent oxygen at a flow of 6 L/min every two hours for four doses and then every four hours for the duration of hospitalization. If the patient response dictated more intensive therapy, every one or two hours nebulized albuterol doses (2.5 mg) were given. Each patient received oral prednisone, 0.5 mg/kg every six hours for the duration of the study, and each patient received oxygen therapy by nasal prongs to assure at least 90 percent saturation of the hemoglobin. If additional therapy was required, subcutaneous epinephrine or terbutaline was given and/or nebulized glycopyrrolate.
Although the primary evaluation of patient response was bedside spirometry, subjective patient assessment of the treatment was also done on a scale of 1 to 5, which corresponded with much worse (1), worse (2), same (3), better (4), much better (5). In addition, aminophylline and placebo groups were compared for duration of hospital stay.
Several FVC maneuvers were done until three acceptable efforts were obtained. The best values for FVC, FEV1 were chosen; FEF 25-75 values were selected from the best FVC maneuver. Hard copy of the flow-volume loop and volume-time curve were obtained from each maneuver; criteria for acceptance or rejection were based on the ATS Statement on Standardization of Spirometry. The spirometer was calibrated daily using a 3.0 L test syringe to calibrate both volume and flow as described in the operators manual. Spirometry was done each day of hospitalization every eight hours (8 am, 4 pm, 12 noon) before and 15 minutes after nebulized albuterol treatments. Other laboratory values done on admission to the study included arterial blood gases, blood chemistries, chest x-ray, ECG, and serum theophylline concentration (determined by the enzyme immunoassay techniques). proventil inhaler
We enrolled 44 adult patients aged 18 to 49 with acute asthma who were seen in the emergency department (ED) in a 450-bed city-county teaching hospital over a 13-month period. All patients enrolled in the study were able to give informed consent and were suffering from an acute exacerbation of asthma without other underlying serious conditions. Diagnosis of asthma was defined by the criteria of the American Thoracic Society. Further inclusion criteria were as follow: (a) failed to respond adequately to four hours of standardized treatment in the ED (albuterol, 2.5 mg nebulized every hour for four doses; methylprednisolone, 125 mg intravenously on admission to ED, and oxygen), and (b) deemed in need of hospitalization by the ED physician guided by the criteria of the American Thoracic Society. Patients with chronic bronchitis or emphysema, pregnancy, respiratory failure (defined as Pco2>45, pH<7.35 with signs of respiratory muscle fatigue), and other complicating cardiopulmonary diseases (eg, pneumonia, decompensated heart failure) were excluded. The study was approved by the University Institutional Review Board. cialis professional
Asthma is a major cause of emergency hospitalizations in the United States, accounting for over 450,000 admissions annually in recent years with an average hospital stay of 4.8 days in 1987. Despite little evidence of efficacy, intravenous aminophylline is routinely added to beta agonist and glucocorticoid therapy in the management of hospitalized asthmatic patients, and texts continue to recommend its use. Although hundreds of papers have been published regarding theophylline pharmacokinetics and proper monitoring of serum concentrations, cases of life-threatening toxicity and death continue to be reported. Therapy with this agent is also costly, especially monitoring serum theophylline concentrations.
We found that the prevalence of exposures and the associations between asthma and some indoor environmental exposures differed between two communities within the southern region of Saskatchewan. We have provided further evidence that exposure to ETS in children is important when considering asthma — flovent inhaler. We have also shown that other indoor environmental characteristics, such as home mould or dampness, are important but may be most significant at a local level. Finally, we have shown that although risk factors for asthma are generally similar in boys and girls, there are potential differences.
Although the communities we studied were both in the southern region of Saskatchewan and had many similarities in size and industry, some differences may have influenced the findings. The area surrounding Estevan is the site of strip mining for coal and coal-fired power plants. Air quality measurements were available in Estevan; however, they were not available in Swift Current and, therefore, could not be used in the present study. Estevan averages more annual rainfall than Swift Current (333.1 mm versus 265.2 mm, respectively), and has a lower unemployment rate than Swift Current (2.2% versus 3.8%), although both communities are below the Canadian unemployment rate. ventolin inhaler
Hessel et al and Duhme et al have shown that environmental factors are not consistently associated with asthma across different locations within the same study. Although our study supports this, some of the significant associations between asthma and environmental factors differed between our study and that of Hessel et al and Duhme et al. These inconsistencies could be due to differences in methods or variations in settings. Buy Asthma Inhalers Online