- Email: [email protected]
262-PA11 Acid-base disturbances in acute asthma severity classification
64
Tubercle and Lung Disease: Supplement 2
ratio of Ca ++ decreased. Our results were not significant statistically. In conclusion, these findings suggest that, in the patients with bronchial asthma, changes in the electrolyte composition of the bronchial wall structures are not reflected to BALF.
158-PAll Comparative effectiveness of Atrovent and Berotec therapy in patients whith bronchial asthma Feschenko, U.I., Yashina, L.A., Poluanskaya, M. Institute of Phthisiology and Pulmonology, F. Ianovsky Academy of Medical Sciences of Ukraine, Kiev, Ukraine
The comparative effectiveness of Atrovent in singleacting dose 0,04 mg and Berotec in single-acting dose 200 mg (Boeringer Ingelheim, Austria) was studied in 20 patients with moderate bronchial asthma (FEV~ 60-75%). Patients had a mean age of 36 years old, male 11, female 9. Clinical symptoms, parameters of body plethysmography, Peaf-Flow Curve of forced expiration were investigated ("Bodytest", Erich Jaeger, Germany). Bronchial dilatation, which was observed under the influence of Atrovent, was less expressive vs Berotec: improvements in FEV1 under the influence of Atrovent in 30 rain and 1 hour after the inhalation of medicine were by 15 per cent whereas the increasing of this index after the inhalation of Berotec were by 30 per cent in 30 rain. Thus, bronchial dilatation under the influence of Atrovent approached later and it was more weak vs Berotec.
176-PAll
Sputum eosinophilia in asthma
Spanevello, A., Migliori, G.B., Satta, A., Landoni, C. V., Neri, M. Fondazione Clinica del Lavoro, Tradate, Italy
The aims of this study were to compare the sputum cell counts in subjects with stable asthma with those in normal subjects and to assess if the % of sputum eosinophils (eo) in asthmatics was correlated with severity of disease and the number of peripheral blood eo (n/L) counted the day of sputum induction. 15 asthmatics (A) with mild to severe asthma (Aas score), mean age: 52.4 + 19.2 yr, FEVI: 84.6 + 21.2% predicted and 8 normals (N), mean age: 35.5 + 7.4 yr, FEVI: 103.1 + 6.1% pred. inhaled hypertonic saline (3-4%) for 20 rain. Sputum analysis was performed as described by Maestrelli et al. (Clin Exp Allergy 1994: 24:29-34). Blood eo (n/L) were counted the day of sputum induction. Mann-Whitney U and Spearman rank test were used for statistical analysis; a value of P < 0.05 (*) was considered significant. Results:
Tot. cell (n/mg) Mac % Neut % Eos % Lym % Epit % Squa %
sputum N
sputum A
1.4 63.0 25.1 0.4 0.1 0.3 11.0
2.4 + 1.6 44.8 + 10.0" 38.9 + 14.2" 10.4 + 11.7" 0.2 + 0.2 0.9 -+ 1.8 4.7 _+ 7.7
+ 1.2 + 11.4 + 10.8 + 0.3 + 0.2 -+ 0.5 -+ 7.3
- correlation Aas score/sputum eo (r = 0.617; P < 0.05) - correlation blood eo/sputum eo (r -- 0.697; P < 0.05) Asthmatics have a higher % of eosinophils and neutrophils in induced sputum compared with normals and the % of sputum eosinophils is correlated with asthma severity and number of peripheral blood eosinophils.
195-PAll A clinical trial of nebulised magsulf vs nebulised salbutamol in acute severe bronchial asthma Mangat, H.S., D'Souza, G.A., Jacob, M.S., Mercy, A. St. John's National Academy Of Health Sciences, Bangalore, India
Recent studies describe the use of intravenous Magnesium Sulfate (MgSO4) to reverse bronchospasm in acute asthma. However no study is available on nebulised MgSO4 in acute asthma. Patients with acute severe bronchial asthma in the Emergency Department and not requiring ventilatory care were included in a double blind randomised controlled trial. All patients received 100 mg hydrocortisone. Patients then were randomly assigned to receive four nebulisations spaced at 20 rains. interval of either 3 ml of 3.2% solution of MgSO4 (95 mg) or 3 ml salbutamol (2.5 rag) each. Serial PEFR was then measured for 2 hours. The mean increase in PEFR was 150% with nebulised MgSO4 and 140% with nebulised salbutamol. All the patients receiving MgSO4 showed a therapeutic response, while 40% of patients who received salbutamol did not and required admission. None of the patients showed any significant adverse effects. We conclude nebulised MgSO4 is safe and consistently effective in acute bronchial asthma, and may offer savings due to its low cost and in preventing the need for admission.
262-PAll Acid-base disturbances in acute asthma severity classification Radovanovic, S., Petrovic, V., Milenkovic, B., Ilic, A., Vukcevic, M. Institute for Pulmonary Diseases and TB, University Clinical Centre, Belgrade, Yugoslavia
We analysed acid-base (AB) profile in 101 acute asthma episodes considering it according to asthma severity. There were 43 cases of moderate (M) and 58 cases of severe (S) asthma. In 101 episodes we found 82 (81,2%) cases of AB disturbances: respiratory alkalosis (RAL), respiratory acidosis (RAC), lactic acidosis (LAC), coexistent RAC and LAC (RLAC) and metabolic alkalosis (MAL). In M group normal AB profile was presenting in 30% episodes and in the others AB disturbances were as follow: 22 (77,3%) cases of RAL, 5 (15,7%) cases of LAC and 3 (10%) cases of MAL. In S group normal AB profile was found in only 6 (10%) cases and in the other 52 attacks acidosis was presenting in 25 (67,3%) cases: RAC, isolated (15) or associated with LAC (13) in more than half of episodes (28) and LAC, isolated (7) or associated with RAC (13) in 20 episodes. RAL was
Abstracts 65
presenting in 14 and MAL in 3 episodes of severe asthma. Difference in AB profile between M and S group was significant (P < 0,001). We conclude that the most moderate and severe asthma attacks are presenting with AB disturbances. While RAL is most common in moderate asthma, RAC or RLAC are presenting only in severe asthma. AB profile could be one of the criteria for asthma severity classification.
302-PAll
Asthma deaths in OAUTHC, Ile-Ife
Erhabor, G.E., Adigun, A.O. Dept. of Medicine, OAUTHC, Ife, Nigeria
Deaths from asthma continue to increase despite increase in antiasthma regime. There is scarcity of data as regards the possible factors contributing to this in the developing world. We studied the records of 226 asthmatics who were admitted over a ten years period (1985-1994) into the OAUTHC, Ile-Ife, South West Nigeria. Patients were included in the study if they fulfilled clinical and physiological criteria for diagnosis of asthma. In all 12 deaths were recorded giving a mortality rate of 5.3%. 2/3 of the deaths occurred within 24 hrs of admission, while the remaining occurred within one week of hospital stay. Possible cause of death in 2/3 of the patients was respiratory failure. Other possible causes identified include superimposed respiratory infections and drug toxicity. Risk factors identified include increasing age (most patients were above 40 years - mean age 51.1%) late presentation to hospital (mean 9½ days after onset of illness), inadequate monitoring of the severity and progress of the disease, underuse of steroids, overdependence on intravenous aminophylline and absence of mechanical ventilation. Also noted was that all the deaths occurred during the cold Harmattan and rainy season. The study confirms previous work that asthma deaths are vastly preventable. Emphasis must be placed on asthma education, identifying possible exacerbating factors, especially the risk of seasonal attack, use of simple monitoring devices such as the peak flow meter and early use of steroids in those with acute severe asthma.
303-PAll Trigger factors for asthma in Nigerian asthmatics Erhabor, G. Dept. of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
Asthma runs a variable course. Acute episodes in most cases are functions of external factors. We studied asthmatics attending the outpatient clinic of Obafemi Awolowo University Teaching Hospital Complex with a view to eliciting common trigger factors of acute attacks within the environment. Questionnaires were administered to subjects which listed common trigger factors known within the environment. This was administered in English but interpretation was done in local language for those patients who do not understand English. In all
94 asthmatics participated in the study. Their age ranged from 12-65 years. Mean duration of asthma was 8.89 years. Results showed that 95% of patient had their most severe attack during cold Harmattan and rainy season. Also noted was the marked diurnal variation in the episodes of attack with all patients having their most severe attack in the night. Other common trigger factors identified include exercise (75%), drugs (7.5%), food and drinks (28.7%), upper respiratory tract infection (60.0%), house dust (86.2%), pollens esp. grass (86.2%), non-specific irritants e.g. indoor fumes (29.4%). Avoidance strategy forms part of asthma management in the developing world where standard asthma drugs are either unavailable or very expensive. Awareness of common trigger factors by both clinician and patient will go a long way to minimise attacks and prevent lifethreatening complications.
316-PAll A spectral analysis of the heart rate in bronchial asthma patients Trophimov, V.L, Martchenko, V.N. Pavlov's 1st Medical University, St Petersburg, Russia
A spectral analysis of R-R intervals' fluctuations was performed on 50 asthmatic patients and on 20 normals. We detached two spectrum areas: LF (0.05-0.11 Hz) and HF (0.13-0.50Hz). Their powers reflect consequently sympathetic or parasympathetic activity of the autonomic nervous system. We found an age-related LF and HF decrease in both groups; however, the decrease of HF was usually faster than of LF. This means that in elderly people, both in sick and healthy, a relative prevalence of sympathetic influence is typical. The comparison of normals and asthmatic patients showed that the sympathetic prevalence was stronger in asthmatics. After medicinal inhalation of the B2-agonist phenoterol (Berotec) the bronchial conductance has shown a 50% increase. There were no changes in heart frequency, but we found a significant increase of the spectrum power in LF area (+ 35% + 10%, p < 0.01). This indicates a marked shift of the autonomic control balance towards a sympathetic activity. These data confirm a high sensitivity of the method applied and testify sympathomimetic influence of the phenoterol not only on bronchial smooth muscles but also on the heart activity. We consider it necessary to be careful when using this medicine, especially in elderly patients.
342-PAll Two years of asthma club activities for asthma patients Raudla, L., Mesimaa, E. Institute of Experimental and Clinical Medicine, Tallinn, Estonia
75 patients (aged 18-56) with mild and/or severe bronchial asthma were observed. The condition of patients was estimated on the basis of clinical symptoms and analysis of lung function. Results characterizing efficacy
Tubercle and Lung Disease: Supplement 2
ratio of Ca ++ decreased. Our results were not significant statistically. In conclusion, these findings suggest that, in the patients with bronchial asthma, changes in the electrolyte composition of the bronchial wall structures are not reflected to BALF.
158-PAll Comparative effectiveness of Atrovent and Berotec therapy in patients whith bronchial asthma Feschenko, U.I., Yashina, L.A., Poluanskaya, M. Institute of Phthisiology and Pulmonology, F. Ianovsky Academy of Medical Sciences of Ukraine, Kiev, Ukraine
The comparative effectiveness of Atrovent in singleacting dose 0,04 mg and Berotec in single-acting dose 200 mg (Boeringer Ingelheim, Austria) was studied in 20 patients with moderate bronchial asthma (FEV~ 60-75%). Patients had a mean age of 36 years old, male 11, female 9. Clinical symptoms, parameters of body plethysmography, Peaf-Flow Curve of forced expiration were investigated ("Bodytest", Erich Jaeger, Germany). Bronchial dilatation, which was observed under the influence of Atrovent, was less expressive vs Berotec: improvements in FEV1 under the influence of Atrovent in 30 rain and 1 hour after the inhalation of medicine were by 15 per cent whereas the increasing of this index after the inhalation of Berotec were by 30 per cent in 30 rain. Thus, bronchial dilatation under the influence of Atrovent approached later and it was more weak vs Berotec.
176-PAll
Sputum eosinophilia in asthma
Spanevello, A., Migliori, G.B., Satta, A., Landoni, C. V., Neri, M. Fondazione Clinica del Lavoro, Tradate, Italy
The aims of this study were to compare the sputum cell counts in subjects with stable asthma with those in normal subjects and to assess if the % of sputum eosinophils (eo) in asthmatics was correlated with severity of disease and the number of peripheral blood eo (n/L) counted the day of sputum induction. 15 asthmatics (A) with mild to severe asthma (Aas score), mean age: 52.4 + 19.2 yr, FEVI: 84.6 + 21.2% predicted and 8 normals (N), mean age: 35.5 + 7.4 yr, FEVI: 103.1 + 6.1% pred. inhaled hypertonic saline (3-4%) for 20 rain. Sputum analysis was performed as described by Maestrelli et al. (Clin Exp Allergy 1994: 24:29-34). Blood eo (n/L) were counted the day of sputum induction. Mann-Whitney U and Spearman rank test were used for statistical analysis; a value of P < 0.05 (*) was considered significant. Results:
Tot. cell (n/mg) Mac % Neut % Eos % Lym % Epit % Squa %
sputum N
sputum A
1.4 63.0 25.1 0.4 0.1 0.3 11.0
2.4 + 1.6 44.8 + 10.0" 38.9 + 14.2" 10.4 + 11.7" 0.2 + 0.2 0.9 -+ 1.8 4.7 _+ 7.7
+ 1.2 + 11.4 + 10.8 + 0.3 + 0.2 -+ 0.5 -+ 7.3
- correlation Aas score/sputum eo (r = 0.617; P < 0.05) - correlation blood eo/sputum eo (r -- 0.697; P < 0.05) Asthmatics have a higher % of eosinophils and neutrophils in induced sputum compared with normals and the % of sputum eosinophils is correlated with asthma severity and number of peripheral blood eosinophils.
195-PAll A clinical trial of nebulised magsulf vs nebulised salbutamol in acute severe bronchial asthma Mangat, H.S., D'Souza, G.A., Jacob, M.S., Mercy, A. St. John's National Academy Of Health Sciences, Bangalore, India
Recent studies describe the use of intravenous Magnesium Sulfate (MgSO4) to reverse bronchospasm in acute asthma. However no study is available on nebulised MgSO4 in acute asthma. Patients with acute severe bronchial asthma in the Emergency Department and not requiring ventilatory care were included in a double blind randomised controlled trial. All patients received 100 mg hydrocortisone. Patients then were randomly assigned to receive four nebulisations spaced at 20 rains. interval of either 3 ml of 3.2% solution of MgSO4 (95 mg) or 3 ml salbutamol (2.5 rag) each. Serial PEFR was then measured for 2 hours. The mean increase in PEFR was 150% with nebulised MgSO4 and 140% with nebulised salbutamol. All the patients receiving MgSO4 showed a therapeutic response, while 40% of patients who received salbutamol did not and required admission. None of the patients showed any significant adverse effects. We conclude nebulised MgSO4 is safe and consistently effective in acute bronchial asthma, and may offer savings due to its low cost and in preventing the need for admission.
262-PAll Acid-base disturbances in acute asthma severity classification Radovanovic, S., Petrovic, V., Milenkovic, B., Ilic, A., Vukcevic, M. Institute for Pulmonary Diseases and TB, University Clinical Centre, Belgrade, Yugoslavia
We analysed acid-base (AB) profile in 101 acute asthma episodes considering it according to asthma severity. There were 43 cases of moderate (M) and 58 cases of severe (S) asthma. In 101 episodes we found 82 (81,2%) cases of AB disturbances: respiratory alkalosis (RAL), respiratory acidosis (RAC), lactic acidosis (LAC), coexistent RAC and LAC (RLAC) and metabolic alkalosis (MAL). In M group normal AB profile was presenting in 30% episodes and in the others AB disturbances were as follow: 22 (77,3%) cases of RAL, 5 (15,7%) cases of LAC and 3 (10%) cases of MAL. In S group normal AB profile was found in only 6 (10%) cases and in the other 52 attacks acidosis was presenting in 25 (67,3%) cases: RAC, isolated (15) or associated with LAC (13) in more than half of episodes (28) and LAC, isolated (7) or associated with RAC (13) in 20 episodes. RAL was
Abstracts 65
presenting in 14 and MAL in 3 episodes of severe asthma. Difference in AB profile between M and S group was significant (P < 0,001). We conclude that the most moderate and severe asthma attacks are presenting with AB disturbances. While RAL is most common in moderate asthma, RAC or RLAC are presenting only in severe asthma. AB profile could be one of the criteria for asthma severity classification.
302-PAll
Asthma deaths in OAUTHC, Ile-Ife
Erhabor, G.E., Adigun, A.O. Dept. of Medicine, OAUTHC, Ife, Nigeria
Deaths from asthma continue to increase despite increase in antiasthma regime. There is scarcity of data as regards the possible factors contributing to this in the developing world. We studied the records of 226 asthmatics who were admitted over a ten years period (1985-1994) into the OAUTHC, Ile-Ife, South West Nigeria. Patients were included in the study if they fulfilled clinical and physiological criteria for diagnosis of asthma. In all 12 deaths were recorded giving a mortality rate of 5.3%. 2/3 of the deaths occurred within 24 hrs of admission, while the remaining occurred within one week of hospital stay. Possible cause of death in 2/3 of the patients was respiratory failure. Other possible causes identified include superimposed respiratory infections and drug toxicity. Risk factors identified include increasing age (most patients were above 40 years - mean age 51.1%) late presentation to hospital (mean 9½ days after onset of illness), inadequate monitoring of the severity and progress of the disease, underuse of steroids, overdependence on intravenous aminophylline and absence of mechanical ventilation. Also noted was that all the deaths occurred during the cold Harmattan and rainy season. The study confirms previous work that asthma deaths are vastly preventable. Emphasis must be placed on asthma education, identifying possible exacerbating factors, especially the risk of seasonal attack, use of simple monitoring devices such as the peak flow meter and early use of steroids in those with acute severe asthma.
303-PAll Trigger factors for asthma in Nigerian asthmatics Erhabor, G. Dept. of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
Asthma runs a variable course. Acute episodes in most cases are functions of external factors. We studied asthmatics attending the outpatient clinic of Obafemi Awolowo University Teaching Hospital Complex with a view to eliciting common trigger factors of acute attacks within the environment. Questionnaires were administered to subjects which listed common trigger factors known within the environment. This was administered in English but interpretation was done in local language for those patients who do not understand English. In all
94 asthmatics participated in the study. Their age ranged from 12-65 years. Mean duration of asthma was 8.89 years. Results showed that 95% of patient had their most severe attack during cold Harmattan and rainy season. Also noted was the marked diurnal variation in the episodes of attack with all patients having their most severe attack in the night. Other common trigger factors identified include exercise (75%), drugs (7.5%), food and drinks (28.7%), upper respiratory tract infection (60.0%), house dust (86.2%), pollens esp. grass (86.2%), non-specific irritants e.g. indoor fumes (29.4%). Avoidance strategy forms part of asthma management in the developing world where standard asthma drugs are either unavailable or very expensive. Awareness of common trigger factors by both clinician and patient will go a long way to minimise attacks and prevent lifethreatening complications.
316-PAll A spectral analysis of the heart rate in bronchial asthma patients Trophimov, V.L, Martchenko, V.N. Pavlov's 1st Medical University, St Petersburg, Russia
A spectral analysis of R-R intervals' fluctuations was performed on 50 asthmatic patients and on 20 normals. We detached two spectrum areas: LF (0.05-0.11 Hz) and HF (0.13-0.50Hz). Their powers reflect consequently sympathetic or parasympathetic activity of the autonomic nervous system. We found an age-related LF and HF decrease in both groups; however, the decrease of HF was usually faster than of LF. This means that in elderly people, both in sick and healthy, a relative prevalence of sympathetic influence is typical. The comparison of normals and asthmatic patients showed that the sympathetic prevalence was stronger in asthmatics. After medicinal inhalation of the B2-agonist phenoterol (Berotec) the bronchial conductance has shown a 50% increase. There were no changes in heart frequency, but we found a significant increase of the spectrum power in LF area (+ 35% + 10%, p < 0.01). This indicates a marked shift of the autonomic control balance towards a sympathetic activity. These data confirm a high sensitivity of the method applied and testify sympathomimetic influence of the phenoterol not only on bronchial smooth muscles but also on the heart activity. We consider it necessary to be careful when using this medicine, especially in elderly patients.
342-PAll Two years of asthma club activities for asthma patients Raudla, L., Mesimaa, E. Institute of Experimental and Clinical Medicine, Tallinn, Estonia
75 patients (aged 18-56) with mild and/or severe bronchial asthma were observed. The condition of patients was estimated on the basis of clinical symptoms and analysis of lung function. Results characterizing efficacy