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Emergency treatment in asthma (asthmatic crisis)
Selected Abstracts Asthma and Hay Fever UNDER THE DIRECTION OF SAMUEL FEINBERG, M.D., C,HICAGO The Function
of the Bronchial
Tubes.
Ellis, M.:
Lancet
1: 734, 1938.
The author made a number of studies of bronchial function in dogs by means of a rubber balloon placed in a bronchus and connected to a pen and recording apparatus. The graphs clearly show that the bronchial lumen widens during the inThe spiratory phase and narrows during the expiratory phase of respiration. mechanism of these rhythmic changes was shown to be entirely due to the mechanical movements of the chest wall. Many factors were shown to modify this normal bronchial tone. For example, adrenalin produced decided dilatation of the bronchus in the normal animal. Various chemical and other manipulations within the nose resulted in an increased tone of the bronchi. It is the opinion of the author that the presence of viscid sputum acts The author emphasizes as an irritant, increasing reflexly the tonicity of bronchi. the fact that asthma is in reality an increased tonicity of sufficient extent to interfere with exchange of air.
The Specific Treatment R. P.:
Rocky
of Hay Fever and Pollen Asthma in Denver.
Mountain
Johnson,
M. J. 35: 305, 1938.
According to Johnson, the pollinating season in Denver is from March to October. During March, April, and May the tree pollens cause hay fever. Of these, the cottonwood is most important. The author believes that some of the cottonwood cases are sensitive also to the “cotton” as well as to the pollen, and, therefore, they may have symptoms after the pollinating season. The grass season occurs from May through July and is caused principally by June grass, orchard grass, timothy, wheat grass, and red top. The weed season is the most important and has a spread from July to October. The chief offenders are Russian thistle, sages, ragweed, and pigweed. The author believes that the scratch test is the method of choice in diagnosis.
Emergency
Treatment
in Asthma
(Asthmatic
Crisis).
Waldbott,
G. L.:
J. A.
M. A. 110: 1423, 1938. The author considers an asthmatic crisis as a type of allergic shock in which the lungs are the shock organs. He outlines the management of the asthmatic crisis along four lines: 1. Avoidance of harmful antigens. He cautions against the use of many drugs to which the individual may be sensitive. He finds that foods that had not been ingested for a long time are particularly harmful. 2. Elimination of antigens is regarded as an important step. A dust-free room is advisable. He believes that adrenalin should be usually discontinued. 3. Symptomatic treatment consists usually of sedation, primarily by the use of barbiturates, although occasionally pantopon may be necessary. Helium with oxygen may be used to advantage at times. Iodides are helpful. Intravenous injections of hypertonic dextrose solutions are commonly used. Frequently the author em525
526
THE
JOURNAL
OF
ALLERGY
ploys blood transfusions. In cases where other methods tail hronchoscopic aspiration is recommended. 4. Rapid hyposensit,ization with antigens to which the patient gives a skin reaction or to whirh he is exposed at the t,ime of the attack is regarded by Waldbott as an important step in the alleviation of the asthmatic crisis.
Roentgen Studies of the Pathological L. G., and Koucky,
R.:
Physiology
Am. J. Roentgenol.
of Bronchial
Asthma.
Rigler,
39: 353, 1938.
The authors made a roentgenologic study of the bronchi of asthmatic patients by means of iodized oil. They believe that such studies throw considerable light on the pathology and physiology of asthma. In early cases the caliber of the bronchi is distinctly narrowed. Later some of the bronchi fail to show the iodized oil shadows, indicating that occlusion has taken place. The presence of occlusive plugs can be definitely shown by this procedure. From this bronchographic and pathologic study the authors conceive the mechanism of asthma to be as follows: The first effect is a hypersecretion of mucus which accumulates within the lumina of the bronchi. Stasis results possibly due to spasm of the bronchial muscle or to marked viscosity of the mucus. A plug is formed partially obstructing the bronchus so that air may be inspired past the occlusion, but is expelled less readily. Emphysema is thus produced. During the asthmatic attack the spastic bronchial muscle clamps down around this plug, aggravating the occlusion.
Dermatology UNDER THE DIRECTION
OF MARION JOSEPH
Eczematous Eruptions Bonnevie,
P.:
Arch.
B.
SULZBERGER, M.D.,
GOODMAN,
NEW
YORK CITY,
Produced by Leaves of Trees and Bushes. Dermat.
AND
M.D., BOSTON
Genner, V., and
& Syph. 37: 583, 1938.
This report concerns three cases of eczema of the face and hands, proved, by studies which included careful investigation by patch testing, to be caused in two instances by elm leaves and in one instance by magnolia leaves. The authors point out that in the study of contact, dermatitis little attention has been paid in the past to the leaves of t,rees and bushes, although the part played by barks and woods has been the subject of considerable attention.
Dermatitis Dermat.
Due to Cocobolo Wood.
Abramowitz,
E. W., and Swarts,
W. B.: Arch.
& Syph. 37: 441, 1938.
The authors report a patient with a dermatitis of four months’ duration, limited to the face, neck, scalp, arms, and the posterior aspect of the knees. The onset of the eruption occurred when the patient started to carve a piece of Patch tests with dry cocobolo sawdust or with an ether extract coeobolo wood. of the wood were positive on three occasions. After each of these patch tests, there was a general flare-up of the eruption.
The Value of the Patch Test in the Investigation Peters,
M.:
Dermat.
Wchnschr.
of Occupational
Dermatitis.
106: 50, 1938.
The author presents statistically her experience with the use of the patch in the investigation of 100 cases of dermatitis of possible industrial origin.
test
In
of the Bronchial
Tubes.
Ellis, M.:
Lancet
1: 734, 1938.
The author made a number of studies of bronchial function in dogs by means of a rubber balloon placed in a bronchus and connected to a pen and recording apparatus. The graphs clearly show that the bronchial lumen widens during the inThe spiratory phase and narrows during the expiratory phase of respiration. mechanism of these rhythmic changes was shown to be entirely due to the mechanical movements of the chest wall. Many factors were shown to modify this normal bronchial tone. For example, adrenalin produced decided dilatation of the bronchus in the normal animal. Various chemical and other manipulations within the nose resulted in an increased tone of the bronchi. It is the opinion of the author that the presence of viscid sputum acts The author emphasizes as an irritant, increasing reflexly the tonicity of bronchi. the fact that asthma is in reality an increased tonicity of sufficient extent to interfere with exchange of air.
The Specific Treatment R. P.:
Rocky
of Hay Fever and Pollen Asthma in Denver.
Mountain
Johnson,
M. J. 35: 305, 1938.
According to Johnson, the pollinating season in Denver is from March to October. During March, April, and May the tree pollens cause hay fever. Of these, the cottonwood is most important. The author believes that some of the cottonwood cases are sensitive also to the “cotton” as well as to the pollen, and, therefore, they may have symptoms after the pollinating season. The grass season occurs from May through July and is caused principally by June grass, orchard grass, timothy, wheat grass, and red top. The weed season is the most important and has a spread from July to October. The chief offenders are Russian thistle, sages, ragweed, and pigweed. The author believes that the scratch test is the method of choice in diagnosis.
Emergency
Treatment
in Asthma
(Asthmatic
Crisis).
Waldbott,
G. L.:
J. A.
M. A. 110: 1423, 1938. The author considers an asthmatic crisis as a type of allergic shock in which the lungs are the shock organs. He outlines the management of the asthmatic crisis along four lines: 1. Avoidance of harmful antigens. He cautions against the use of many drugs to which the individual may be sensitive. He finds that foods that had not been ingested for a long time are particularly harmful. 2. Elimination of antigens is regarded as an important step. A dust-free room is advisable. He believes that adrenalin should be usually discontinued. 3. Symptomatic treatment consists usually of sedation, primarily by the use of barbiturates, although occasionally pantopon may be necessary. Helium with oxygen may be used to advantage at times. Iodides are helpful. Intravenous injections of hypertonic dextrose solutions are commonly used. Frequently the author em525
526
THE
JOURNAL
OF
ALLERGY
ploys blood transfusions. In cases where other methods tail hronchoscopic aspiration is recommended. 4. Rapid hyposensit,ization with antigens to which the patient gives a skin reaction or to whirh he is exposed at the t,ime of the attack is regarded by Waldbott as an important step in the alleviation of the asthmatic crisis.
Roentgen Studies of the Pathological L. G., and Koucky,
R.:
Physiology
Am. J. Roentgenol.
of Bronchial
Asthma.
Rigler,
39: 353, 1938.
The authors made a roentgenologic study of the bronchi of asthmatic patients by means of iodized oil. They believe that such studies throw considerable light on the pathology and physiology of asthma. In early cases the caliber of the bronchi is distinctly narrowed. Later some of the bronchi fail to show the iodized oil shadows, indicating that occlusion has taken place. The presence of occlusive plugs can be definitely shown by this procedure. From this bronchographic and pathologic study the authors conceive the mechanism of asthma to be as follows: The first effect is a hypersecretion of mucus which accumulates within the lumina of the bronchi. Stasis results possibly due to spasm of the bronchial muscle or to marked viscosity of the mucus. A plug is formed partially obstructing the bronchus so that air may be inspired past the occlusion, but is expelled less readily. Emphysema is thus produced. During the asthmatic attack the spastic bronchial muscle clamps down around this plug, aggravating the occlusion.
Dermatology UNDER THE DIRECTION
OF MARION JOSEPH
Eczematous Eruptions Bonnevie,
P.:
Arch.
B.
SULZBERGER, M.D.,
GOODMAN,
NEW
YORK CITY,
Produced by Leaves of Trees and Bushes. Dermat.
AND
M.D., BOSTON
Genner, V., and
& Syph. 37: 583, 1938.
This report concerns three cases of eczema of the face and hands, proved, by studies which included careful investigation by patch testing, to be caused in two instances by elm leaves and in one instance by magnolia leaves. The authors point out that in the study of contact, dermatitis little attention has been paid in the past to the leaves of t,rees and bushes, although the part played by barks and woods has been the subject of considerable attention.
Dermatitis Dermat.
Due to Cocobolo Wood.
Abramowitz,
E. W., and Swarts,
W. B.: Arch.
& Syph. 37: 441, 1938.
The authors report a patient with a dermatitis of four months’ duration, limited to the face, neck, scalp, arms, and the posterior aspect of the knees. The onset of the eruption occurred when the patient started to carve a piece of Patch tests with dry cocobolo sawdust or with an ether extract coeobolo wood. of the wood were positive on three occasions. After each of these patch tests, there was a general flare-up of the eruption.
The Value of the Patch Test in the Investigation Peters,
M.:
Dermat.
Wchnschr.
of Occupational
Dermatitis.
106: 50, 1938.
The author presents statistically her experience with the use of the patch in the investigation of 100 cases of dermatitis of possible industrial origin.
test
In