In a double blind crossover study oral prednisolone was compared with intramuscular depot triamcinolone in the treatment of 20 patients with severe chronic asthma. A short term study comparing each treatment over four weeks showed only minor differences in therapeutic efficacy, but at the end of 24 week periods on each of the two treatments triamcinolone was significantly more effective than prednisolone in terms of forced expiratory volume in one second and forced vital capacity. Better control of asthma was accompanied by a significant fall in weight and some evidence of reduced adrenal suppression (improved cortisol response following a short tetracosactrin test). Side effects, including menstrual irregularities, muscle pain, and hirsuitism, were, however, more common during treatment with triamcinolone.Although treatment with corticosteroids by inhalation controls symptoms in many patients with chronic asthma, those with either severe asthma or a poor response to inhaled corticosteroid aerosols often require supplementary systemic treatment. Traditionally this is given in the form of oral prednisolone. A maintenance dose of 10 mg or more a day is required in only a small proportion of patients with chronic asthma, but such patients form a significant number of those attending asthma clinics and they are prone to develop side effects that may be seriously disabling and occasionally life threatening.It has been suggested in an open study' that better control is achieved, with no greater incidence of side effects, when corticosteroid treatment is given in the form of injections of depot triamcinolone at intervals of four weeks. This paper describes the results of studies designed to compare treatment with oral prednisolone and intramuscular triamcinolone in patients with poorly controlled asthma. A double blind crossover study of four weeks of each treatment was undertaken first, but as it showed only Address for reprint requests: Dr RF Willey, Royal Lancaster Infirmary, Lancaster LA1 4RP.Accepted 4 January 1984 minor differences in therapeutic efficacy it was followed by a study of the same design in which each treatment was continued for 24 weeks. Patients and methodsTwenty outpatients (8 male and 12 female) with chronic bronchial asthma were included in the study. Their ages ranged from 15 to 76 years (mean 48.9).Informed consent for inclusion in the study was obtained in all cases.All the patients had previously shown an improvement in FEV, of at least 25% after treatment with an aqueous salbutamol aerosol (5 mg) delivered by intermittent positive pressure breathing (IPPB). They all had an FEV, of less than 75% of the predicted normal despite regular treatment with oral prednisolone, 10 mg daily, and inhaled beclomethasone, 400 ,ug daily. At the time of entry all had required at least two courses of prednisolone in increased dosage for exacerbations of asthma in the preceding 12 months but not in the last four weeks.Initially a short term double blind crossover study was performed on 20 patients. T...

In a study of 100 patients undergoing rigid bronchoscopy under intravenous general anaesthesia with oxygen Venturi ventilation no major complications were observed. Minor complications included one adverse reaction to alphaxalone-alphadolone acetate (Althesin), one prolonged episode of laryngeal spasm after removal of the bronchoscope, and subsequent muscle pain attributed to suxamethonium in 36 patients. The last complication occurred significantly less frequently (p < 0-025) in those patients who were pretreated with a small dose of a nondepolarising neuromuscular blocking agent.

Bronchoconstriction was induced in asthmatic patients by means of isocapnic hyperventilation with dry air. Responses both within a day and between days did not differ significantly and corresponded closely with those observed after exercise. The mean fall in forced expiratory volume in one second (FEV1) observed with both techniques was equivalent to 36o%. Isocapnic hyperventilation with dry air, as used in this study, was a potent stimulus and provoked a reproducible response. The method was physically less demanding than exercise and was more acceptable to patients.

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Domiciliary nebulisers are in widespread use for patients who have severe chronic airways disease, both asthma and chronic obstructive pulmonary disease (COPD). We report a study of the use of domiciliary nebulisers designed to assess practical problems and the value of such therapy in preventing hospital admissions. A total of 405 patients underwent a structured interview at home and their case records were reviewed. Technical performance of the nebuliser compressors was assessed. The mean (SD) age of those interviewed was 64.5 (12) years. 185 patients had a physician diagnosis of asthma, and 208 had COPD. 87% patients used their nebuliser at least once daily. Side effects, reported by 54%, were related to frequency of use and commoner in younger patients. 29 subjects (7%) died within 2 years of receiving their nebuliser. Among the survivors, the 2 year periods before and after supply of the nebuliser were compared. The percentage of patients requiring hospital admission for exacerbations of lung disease fell from 56% to 46% (p < 0.01) but the number and duration of admissions was unchanged. Those whose admission duration increased had more severely impaired spirometry when the nebuliser was supplied and had lower activity scores and higher breathlessness scores at the time of interview indicating more severe disease. Approximately half of the compressors were malfunctioning and patients' understanding of the principles of nebuliser treatment was poor. The provision of domiciliary nebuliser can influence hospital admission in patients with obstructive airways disease. There is also a need for improved patient education and for technical support which may require the development of a nurse-run nebuliser service.