The prognostic relevance of an enhanced variability of peak expiratory flow rate (PEFR) throughout the day was evaluated in asthmatics in remission: it was expressed as the coefficient of variation (CV) of values recorded 4 times daily for weeks. Outcome at 3, 6, and 12 months was assessed in 2 groups of 16 patients each, differing because of a CV respectively higher (group A) and lower (group B) than 8%. A significantly higher frequency of abnormal PEFR values during the subsequent months was recorded in patients of group A, and found as correlated to the magnitude of CV; in the same group a significantly worse clinical status – scored on the basis of response to treatment – was pointed out. Therefore, a high CV of PEFR may be assumed as a reliable indicator of the risk of exacerbation – not otherwise predictable – both in a short and a longer term; on this basis home monitoring of PEFR may be recommended as a useful tool in the evaluation of all the cases of asthma in remission

No abstract

Summary:The effects of a new inhaled antimuscarinic drug, oxitropium bromide, and of a slowrelease theophylline preparation upon nocturnal asthma were compared in a placebo-controlled double-blind study. Two samples were studied: 12 patients received oxitropium at 600,pg (6 subjects) or at 400,pg t.i.d. (6 subjects) whereas 11 received theophylline at 300mg b.i.d. Morning dipping, assessed by the fall in peak flow overnight, was significantly reduced in the periods when either active drug was taken, whereas no difference was noticed during the placebo administration. No significant difference was noticed between results obtained with either active drug, as well as with either dosage of oxitropium. No subject reported side effects of oxitropium, as compared to three subjects reporting nausea, vomiting and tremors after theophylline.Oxitropium proves to be a valuable alternative to theophylline in nocturnal asthma, since it is equally potent, safer and does not require the titration of dosage.

The applicability of nasal challenge for etiologic diagnosis of extrinsic asthma was evaluated by assessing easiness of performance, precision, and cost of a standardized test by metered nebulizer in 20 asthmatics with and without concurrent rhinitis submitted also to skin prick tests and RAST. Although less sensitive than in the group with rhinitis (where precision was 90.4%), the nasal provocation test proved to be an easy, inexpensive, and specific (82.3%) means for contributing to the identification of allergic sensitization in patients affected by asthma alone.

Combinations of beta-stimulant and anticholinergic drugs have been advocated as a potentially useful tool in the treatment of reversible airway obstruction. We investigated the effectiveness and safety of a metered aerosol preparation delivering fenoterol 100 µg and ipratropium bromide 40 µg per puff: two dosages (2 puffs and 4 puffs) were used in 16 asthmatic patients, and their acute effects (up to 420 min) were investigated in a double-blind randomized trial. The results point out a reasonably good response to both dosages, with no notable difference between them as far as vital capacity, FEV₁, MMEF and Vmax75 are concerned. This finding indicates the possibility of achieving a satisfactory bronchodilation at beta-stimulant dosages far lower than the standard ones commonly used and therefore minimizing the risk of untoward cardiovascular effects.