No abstract

and conclusions Out of 62 asthmatic patients admitted to hospital with an acute exacerbation of their disease, those whose symptoms had not sufficiently improved 15 minutes after an initial intensive regimen were randomly allocated to receive an intravenous infusion of either salbutamol 10 jug min (20 patients) or aminophylline 1 mg, min (19 patients). During the infusions, which lasted 36 hours, peak expiratory flow rates and spirometric values improved in both groups, but differences between the groups did not achieve statistical significance.Although salbutamol may be infused safely for a prolonged period to patients with acute asthma, it has no particular advantage over aminophylline. Furthermore, in patients who respond poorly to initial intensive treatment the subsequent infusion of a bronchodilator may not increase the rate of recovery from the rate that would occur naturally.

Bone marrow culture in a patient with aplastic anaemia responding to anabolic steroid (methandienone) therapy, showed an unusually high degree of growth in unstimulated cultures. Growth in unstimulated cultures is due to factors with colony stimulating activity (CSA) released by monocyte macrophages in the bone marrow sample. These cells, which can be identified by staining for non-specific esterase activity, were not increased in this patient's marrow, implying either increased production of colony stimulating factors or increased sensitivity to these factors. Addition ofmethandienone or testosterone to feeder-layers containingnormal peripheral blood leucocytes increased their stimulatory activity. Addition of these drugs to feeder-layers of CSF-containing conditioned medium did not have this effect, implying that androstanes cause increased production of colony stimulating factors rather than increased sensitivity to them. Lack of response to androstane therapy may be related to lack of response by bone marrow monocyte macrophages or to the inability ofgranulopoietic cells to respond to the increased CSF production induced by androstane therapy. A means of predicting lack of response is proposed.Androstanes are 19 carbon steroids characterized by methyl groups attached to carbons 10 and

1 The metabolic effects of salbutamol (5 mg) given by intermittent positive pressure breathing have been studied in eight patients with airflow obstruction. 2 No changes in plasma nonesterified fatty acids, triglyceride, glucose, insulin or cortisol were seen 1 and 4 h after administration. 3 It is concluded that inhaled salbutamol does not cause the unwanted metabolic effects reported with oral or parenteral administration, and that this is a further indication for this route of administration.