Introduction: In cases of idiopathic pulmonary fibrosis, we have observed an elevation in mean red cell volume, serum gamma glutamyl transferase and peripheral monocyte counts, initially in a pilot study but also in n...Introduction: In cases of idiopathic pulmonary fibrosis, we have observed an elevation in mean red cell volume, serum gamma glutamyl transferase and peripheral monocyte counts, initially in a pilot study but also in new incident cases. These changes could not be explained by drug therapy, vitamin deficiency or other diseases. Method: We compared the peripheral blood abnormalities in 149 patients with lung fibrosis to 448 age and sex matched controls. We also examined the effect of cotrimoxazole treatment for 12 weeks on these abnormalities. From the pilot study of cotrimoxazole in lung fibrosis patients, the relationship of the peripheral blood monocyte count and serum cytokine transforming growth factor beta-1 was examined. Epstein Barr viral status was examined in a selection of patients in case it explained our observations. Results: The findings confirm the elevation in mean red cell volume, gamma glutamyl transferase and peripheral monocyte counts in patients compared with matched controls. Oral cotrimoxazole ameliorated these 3 blood abnormalities. Serological evidence of Epstein Barr viral infection was present in tested patients but active viral replication was absent. The monocyte count had a linear relationship with the serum transforming growth factor beta-1 levels, which increased by 600 pg/ml for every of 0.1 × 109/l increase in the monocyte count. Conclusion: These observations may reflect oxidative stress which was reduced by cotrimoxazole. A related sulphonamide “dapsone” is known to reduce oxidative stress through direct effects on neutrophil and monocyte function;similar effects may explain these findings and require a formal study.展开更多
We present 7 adults atopic asthmatics that were referred due to repeatedly relapsing asthma requiring oral courses of prednisolone. All were steroid responsive yet steroid dependant and were screened for adrenal insuf...We present 7 adults atopic asthmatics that were referred due to repeatedly relapsing asthma requiring oral courses of prednisolone. All were steroid responsive yet steroid dependant and were screened for adrenal insufficiency after changes to inhaled therapy and other standard anti-asthma treatments failed to improve the situation. All were deemed to be compliant. 4 used long-term intranasal steroids in addition to inhaled corticosteroids. No topical steroid creams were used by these patients. Adrenal suppression was examined via a 9 am cortisol level and a short synacthen test (using intravenous tetracosactide 250 mcg) along with measurement of ACTH (Adreno-Cortico-Trophic Hormone). The tests were performed in periods off prednisolone. We report the observed beneficial effects after treatment of the adrenal insufficiency with hydrocor-tisone acetate replacement therapy in these cases, and the benefit to their exacerbations, hospital admission and the requirement for prednisolone courses. These patients would have been stepped up to yet higher doses of inhaled steroids and even referred for anti-IgE treatment etc. Adrenal suppression is well described in the medical literature for asthmatics, but the beneficial outcomes of treating this are unknown. These 7 cases have been followed for up to 3 years since hydrocorti-sone replacement therapy. Most improved to a stable asthma without frequent exacerbations nor requirement for prednisolone and only 1 had a hospital admission.展开更多
文摘Introduction: In cases of idiopathic pulmonary fibrosis, we have observed an elevation in mean red cell volume, serum gamma glutamyl transferase and peripheral monocyte counts, initially in a pilot study but also in new incident cases. These changes could not be explained by drug therapy, vitamin deficiency or other diseases. Method: We compared the peripheral blood abnormalities in 149 patients with lung fibrosis to 448 age and sex matched controls. We also examined the effect of cotrimoxazole treatment for 12 weeks on these abnormalities. From the pilot study of cotrimoxazole in lung fibrosis patients, the relationship of the peripheral blood monocyte count and serum cytokine transforming growth factor beta-1 was examined. Epstein Barr viral status was examined in a selection of patients in case it explained our observations. Results: The findings confirm the elevation in mean red cell volume, gamma glutamyl transferase and peripheral monocyte counts in patients compared with matched controls. Oral cotrimoxazole ameliorated these 3 blood abnormalities. Serological evidence of Epstein Barr viral infection was present in tested patients but active viral replication was absent. The monocyte count had a linear relationship with the serum transforming growth factor beta-1 levels, which increased by 600 pg/ml for every of 0.1 × 109/l increase in the monocyte count. Conclusion: These observations may reflect oxidative stress which was reduced by cotrimoxazole. A related sulphonamide “dapsone” is known to reduce oxidative stress through direct effects on neutrophil and monocyte function;similar effects may explain these findings and require a formal study.
文摘We present 7 adults atopic asthmatics that were referred due to repeatedly relapsing asthma requiring oral courses of prednisolone. All were steroid responsive yet steroid dependant and were screened for adrenal insufficiency after changes to inhaled therapy and other standard anti-asthma treatments failed to improve the situation. All were deemed to be compliant. 4 used long-term intranasal steroids in addition to inhaled corticosteroids. No topical steroid creams were used by these patients. Adrenal suppression was examined via a 9 am cortisol level and a short synacthen test (using intravenous tetracosactide 250 mcg) along with measurement of ACTH (Adreno-Cortico-Trophic Hormone). The tests were performed in periods off prednisolone. We report the observed beneficial effects after treatment of the adrenal insufficiency with hydrocor-tisone acetate replacement therapy in these cases, and the benefit to their exacerbations, hospital admission and the requirement for prednisolone courses. These patients would have been stepped up to yet higher doses of inhaled steroids and even referred for anti-IgE treatment etc. Adrenal suppression is well described in the medical literature for asthmatics, but the beneficial outcomes of treating this are unknown. These 7 cases have been followed for up to 3 years since hydrocorti-sone replacement therapy. Most improved to a stable asthma without frequent exacerbations nor requirement for prednisolone and only 1 had a hospital admission.
