The forced expiratory flow during the middle half of FVC (FEF25-75%) was calculated from the curve with the largest sum of FVC and FEV^ We used the normal values of Morris for all spirometric parameters. Spirometry was thereafter done daily for the duration of the stud); which encompassed the first four days of hospitalization. Peak expiratory flow rate was measured every 8 h using a Wright peak flow meter (Clement Clark International). Arterial blood was drawn initially and on day 4, with the patient resting and supine, blood gas tension and pH values were measured using a standard blood gas analyzer (Radiometer). Venous blood was drawn for measurement of serum theophylline levels before the onset of treatment and on day 4. travoprost eye drops
After the initial studies, each patient was randomly assigned to receive either methylprednisolone, 80 mg/24 h, and aminophylline, based on body weight (see below), by continuous IV infusion (group A); or a comparable dose of a sustained-release theophylline preparation (Theo-dur) and MI? 80 mg in two equally divided doses, by mouth (group B). The dose of theophylline was based on the following guidelines. Patients who weighed ^55 kg received either 200 mg of SRT twice daily or 600 mg of aminophylline daily by infusion; those weighing >55 kg and £75 kg received either 300 mg SRT twice daily or 800 mg of aminophylline; and those weighing more than 75 kg received 400 mg of SRT twice a day or 1,000 mg of aminophylline. This was designed to result in a mean dose of aminophylline of 12 mg/kg/24 h and an equivalent amount of SRT. All patients received inhaled (3-agonists either by conventional metered-dose inhaler or by compressor nebulizer. The use of antibiotics and oxygen was based on the needs of the individual patient as assessed by the attending physician.
For assessment of symptomatic response, dyspnea was graded daily on a scale of 0 to 6. The dyspnea index was modified from that published by the American Medical Association, with the addition of a grade 6 for continuous dyspnea at rest Auscultatory evidence of wheezing was graded on a scale of 0 to 4 as follows: grade 0: no wheezing; grade 1: wheezing heard only on forced exhalation; grade 2: wheezing heard on expiration during normal tidal breathing; grade 3: wheezing on inspiration and expiration; grade 4: wheezing on inspiration and expiration, with reduced intensity of breath sounds.
To assess the DI, the patients were questioned, and when their condition improved, allowed to walk on level ground or on stairs under the supervision of the staff. The dyspnea and wheezing indices were assessed on admission and daily by the same physician. Any adverse effects of therapy reported by the patients were recorded with results of clinical and laboratory data. Statistical comparison of clinical and laboratory parameters between groups A and B was performed using the Students t tests, with p<0.05 considered to be significant.