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|00000590| 00 00 00 00 d2 d4 05 00 | 00 00 00 00 24 55 6e 69 |........|....$Uni|
|000005a0| 71 75 65 5f 49 44 7b 59 | 52 42 30 36 35 30 30 7d |que_ID{Y|RB06500}|
|000005b0| 0d 0a 24 54 69 74 6c 65 | 7b 49 6e 76 65 73 74 69 |..$Title|{Investi|
|000005c0| 67 61 74 69 6f 6e 73 20 | 6f 66 20 41 49 44 53 20 |gations |of AIDS |
|000005d0| 50 61 74 69 65 6e 74 73 | 20 57 69 74 68 20 4e 6f |Patients| With No|
|000005e0| 20 50 72 65 76 69 6f 75 | 73 6c 79 20 49 64 65 6e | Previou|sly Iden|
|000005f0| 74 69 66 69 65 64 20 52 | 69 73 6b 20 46 61 63 74 |tified R|isk Fact|
|00000600| 6f 72 73 7d 0d 0a 24 41 | 75 74 68 6f 72 7b 43 61 |ors}..$A|uthor{Ca|
|00000610| 73 74 72 6f 20 4b 47 0d | 0a 4c 69 66 73 6f 6e 20 |stro KG.|.Lifson |
|00000620| 41 52 0d 0a 57 68 69 74 | 65 20 43 52 0d 0a 42 75 |AR..Whit|e CR..Bu|
|00000630| 73 68 20 54 4a 0d 0a 43 | 68 61 6d 62 65 72 6c 61 |sh TJ..C|hamberla|
|00000640| 6e 64 20 4d 45 0d 0a 4c | 65 6b 61 74 73 61 73 20 |nd ME..L|ekatsas |
|00000650| 41 4d 0d 0a 4a 61 66 66 | 65 20 48 57 7d 0d 0a 24 |AM..Jaff|e HW}..$|
|00000660| 41 66 66 69 6c 69 61 74 | 69 6f 6e 7b 43 74 72 73 |Affiliat|ion{Ctrs|
|00000670| 20 66 6f 72 20 44 69 73 | 65 61 73 65 20 43 6f 6e | for Dis|ease Con|
|00000680| 74 72 6f 6c 2c 20 41 74 | 6c 61 6e 74 61 3b 20 4e |trol, At|lanta; N|
|00000690| 65 77 20 59 6f 72 6b 20 | 43 69 74 79 20 44 65 70 |ew York |City Dep|
|000006a0| 74 20 6f 66 20 48 65 61 | 6c 74 68 7d 0d 0a 24 53 |t of Hea|lth}..$S|
|000006b0| 75 62 6a 65 63 74 7b 41 | 49 44 53 2c 20 70 61 74 |ubject{A|IDS, pat|
|000006c0| 69 65 6e 74 73 20 77 69 | 74 68 20 6e 6f 20 70 72 |ients wi|th no pr|
|000006d0| 65 76 69 6f 75 73 6c 79 | 20 69 64 65 6e 74 69 66 |eviously| identif|
|000006e0| 69 65 64 20 72 69 73 6b | 20 66 61 63 74 6f 72 73 |ied risk| factors|
|000006f0| 2c 20 69 6e 76 65 73 74 | 69 67 61 74 69 6f 6e 73 |, invest|igations|
|00000700| 20 6f 66 7d 0d 0a 24 4a | 6f 75 72 6e 61 6c 7b 4a | of}..$J|ournal{J|
|00000710| 41 4d 41 7d 0d 0a 24 56 | 6f 6c 75 6d 65 7b 32 35 |AMA}..$V|olume{25|
|00000720| 39 7d 0d 0a 24 50 61 67 | 65 7b 31 33 33 38 2d 31 |9}..$Pag|e{1338-1|
|00000730| 33 34 32 7d 0d 0a 24 44 | 61 74 65 7b 4d 61 72 63 |342}..$D|ate{Marc|
|00000740| 68 20 34 2c 20 31 39 38 | 38 7d 0d 0a 24 59 42 56 |h 4, 198|8}..$YBV|
|00000750| 6f 6c 7b 31 39 38 39 20 | 59 65 61 72 20 42 6f 6f |ol{1989 |Year Boo|
|00000760| 6b 20 6f 66 20 46 61 6d | 69 6c 79 20 50 72 61 63 |k of Fam|ily Prac|
|00000770| 74 69 63 65 7d 0d 0a 24 | 43 68 61 70 74 65 72 7b |tice}..$|Chapter{|
|00000780| 39 2d 32 30 7d 0d 0a 24 | 59 42 45 64 69 74 6f 72 |9-20}..$|YBEditor|
|00000790| 7b 44 72 73 2e 20 52 61 | 6b 65 6c 2c 20 41 76 61 |{Drs. Ra|kel, Ava|
|000007a0| 6e 74 2c 20 44 72 69 73 | 63 6f 6c 6c 2c 20 50 72 |nt, Dris|coll, Pr|
|000007b0| 69 63 68 61 72 64 2c 20 | 61 6e 64 20 53 6d 69 74 |ichard, |and Smit|
|000007c0| 68 7d 0d 0a 24 54 61 62 | 6c 65 7b 7d 0d 0a 24 43 |h}..$Tab|le{}..$C|
|000007d0| 6f 6d 6d 65 6e 74 61 74 | 6f 72 7b 4a 2e 47 2e 20 |ommentat|or{J.G. |
|000007e0| 50 72 69 63 68 61 72 64 | 2c 20 4d 2e 44 2e 2c 20 |Prichard|, M.D., |
|000007f0| 4d 2e 48 2e 53 2e 7d 0d | 0a 0d 0a 43 6f 70 79 72 |M.H.S.}.|...Copyr|
|00000800| 69 67 68 74 20 28 63 29 | 20 59 65 61 72 20 42 6f |ight (c)| Year Bo|
|00000810| 6f 6b 20 4d 65 64 69 63 | 61 6c 20 50 75 62 6c 69 |ok Medic|al Publi|
|00000820| 73 68 65 72 73 2c 20 49 | 6e 63 2e 2c 20 31 39 38 |shers, I|nc., 198|
|00000830| 39 0d 0a 0d 0a 31 39 38 | 39 20 59 65 61 72 20 42 |9....198|9 Year B|
|00000840| 6f 6f 6b 20 6f 66 20 46 | 61 6d 69 6c 79 20 50 72 |ook of F|amily Pr|
|00000850| 61 63 74 69 63 65 20 28 | 52 29 0d 0a 0d 0a 43 68 |actice (|R)....Ch|
|00000860| 61 70 74 65 72 20 39 2d | 2d 44 69 73 65 61 73 65 |apter 9-|-Disease|
|00000870| 73 20 6f 66 20 74 68 65 | 20 52 65 73 70 69 72 61 |s of the| Respira|
|00000880| 74 6f 72 79 20 53 79 73 | 74 65 6d 0d 0a 0d 0a 49 |tory Sys|tem....I|
|00000890| 6e 66 65 63 74 69 6f 75 | 73 20 44 69 73 65 61 73 |nfectiou|s Diseas|
|000008a0| 65 73 0d 0a 0d 0a 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |es....--|--------|
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|000008e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000008f0| 2d 2d 2d 2d 2d 2d 0d 0a | 49 6e 76 65 73 74 69 67 |------..|Investig|
|00000900| 61 74 69 6f 6e 73 20 6f | 66 20 41 49 44 53 20 50 |ations o|f AIDS P|
|00000910| 61 74 69 65 6e 74 73 20 | 57 69 74 68 20 4e 6f 20 |atients |With No |
|00000920| 50 72 65 76 69 6f 75 73 | 6c 79 20 49 64 65 6e 74 |Previous|ly Ident|
|00000930| 69 66 69 65 64 20 52 69 | 73 6b 20 46 61 63 74 6f |ified Ri|sk Facto|
|00000940| 72 73 0d 0a 0d 0a 43 61 | 73 74 72 6f 20 4b 47 3b |rs....Ca|stro KG;|
|00000950| 20 4c 69 66 73 6f 6e 20 | 41 52 3b 20 57 68 69 74 | Lifson |AR; Whit|
|00000960| 65 20 43 52 3b 20 42 75 | 73 68 20 54 4a 3b 20 43 |e CR; Bu|sh TJ; C|
|00000970| 68 61 6d 62 65 72 6c 61 | 6e 64 20 4d 45 3b 20 4c |hamberla|nd ME; L|
|00000980| 65 6b 61 74 73 61 73 20 | 41 4d 3b 20 4a 61 66 66 |ekatsas |AM; Jaff|
|00000990| 65 20 48 57 0d 0a 28 43 | 74 72 73 20 66 6f 72 20 |e HW..(C|trs for |
|000009a0| 44 69 73 65 61 73 65 20 | 43 6f 6e 74 72 6f 6c 2c |Disease |Control,|
|000009b0| 20 41 74 6c 61 6e 74 61 | 3b 20 4e 65 77 20 59 6f | Atlanta|; New Yo|
|000009c0| 72 6b 20 43 69 74 79 20 | 44 65 70 74 20 6f 66 20 |rk City |Dept of |
|000009d0| 48 65 61 6c 74 68 29 0d | 0a 4a 41 4d 41 20 32 35 |Health).|.JAMA 25|
|000009e0| 39 3a 31 33 33 38 2d 31 | 33 34 32 2c 20 4d 61 72 |9:1338-1|342, Mar|
|000009f0| 63 68 20 34 2c 20 31 39 | 38 38 0d 0a 2d 2d 2d 2d |ch 4, 19|88..----|
|00000a00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000a10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000a20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000a30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000a40| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 0d 0a 0d 0a |--------|----....|
|00000a50| 41 62 73 74 72 61 63 74 | 0d 0a 0d 0a 20 20 20 20 |Abstract|....    |
|00000a60| 20 41 64 75 6c 74 73 20 | 77 69 74 68 20 61 63 71 | Adults |with acq|
|00000a70| 75 69 72 65 64 20 69 6d | 6d 75 6e 6f 64 65 66 69 |uired im|munodefi|
|00000a80| 63 69 65 6e 63 79 20 73 | 79 6e 64 72 6f 6d 65 20 |ciency s|yndrome |
|00000a90| 28 41 49 44 53 29 20 77 | 68 6f 20 63 61 6e 6e 6f |(AIDS) w|ho canno|
|00000aa0| 74 20 62 65 0d 0a 63 6c | 61 73 73 69 66 69 65 64 |t be..cl|assified|
|00000ab0| 20 69 6e 74 6f 20 31 20 | 6f 66 20 74 68 65 20 67 | into 1 |of the g|
|00000ac0| 72 6f 75 70 73 20 61 74 | 20 69 6e 63 72 65 61 73 |roups at| increas|
|00000ad0| 65 64 20 72 69 73 6b 20 | 66 6f 72 20 41 49 44 53 |ed risk |for AIDS|
|00000ae0| 20 77 65 72 65 20 65 76 | 61 6c 75 61 74 65 64 20 | were ev|aluated |
|00000af0| 74 6f 0d 0a 69 6e 76 65 | 73 74 69 67 61 74 65 20 |to..inve|stigate |
|00000b00| 74 68 65 20 70 6f 73 73 | 69 62 69 6c 69 74 79 20 |the poss|ibility |
|00000b10| 6f 66 20 6e 65 77 20 6f | 72 20 75 6e 72 65 63 6f |of new o|r unreco|
|00000b20| 67 6e 69 7a 65 64 20 6d | 6f 64 65 73 20 6f 66 20 |gnized m|odes of |
|00000b30| 74 72 61 6e 73 6d 69 73 | 73 69 6f 6e 20 6f 66 20 |transmis|sion of |
|00000b40| 74 68 65 0d 0a 68 75 6d | 61 6e 20 69 6d 6d 75 6e |the..hum|an immun|
|00000b50| 6f 64 65 66 69 63 69 65 | 6e 63 79 20 76 69 72 75 |odeficie|ncy viru|
|00000b60| 73 20 28 48 49 56 29 2e | 20 20 49 6e 76 65 73 74 |s (HIV).|  Invest|
|00000b70| 69 67 61 74 69 76 65 20 | 66 69 6e 64 69 6e 67 73 |igative |findings|
|00000b80| 20 77 65 72 65 20 73 74 | 75 64 69 65 64 20 69 6e | were st|udied in|
|00000b90| 0d 0a 32 2c 30 35 39 20 | 28 35 25 29 20 6f 66 20 |..2,059 |(5%) of |
|00000ba0| 34 31 2c 37 37 30 20 61 | 64 75 6c 74 73 20 77 69 |41,770 a|dults wi|
|00000bb0| 74 68 20 41 49 44 53 20 | 72 65 70 6f 72 74 65 64 |th AIDS |reported|
|00000bc0| 20 74 6f 20 74 68 65 20 | 43 65 6e 74 65 72 73 20 | to the |Centers |
|00000bd0| 66 6f 72 20 44 69 73 65 | 61 73 65 0d 0a 43 6f 6e |for Dise|ase..Con|
|00000be0| 74 72 6f 6c 20 74 68 72 | 6f 75 67 68 20 53 65 70 |trol thr|ough Sep|
|00000bf0| 74 65 6d 62 65 72 20 33 | 30 2c 20 31 39 38 37 2c |tember 3|0, 1987,|
|00000c00| 20 77 68 6f 20 63 6f 75 | 6c 64 20 6e 6f 74 20 62 | who cou|ld not b|
|00000c10| 65 20 63 6c 61 73 73 69 | 66 69 65 64 20 69 6e 69 |e classi|fied ini|
|00000c20| 74 69 61 6c 6c 79 20 61 | 73 0d 0a 68 61 76 69 6e |tially a|s..havin|
|00000c30| 67 20 72 69 73 6b 20 66 | 61 63 74 6f 72 73 20 66 |g risk f|actors f|
|00000c40| 6f 72 20 48 49 56 20 74 | 72 61 6e 73 6d 69 73 73 |or HIV t|ransmiss|
|00000c50| 69 6f 6e 2e 0d 0a 20 20 | 20 20 20 52 69 73 6b 20 |ion...  |   Risk |
|00000c60| 68 69 73 74 6f 72 79 20 | 77 61 73 20 69 6e 63 6f |history |was inco|
|00000c70| 6d 70 6c 65 74 65 20 6f | 72 20 75 6e 6f 62 74 61 |mplete o|r unobta|
|00000c80| 69 6e 61 62 6c 65 20 66 | 6f 72 20 39 32 31 20 28 |inable f|or 921 (|
|00000c90| 34 35 25 29 20 6f 66 20 | 74 68 65 73 65 0d 0a 70 |45%) of |these..p|
|00000ca0| 61 74 69 65 6e 74 73 2e | 20 20 4f 66 20 74 68 65 |atients.|  Of the|
|00000cb0| 20 72 65 6d 61 69 6e 69 | 6e 67 20 31 2c 31 33 38 | remaini|ng 1,138|
|00000cc0| 20 70 61 74 69 65 6e 74 | 73 2c 20 72 69 73 6b 20 | patient|s, risk |
|00000cd0| 66 61 63 74 6f 72 73 20 | 77 65 72 65 20 75 6c 74 |factors |were ult|
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|00000cf0| 69 65 64 20 66 6f 72 20 | 38 32 35 20 28 37 32 25 |ied for |825 (72%|
|00000d00| 29 20 62 75 74 20 6e 6f | 74 20 66 6f 72 20 32 38 |) but no|t for 28|
|00000d10| 31 20 28 32 35 25 29 20 | 64 65 73 70 69 74 65 20 |1 (25%) |despite |
|00000d20| 61 64 64 69 74 69 6f 6e | 61 6c 20 69 6e 66 6f 72 |addition|al infor|
|00000d30| 6d 61 74 69 6f 6e 3b 0d | 0a 74 68 65 20 72 65 6d |mation;.|.the rem|
|00000d40| 61 69 6e 69 6e 67 20 33 | 32 20 28 33 25 29 20 70 |aining 3|2 (3%) p|
|00000d50| 65 72 73 6f 6e 73 20 64 | 69 64 20 6e 6f 74 20 6d |ersons d|id not m|
|00000d60| 65 65 74 20 74 68 65 20 | 63 61 73 65 20 64 65 66 |eet the |case def|
|00000d70| 69 6e 69 74 69 6f 6e 20 | 66 6f 72 20 41 49 44 53 |inition |for AIDS|
|00000d80| 2e 20 20 4d 6f 73 74 0d | 0a 6f 66 20 74 68 65 20 |.  Most.|.of the |
|00000d90| 32 38 31 20 70 61 74 69 | 65 6e 74 73 20 77 69 74 |281 pati|ents wit|
|00000da0| 68 20 6e 6f 20 69 64 65 | 6e 74 69 66 69 65 64 20 |h no ide|ntified |
|00000db0| 72 69 73 6b 20 66 61 63 | 74 6f 72 73 20 77 65 72 |risk fac|tors wer|
|00000dc0| 65 20 6d 61 6c 65 20 61 | 6e 64 20 6e 6f 6e 77 68 |e male a|nd nonwh|
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|00002940| 6f 70 79 72 69 67 68 74 | 20 28 63 29 20 59 65 61 |opyright| (c) Yea|
|00002950| 72 20 42 6f 6f 6b 20 4d | 65 64 69 63 61 6c 20 50 |r Book M|edical P|
|00002960| 75 62 6c 69 73 68 65 72 | 73 2c 20 49 6e 63 2e 2c |ublisher|s, Inc.,|
|00002970| 20 31 39 38 39 0d 0a 0d | 0a 31 39 38 39 20 59 65 | 1989...|.1989 Ye|
|00002980| 61 72 20 42 6f 6f 6b 20 | 6f 66 20 46 61 6d 69 6c |ar Book |of Famil|
|00002990| 79 20 50 72 61 63 74 69 | 63 65 20 28 52 29 0d 0a |y Practi|ce (R)..|
|000029a0| 0d 0a 43 68 61 70 74 65 | 72 20 39 2d 2d 44 69 73 |..Chapte|r 9--Dis|
|000029b0| 65 61 73 65 73 20 6f 66 | 20 74 68 65 20 52 65 73 |eases of| the Res|
|000029c0| 70 69 72 61 74 6f 72 79 | 20 53 79 73 74 65 6d 0d |piratory| System.|
|000029d0| 0a 0d 0a 4d 69 73 63 65 | 6c 6c 61 6e 65 6f 75 73 |...Misce|llaneous|
|000029e0| 20 54 6f 70 69 63 73 0d | 0a 0d 0a 2d 2d 2d 2d 2d | Topics.|...-----|
|000029f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002a00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002a10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002a20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002a30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 0d 0a 41 6e 74 |--------|---..Ant|
|00002a40| 69 74 75 73 73 69 76 65 | 20 45 66 66 65 63 74 20 |itussive| Effect |
|00002a50| 6f 66 20 44 65 78 74 72 | 6f 6d 65 74 68 6f 72 70 |of Dextr|omethorp|
|00002a60| 68 61 6e 20 61 6e 64 20 | 44 65 78 74 72 6f 6d 65 |han and |Dextrome|
|00002a70| 74 68 6f 72 70 68 61 6e | 2d 53 61 6c 62 75 74 61 |thorphan|-Salbuta|
|00002a80| 6d 6f 6c 0d 0a 43 6f 6d | 62 69 6e 61 74 69 6f 6e |mol..Com|bination|
|00002a90| 20 69 6e 20 48 65 61 6c | 74 68 79 20 56 6f 6c 75 | in Heal|thy Volu|
|00002aa0| 6e 74 65 65 72 73 20 77 | 69 74 68 20 41 72 74 69 |nteers w|ith Arti|
|00002ab0| 66 69 63 69 61 6c 6c 79 | 20 49 6e 64 75 63 65 64 |ficially| Induced|
|00002ac0| 20 43 6f 75 67 68 0d 0a | 0d 0a 4b 61 72 74 74 75 | Cough..|..Karttu|
|00002ad0| 6e 65 6e 20 50 3b 20 54 | 75 6b 69 61 69 6e 65 6e |nen P; T|ukiainen|
|00002ae0| 20 48 3b 20 53 69 6c 76 | 61 73 74 69 20 4d 3b 20 | H; Silv|asti M; |
|00002af0| 4b 6f 6c 6f 6e 65 6e 20 | 53 0d 0a 28 52 65 6d 65 |Kolonen |S..(Reme|
|00002b00| 64 61 20 50 68 61 72 6d | 61 63 65 75 74 69 63 61 |da Pharm|aceutica|
|00002b10| 6c 20 43 6f 2c 20 4b 75 | 6f 70 69 6f 2c 20 46 69 |l Co, Ku|opio, Fi|
|00002b20| 6e 6c 61 6e 64 3b 20 55 | 6e 69 76 20 6f 66 20 4b |nland; U|niv of K|
|00002b30| 75 6f 70 69 6f 29 0d 0a | 52 65 73 70 69 72 61 74 |uopio)..|Respirat|
|00002b40| 69 6f 6e 20 35 32 3a 34 | 39 2d 35 33 2c 20 31 39 |ion 52:4|9-53, 19|
|00002b50| 38 37 0d 0a 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |87..----|--------|
|00002b60| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002b70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002b80| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002b90| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002ba0| 2d 2d 2d 2d 0d 0a 0d 0a | 41 62 73 74 72 61 63 74 |----....|Abstract|
|00002bb0| 0d 0a 0d 0a 20 20 20 20 | 20 54 68 65 72 65 20 69 |....    | There i|
|00002bc0| 73 20 73 6f 6d 65 20 65 | 76 69 64 65 6e 63 65 20 |s some e|vidence |
|00002bd0| 74 68 61 74 20 20 62 65 | 74 61 32 2d 73 79 6d 70 |that  be|ta2-symp|
|00002be0| 61 74 68 6f 6d 69 6d 65 | 74 69 63 73 20 6d 61 79 |athomime|tics may|
|00002bf0| 20 62 65 20 75 73 65 66 | 75 6c 20 69 6e 20 74 68 | be usef|ul in th|
|00002c00| 65 0d 0a 74 72 65 61 74 | 6d 65 6e 74 20 6f 66 20 |e..treat|ment of |
|00002c10| 63 6f 75 67 68 2e 20 20 | 41 20 64 6f 75 62 6c 65 |cough.  |A double|
|00002c20| 2d 62 6c 69 6e 64 20 63 | 72 6f 73 73 6f 76 65 72 |-blind c|rossover|
|00002c30| 20 73 74 75 64 79 20 77 | 61 73 20 75 6e 64 65 72 | study w|as under|
|00002c40| 74 61 6b 65 6e 20 74 6f | 20 63 6f 6d 70 61 72 65 |taken to| compare|
|00002c50| 0d 0a 74 68 65 20 61 6e | 74 69 74 75 73 73 69 76 |..the an|titussiv|
|00002c60| 65 20 65 66 66 65 63 74 | 20 6f 66 20 74 68 65 20 |e effect| of the |
|00002c70| 63 6f 6d 62 69 6e 61 74 | 69 6f 6e 20 6f 66 20 33 |combinat|ion of 3|
|00002c80| 30 20 6d 67 20 6f 66 20 | 64 65 78 74 72 6f 6d 65 |0 mg of |dextrome|
|00002c90| 74 68 6f 72 70 68 61 6e | 20 61 6e 64 20 32 20 6d |thorphan| and 2 m|
|00002ca0| 67 0d 0a 6f 66 20 73 61 | 6c 62 75 74 61 6d 6f 6c |g..of sa|lbutamol|
|00002cb0| 20 77 69 74 68 20 74 68 | 61 74 20 6f 66 20 33 30 | with th|at of 30|
|00002cc0| 20 6d 67 20 6f 66 20 64 | 65 78 74 72 6f 6d 65 74 | mg of d|extromet|
|00002cd0| 68 6f 72 70 68 61 6e 20 | 61 6c 6f 6e 65 20 61 6e |horphan |alone an|
|00002ce0| 64 20 70 6c 61 63 65 62 | 6f 20 69 6e 20 31 39 0d |d placeb|o in 19.|
|00002cf0| 0a 68 65 61 6c 74 68 79 | 20 6e 6f 6e 73 6d 6f 6b |.healthy| nonsmok|
|00002d00| 65 72 73 20 77 69 74 68 | 20 61 72 74 69 66 69 63 |ers with| artific|
|00002d10| 69 61 6c 20 63 6f 75 67 | 68 20 69 6e 64 75 63 65 |ial coug|h induce|
|00002d20| 64 20 62 79 20 69 6e 68 | 61 6c 65 64 20 63 69 74 |d by inh|aled cit|
|00002d30| 72 69 63 20 61 63 69 64 | 2e 20 20 54 68 65 0d 0a |ric acid|.  The..|
|00002d40| 63 6f 75 67 68 20 74 68 | 72 65 73 68 6f 6c 64 20 |cough th|reshold |
|00002d50| 6c 65 76 65 6c 20 77 61 | 73 20 61 73 73 65 73 73 |level wa|s assess|
|00002d60| 65 64 20 62 65 66 6f 72 | 65 20 61 6e 64 20 39 30 |ed befor|e and 90|
|00002d70| 20 61 6e 64 20 31 38 30 | 20 6d 69 6e 75 74 65 73 | and 180| minutes|
|00002d80| 20 61 66 74 65 72 20 65 | 61 63 68 20 64 72 75 67 | after e|ach drug|
|00002d90| 0d 0a 77 61 73 20 67 69 | 76 65 6e 2e 0d 0a 20 20 |..was gi|ven...  |
|00002da0| 20 20 20 41 20 6d 65 74 | 68 6f 64 20 74 68 61 74 |   A met|hod that|
|00002db0| 20 69 6e 76 6f 6c 76 65 | 64 20 75 73 69 6e 67 20 | involve|d using |
|00002dc0| 69 6e 63 72 65 61 73 69 | 6e 67 20 63 6f 6e 63 65 |increasi|ng conce|
|00002dd0| 6e 74 72 61 74 69 6f 6e | 73 20 6f 66 20 6e 65 62 |ntration|s of neb|
|00002de0| 75 6c 69 7a 65 64 20 63 | 69 74 72 69 63 0d 0a 61 |ulized c|itric..a|
|00002df0| 63 69 64 20 74 6f 20 65 | 73 74 61 62 6c 69 73 68 |cid to e|stablish|
|00002e00| 20 74 68 65 20 63 6f 75 | 67 68 20 74 68 72 65 73 | the cou|gh thres|
|00002e10| 68 6f 6c 64 20 73 68 6f | 77 65 64 20 61 6e 20 61 |hold sho|wed an a|
|00002e20| 63 63 65 70 74 61 62 6c | 65 20 72 65 70 72 6f 64 |cceptabl|e reprod|
|00002e30| 75 63 69 62 69 6c 69 74 | 79 20 61 6e 64 0d 0a 70 |ucibilit|y and..p|
|00002e40| 72 6f 76 65 64 20 74 6f | 20 62 65 20 73 75 69 74 |roved to| be suit|
|00002e50| 61 62 6c 65 20 66 6f 72 | 20 63 6f 6d 70 61 72 69 |able for| compari|
|00002e60| 73 6f 6e 20 6f 66 20 74 | 68 65 20 61 6e 74 69 74 |son of t|he antit|
|00002e70| 75 73 73 69 76 65 20 65 | 66 66 65 63 74 73 20 6f |ussive e|ffects o|
|00002e80| 66 20 74 68 65 20 64 72 | 75 67 73 2e 0d 0a 54 68 |f the dr|ugs...Th|
|00002e90| 65 72 65 20 77 61 73 20 | 6e 6f 20 73 74 61 74 69 |ere was |no stati|
|00002ea0| 73 74 69 63 61 6c 6c 79 | 20 73 69 67 6e 69 66 69 |stically| signifi|
|00002eb0| 63 61 6e 74 20 69 6e 63 | 72 65 61 73 65 20 69 6e |cant inc|rease in|
|00002ec0| 20 63 6f 75 67 68 20 74 | 68 72 65 73 68 6f 6c 64 | cough t|hreshold|
|00002ed0| 20 61 66 74 65 72 20 70 | 6c 61 63 65 62 6f 0d 0a | after p|lacebo..|
|00002ee0| 77 61 73 20 67 69 76 65 | 6e 2e 20 20 49 6e 20 63 |was give|n.  In c|
|00002ef0| 6f 6e 74 72 61 73 74 2c | 20 68 69 67 68 6c 79 20 |ontrast,| highly |
|00002f00| 73 69 67 6e 69 66 69 63 | 61 6e 74 20 69 6e 63 72 |signific|ant incr|
|00002f10| 65 61 73 65 73 20 77 65 | 72 65 20 73 68 6f 77 6e |eases we|re shown|
|00002f20| 20 61 66 74 65 72 20 74 | 72 65 61 74 6d 65 6e 74 | after t|reatment|
|00002f30| 0d 0a 77 69 74 68 20 64 | 65 78 74 72 6f 6d 65 74 |..with d|extromet|
|00002f40| 68 6f 72 70 68 61 6e 20 | 61 6c 6f 6e 65 20 61 6e |horphan |alone an|
|00002f50| 64 20 74 68 65 20 64 65 | 78 74 72 6f 6d 65 74 68 |d the de|xtrometh|
|00002f60| 6f 72 70 68 61 6e 2d 73 | 61 6c 62 75 74 61 6d 6f |orphan-s|albutamo|
|00002f70| 6c 20 63 6f 6d 62 69 6e | 61 74 69 6f 6e 2e 0d 0a |l combin|ation...|
|00002f80| 42 65 74 77 65 65 6e 20 | 74 72 65 61 74 6d 65 6e |Between |treatmen|
|00002f90| 74 73 20 73 69 67 6e 69 | 66 69 63 61 6e 74 20 64 |ts signi|ficant d|
|00002fa0| 69 66 66 65 72 65 6e 63 | 65 73 20 77 65 72 65 20 |ifferenc|es were |
|00002fb0| 66 6f 75 6e 64 20 69 6e | 20 66 61 76 6f 72 20 6f |found in| favor o|
|00002fc0| 66 20 74 68 65 0d 0a 64 | 65 78 74 72 6f 6d 65 74 |f the..d|extromet|
|00002fd0| 68 6f 72 70 68 61 6e 2d | 73 61 6c 62 75 74 61 6d |horphan-|salbutam|
|00002fe0| 6f 6c 20 63 6f 6d 62 69 | 6e 61 74 69 6f 6e 2e 0d |ol combi|nation..|
|00002ff0| 0a 20 20 20 20 20 53 61 | 6c 62 75 74 61 6d 6f 6c |.     Sa|lbutamol|
|00003000| 20 68 61 73 20 61 6e 20 | 61 6e 74 69 74 75 73 73 | has an |antituss|
|00003010| 69 76 65 20 70 6f 74 65 | 6e 74 69 61 6c 20 74 68 |ive pote|ntial th|
|00003020| 61 74 20 63 61 6e 20 65 | 6e 68 61 6e 63 65 20 74 |at can e|nhance t|
|00003030| 68 65 20 61 63 74 69 6f | 6e 20 6f 66 0d 0a 70 6c |he actio|n of..pl|
|00003040| 61 69 6e 20 64 65 78 74 | 72 6f 6d 65 74 68 6f 72 |ain dext|romethor|
|00003050| 70 68 61 6e 2e 20 20 54 | 68 65 20 63 6f 6d 62 69 |phan.  T|he combi|
|00003060| 6e 61 74 69 6f 6e 20 6f | 66 20 61 6e 20 61 6e 74 |nation o|f an ant|
|00003070| 69 74 75 73 73 69 76 65 | 20 61 67 65 6e 74 20 61 |itussive| agent a|
|00003080| 6e 64 20 61 20 20 62 65 | 74 61 0d 0a 0d 0a 50 6f |nd a  be|ta....Po|
|00003090| 73 74 2d 43 6f 6d 6d 65 | 6e 74 0d 0a 0d 0a 20 20 |st-Comme|nt....  |
|000030a0| 20 20 20 50 65 72 73 69 | 73 74 65 6e 74 20 63 6f |   Persi|stent co|
|000030b0| 75 67 68 20 61 66 74 65 | 72 20 76 69 72 61 6c 20 |ugh afte|r viral |
|000030c0| 69 6e 66 65 63 74 69 6f | 6e 20 6f 66 20 74 68 65 |infectio|n of the|
|000030d0| 20 6c 6f 77 65 72 20 72 | 65 73 70 69 72 61 74 6f | lower r|espirato|
|000030e0| 72 79 20 74 72 61 63 74 | 20 6f 72 20 61 6e 0d 0a |ry tract| or an..|
|000030f0| 65 70 69 73 6f 64 65 20 | 6f 66 20 70 75 72 75 6c |episode |of purul|
|00003100| 65 6e 74 20 62 72 6f 6e | 63 68 69 74 69 73 20 6d |ent bron|chitis m|
|00003110| 61 79 20 72 65 66 6c 65 | 63 74 20 75 6e 64 65 72 |ay refle|ct under|
|00003120| 6c 79 69 6e 67 20 72 65 | 61 63 74 69 76 65 20 61 |lying re|active a|
|00003130| 69 72 77 61 79 73 20 64 | 69 73 65 61 73 65 0d 0a |irways d|isease..|
|00003140| 28 73 65 65 20 74 68 65 | 20 31 39 38 37 20 59 45 |(see the| 1987 YE|
|00003150| 41 52 20 42 4f 4f 4b 2c | 20 70 70 2e 20 32 39 32 |AR BOOK,| pp. 292|
|00003160| 2d 32 39 33 2c 20 61 6e | 64 20 74 68 65 20 31 39 |-293, an|d the 19|
|00003170| 38 38 20 59 45 41 52 20 | 42 4f 4f 4b 2c 20 70 70 |88 YEAR |BOOK, pp|
|00003180| 2e 20 32 38 39 2d 32 39 | 30 29 2e 0d 0a 54 68 6f |. 289-29|0)...Tho|
|00003190| 75 67 68 20 74 68 69 73 | 20 77 61 73 20 61 20 73 |ugh this| was a s|
|000031a0| 74 75 64 79 20 6f 66 20 | 74 68 65 20 63 6f 6d 62 |tudy of |the comb|
|000031b0| 69 6e 65 64 20 75 73 65 | 20 6f 66 20 64 65 78 74 |ined use| of dext|
|000031c0| 72 6f 6d 65 74 68 6f 72 | 70 68 61 6e 20 61 6e 64 |romethor|phan and|
|000031d0| 20 73 61 6c 62 75 74 61 | 6d 6f 6c 0d 0a 69 6e 20 | salbuta|mol..in |
|000031e0| 63 6f 6e 74 72 6f 6c 6c | 69 6e 67 20 61 6e 20 61 |controll|ing an a|
|000031f0| 72 74 69 66 69 63 69 61 | 6c 6c 79 20 69 6e 64 75 |rtificia|lly indu|
|00003200| 63 65 64 20 63 6f 75 67 | 68 2c 20 74 68 65 20 63 |ced coug|h, the c|
|00003210| 6f 6d 62 69 6e 61 74 69 | 6f 6e 20 61 70 70 65 61 |ombinati|on appea|
|00003220| 72 73 20 74 6f 20 62 65 | 20 61 0d 0a 72 61 74 69 |rs to be| a..rati|
|00003230| 6f 6e 61 6c 20 6f 6e 65 | 20 66 6f 72 20 70 65 72 |onal one| for per|
|00003240| 73 69 73 74 65 6e 74 20 | 63 6f 75 67 68 20 61 66 |sistent |cough af|
|00003250| 74 65 72 20 72 65 73 6f | 6c 75 74 69 6f 6e 20 6f |ter reso|lution o|
|00003260| 66 20 61 20 6c 6f 77 65 | 72 20 76 69 72 61 6c 20 |f a lowe|r viral |
|00003270| 72 65 73 70 69 72 61 74 | 6f 72 79 0d 0a 74 72 61 |respirat|ory..tra|
|00003280| 63 74 20 69 6e 66 65 63 | 74 69 6f 6e 2e 2d 2d 4a |ct infec|tion.--J|
|00003290| 2e 47 2e 20 50 72 69 63 | 68 61 72 64 2c 20 4d 2e |.G. Pric|hard, M.|
|000032a0| 44 2e 2c 20 4d 2e 48 2e | 53 2e 0d 0a 24 55 6e 69 |D., M.H.|S...$Uni|
|000032b0| 71 75 65 5f 49 44 7b 59 | 52 42 30 36 35 30 33 7d |que_ID{Y|RB06503}|
|000032c0| 0d 0a 24 54 69 74 6c 65 | 7b 43 61 70 74 6f 70 72 |..$Title|{Captopr|
|000032d0| 69 6c 2d 49 6e 64 75 63 | 65 64 20 43 6f 75 67 68 |il-Induc|ed Cough|
|000032e0| 7d 0d 0a 24 41 75 74 68 | 6f 72 7b 53 74 6f 6c 6c |}..$Auth|or{Stoll|
|000032f0| 65 72 20 4a 4b 0d 0a 45 | 6c 67 68 61 7a 61 77 69 |er JK..E|lghazawi|
|00003300| 20 41 0d 0a 4d 65 68 74 | 61 20 41 43 0d 0a 56 69 | A..Meht|a AC..Vi|
|00003310| 64 74 20 44 47 7d 0d 0a | 24 41 66 66 69 6c 69 61 |dt DG}..|$Affilia|
|00003320| 74 69 6f 6e 7b 43 6c 65 | 76 65 6c 61 6e 64 20 43 |tion{Cle|veland C|
|00003330| 6c 69 6e 69 63 20 46 6f | 75 6e 64 7d 0d 0a 24 53 |linic Fo|und}..$S|
|00003340| 75 62 6a 65 63 74 7b 43 | 6f 75 67 68 2c 20 63 61 |ubject{C|ough, ca|
|00003350| 70 74 6f 70 72 69 6c 2d | 61 73 73 6f 63 69 61 74 |ptopril-|associat|
|00003360| 65 64 3b 0d 0a 43 61 70 | 74 6f 70 72 69 6c 2d 61 |ed;..Cap|topril-a|
|00003370| 73 73 6f 63 69 61 74 65 | 64 20 63 6f 75 67 68 2c |ssociate|d cough,|
|00003380| 20 64 69 73 63 75 73 73 | 69 6f 6e 20 6f 66 7d 0d | discuss|ion of}.|
|00003390| 0a 24 4a 6f 75 72 6e 61 | 6c 7b 43 68 65 73 74 7d |.$Journa|l{Chest}|
|000033a0| 0d 0a 24 56 6f 6c 75 6d | 65 7b 39 33 7d 0d 0a 24 |..$Volum|e{93}..$|
|000033b0| 50 61 67 65 7b 36 35 39 | 2d 36 36 31 7d 0d 0a 24 |Page{659|-661}..$|
|000033c0| 44 61 74 65 7b 4d 61 72 | 63 68 20 31 39 38 38 7d |Date{Mar|ch 1988}|
|000033d0| 0d 0a 24 59 42 56 6f 6c | 7b 31 39 38 39 20 59 65 |..$YBVol|{1989 Ye|
|000033e0| 61 72 20 42 6f 6f 6b 20 | 6f 66 20 46 61 6d 69 6c |ar Book |of Famil|
|000033f0| 79 20 50 72 61 63 74 69 | 63 65 7d 0d 0a 24 43 68 |y Practi|ce}..$Ch|
|00003400| 61 70 74 65 72 7b 39 2d | 32 33 7d 0d 0a 24 59 42 |apter{9-|23}..$YB|
|00003410| 45 64 69 74 6f 72 7b 44 | 72 73 2e 20 52 61 6b 65 |Editor{D|rs. Rake|
|00003420| 6c 2c 20 41 76 61 6e 74 | 2c 20 44 72 69 73 63 6f |l, Avant|, Drisco|
|00003430| 6c 6c 2c 20 50 72 69 63 | 68 61 72 64 2c 20 61 6e |ll, Pric|hard, an|
|00003440| 64 20 53 6d 69 74 68 7d | 0d 0a 24 54 61 62 6c 65 |d Smith}|..$Table|
|00003450| 7b 7d 0d 0a 24 43 6f 6d | 6d 65 6e 74 61 74 6f 72 |{}..$Com|mentator|
|00003460| 7b 4a 2e 47 2e 20 50 72 | 69 63 68 61 72 64 2c 20 |{J.G. Pr|ichard, |
|00003470| 4d 2e 44 2e 2c 20 4d 2e | 48 2e 53 2e 7d 0d 0a 0d |M.D., M.|H.S.}...|
|00003480| 0a 43 6f 70 79 72 69 67 | 68 74 20 28 63 29 20 59 |.Copyrig|ht (c) Y|
|00003490| 65 61 72 20 42 6f 6f 6b | 20 4d 65 64 69 63 61 6c |ear Book| Medical|
|000034a0| 20 50 75 62 6c 69 73 68 | 65 72 73 2c 20 49 6e 63 | Publish|ers, Inc|
|000034b0| 2e 2c 20 31 39 38 39 0d | 0a 0d 0a 31 39 38 39 20 |., 1989.|...1989 |
|000034c0| 59 65 61 72 20 42 6f 6f | 6b 20 6f 66 20 46 61 6d |Year Boo|k of Fam|
|000034d0| 69 6c 79 20 50 72 61 63 | 74 69 63 65 20 28 52 29 |ily Prac|tice (R)|
|000034e0| 0d 0a 0d 0a 43 68 61 70 | 74 65 72 20 39 2d 2d 44 |....Chap|ter 9--D|
|000034f0| 69 73 65 61 73 65 73 20 | 6f 66 20 74 68 65 20 52 |iseases |of the R|
|00003500| 65 73 70 69 72 61 74 6f | 72 79 20 53 79 73 74 65 |espirato|ry Syste|
|00003510| 6d 0d 0a 0d 0a 4d 69 73 | 63 65 6c 6c 61 6e 65 6f |m....Mis|cellaneo|
|00003520| 75 73 20 54 6f 70 69 63 | 73 0d 0a 0d 0a 2d 2d 2d |us Topic|s....---|
|00003530| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003540| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003550| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003560| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003570| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0a 43 |--------|-----..C|
|00003580| 61 70 74 6f 70 72 69 6c | 2d 49 6e 64 75 63 65 64 |aptopril|-Induced|
|00003590| 20 43 6f 75 67 68 0d 0a | 0d 0a 53 74 6f 6c 6c 65 | Cough..|..Stolle|
|000035a0| 72 20 4a 4b 3b 20 45 6c | 67 68 61 7a 61 77 69 20 |r JK; El|ghazawi |
|000035b0| 41 3b 20 4d 65 68 74 61 | 20 41 43 3b 20 56 69 64 |A; Mehta| AC; Vid|
|000035c0| 74 20 44 47 0d 0a 28 43 | 6c 65 76 65 6c 61 6e 64 |t DG..(C|leveland|
|000035d0| 20 43 6c 69 6e 69 63 20 | 46 6f 75 6e 64 29 0d 0a | Clinic |Found)..|
|000035e0| 43 68 65 73 74 20 39 33 | 3a 36 35 39 2d 36 36 31 |Chest 93|:659-661|
|000035f0| 2c 20 4d 61 72 63 68 20 | 31 39 38 38 0d 0a 2d 2d |, March |1988..--|
|00003600| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003610| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003620| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003630| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003640| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 0d 0a |--------|------..|
|00003650| 0d 0a 41 62 73 74 72 61 | 63 74 0d 0a 0d 0a 20 20 |..Abstra|ct....  |
|00003660| 20 20 20 43 6f 75 67 68 | 20 68 61 73 20 6f 63 63 |   Cough| has occ|
|00003670| 61 73 69 6f 6e 61 6c 6c | 79 20 62 65 65 6e 20 72 |asionall|y been r|
|00003680| 65 63 6f 67 6e 69 7a 65 | 64 20 61 73 20 61 20 73 |ecognize|d as a s|
|00003690| 69 64 65 20 65 66 66 65 | 63 74 20 6f 66 20 74 68 |ide effe|ct of th|
|000036a0| 65 0d 0a 61 6e 67 69 6f | 74 65 6e 73 69 6e 2d 63 |e..angio|tensin-c|
|000036b0| 6f 6e 76 65 72 74 69 6e | 67 20 65 6e 7a 79 6d 65 |onvertin|g enzyme|
|000036c0| 20 28 41 43 45 29 20 69 | 6e 68 69 62 69 74 6f 72 | (ACE) i|nhibitor|
|000036d0| 73 20 63 61 70 74 6f 70 | 72 69 6c 20 61 6e 64 20 |s captop|ril and |
|000036e0| 65 6e 61 6c 61 70 72 69 | 6c 2e 20 20 54 77 6f 0d |enalapri|l.  Two.|
|000036f0| 0a 70 61 74 69 65 6e 74 | 73 20 77 65 72 65 20 73 |.patient|s were s|
|00003700| 65 65 6e 20 77 69 74 68 | 20 63 61 70 74 6f 70 72 |een with| captopr|
|00003710| 69 6c 2d 69 6e 64 75 63 | 65 64 20 63 6f 75 67 68 |il-induc|ed cough|
|00003720| 2e 20 20 54 68 65 20 6c | 69 74 65 72 61 74 75 72 |.  The l|iteratur|
|00003730| 65 20 6f 6e 20 41 43 45 | 0d 0a 69 6e 68 69 62 69 |e on ACE|..inhibi|
|00003740| 74 6f 72 2d 69 6e 64 75 | 63 65 64 20 63 6f 75 67 |tor-indu|ced coug|
|00003750| 68 20 77 61 73 20 72 65 | 76 69 65 77 65 64 2e 20 |h was re|viewed. |
|00003760| 20 54 68 65 20 70 61 74 | 69 65 6e 74 73 2c 20 62 | The pat|ients, b|
|00003770| 6f 74 68 20 68 79 70 65 | 72 74 65 6e 73 69 76 65 |oth hype|rtensive|
|00003780| 2c 20 68 61 64 0d 0a 70 | 65 72 73 69 73 74 65 6e |, had..p|ersisten|
|00003790| 74 20 63 6f 75 67 68 20 | 66 6f 72 20 6e 65 61 72 |t cough |for near|
|000037a0| 6c 79 20 61 20 79 65 61 | 72 2e 20 20 43 68 65 73 |ly a yea|r.  Ches|
|000037b0| 74 20 78 2d 72 61 79 20 | 61 70 70 65 61 72 61 6e |t x-ray |appearan|
|000037c0| 63 65 73 20 61 6e 64 20 | 73 70 69 72 6f 6d 65 74 |ces and |spiromet|
|000037d0| 72 79 0d 0a 72 65 73 75 | 6c 74 73 20 77 65 72 65 |ry..resu|lts were|
|000037e0| 20 6e 6f 72 6d 61 6c 2e | 20 20 53 79 6d 70 74 6f | normal.|  Sympto|
|000037f0| 6d 73 20 72 65 73 6f 6c | 76 65 64 20 69 6e 20 62 |ms resol|ved in b|
|00003800| 6f 74 68 20 70 61 74 69 | 65 6e 74 73 20 77 68 65 |oth pati|ents whe|
|00003810| 6e 20 63 61 70 74 6f 70 | 72 69 6c 20 74 68 65 72 |n captop|ril ther|
|00003820| 61 70 79 0d 0a 77 61 73 | 20 64 69 73 63 6f 6e 74 |apy..was| discont|
|00003830| 69 6e 75 65 64 2e 0d 0a | 20 20 20 20 20 45 73 74 |inued...|     Est|
|00003840| 69 6d 61 74 65 73 20 6f | 66 20 74 68 65 20 70 72 |imates o|f the pr|
|00003850| 65 76 61 6c 65 6e 63 65 | 20 6f 66 20 41 43 45 20 |evalence| of ACE |
|00003860| 69 6e 68 69 62 69 74 6f | 72 2d 69 6e 64 75 63 65 |inhibito|r-induce|
|00003870| 64 20 63 6f 75 67 68 20 | 76 61 72 79 20 66 72 6f |d cough |vary fro|
|00003880| 6d 20 30 2e 37 25 0d 0a | 74 6f 20 31 36 2e 37 25 |m 0.7%..|to 16.7%|
|00003890| 20 77 69 74 68 20 63 61 | 70 74 6f 70 72 69 6c 20 | with ca|ptopril |
|000038a0| 74 68 65 72 61 70 79 20 | 61 6e 64 20 66 72 6f 6d |therapy |and from|
|000038b0| 20 31 2e 33 25 20 74 6f | 20 31 30 25 20 77 69 74 | 1.3% to| 10% wit|
|000038c0| 68 20 65 6e 61 6c 61 70 | 72 69 6c 20 74 72 65 61 |h enalap|ril trea|
|000038d0| 74 6d 65 6e 74 2e 0d 0a | 50 72 65 6c 69 6d 69 6e |tment...|Prelimin|
|000038e0| 61 72 79 20 72 65 70 6f | 72 74 73 20 6f 66 20 63 |ary repo|rts of c|
|000038f0| 6f 75 67 68 20 69 6e 64 | 75 63 65 64 20 62 79 20 |ough ind|uced by |
|00003900| 63 69 6c 61 7a 61 70 72 | 69 6c 20 73 75 67 67 65 |cilazapr|il sugge|
|00003910| 73 74 20 61 20 70 72 65 | 76 61 6c 65 6e 63 65 20 |st a pre|valence |
|00003920| 6f 66 20 32 33 25 2e 0d | 0a 4f 6e 73 65 74 20 6f |of 23%..|.Onset o|
|00003930| 66 20 63 6f 75 67 68 20 | 61 66 74 65 72 20 73 74 |f cough |after st|
|00003940| 61 72 74 69 6e 67 20 74 | 72 65 61 74 6d 65 6e 74 |arting t|reatment|
|00003950| 20 77 69 74 68 20 61 6e | 20 41 43 45 20 69 6e 68 | with an| ACE inh|
|00003960| 69 62 69 74 6f 72 20 68 | 61 73 20 62 65 65 6e 20 |ibitor h|as been |
|00003970| 72 65 70 6f 72 74 65 64 | 0d 0a 61 73 20 62 65 69 |reported|..as bei|
|00003980| 6e 67 20 66 72 6f 6d 20 | 33 20 64 61 79 73 20 74 |ng from |3 days t|
|00003990| 6f 20 31 20 79 65 61 72 | 2e 0d 0a 20 20 20 20 20 |o 1 year|...     |
|000039a0| 54 68 65 20 70 61 74 68 | 6f 67 65 6e 69 63 20 6d |The path|ogenic m|
|000039b0| 65 63 68 61 6e 69 73 6d | 20 69 73 20 75 6e 63 6c |echanism| is uncl|
|000039c0| 65 61 72 2c 20 62 75 74 | 20 41 43 45 20 69 6e 68 |ear, but| ACE inh|
|000039d0| 69 62 69 74 6f 72 73 20 | 61 70 70 65 61 72 20 74 |ibitors |appear t|
|000039e0| 6f 20 69 6e 64 75 63 65 | 0d 0a 63 6f 75 67 68 2e |o induce|..cough.|
|000039f0| 20 20 41 73 20 75 73 65 | 20 6f 66 20 41 43 45 20 |  As use| of ACE |
|00003a00| 69 6e 68 69 62 69 74 6f | 72 73 20 62 65 63 6f 6d |inhibito|rs becom|
|00003a10| 65 73 20 6d 6f 72 65 20 | 77 69 64 65 73 70 72 65 |es more |widespre|
|00003a20| 61 64 20 61 6e 64 20 6e | 65 77 20 66 6f 72 6d 73 |ad and n|ew forms|
|00003a30| 20 62 65 63 6f 6d 65 0d | 0a 61 76 61 69 6c 61 62 | become.|.availab|
|00003a40| 6c 65 2c 20 41 43 45 20 | 69 6e 68 69 62 69 74 6f |le, ACE |inhibito|
|00003a50| 72 2d 69 6e 64 75 63 65 | 64 20 63 6f 75 67 68 20 |r-induce|d cough |
|00003a60| 6d 61 79 20 62 65 20 72 | 65 63 6f 67 6e 69 7a 65 |may be r|ecognize|
|00003a70| 64 20 77 69 74 68 20 69 | 6e 63 72 65 61 73 69 6e |d with i|ncreasin|
|00003a80| 67 0d 0a 66 72 65 71 75 | 65 6e 63 79 2e 0d 0a 0d |g..frequ|ency....|
|00003a90| 0a 50 6f 73 74 2d 43 6f | 6d 6d 65 6e 74 0d 0a 0d |.Post-Co|mment...|
|00003aa0| 0a 20 20 20 20 20 41 6e | 67 69 6f 74 65 6e 73 69 |.     An|giotensi|
|00003ab0| 6e 2d 63 6f 6e 76 65 72 | 74 69 6e 67 20 65 6e 7a |n-conver|ting enz|
|00003ac0| 79 6d 65 20 69 6e 68 69 | 62 69 74 6f 72 73 20 61 |yme inhi|bitors a|
|00003ad0| 72 65 20 77 69 64 65 6c | 79 20 70 72 65 73 63 72 |re widel|y prescr|
|00003ae0| 69 62 65 64 20 66 6f 72 | 20 74 68 65 0d 0a 6d 61 |ibed for| the..ma|
|00003af0| 6e 61 67 65 6d 65 6e 74 | 20 6f 66 20 68 79 70 65 |nagement| of hype|
|00003b00| 72 74 65 6e 73 69 6f 6e | 20 61 6e 64 20 63 6f 6e |rtension| and con|
|00003b10| 67 65 73 74 69 76 65 20 | 68 65 61 72 74 20 66 61 |gestive |heart fa|
|00003b20| 69 6c 75 72 65 2e 20 20 | 54 68 69 73 20 72 65 70 |ilure.  |This rep|
|00003b30| 6f 72 74 20 69 73 20 31 | 20 6f 66 20 61 6e 0d 0a |ort is 1| of an..|
|00003b40| 69 6e 63 72 65 61 73 69 | 6e 67 20 6e 75 6d 62 65 |increasi|ng numbe|
|00003b50| 72 20 6f 66 20 63 61 73 | 65 20 72 65 70 6f 72 74 |r of cas|e report|
|00003b60| 73 20 69 6e 64 69 63 61 | 74 69 6e 67 20 74 68 61 |s indica|ting tha|
|00003b70| 74 20 41 43 45 20 69 6e | 68 69 62 69 74 6f 72 73 |t ACE in|hibitors|
|00003b80| 20 63 61 6e 20 69 6e 64 | 75 63 65 20 61 0d 0a 70 | can ind|uce a..p|
|00003b90| 65 72 73 69 73 74 65 6e | 74 20 63 6f 75 67 68 20 |ersisten|t cough |
|00003ba0| 69 6e 20 73 6f 6d 65 20 | 70 61 74 69 65 6e 74 73 |in some |patients|
|00003bb0| 2e 20 20 57 6f 6d 65 6e | 20 61 70 70 65 61 72 20 |.  Women| appear |
|00003bc0| 74 6f 20 62 65 20 6d 6f | 73 74 20 63 6f 6d 6d 6f |to be mo|st commo|
|00003bd0| 6e 6c 79 20 61 66 66 65 | 63 74 65 64 2e 0d 0a 54 |nly affe|cted...T|
|00003be0| 68 65 20 63 6f 75 67 68 | 20 75 73 75 61 6c 6c 79 |he cough| usually|
|00003bf0| 20 72 65 73 6f 6c 76 65 | 73 20 77 69 74 68 69 6e | resolve|s within|
|00003c00| 20 64 61 79 73 20 61 66 | 74 65 72 20 64 69 73 63 | days af|ter disc|
|00003c10| 6f 6e 74 69 6e 75 61 6e | 63 65 20 6f 66 20 6d 65 |ontinuan|ce of me|
|00003c20| 64 69 63 61 74 69 6f 6e | 2e 0d 0a 44 72 75 67 2d |dication|...Drug-|
|00003c30| 69 6e 64 75 63 65 64 20 | 63 6f 75 67 68 20 68 61 |induced |cough ha|
|00003c40| 73 20 62 65 65 6e 20 61 | 73 73 6f 63 69 61 74 65 |s been a|ssociate|
|00003c50| 64 20 77 69 74 68 20 62 | 6f 74 68 20 65 6e 61 6c |d with b|oth enal|
|00003c60| 61 70 72 69 6c 20 61 6e | 64 20 63 61 70 74 6f 70 |april an|d captop|
|00003c70| 72 69 6c 2e 20 20 54 68 | 65 0d 0a 66 6f 6c 6c 6f |ril.  Th|e..follo|
|00003c80| 77 69 6e 67 20 70 61 70 | 65 72 20 62 79 20 42 75 |wing pap|er by Bu|
|00003c90| 63 6b 6e 61 6c 6c 20 65 | 74 20 61 6c 2e 20 73 75 |cknall e|t al. su|
|00003ca0| 67 67 65 73 74 73 20 74 | 68 61 74 20 63 61 70 74 |ggests t|hat capt|
|00003cb0| 6f 70 72 69 6c 20 6d 61 | 79 20 69 6e 64 75 63 65 |opril ma|y induce|
|00003cc0| 20 63 6f 75 67 68 20 69 | 6e 0d 0a 70 65 72 73 6f | cough i|n..perso|
|00003cd0| 6e 73 20 77 68 6f 20 61 | 72 65 20 73 75 73 63 65 |ns who a|re susce|
|00003ce0| 70 74 69 62 6c 65 20 6f | 77 69 6e 67 20 74 6f 20 |ptible o|wing to |
|00003cf0| 75 6e 72 65 63 6f 67 6e | 69 7a 65 64 20 72 65 61 |unrecogn|ized rea|
|00003d00| 63 74 69 76 65 20 61 69 | 72 77 61 79 73 20 28 61 |ctive ai|rways (a|
|00003d10| 6c 73 6f 2c 20 73 65 65 | 0d 0a 41 62 73 74 72 61 |lso, see|..Abstra|
|00003d20| 63 74 20 38 2d 34 37 29 | 2e 2d 2d 4a 2e 47 2e 20 |ct 8-47)|.--J.G. |
|00003d30| 50 72 69 63 68 61 72 64 | 2c 20 4d 2e 44 2e 2c 20 |Prichard|, M.D., |
|00003d40| 4d 2e 48 2e 53 2e 0d 0a | 0d 0a 24 55 6e 69 71 75 |M.H.S...|..$Uniqu|
|00003d50| 65 5f 49 44 7b 59 52 42 | 30 36 35 30 34 7d 0d 0a |e_ID{YRB|06504}..|
|00003d60| 24 54 69 74 6c 65 7b 42 | 72 6f 6e 63 68 69 61 6c |$Title{B|ronchial|
|00003d70| 20 48 79 70 65 72 72 65 | 61 63 74 69 76 69 74 79 | Hyperre|activity|
|00003d80| 20 69 6e 20 50 61 74 69 | 65 6e 74 73 20 57 68 6f | in Pati|ents Who|
|00003d90| 20 43 6f 75 67 68 20 41 | 66 74 65 72 20 52 65 63 | Cough A|fter Rec|
|00003da0| 65 69 76 69 6e 67 20 41 | 6e 67 69 6f 74 65 6e 73 |eiving A|ngiotens|
|00003db0| 69 6e 20 43 6f 6e 76 65 | 72 74 69 6e 67 20 45 6e |in Conve|rting En|
|00003dc0| 7a 79 6d 65 20 49 6e 68 | 69 62 69 74 6f 72 73 7d |zyme Inh|ibitors}|
|00003dd0| 0d 0a 24 41 75 74 68 6f | 72 7b 42 75 63 6b 6e 61 |..$Autho|r{Buckna|
|00003de0| 6c 6c 20 43 45 0d 0a 4e | 65 69 6c 6c 79 20 4a 42 |ll CE..N|eilly JB|
|00003df0| 0d 0a 43 61 72 74 65 72 | 20 52 0d 0a 53 74 65 76 |..Carter| R..Stev|
|00003e00| 65 6e 73 6f 6e 20 52 44 | 0d 0a 53 65 6d 70 6c 65 |enson RD|..Semple|
|00003e10| 20 50 46 7d 0d 0a 24 41 | 66 66 69 6c 69 61 74 69 | PF}..$A|ffiliati|
|00003e20| 6f 6e 7b 52 6f 79 61 6c | 20 49 6e 66 69 72 6d 61 |on{Royal| Infirma|
|00003e30| 72 79 2c 20 47 6c 61 73 | 67 6f 77 3b 20 57 65 73 |ry, Glas|gow; Wes|
|00003e40| 74 65 72 6e 20 49 6e 66 | 69 72 6d 61 72 79 2c 20 |tern Inf|irmary, |
|00003e50| 47 6c 61 73 67 6f 77 2c | 20 53 63 6f 74 6c 61 6e |Glasgow,| Scotlan|
|00003e60| 64 7d 0d 0a 24 53 75 62 | 6a 65 63 74 7b 43 6f 75 |d}..$Sub|ject{Cou|
|00003e70| 67 68 2c 20 62 72 6f 6e | 63 68 69 61 6c 20 68 79 |gh, bron|chial hy|
|00003e80| 70 65 72 72 65 61 63 74 | 69 76 69 74 79 20 61 6e |perreact|ivity an|
|00003e90| 64 3b 0d 0a 42 72 6f 6e | 63 68 69 61 6c 20 68 79 |d;..Bron|chial hy|
|00003ea0| 70 65 72 72 65 61 63 74 | 69 76 69 74 79 20 69 6e |perreact|ivity in|
|00003eb0| 20 70 61 74 69 65 6e 74 | 73 20 77 68 6f 20 63 6f | patient|s who co|
|00003ec0| 75 67 68 20 61 66 74 65 | 72 20 61 6e 67 69 6f 74 |ugh afte|r angiot|
|00003ed0| 65 6e 73 69 6e 20 63 6f | 6e 76 65 72 74 69 6e 67 |ensin co|nverting|
|00003ee0| 20 65 6e 7a 79 6d 65 20 | 69 6e 68 69 62 69 74 6f | enzyme |inhibito|
|00003ef0| 72 73 3b 0d 0a 41 6e 67 | 69 6f 74 65 6e 73 69 6e |rs;..Ang|iotensin|
|00003f00| 2d 63 6f 6e 76 65 72 74 | 69 6e 67 20 65 6e 7a 79 |-convert|ing enzy|
|00003f10| 6d 65 20 69 6e 68 69 62 | 69 74 6f 72 73 2c 20 63 |me inhib|itors, c|
|00003f20| 6f 75 67 68 20 77 69 74 | 68 2c 20 61 6e 64 20 62 |ough wit|h, and b|
|00003f30| 72 6f 6e 63 68 69 61 6c | 20 68 79 70 65 72 72 65 |ronchial| hyperre|
|00003f40| 61 63 74 69 76 69 74 79 | 7d 0d 0a 24 4a 6f 75 72 |activity|}..$Jour|
|00003f50| 6e 61 6c 7b 42 72 20 4d | 65 64 20 4a 7d 0d 0a 24 |nal{Br M|ed J}..$|
|00003f60| 56 6f 6c 75 6d 65 7b 32 | 39 36 7d 0d 0a 24 50 61 |Volume{2|96}..$Pa|
|00003f70| 67 65 7b 38 36 2d 38 38 | 7d 0d 0a 24 44 61 74 65 |ge{86-88|}..$Date|
|00003f80| 7b 4a 61 6e 20 39 2c 20 | 31 39 38 38 7d 0d 0a 24 |{Jan 9, |1988}..$|
|00003f90| 59 42 56 6f 6c 7b 31 39 | 38 39 20 59 65 61 72 20 |YBVol{19|89 Year |
|00003fa0| 42 6f 6f 6b 20 6f 66 20 | 46 61 6d 69 6c 79 20 50 |Book of |Family P|
|00003fb0| 72 61 63 74 69 63 65 7d | 0d 0a 24 43 68 61 70 74 |ractice}|..$Chapt|
|00003fc0| 65 72 7b 39 2d 32 34 7d | 0d 0a 24 59 42 45 64 69 |er{9-24}|..$YBEdi|
|00003fd0| 74 6f 72 7b 44 72 73 2e | 20 52 61 6b 65 6c 2c 20 |tor{Drs.| Rakel, |
|00003fe0| 41 76 61 6e 74 2c 20 44 | 72 69 73 63 6f 6c 6c 2c |Avant, D|riscoll,|
|00003ff0| 20 50 72 69 63 68 61 72 | 64 2c 20 61 6e 64 20 53 | Prichar|d, and S|
|00004000| 6d 69 74 68 7d 0d 0a 24 | 54 61 62 6c 65 7b 7d 0d |mith}..$|Table{}.|
|00004010| 0a 24 43 6f 6d 6d 65 6e | 74 61 74 6f 72 7b 7d 0d |.$Commen|tator{}.|
|00004020| 0a 0d 0a 43 6f 70 79 72 | 69 67 68 74 20 28 63 29 |...Copyr|ight (c)|
|00004030| 20 59 65 61 72 20 42 6f | 6f 6b 20 4d 65 64 69 63 | Year Bo|ok Medic|
|00004040| 61 6c 20 50 75 62 6c 69 | 73 68 65 72 73 2c 20 49 |al Publi|shers, I|
|00004050| 6e 63 2e 2c 20 31 39 38 | 39 0d 0a 0d 0a 31 39 38 |nc., 198|9....198|
|00004060| 39 20 59 65 61 72 20 42 | 6f 6f 6b 20 6f 66 20 46 |9 Year B|ook of F|
|00004070| 61 6d 69 6c 79 20 50 72 | 61 63 74 69 63 65 20 28 |amily Pr|actice (|
|00004080| 52 29 0d 0a 0d 0a 43 68 | 61 70 74 65 72 20 39 2d |R)....Ch|apter 9-|
|00004090| 2d 44 69 73 65 61 73 65 | 73 20 6f 66 20 74 68 65 |-Disease|s of the|
|000040a0| 20 52 65 73 70 69 72 61 | 74 6f 72 79 20 53 79 73 | Respira|tory Sys|
|000040b0| 74 65 6d 0d 0a 0d 0a 4d | 69 73 63 65 6c 6c 61 6e |tem....M|iscellan|
|000040c0| 65 6f 75 73 20 54 6f 70 | 69 63 73 0d 0a 0d 0a 2d |eous Top|ics....-|
|000040d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000040e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000040f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004100| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004110| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 0d |--------|-------.|
|00004120| 0a 42 72 6f 6e 63 68 69 | 61 6c 20 48 79 70 65 72 |.Bronchi|al Hyper|
|00004130| 72 65 61 63 74 69 76 69 | 74 79 20 69 6e 20 50 61 |reactivi|ty in Pa|
|00004140| 74 69 65 6e 74 73 20 57 | 68 6f 20 43 6f 75 67 68 |tients W|ho Cough|
|00004150| 20 41 66 74 65 72 20 52 | 65 63 65 69 76 69 6e 67 | After R|eceiving|
|00004160| 20 41 6e 67 69 6f 74 65 | 6e 73 69 6e 0d 0a 43 6f | Angiote|nsin..Co|
|00004170| 6e 76 65 72 74 69 6e 67 | 20 45 6e 7a 79 6d 65 20 |nverting| Enzyme |
|00004180| 49 6e 68 69 62 69 74 6f | 72 73 0d 0a 0d 0a 42 75 |Inhibito|rs....Bu|
|00004190| 63 6b 6e 61 6c 6c 20 43 | 45 3b 20 4e 65 69 6c 6c |cknall C|E; Neill|
|000041a0| 79 20 4a 42 3b 20 43 61 | 72 74 65 72 20 52 3b 20 |y JB; Ca|rter R; |
|000041b0| 53 74 65 76 65 6e 73 6f | 6e 20 52 44 3b 20 53 65 |Stevenso|n RD; Se|
|000041c0| 6d 70 6c 65 20 50 46 0d | 0a 28 52 6f 79 61 6c 20 |mple PF.|.(Royal |
|000041d0| 49 6e 66 69 72 6d 61 72 | 79 2c 20 47 6c 61 73 67 |Infirmar|y, Glasg|
|000041e0| 6f 77 3b 20 57 65 73 74 | 65 72 6e 20 49 6e 66 69 |ow; West|ern Infi|
|000041f0| 72 6d 61 72 79 2c 20 47 | 6c 61 73 67 6f 77 2c 20 |rmary, G|lasgow, |
|00004200| 53 63 6f 74 6c 61 6e 64 | 29 0d 0a 42 72 20 4d 65 |Scotland|)..Br Me|
|00004210| 64 20 4a 20 32 39 36 3a | 38 36 2d 38 38 2c 20 4a |d J 296:|86-88, J|
|00004220| 61 6e 20 39 2c 20 31 39 | 38 38 0d 0a 2d 2d 2d 2d |an 9, 19|88..----|
|00004230| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004240| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004250| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004260| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004270| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 0d 0a 0d 0a |--------|----....|
|00004280| 41 62 73 74 72 61 63 74 | 0d 0a 0d 0a 20 20 20 20 |Abstract|....    |
|00004290| 20 53 65 76 65 72 61 6c | 20 63 61 73 65 20 72 65 | Several| case re|
|000042a0| 70 6f 72 74 73 20 68 61 | 76 65 20 62 65 65 6e 20 |ports ha|ve been |
|000042b0| 70 75 62 6c 69 73 68 65 | 64 20 6f 66 20 70 61 74 |publishe|d of pat|
|000042c0| 69 65 6e 74 73 20 69 6e | 20 77 68 6f 6d 20 61 20 |ients in| whom a |
|000042d0| 63 6f 75 67 68 0d 0a 64 | 65 76 65 6c 6f 70 65 64 |cough..d|eveloped|
|000042e0| 20 61 66 74 65 72 20 74 | 72 65 61 74 6d 65 6e 74 | after t|reatment|
|000042f0| 20 77 69 74 68 20 61 6e | 67 69 6f 74 65 6e 73 69 | with an|giotensi|
|00004300| 6e 20 63 6f 6e 76 65 72 | 74 69 6e 67 20 65 6e 7a |n conver|ting enz|
|00004310| 79 6d 65 20 69 6e 68 69 | 62 69 74 6f 72 73 2e 20 |yme inhi|bitors. |
|00004320| 20 54 6f 0d 0a 69 6e 76 | 65 73 74 69 67 61 74 65 | To..inv|estigate|
|00004330| 20 74 68 65 20 6d 65 63 | 68 61 6e 69 73 6d 20 63 | the mec|hanism c|
|00004340| 61 75 73 69 6e 67 20 74 | 68 69 73 20 73 69 64 65 |ausing t|his side|
|00004350| 20 65 66 66 65 63 74 2c | 20 70 61 74 69 65 6e 74 | effect,| patient|
|00004360| 73 20 77 68 6f 20 68 61 | 64 20 70 72 65 76 69 6f |s who ha|d previo|
|00004370| 75 73 6c 79 0d 0a 72 65 | 70 6f 72 74 65 64 20 63 |usly..re|ported c|
|00004380| 6f 75 67 68 20 6f 72 20 | 77 68 65 65 7a 69 6e 67 |ough or |wheezing|
|00004390| 20 69 6e 20 61 73 73 6f | 63 69 61 74 69 6f 6e 20 | in asso|ciation |
|000043a0| 77 69 74 68 20 74 68 65 | 73 65 20 61 67 65 6e 74 |with the|se agent|
|000043b0| 73 20 77 65 72 65 20 72 | 65 63 68 61 6c 6c 65 6e |s were r|echallen|
|000043c0| 67 65 64 2e 0d 0a 20 20 | 20 20 20 53 69 78 20 68 |ged...  |   Six h|
|000043d0| 79 70 65 72 74 65 6e 73 | 69 76 65 20 70 61 74 69 |ypertens|ive pati|
|000043e0| 65 6e 74 73 20 68 61 64 | 20 63 6f 75 67 68 20 64 |ents had| cough d|
|000043f0| 75 72 69 6e 67 20 74 72 | 65 61 74 6d 65 6e 74 20 |uring tr|eatment |
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|00004940| 76 69 63 68 20 4a 0d 0a | 53 75 73 73 6d 61 6e 20 |vich J..|Sussman |
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|00004970| 2c 20 54 6f 72 6f 6e 74 | 6f 3b 20 4d 63 4d 61 73 |, Toront|o; McMas|
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|000049c0| 61 6c 20 70 65 72 73 6f | 6e 6e 65 6c 3b 0d 0a 50 |al perso|nnel;..P|
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|000049e0| 61 6c 2c 20 70 73 79 6c | 6c 69 75 6d 20 61 6c 6c |al, psyl|lium all|
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|00004a00| 61 6c 2c 20 70 65 72 73 | 6f 6e 6e 65 6c 2c 20 70 |al, pers|onnel, p|
|00004a10| 73 79 6c 6c 69 75 6d 20 | 61 6c 6c 65 72 67 79 20 |syllium |allergy |
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|00004a30| 79 6c 6c 69 75 6d 2c 20 | 69 6e 20 68 6f 73 70 69 |yllium, |in hospi|
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|00004a90| 4d 61 72 63 68 20 31 39 | 38 38 7d 0d 0a 24 59 42 |March 19|88}..$YB|
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|00004b70| 20 4d 65 64 69 63 61 6c | 20 50 75 62 6c 69 73 68 | Medical| Publish|
|00004b80| 65 72 73 2c 20 49 6e 63 | 2e 2c 20 31 39 38 39 0d |ers, Inc|., 1989.|
|00004b90| 0a 0d 0a 31 39 38 39 20 | 59 65 61 72 20 42 6f 6f |...1989 |Year Boo|
|00004ba0| 6b 20 6f 66 20 46 61 6d | 69 6c 79 20 50 72 61 63 |k of Fam|ily Prac|
|00004bb0| 74 69 63 65 20 28 52 29 | 0d 0a 0d 0a 43 68 61 70 |tice (R)|....Chap|
|00004bc0| 74 65 72 20 39 2d 2d 44 | 69 73 65 61 73 65 73 20 |ter 9--D|iseases |
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|00004be0| 72 79 20 53 79 73 74 65 | 6d 0d 0a 0d 0a 4d 69 73 |ry Syste|m....Mis|
|00004bf0| 63 65 6c 6c 61 6e 65 6f | 75 73 20 54 6f 70 69 63 |cellaneo|us Topic|
|00004c00| 73 0d 0a 0d 0a 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |s....---|--------|
|00004c10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004c20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004c30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004c40| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004c50| 2d 2d 2d 2d 2d 0d 0a 50 | 73 79 6c 6c 69 75 6d 20 |-----..P|syllium |
|00004c60| 41 6c 6c 65 72 67 79 20 | 69 6e 20 48 6f 73 70 69 |Allergy |in Hospi|
|00004c70| 74 61 6c 20 50 65 72 73 | 6f 6e 6e 65 6c 3a 20 20 |tal Pers|onnel:  |
|00004c80| 41 20 52 65 70 6f 72 74 | 20 6f 6e 20 54 77 65 6c |A Report| on Twel|
|00004c90| 76 65 20 50 61 74 69 65 | 6e 74 73 0d 0a 0d 0a 4a |ve Patie|nts....J|
|00004ca0| 61 6e 63 65 6c 65 77 69 | 63 7a 20 5a 3b 20 44 6f |ancelewi|cz Z; Do|
|00004cb0| 6c 6f 76 69 63 68 20 4a | 3b 20 53 75 73 73 6d 61 |lovich J|; Sussma|
|00004cc0| 6e 20 47 4c 0d 0a 28 57 | 65 6c 6c 65 73 6c 65 79 |n GL..(W|ellesley|
|00004cd0| 20 48 6f 73 70 2c 20 54 | 6f 72 6f 6e 74 6f 3b 20 | Hosp, T|oronto; |
|00004ce0| 4d 63 4d 61 73 74 65 72 | 20 55 6e 69 76 3b 20 55 |McMaster| Univ; U|
|00004cf0| 6e 69 76 20 6f 66 20 54 | 6f 72 6f 6e 74 6f 29 0d |niv of T|oronto).|
|00004d00| 0a 43 61 6e 20 46 61 6d | 20 50 68 79 73 69 63 69 |.Can Fam| Physici|
|00004d10| 61 6e 20 33 34 3a 35 37 | 33 2d 35 37 36 2c 20 4d |an 34:57|3-576, M|
|00004d20| 61 72 63 68 20 31 39 38 | 38 0d 0a 2d 2d 2d 2d 2d |arch 198|8..-----|
|00004d30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004d40| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004d50| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004d60| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004d70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 0d 0a 0d 0a 41 |--------|---....A|
|00004d80| 62 73 74 72 61 63 74 0d | 0a 0d 0a 20 20 20 20 20 |bstract.|...     |
|00004d90| 53 70 6f 72 61 64 69 63 | 20 6f 63 63 75 72 72 65 |Sporadic| occurre|
|00004da0| 6e 63 65 73 20 6f 66 20 | 61 6c 6c 65 72 67 69 63 |nces of |allergic|
|00004db0| 20 72 65 73 70 69 72 61 | 74 6f 72 79 20 64 69 73 | respira|tory dis|
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|00004dd0| 73 79 6c 6c 69 75 6d 0d | 0a 68 61 76 65 20 62 65 |syllium.|.have be|
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|00004e70| 72 69 6f 64 2e 0d 0a 20 | 20 20 20 20 41 6c 6c 20 |riod... |    All |
|00004e80| 31 32 20 70 61 74 69 65 | 6e 74 73 20 77 65 72 65 |12 patie|nts were|
|00004e90| 20 66 65 6d 61 6c 65 20 | 68 6f 73 70 69 74 61 6c | female |hospital|
|00004ea0| 20 70 65 72 73 6f 6e 6e | 65 6c 20 77 69 74 68 20 | personn|el with |
|00004eb0| 65 76 69 64 65 6e 63 65 | 20 6f 66 20 61 74 6f 70 |evidence| of atop|
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|00004f00| 6e 20 77 68 69 6c 65 20 | 64 69 73 70 65 6e 73 69 |n while |dispensi|
|00004f10| 6e 67 0d 0a 70 73 79 6c | 6c 69 75 6d 20 70 6f 77 |ng..psyl|lium pow|
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|00004f30| 75 74 65 73 20 6f 66 20 | 69 6e 68 61 6c 69 6e 67 |utes of |inhaling|
|00004f40| 20 70 73 79 6c 6c 69 75 | 6d 2c 20 72 68 69 6e 69 | psylliu|m, rhini|
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|00004f60| 31 32 0d 0a 70 61 74 69 | 65 6e 74 73 3b 20 63 6f |12..pati|ents; co|
|00004f70| 6e 6a 75 6e 63 74 69 76 | 69 74 69 73 2c 20 69 6e |njunctiv|itis, in|
|00004f80| 20 31 30 3b 20 61 6e 64 | 20 77 68 65 65 7a 69 6e | 10; and| wheezin|
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|00004fa0| 6f 66 20 62 72 65 61 74 | 68 2c 20 69 6e 20 31 32 |of breat|h, in 12|
|00004fb0| 2e 0d 0a 41 6c 6c 20 73 | 79 6d 70 74 6f 6d 73 20 |...All s|ymptoms |
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|00004fd0| 20 73 65 6e 73 69 74 69 | 76 69 74 79 20 70 65 72 | sensiti|vity per|
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|00005000| 0a 33 2d 79 65 61 72 20 | 66 6f 6c 6c 6f 77 2d 75 |.3-year |follow-u|
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|00005070| 69 74 68 65 72 20 70 6f | 73 69 74 69 76 65 20 73 |ither po|sitive s|
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|00005130| 45 2d 6d 65 64 69 61 74 | 65 64 20 6f 63 63 75 70 |E-mediat|ed occup|
|00005140| 61 74 69 6f 6e 61 6c 20 | 61 6c 6c 65 72 67 79 20 |ational |allergy |
|00005150| 69 6e 20 68 6f 73 70 69 | 74 61 6c 0d 0a 70 65 72 |in hospi|tal..per|
|00005160| 73 6f 6e 6e 65 6c 2e 20 | 20 49 74 20 70 72 6f 64 |sonnel. | It prod|
|00005170| 75 63 65 73 20 73 69 67 | 6e 69 66 69 63 61 6e 74 |uces sig|nificant|
|00005180| 20 73 79 6d 70 74 6f 6d | 73 20 62 75 74 20 69 73 | symptom|s but is|
|00005190| 20 6f 66 74 65 6e 20 75 | 6e 72 65 63 6f 67 6e 69 | often u|nrecogni|
|000051a0| 7a 65 64 2e 20 20 42 65 | 63 61 75 73 65 0d 0a 6f |zed.  Be|cause..o|
|000051b0| 66 20 70 65 72 73 69 73 | 74 65 6e 74 20 73 65 6e |f persis|tent sen|
|000051c0| 73 69 74 69 76 69 74 79 | 2c 20 65 78 70 6f 73 75 |sitivity|, exposu|
|000051d0| 72 65 20 74 6f 20 70 73 | 79 6c 6c 69 75 6d 20 62 |re to ps|yllium b|
|000051e0| 79 20 61 6c 6c 20 72 6f | 75 74 65 73 20 73 68 6f |y all ro|utes sho|
|000051f0| 75 6c 64 20 62 65 20 61 | 76 6f 69 64 65 64 2e 0d |uld be a|voided..|
|00005200| 0a 0d 0a 50 6f 73 74 2d | 43 6f 6d 6d 65 6e 74 0d |...Post-|Comment.|
|00005210| 0a 0d 0a 20 20 20 20 20 | 50 73 79 6c 6c 69 75 6d |...     |Psyllium|
|00005220| 20 69 73 20 6e 6f 77 20 | 77 69 64 65 6c 79 20 75 | is now |widely u|
|00005230| 73 65 64 20 69 6e 20 61 | 63 75 74 65 20 63 61 72 |sed in a|cute car|
|00005240| 65 20 68 6f 73 70 69 74 | 61 6c 73 2c 20 6e 75 72 |e hospit|als, nur|
|00005250| 73 69 6e 67 20 68 6f 6d | 65 73 2c 20 61 6e 64 0d |sing hom|es, and.|
|00005260| 0a 6c 6f 6e 67 2d 74 65 | 72 6d 20 63 61 72 65 20 |.long-te|rm care |
|00005270| 66 61 63 69 6c 69 74 69 | 65 73 2e 20 20 44 6f 6d |faciliti|es.  Dom|
|00005280| 69 63 69 6c 69 61 72 79 | 20 75 73 65 20 6f 66 20 |iciliary| use of |
|00005290| 70 73 79 6c 6c 69 75 6d | 20 61 73 20 61 20 62 75 |psyllium| as a bu|
|000052a0| 6c 6b 20 6c 61 78 61 74 | 69 76 65 20 69 73 0d 0a |lk laxat|ive is..|
|000052b0| 63 6f 6d 6d 6f 6e 2e 20 | 20 54 68 69 73 20 72 65 |common. | This re|
|000052c0| 70 6f 72 74 20 69 6e 64 | 69 63 61 74 65 73 20 74 |port ind|icates t|
|000052d0| 68 61 74 20 73 65 6e 73 | 69 74 69 7a 61 74 69 6f |hat sens|itizatio|
|000052e0| 6e 20 6f 63 63 75 72 73 | 20 66 72 6f 6d 20 69 6e |n occurs| from in|
|000052f0| 68 61 6c 69 6e 67 20 70 | 73 79 6c 6c 69 75 6d 0d |haling p|syllium.|
|00005300| 0a 77 68 69 6c 65 20 64 | 69 73 70 65 6e 73 69 6e |.while d|ispensin|
|00005310| 67 20 74 68 65 20 6d 65 | 64 69 63 61 74 69 6f 6e |g the me|dication|
|00005320| 2e 20 20 42 65 63 61 75 | 73 65 20 6d 61 6e 79 20 |.  Becau|se many |
|00005330| 6f 76 65 72 2d 74 68 65 | 2d 63 6f 75 6e 74 65 72 |over-the|-counter|
|00005340| 20 62 75 6c 6b 20 6c 61 | 78 61 74 69 76 65 73 0d | bulk la|xatives.|
|00005350| 0a 63 6f 6e 74 61 69 6e | 20 70 73 79 6c 6c 69 75 |.contain| psylliu|
|00005360| 6d 2c 20 71 75 65 73 74 | 69 6f 6e 73 20 72 65 67 |m, quest|ions reg|
|00005370| 61 72 64 69 6e 67 20 74 | 68 65 69 72 20 75 73 65 |arding t|heir use|
|00005380| 20 6d 61 79 20 62 65 20 | 64 69 72 65 63 74 65 64 | may be |directed|
|00005390| 20 74 6f 20 70 61 74 69 | 65 6e 74 73 20 77 68 6f | to pati|ents who|
|000053a0| 0d 0a 61 72 65 20 65 78 | 70 65 72 69 65 6e 63 69 |..are ex|perienci|
|000053b0| 6e 67 20 6e 65 77 2c 20 | 70 65 72 73 69 73 74 65 |ng new, |persiste|
|000053c0| 6e 74 2c 20 61 6e 64 20 | 75 6e 65 78 70 6c 61 69 |nt, and |unexplai|
|000053d0| 6e 65 64 20 73 79 6d 70 | 74 6f 6d 73 20 6f 66 20 |ned symp|toms of |
|000053e0| 72 68 69 6e 6f 72 72 68 | 65 61 2c 0d 0a 63 6f 6e |rhinorrh|ea,..con|
|000053f0| 6a 75 6e 63 74 69 76 69 | 74 69 73 2c 20 6f 72 20 |junctivi|tis, or |
|00005400| 77 68 65 65 7a 69 6e 67 | 20 28 61 6c 73 6f 2c 20 |wheezing| (also, |
|00005410| 73 65 65 20 41 62 73 74 | 72 61 63 74 20 38 2d 31 |see Abst|ract 8-1|
|00005420| 34 29 2e 2d 2d 4a 2e 47 | 2e 20 50 72 69 63 68 61 |4).--J.G|. Pricha|
|00005430| 72 64 2c 20 4d 2e 44 2e | 2c 0d 0a 4d 2e 48 2e 53 |rd, M.D.|,..M.H.S|
|00005440| 2e 0d 0a 24 55 6e 69 71 | 75 65 5f 49 44 7b 59 52 |...$Uniq|ue_ID{YR|
|00005450| 42 30 36 35 30 36 7d 0d | 0a 24 54 69 74 6c 65 7b |B06506}.|.$Title{|
|00005460| 43 72 61 63 6b 20 4c 75 | 6e 67 3a 20 20 50 75 6c |Crack Lu|ng:  Pul|
|00005470| 6d 6f 6e 61 72 79 20 44 | 69 73 65 61 73 65 20 43 |monary D|isease C|
|00005480| 61 75 73 65 64 20 62 79 | 20 43 6f 63 61 69 6e 65 |aused by| Cocaine|
|00005490| 20 41 62 75 73 65 7d 0d | 0a 24 41 75 74 68 6f 72 | Abuse}.|.$Author|
|000054a0| 7b 4b 69 73 73 6e 65 72 | 20 44 47 0d 0a 4c 61 77 |{Kissner| DG..Law|
|000054b0| 72 65 6e 63 65 20 57 44 | 0d 0a 53 65 6c 69 73 20 |rence WD|..Selis |
|000054c0| 4a 45 0d 0a 46 6c 69 6e | 74 20 41 7d 0d 0a 24 41 |JE..Flin|t A}..$A|
|000054d0| 66 66 69 6c 69 61 74 69 | 6f 6e 7b 48 75 74 7a 65 |ffiliati|on{Hutze|
|000054e0| 6c 20 48 6f 73 70 2c 20 | 44 65 74 72 6f 69 74 3b |l Hosp, |Detroit;|
|000054f0| 20 57 61 79 6e 65 20 53 | 74 61 74 65 20 55 6e 69 | Wayne S|tate Uni|
|00005500| 76 2c 20 55 6e 69 76 20 | 6f 66 20 4d 69 63 68 69 |v, Univ |of Michi|
|00005510| 67 61 6e 7d 0d 0a 24 53 | 75 62 6a 65 63 74 7b 4c |gan}..$S|ubject{L|
|00005520| 75 6e 67 2c 20 63 72 61 | 63 6b 2c 20 64 69 73 63 |ung, cra|ck, disc|
|00005530| 75 73 73 69 6f 6e 20 6f | 66 3b 0d 0a 43 72 61 63 |ussion o|f;..Crac|
|00005540| 6b 20 6c 75 6e 67 2c 20 | 64 69 73 63 75 73 73 69 |k lung, |discussi|
|00005550| 6f 6e 20 6f 66 3b 0d 0a | 43 6f 63 61 69 6e 65 20 |on of;..|Cocaine |
|00005560| 61 62 75 73 65 2c 20 70 | 75 6c 6d 6f 6e 61 72 79 |abuse, p|ulmonary|
|00005570| 20 64 69 73 65 61 73 65 | 20 64 75 65 20 74 6f 7d | disease| due to}|
|00005580| 0d 0a 24 4a 6f 75 72 6e | 61 6c 7b 41 6d 20 52 65 |..$Journ|al{Am Re|
|00005590| 76 20 52 65 73 70 69 72 | 20 44 69 73 7d 0d 0a 24 |v Respir| Dis}..$|
|000055a0| 56 6f 6c 75 6d 65 7b 31 | 33 36 7d 0d 0a 24 50 61 |Volume{1|36}..$Pa|
|000055b0| 67 65 7b 31 32 35 30 2d | 31 32 35 32 7d 0d 0a 24 |ge{1250-|1252}..$|
|000055c0| 44 61 74 65 7b 4e 6f 76 | 65 6d 62 65 72 20 31 39 |Date{Nov|ember 19|
|000055d0| 38 37 7d 0d 0a 24 59 42 | 56 6f 6c 7b 31 39 38 39 |87}..$YB|Vol{1989|
|000055e0| 20 59 65 61 72 20 42 6f | 6f 6b 20 6f 66 20 46 61 | Year Bo|ok of Fa|
|000055f0| 6d 69 6c 79 20 50 72 61 | 63 74 69 63 65 7d 0d 0a |mily Pra|ctice}..|
|00005600| 24 43 68 61 70 74 65 72 | 7b 39 2d 32 36 7d 0d 0a |$Chapter|{9-26}..|
|00005610| 24 59 42 45 64 69 74 6f | 72 7b 44 72 73 2e 20 52 |$YBEdito|r{Drs. R|
|00005620| 61 6b 65 6c 2c 20 41 76 | 61 6e 74 2c 20 44 72 69 |akel, Av|ant, Dri|
|00005630| 73 63 6f 6c 6c 2c 20 50 | 72 69 63 68 61 72 64 2c |scoll, P|richard,|
|00005640| 20 61 6e 64 20 53 6d 69 | 74 68 7d 0d 0a 24 54 61 | and Smi|th}..$Ta|
|00005650| 62 6c 65 7b 54 61 62 6c | 65 20 4f 6d 69 74 74 65 |ble{Tabl|e Omitte|
|00005660| 64 7d 0d 0a 24 43 6f 6d | 6d 65 6e 74 61 74 6f 72 |d}..$Com|mentator|
|00005670| 7b 4a 2e 47 2e 20 50 72 | 69 63 68 61 72 64 2c 20 |{J.G. Pr|ichard, |
|00005680| 4d 2e 44 2e 2c 20 4d 2e | 48 2e 53 2e 7d 0d 0a 0d |M.D., M.|H.S.}...|
|00005690| 0a 43 6f 70 79 72 69 67 | 68 74 20 28 63 29 20 59 |.Copyrig|ht (c) Y|
|000056a0| 65 61 72 20 42 6f 6f 6b | 20 4d 65 64 69 63 61 6c |ear Book| Medical|
|000056b0| 20 50 75 62 6c 69 73 68 | 65 72 73 2c 20 49 6e 63 | Publish|ers, Inc|
|000056c0| 2e 2c 20 31 39 38 39 0d | 0a 0d 0a 31 39 38 39 20 |., 1989.|...1989 |
|000056d0| 59 65 61 72 20 42 6f 6f | 6b 20 6f 66 20 46 61 6d |Year Boo|k of Fam|
|000056e0| 69 6c 79 20 50 72 61 63 | 74 69 63 65 20 28 52 29 |ily Prac|tice (R)|
|000056f0| 0d 0a 0d 0a 43 68 61 70 | 74 65 72 20 39 2d 2d 44 |....Chap|ter 9--D|
|00005700| 69 73 65 61 73 65 73 20 | 6f 66 20 74 68 65 20 52 |iseases |of the R|
|00005710| 65 73 70 69 72 61 74 6f | 72 79 20 53 79 73 74 65 |espirato|ry Syste|
|00005720| 6d 0d 0a 0d 0a 4d 69 73 | 63 65 6c 6c 61 6e 65 6f |m....Mis|cellaneo|
|00005730| 75 73 20 54 6f 70 69 63 | 73 0d 0a 0d 0a 2d 2d 2d |us Topic|s....---|
|00005740| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005750| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005760| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005770| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005780| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0a 43 |--------|-----..C|
|00005790| 72 61 63 6b 20 4c 75 6e | 67 3a 20 20 50 75 6c 6d |rack Lun|g:  Pulm|
|000057a0| 6f 6e 61 72 79 20 44 69 | 73 65 61 73 65 20 43 61 |onary Di|sease Ca|
|000057b0| 75 73 65 64 20 62 79 20 | 43 6f 63 61 69 6e 65 20 |used by |Cocaine |
|000057c0| 41 62 75 73 65 0d 0a 0d | 0a 4b 69 73 73 6e 65 72 |Abuse...|.Kissner|
|000057d0| 20 44 47 3b 20 4c 61 77 | 72 65 6e 63 65 20 57 44 | DG; Law|rence WD|
|000057e0| 3b 20 53 65 6c 69 73 20 | 4a 45 3b 20 46 6c 69 6e |; Selis |JE; Flin|
|000057f0| 74 20 41 0d 0a 28 48 75 | 74 7a 65 6c 20 48 6f 73 |t A..(Hu|tzel Hos|
|00005800| 70 2c 20 44 65 74 72 6f | 69 74 3b 20 57 61 79 6e |p, Detro|it; Wayn|
|00005810| 65 20 53 74 61 74 65 20 | 55 6e 69 76 2c 20 55 6e |e State |Univ, Un|
|00005820| 69 76 20 6f 66 20 4d 69 | 63 68 69 67 61 6e 29 0d |iv of Mi|chigan).|
|00005830| 0a 41 6d 20 52 65 76 20 | 52 65 73 70 69 72 20 44 |.Am Rev |Respir D|
|00005840| 69 73 20 31 33 36 3a 31 | 32 35 30 2d 31 32 35 32 |is 136:1|250-1252|
|00005850| 2c 20 4e 6f 76 65 6d 62 | 65 72 20 31 39 38 37 0d |, Novemb|er 1987.|
|00005860| 0a 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |.-------|--------|
|00005870| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005880| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005890| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000058a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000058b0| 2d 0d 0a 0d 0a 41 62 73 | 74 72 61 63 74 0d 0a 0d |-....Abs|tract...|
|000058c0| 0a 20 20 20 20 20 54 68 | 65 20 63 68 61 6e 67 69 |.     Th|e changi|
|000058d0| 6e 67 20 63 68 61 72 61 | 63 74 65 72 69 73 74 69 |ng chara|cteristi|
|000058e0| 63 73 20 6f 66 20 63 6f | 63 61 69 6e 65 20 75 73 |cs of co|caine us|
|000058f0| 65 20 69 6e 20 74 68 65 | 20 70 61 73 74 20 64 65 |e in the| past de|
|00005900| 63 61 64 65 20 68 61 76 | 65 0d 0a 70 72 6f 64 75 |cade hav|e..produ|
|00005910| 63 65 64 20 61 20 68 69 | 67 68 65 72 20 69 6e 63 |ced a hi|gher inc|
|00005920| 69 64 65 6e 63 65 20 61 | 6e 64 20 67 72 65 61 74 |idence a|nd great|
|00005930| 65 72 20 61 77 61 72 65 | 6e 65 73 73 20 6f 66 20 |er aware|ness of |
|00005940| 63 6f 63 61 69 6e 65 2d | 61 73 73 6f 63 69 61 74 |cocaine-|associat|
|00005950| 65 64 20 6d 65 64 69 63 | 61 6c 0d 0a 63 6f 6d 70 |ed medic|al..comp|
|00005960| 6c 69 63 61 74 69 6f 6e | 73 2e 20 20 41 20 70 61 |lication|s.  A pa|
|00005970| 74 69 65 6e 74 20 77 61 | 73 20 73 65 65 6e 20 77 |tient wa|s seen w|
|00005980| 68 6f 20 68 61 64 20 33 | 20 73 65 70 61 72 61 74 |ho had 3| separat|
|00005990| 65 20 65 70 69 73 6f 64 | 65 73 20 6f 66 20 70 75 |e episod|es of pu|
|000059a0| 6c 6d 6f 6e 61 72 79 0d | 0a 69 6e 66 69 6c 74 72 |lmonary.|.infiltr|
|000059b0| 61 74 65 73 2c 20 66 65 | 76 65 72 2c 20 61 6e 64 |ates, fe|ver, and|
|000059c0| 20 62 72 6f 6e 63 68 6f | 73 70 61 73 6d 20 61 66 | broncho|spasm af|
|000059d0| 74 65 72 20 63 6f 63 61 | 69 6e 65 20 69 6e 68 61 |ter coca|ine inha|
|000059e0| 6c 61 74 69 6f 6e 2e 20 | 20 54 68 65 20 69 6c 6c |lation. | The ill|
|000059f0| 6e 65 73 73 20 77 61 73 | 0d 0a 61 73 73 6f 63 69 |ness was|..associ|
|00005a00| 61 74 65 64 20 77 69 74 | 68 20 65 6f 73 69 6e 6f |ated wit|h eosino|
|00005a10| 70 68 69 6c 69 61 2c 20 | 70 72 75 72 69 74 75 73 |philia, |pruritus|
|00005a20| 2c 20 61 6e 64 20 61 6e | 20 65 6c 65 76 61 74 65 |, and an| elevate|
|00005a30| 64 20 69 6d 6d 75 6e 6f | 67 6c 6f 62 75 6c 69 6e |d immuno|globulin|
|00005a40| 20 45 20 6c 65 76 65 6c | 2c 0d 0a 69 6e 64 69 63 | E level|,..indic|
|00005a50| 61 74 69 6e 67 20 61 6e | 20 69 6d 6d 75 6e 6f 6c |ating an| immunol|
|00005a60| 6f 67 69 63 20 70 61 74 | 68 6f 67 65 6e 65 74 69 |ogic pat|hogeneti|
|00005a70| 63 20 6d 65 63 68 61 6e | 69 73 6d 2e 20 20 54 68 |c mechan|ism.  Th|
|00005a80| 69 73 20 63 6f 6d 70 6c | 69 63 61 74 69 6f 6e 20 |is compl|ication |
|00005a90| 6f 66 20 63 6f 63 61 69 | 6e 65 0d 0a 61 62 75 73 |of cocai|ne..abus|
|00005aa0| 65 20 68 61 73 20 6e 6f | 74 20 62 65 65 6e 20 72 |e has no|t been r|
|00005ab0| 65 70 6f 72 74 65 64 20 | 70 72 65 76 69 6f 75 73 |eported |previous|
|00005ac0| 6c 79 2e 0d 0a 20 20 20 | 20 20 57 6f 6d 61 6e 2c |ly...   |  Woman,|
|00005ad0| 20 34 37 2c 20 68 61 64 | 20 62 65 65 6e 20 77 65 | 47, had| been we|
|00005ae0| 6c 6c 20 75 6e 74 69 6c | 20 62 65 67 69 6e 6e 69 |ll until| beginni|
|00005af0| 6e 67 20 64 61 69 6c 79 | 20 63 6f 63 61 69 6e 65 |ng daily| cocaine|
|00005b00| 20 75 73 65 2e 20 20 54 | 68 65 20 64 72 75 67 2c | use.  T|he drug,|
|00005b10| 0d 0a 22 63 72 61 63 6b | 22 20 28 61 6c 6b 61 6c |.."crack|" (alkal|
|00005b20| 6f 69 64 61 6c 20 6f 72 | 20 66 72 65 65 62 61 73 |oidal or| freebas|
|00005b30| 65 20 63 6f 63 61 69 6e | 65 29 2c 20 77 61 73 20 |e cocain|e), was |
|00005b40| 69 6e 68 61 6c 65 64 20 | 74 68 72 6f 75 67 68 20 |inhaled |through |
|00005b50| 61 20 70 69 70 65 20 61 | 6e 64 0d 0a 6f 63 63 61 |a pipe a|nd..occa|
|00005b60| 73 69 6f 6e 61 6c 6c 79 | 20 75 73 65 64 20 69 6e |sionally| used in|
|00005b70| 74 72 61 6e 61 73 61 6c | 6c 79 2e 20 20 41 66 74 |tranasal|ly.  Aft|
|00005b80| 65 72 20 31 20 77 65 65 | 6b 20 6f 66 20 64 61 69 |er 1 wee|k of dai|
|00005b90| 6c 79 20 69 6e 74 65 6e | 73 69 76 65 20 75 73 65 |ly inten|sive use|
|00005ba0| 2c 20 74 68 65 0d 0a 70 | 61 74 69 65 6e 74 20 65 |, the..p|atient e|
|00005bb0| 78 70 65 72 69 65 6e 63 | 65 64 20 70 72 6f 67 72 |xperienc|ed progr|
|00005bc0| 65 73 73 69 76 65 20 64 | 79 73 70 6e 65 61 20 61 |essive d|yspnea a|
|00005bd0| 6e 64 20 61 20 70 72 6f | 64 75 63 74 69 76 65 20 |nd a pro|ductive |
|00005be0| 63 6f 75 67 68 2e 20 20 | 53 68 65 20 77 61 73 0d |cough.  |She was.|
|00005bf0| 0a 68 6f 73 70 69 74 61 | 6c 69 7a 65 64 20 77 69 |.hospita|lized wi|
|00005c00| 74 68 20 61 20 74 65 6d | 70 65 72 61 74 75 72 65 |th a tem|perature|
|00005c10| 20 6f 66 20 33 39 2e 33 | 20 64 65 67 72 65 65 73 | of 39.3| degrees|
|00005c20| 5f 43 20 61 6e 64 20 72 | 65 73 70 69 72 61 74 69 |_C and r|espirati|
|00005c30| 6f 6e 73 20 6f 66 20 33 | 30 20 62 72 65 61 74 68 |ons of 3|0 breath|
|00005c40| 73 0d 0a 70 65 72 20 6d | 69 6e 75 74 65 2e 20 20 |s..per m|inute.  |
|00005c50| 52 68 6f 6e 63 68 69 20 | 77 65 72 65 20 68 65 61 |Rhonchi |were hea|
|00005c60| 72 64 20 6f 76 65 72 20 | 74 68 65 20 70 6f 73 74 |rd over |the post|
|00005c70| 65 72 69 6f 72 20 63 68 | 65 73 74 2e 20 20 54 68 |erior ch|est.  Th|
|00005c80| 65 20 6c 65 75 6b 6f 63 | 79 74 65 20 63 6f 75 6e |e leukoc|yte coun|
|00005c90| 74 0d 0a 77 61 73 20 31 | 32 2c 37 30 30 2f 6d 6d |t..was 1|2,700/mm|
|00005ca0| 5e 33 20 77 69 74 68 20 | 31 38 25 20 65 6f 73 69 |^3 with |18% eosi|
|00005cb0| 6e 6f 70 68 69 6c 73 2e | 20 20 43 68 65 73 74 20 |nophils.|  Chest |
|00005cc0| 72 61 64 69 6f 67 72 61 | 70 68 79 20 73 68 6f 77 |radiogra|phy show|
|00005cd0| 65 64 20 69 6e 74 65 72 | 73 74 69 74 69 61 6c 0d |ed inter|stitial.|
|00005ce0| 0a 64 65 6e 73 69 74 69 | 65 73 20 69 6e 20 74 68 |.densiti|es in th|
|00005cf0| 65 20 72 69 67 68 74 20 | 70 61 72 61 68 69 6c 61 |e right |parahila|
|00005d00| 72 20 72 65 67 69 6f 6e | 20 61 6e 64 20 73 65 67 |r region| and seg|
|00005d10| 6d 65 6e 74 61 6c 6c 79 | 20 64 69 73 74 72 69 62 |mentally| distrib|
|00005d20| 75 74 65 64 20 61 6c 76 | 65 6f 6c 61 72 0d 0a 69 |uted alv|eolar..i|
|00005d30| 6e 66 69 6c 74 72 61 74 | 65 73 20 69 6e 20 74 68 |nfiltrat|es in th|
|00005d40| 65 20 72 69 67 68 74 20 | 61 6e 64 20 6c 65 66 74 |e right |and left|
|00005d50| 20 6c 6f 77 65 72 20 61 | 6e 64 20 6c 65 66 74 20 | lower a|nd left |
|00005d60| 75 70 70 65 72 20 6c 6f | 62 65 73 20 28 46 69 67 |upper lo|bes (Fig|
|00005d70| 20 39 2d 39 29 2e 20 20 | 54 68 65 72 61 70 79 0d | 9-9).  |Therapy.|
|00005d80| 0a 69 6e 63 6c 75 64 65 | 64 20 63 65 66 61 7a 6f |.include|d cefazo|
|00005d90| 6c 69 6e 20 61 6e 64 20 | 61 6d 69 6e 6f 70 68 79 |lin and |aminophy|
|00005da0| 6c 6c 69 6e 65 2e 20 20 | 50 72 75 72 69 74 75 73 |lline.  |Pruritus|
|00005db0| 20 77 61 73 20 74 72 65 | 61 74 65 64 20 77 69 74 | was tre|ated wit|
|00005dc0| 68 20 68 79 64 72 6f 78 | 79 7a 69 6e 65 20 61 6e |h hydrox|yzine an|
|00005dd0| 64 0d 0a 64 69 70 68 65 | 6e 68 79 64 72 61 6d 69 |d..diphe|nhydrami|
|00005de0| 6e 65 2e 0d 0a 20 20 20 | 20 20 46 69 76 65 20 64 |ne...   |  Five d|
|00005df0| 61 79 73 20 61 66 74 65 | 72 20 61 64 6d 69 73 73 |ays afte|r admiss|
|00005e00| 69 6f 6e 20 74 68 65 20 | 63 68 65 73 74 20 72 61 |ion the |chest ra|
|00005e10| 64 69 6f 67 72 61 70 68 | 20 73 68 6f 77 65 64 20 |diograph| showed |
|00005e20| 73 69 67 6e 69 66 69 63 | 61 6e 74 0d 0a 69 6d 70 |signific|ant..imp|
|00005e30| 72 6f 76 65 6d 65 6e 74 | 2e 20 20 41 66 74 65 72 |rovement|.  After|
|00005e40| 20 64 69 73 63 68 61 72 | 67 65 2c 20 74 68 65 20 | dischar|ge, the |
|00005e50| 70 61 74 69 65 6e 74 20 | 72 65 66 72 61 69 6e 65 |patient |refraine|
|00005e60| 64 20 66 72 6f 6d 20 63 | 6f 63 61 69 6e 65 20 75 |d from c|ocaine u|
|00005e70| 73 65 20 61 6e 64 0d 0a | 72 65 6d 61 69 6e 65 64 |se and..|remained|
|00005e80| 20 77 65 6c 6c 20 66 6f | 72 20 33 20 77 65 65 6b | well fo|r 3 week|
|00005e90| 73 2c 20 74 68 65 6e 20 | 72 65 73 75 6d 65 64 20 |s, then |resumed |
|00005ea0| 64 61 69 6c 79 20 63 6f | 63 61 69 6e 65 20 75 73 |daily co|caine us|
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+--------+-------------------------+-------------------------+--------+--------+