SUDAFED TABLETS / SYRUP Pseudoephedrine HOI Decongestant
Indications: Relief of nasal congestion associated with allergic rhinitis, acute coryza, vasomotor rhinitis, acute and subacute sinusitis, acute otitis media, asthma, postnasal drip, acute eustachian salpingitis. It may also be used as an adjunct to antibiotics, antihistamines, analgesics and antitussives in the treatment oftheaboveconditions. Contraindications: Patients receiving or having received MAO inhibitors in the preceding 3 weeks; known hypersensitivity to pressor amines. Precautions: As pseudoephedrine is a sympathomimetic amine, it should be used with caution in hypertensive and diabetic patients, patients with latent or clinically recognized angle-closure glaucoma, coronary artery disease, congestive heart failure, prostatic hypertrophy, hyperthyroidism, urinary retention. Adverse Effects: As with other sympathomimetic amines, headache, dizziness, insomnia, tremor, confusion, CNS stimulation, muscular weakness, dry mouth, nausea, vomiting, difficulty in micturition, palpitations, tightness in thechest and syncope may beencountered. Overdose: Symptoms: Increase in pulse and respiratory rate, CNS stimulation, disorientation, headache, dry mouth, nausea and vomiting. Treatment: Gastric lavage, repeated if necessary. Acidify the urine and institute general supportive measures. If CNS excitement is prominent, a short-acting barbiturate may be used. Dosage: Adults and children over 6 years: 2 teaspoonfuls of syrup or 1 tablet 3 times daily. Children 4 months to 6 years: ½ adult dose. Infants upto4 months: ½ teaspoonful of syrup 3 times daily. Supplied: Syrup: Each 5 ml of clear purplish-red syrup with a sweet raspberry flavor conta.g.s: pseudoephedrine HCI 30 mg. Available in 1.0 ml and 250 ml bottles. Tablets: Each white, biconvex tablet 8.6 mm in diameter with code number WELLCOME S7A on same side as diagonal score mark contains: pseudoephedrine HCI 60 mg. Available in cartonsof 18 and bottlesof iQOand SOOtablets. Additional prescribing information available on request.
.I Weilcome Medcal Division Burroughs Weflcome Ltd. LaSalte, Qu6. PAAI *Trade Mark .
W-8004
throat. The mouth is held wide open to obtain the maximum flow of gas into the lungs and to minimize the baffle-like effect of the tongue and palate. Expiration should be relaxed, not full, since the latter results in the collapse of some airways and poorer distribution of the aerosol when inspired. The aerosol should be released toward the middle of full inspiration since the airways are then widely dilated, which results in more even distribution of the aerosol and better penetration into the lungs. If the aerosol is released at the beginning of inspiration it is distributed mainly to the upper lobes of the lungs. This effect is greatest if inspiration follows full expiration. C.R. WOOLF, MD, FRCP[C], FRCP Chairman, standards committee Canadian Thoracic Society Ottawa, Ont.
Recommended reading 1. RILEY DJ, WEITZ BW, EDELMAN NH:
The responses of asthmatic subjects to isoproterenol inhaled at differing lung volumes. Am Rev Respir Dis 114: 509, 1976 2. CONNOLLY CK: Method of using
pressurized aerosols. Br Med J 3: 21, 1975
To the editor: Dr. Woolf's letter has double merit. First, it strengthens the results of our survey by stressing the problem of improper use of pressurized aerosol inhalers in clinical practice. Second, and more important, the standards committee suggests a valid means of improving inhaler use on the basis of a logical and well documented technique. S.W. EPSTEIN, MD, FRCP[C]
Toronto Western Hospital Toronto, Ont.
Quality of Canada's health care system To the editor: In the Ottawa File (Can Med Assoc J 120: 979, 1979) Jim Garner has stated: "High-quality care, thundered the politicians, should be available to all, rich and poor." Interestingly, in the present debate relating to medicare, the one topic that is rarely ever discussed is the question of maintaining a health care system of high quality. The obsession of politicians, particularly those supporting a left-
714 CMA JOURNAL/SEPTEMBER 22, 1979/VOL. 121
wing ideology, is mainly that of free access to health care, as well as legislation against doctors who opt out and the banning of extra billing. A news item released by the Canadian Labour Congress on Apr. 25, 1979 illustrates this obsession: Labour is committed to a Medicare program that guarantees free access to the health care system. The direct billing of patients by doctors and the imposition of health care premiums are an infringement of the principle of free access. In the May 14, 1979 issue of Maclean's (page 41) an article entitled "The Medicare issue - election sleeper?" discusses shortage of money, bureaucratic inefficiency, political opportunism, abuse, overuse and greed. The one matter that is not touched on directly is the threat to the quality of medical services, which inevitably follows the socialization of medical services. Indeed, the phrase "quality of health care.. never appears in the article. The deterioration of the quality of services available under a staterun medical scheme has been documented by a young physician who has done a number of locums in British hospitals. He commented: "The conditions and standards in a few of the peripheral hospitals in poor areas of London were appalling." He concluded: "My recent experiences confirmed the enormous variability in standards in the hospital services, leaving many patients, especially in deprived city areas, with fragmented nursing and medical care in outdated conditions."' One of the most important arguments physicians can, and should, use in the present debate is that medicare, as it is presently organized, is a threat to excellence in health care delivery. We should be making this point at every opportunity, especially in discussions with our representatives in the provincial legislatures and our members of Parliament. A.G. DAWRANT, MA, MB, B CH, LMcc, CCFP
270 Meadowlark Professional Bldg. 8702 Meadowlark Rd. Edmonton, Alta.
Reference 1. SPEAR B: Personal view. Br Med J 1: 886, 1979
Indications: Relief of nasal congestion associated with allergic rhinitis, acute coryza, vasomotor rhinitis, acute and subacute sinusitis, acute otitis media, asthma, postnasal drip, acute eustachian salpingitis. It may also be used as an adjunct to antibiotics, antihistamines, analgesics and antitussives in the treatment oftheaboveconditions. Contraindications: Patients receiving or having received MAO inhibitors in the preceding 3 weeks; known hypersensitivity to pressor amines. Precautions: As pseudoephedrine is a sympathomimetic amine, it should be used with caution in hypertensive and diabetic patients, patients with latent or clinically recognized angle-closure glaucoma, coronary artery disease, congestive heart failure, prostatic hypertrophy, hyperthyroidism, urinary retention. Adverse Effects: As with other sympathomimetic amines, headache, dizziness, insomnia, tremor, confusion, CNS stimulation, muscular weakness, dry mouth, nausea, vomiting, difficulty in micturition, palpitations, tightness in thechest and syncope may beencountered. Overdose: Symptoms: Increase in pulse and respiratory rate, CNS stimulation, disorientation, headache, dry mouth, nausea and vomiting. Treatment: Gastric lavage, repeated if necessary. Acidify the urine and institute general supportive measures. If CNS excitement is prominent, a short-acting barbiturate may be used. Dosage: Adults and children over 6 years: 2 teaspoonfuls of syrup or 1 tablet 3 times daily. Children 4 months to 6 years: ½ adult dose. Infants upto4 months: ½ teaspoonful of syrup 3 times daily. Supplied: Syrup: Each 5 ml of clear purplish-red syrup with a sweet raspberry flavor conta.g.s: pseudoephedrine HCI 30 mg. Available in 1.0 ml and 250 ml bottles. Tablets: Each white, biconvex tablet 8.6 mm in diameter with code number WELLCOME S7A on same side as diagonal score mark contains: pseudoephedrine HCI 60 mg. Available in cartonsof 18 and bottlesof iQOand SOOtablets. Additional prescribing information available on request.
.I Weilcome Medcal Division Burroughs Weflcome Ltd. LaSalte, Qu6. PAAI *Trade Mark .
W-8004
throat. The mouth is held wide open to obtain the maximum flow of gas into the lungs and to minimize the baffle-like effect of the tongue and palate. Expiration should be relaxed, not full, since the latter results in the collapse of some airways and poorer distribution of the aerosol when inspired. The aerosol should be released toward the middle of full inspiration since the airways are then widely dilated, which results in more even distribution of the aerosol and better penetration into the lungs. If the aerosol is released at the beginning of inspiration it is distributed mainly to the upper lobes of the lungs. This effect is greatest if inspiration follows full expiration. C.R. WOOLF, MD, FRCP[C], FRCP Chairman, standards committee Canadian Thoracic Society Ottawa, Ont.
Recommended reading 1. RILEY DJ, WEITZ BW, EDELMAN NH:
The responses of asthmatic subjects to isoproterenol inhaled at differing lung volumes. Am Rev Respir Dis 114: 509, 1976 2. CONNOLLY CK: Method of using
pressurized aerosols. Br Med J 3: 21, 1975
To the editor: Dr. Woolf's letter has double merit. First, it strengthens the results of our survey by stressing the problem of improper use of pressurized aerosol inhalers in clinical practice. Second, and more important, the standards committee suggests a valid means of improving inhaler use on the basis of a logical and well documented technique. S.W. EPSTEIN, MD, FRCP[C]
Toronto Western Hospital Toronto, Ont.
Quality of Canada's health care system To the editor: In the Ottawa File (Can Med Assoc J 120: 979, 1979) Jim Garner has stated: "High-quality care, thundered the politicians, should be available to all, rich and poor." Interestingly, in the present debate relating to medicare, the one topic that is rarely ever discussed is the question of maintaining a health care system of high quality. The obsession of politicians, particularly those supporting a left-
714 CMA JOURNAL/SEPTEMBER 22, 1979/VOL. 121
wing ideology, is mainly that of free access to health care, as well as legislation against doctors who opt out and the banning of extra billing. A news item released by the Canadian Labour Congress on Apr. 25, 1979 illustrates this obsession: Labour is committed to a Medicare program that guarantees free access to the health care system. The direct billing of patients by doctors and the imposition of health care premiums are an infringement of the principle of free access. In the May 14, 1979 issue of Maclean's (page 41) an article entitled "The Medicare issue - election sleeper?" discusses shortage of money, bureaucratic inefficiency, political opportunism, abuse, overuse and greed. The one matter that is not touched on directly is the threat to the quality of medical services, which inevitably follows the socialization of medical services. Indeed, the phrase "quality of health care.. never appears in the article. The deterioration of the quality of services available under a staterun medical scheme has been documented by a young physician who has done a number of locums in British hospitals. He commented: "The conditions and standards in a few of the peripheral hospitals in poor areas of London were appalling." He concluded: "My recent experiences confirmed the enormous variability in standards in the hospital services, leaving many patients, especially in deprived city areas, with fragmented nursing and medical care in outdated conditions."' One of the most important arguments physicians can, and should, use in the present debate is that medicare, as it is presently organized, is a threat to excellence in health care delivery. We should be making this point at every opportunity, especially in discussions with our representatives in the provincial legislatures and our members of Parliament. A.G. DAWRANT, MA, MB, B CH, LMcc, CCFP
270 Meadowlark Professional Bldg. 8702 Meadowlark Rd. Edmonton, Alta.
Reference 1. SPEAR B: Personal view. Br Med J 1: 886, 1979
