Bronchial asthma: current concepts in pathophysiology and management of status asthmaticus.
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Biomedical subjects
Publications and source records attributed to S Chodosh.
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A modification of the sulfur dioxide (SO2)-exposed rat model proposed by Reid for the study of chronic bronchitis was employed to evaluate mucus retention and cytologic changes. Rats were exposed to from 600 to 700 ppm of SO2 for 3 hours per day, and groups were examined after 0, 9, 18, and 30 hours of cumulative exposure. Tracheal mucus retention and statistically significant increases (two- to four-fold) in the amount of solid material (cellular and mucus) recovered by bronchia lavage developed as a function of exposure time. The increase in bronchial solids was primarily due to inflammatory cells. The goblet cell population in secondary bronchi declined initially, with a significant increase after 30 hours of exposure (P less than .001). The cytologic data provide additional support to Reid's suggestion that the SO2-exposed rat may be considered as a chronic bronchitis model.
Sixteen patients with chronic bronchitis were treated in a single-blind crossover study during two separate acute exacerbations caused by bacterial infections. During one of the episodes a regimen consisting of two 800-mg doses of bacampicillin per day was given; therapy for the other episode was four 500-mg doses of ampicillin per day. Each drug was given for 14 days. Patients were observed once before therapy was started, twice a week during therapy, and weekly after therapy; the investigator did not know which drug the patients were receiving. Graded clinical observations included frequency and severity of cough, wheezing, rales, rhonchi, breath sounds, and prolongation of expiration. Objective sputum measurements included daily volume, qualitative and quantitative cytology, and quantitative bacterial counts. Paired t-test analyses revealed that before therapy was begun the group receiving bacampicillin was sicker. Both agents effectively decreased inflammation and counts of bacterial flora. Clinical symptoms cleared 11 days after institution of therapy with either drug, but patients tended to favor bacampicillin in overall clinical effects. Adverse effects were similar with both agents, but bacampicillin was associated with fewer upper and more lower gastrointestinal symptoms.
Two separate acute bacterial exacerbations of chronic bronchitis or chronic asthmatic bronchitis were treated in 20 patients in a double-blind crossover study. One course of treatment consisted of 320 mg of trimethoprim (TMP) plus, 1,600 mg of sulfamethoxazole (SMZ) daily and the other of 2 g of ampicillin daily; each drug was given for 14 days. Patients were observed initially, twice a week during therapy, and weekly after therapy. Observations that were recorded included graded chest symptoms and physical findings, vital signs, pulmonary function, hematologic parameters, and objective sputum measurements (daily volume, purulence, differential quantitative cytology, quantitative bacterial counts, physical properties, levels of lactate dehydrogenase with its isoenzymes, levels of myeloperoxidase, and presence of deoxyribonucleic acid fibers). Both antibiotic regimens were effective in resolving these acute bacterial exacerbations. Paired t-test analysis revealed few and minor differences between TMP-SMZ and ampicillin during therapy, although three patients did not complete TMP-SMZ therapy because of adverse reactions. However, the period between the two bacterial exacerbations was significantly longer after ampicillin therapy. Innovative in this investigation are the study design and the objective quantitative measurements of inflammatory response and bacterial populations in sputum.
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