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PubMed1997

Chronic bronchitis, shortness of breath, and airway obstruction by occupation in New Zealand.

The objectives of this study were to measure the population prevalence of symptoms of chronic obstructive lung disease and mild airway obstruction and to compare these between occupational groups. There were 1,609 subjects (63.9% response rate) who completed a respiratory questionnaire. Of these, 1,132 (70.4%) underwent pulmonary function testing (FEV1 and FVC). Twenty-one categories of current occupation were used for analysis. Four definitions of chronic obstructive pulmonary disease (COPD) were used: (1) chronic bronchitis, (2) chronic bronchitis with airway obstruction, (3) shortness of breath, and (4) shortness of breath with airway obstruction. For chronic bronchitis, adjusted prevalence odds ratios were significantly elevated for food processors other than bakers (OR = 2.83; 95% CI, 1.27 to 6.29) and chemical processors (OR = 18.84; 3.71 to 95.64). The combination of chronic bronchitis and mild airway obstruction (FEV1/FVC < 0.75) was associated with bakers (OR = 25.5; 3.86 to 168.53) and spray painters (OR = 14.40; 2.85-72.69). Shortness of breath was associated with hairdressers (OR = 2.75; 0.80 to 9.42) and bakers (OR = 6.72; 0.57 to 79.66), and nursing was associated with lower levels of shortness of breath (OR = 0.42; 0.16 to 1.15). Working ever with vapors, gases, dust, or fumes was significantly associated with chronic bronchitis and airway obstruction (OR = 3.13; 1.07 to 9.12). This population-based study has identified certain occupations with increased prevalence of chronic bronchitis and COPD.

Adult↗
PubMed1999

Eosinophilic bronchitis is an important cause of chronic cough.

Eosinophilic bronchitis presents with chronic cough and sputum eosinophilia, but without the abnormalities of airway function seen in asthma. It is important to know how commonly eosinophilic bronchitis causes cough, since in contrast to cough in patients without sputum eosinophilia, the cough responds to inhaled corticosteroids. We investigated patients referred over a 2-yr period with chronic cough, using a well-established protocol with the addition of induced sputum in selected cases. Eosinophilic bronchitis was diagnosed if patients had no symptoms suggesting variable airflow obstruction, and had normal spirometric values, normal peak expiratory flow variability, no airway hyperresponsiveness (provocative concentration of methacholine producing a 20% decrease in FEV(1) ([PC(20)] > 8 mg/ml), and sputum eosinophilia (> 3%). Ninety-one patients with chronic cough were identified among 856 referrals. The primary diagnosis was eosinophilic bronchitis in 12 patients, rhinitis in 20, asthma in 16, post-viral-infection status in 12, and gastroesophageal reflux in seven. In a further 18 patients a diagnosis was established. The cause of chronic cough remained unexplained in six patients. In all 12 patients with eosinophilic bronchitis, the cough improved after treatment with inhaled budesonide 400 micrograms twice daily, and in eight of these patients who had a follow-up sputum analysis, the eosinophil count decreased significantly, from 16.8% to 1.6%. We conclude that eosinophilic bronchitis is a common cause of chronic cough, and that sputum induction is important in the investigation of cough.

Administration, Inhalation↗
PubMed2001

Occupation, chronic bronchitis, and lung function in young adults. An international study.

We studied the relationship between occupational exposures, chronic bronchitis, and lung function in a general population survey in 14 industrialized countries, including 13,253 men and women aged 20 to 44 yr. We studied associations between occupational group, occupational exposures, bronchitis symptoms (cough and phlegm production for at least 3 mo each year), FEV(1), and nonspecific bronchial responsiveness (NSBR) separately in lifetime nonsmokers, cigarette smokers, and ex-smokers. Occupational exposure to vapors, gas, dust, or fumes, estimated with a job exposure matrix (JEM), was associated with chronic bronchitis among current smokers only (prevalence ratio (PR): 1.2 to 1.7). The interaction of occupational exposure with smoking, however, was not statistically significant (p > 0.1). Self-reported exposure was related to chronic bronchitis in all smoking groups. An increased risk for chronic bronchitis was found in agricultural, textile, paper, wood, chemical, and food processing workers, being more pronounced in smokers. Lung function and NSBR were not clearly related to occupational exposures. Findings were similar for asthmatic and nonasthmatic subjects. In conclusion, occupational exposures contributed to the occurrence of chronic (industrial) bronchitis in young adults. Fixed airflow limitation was not evident, probably due to the relatively young age of this population.

Adult↗
PubMed2004

Role of microvascular permeability on physiologic differences in asthma and eosinophilic bronchitis.

Asthma and eosinophilic bronchitis are characterized by a similar type of eosinophilic inflammation. However, eosinophilic bronchitis differs from asthma in that there is no variable airflow obstruction or airway hyperresponsiveness. We evaluated the roles of vascular endothelial growth factor (VEGF) and microvascular permeability in causing these differences between the two diseases. Inflammatory indexes in induced sputum, exhaled nitric oxide levels, and vascular permeability index were examined in 11 normal control subjects, 19 beclomethasone dipropionate (BDP)-treated subjects with asthma, 20 non-BDP-treated subjects with asthma, and 17 patients with eosinophilic bronchitis. The percentage of eosinophils in sputum and exhaled nitric oxide levels were significantly higher in non-BDP-treated subjects with asthma and patients with eosinophilic bronchitis than in other two groups; however, VEGF levels and vascular permeability index were significantly higher in non-BDP-treated (VEGF: mean; 4,710 [SD; 1,150] pg/ml, p < 0.0001; vascular permeability index: 0.028 [0.009], p < 0.0001) and BDP-treated (2,560 [1,070] pg/ml, p = 0.0002; 0.016 [0.006], p = 0.004) subjects with asthma than in patients with eosinophilic bronchitis (1,120 [800] pg/ml; 0.01 [0.005]) and normal control subjects (1,390 [1,280] pg/ml; 0.008 [0.003]). We found significant correlations between the VEGF level and the airway vascular permeability index in all patient groups. Thus, interaction between airway microcirculation and VEGF may be a key element in differences in airway function between asthma and eosinophilic bronchitis.

Adult↗
PubMed2004

Vasoactive intestinal peptide receptors in the airways of smokers with chronic bronchitis.

Vasoactive intestinal peptide (VIP) is a neuropeptide involved in the regulation of airway mucus secretion. The biological functions of VIP are mediated through two receptors, the vasoactive intestinal peptide receptor type 1 (VPAC1R) and type 2 (VPAC2R). The aim of this study was to quantify the expression of both VPAC1R and VPAC2R in the central airways of smokers with chronic bronchitis. Surgical specimens were obtained from 33 smokers undergoing thoracotomy for localised pulmonary lesions: 23 smokers with symptoms of chronic bronchitis and 10 asymptomatic smokers with normal lung function. By using immunohistochemical and microscopic analysis, an increased expression of VPAC1R, but not VPAC2R, was found in bronchial epithelium, bronchial glands and vessels of smokers with symptoms of chronic bronchitis compared with asymptomatic smokers. Smokers with symptoms of chronic bronchitis also had an increased number of mononuclear cells positive for both VPAC1R and VPAC2R in the bronchial submucosa. In conclusion, the expression of type 1 and type 2 vasoactive intestinal peptide receptors is increased in the central airways of smokers with chronic bronchitis, suggesting their possible involvement in the pathogenesis of chronic bronchitis.

Adult↗
PubMed1994

The intrabronchial microbial flora in chronic bronchitis patients: a target for N-acetylcysteine therapy?

Chronic bronchitis is common among smokers, often together with recurrent infectious exacerbations. Streptococcus pneumoniae and Haemophilus influenzae are the pathogens traditionally considered most important. N-acetylcysteine (NAC) treatment has been shown to reduce the number of infectious exacerbations in patients with chronic bronchitis. The mechanism behind this is unknown. We attempted to characterize the intrabronchial bacterial flora in patients with chronic bronchitis in an infection-free interval, and to determine whether pharmacological and immunological factors effected the bacterial occurrence. Twenty two smokers with non-obstructive chronic bronchitis, 19 smokers with chronic bronchitis and chronic obstructive pulmonary disease (COPD) and 14 healthy nonsmokers underwent bronchoscopy. To obtain uncontaminated intrabronchial samples, a protected specimen brush was used. Quantitative bacterial cultures and virus isolations were performed. Significantly positive bacterial cultures (> 1,000 colony-forming units (cfu).ml-1) were found only in the patients. S. pneumoniae and H. influenzae were found in five patients, and only in the patients without NAC treatment. The most common bacterium was alpha-haemolytic streptococcus. Negative cultures were more common in the healthy controls. Of the various factors examined, only NAC medication had an influence on bacterial numbers. Significantly fewer patients with NAC medication had positive cultures (3 out of 16) than in the group of patients without NAC therapy (15 out of 21). Our results confirm that chronic bronchitis in smokers leads to increased intrabronchial bacterial colonization. We could also confirm that 1,000 cfu.ml-1 is an adequate cut-off level for significant bacterial growth when using the protected specimen brush. NAC medication was associated with low bacterial numbers.

Acetylcysteine↗
PubMed2004

Chronic bronchitis: should it worry us?

BACKGROUND: Chronic bronchitis (CB) has been studied using standardized questionnaires for decades. From being the key element in the 'British hypothesis' chronic bronchitis was reduced to being an innocent disorder in the 1980s. However, there is now good evidence that chronic bronchitis is associated with an increased risk from both overall and chronic obstructive pulmonary disease (COPD) specific mortality. Presumably through increasing the frequency of lower respiratory tract infections chronic bronchitis is associated with excess decline in lung function, hospital admission and other disease specific outcomes. The prevalence of chronic bronchitis increases with increasing age and the burden associated with chronic bronchitis in this growing proportion of the population is large. Vital prognosis in the elderly is affected by CB and this condition presumably deserves more attention from the medical profession.

Bronchitis, Chronic↗
PubMed2006

Chronic cough due to nonasthmatic eosinophilic bronchitis: ACCP evidence-based clinical practice guidelines.

OBJECTIVES: Nonasthmatic eosinophilic bronchitis is a newly recognized cause of chronic cough. Our objective was to review the pathogenesis, natural history, diagnosis, and treatment of this condition. METHODS: The current literature was reviewed using an Ovid MEDLINE and PubMed literature review for all studies published in the English language from 1963 to December 2004 using the medical subject heading term "eosinophilic bronchitis." RESULTS: Nonasthmatic eosinophilic bronchitis is a common cause of chronic cough. It is characterized by the presence of eosinophilic airway inflammation, similar to that seen in asthma. However, in contrast to asthma, nonasthmatic eosinophilic bronchitis is not associated with variable airflow limitation or airway hyperresponsiveness. The differences in functional association are related to differences in the localization of mast cells within the airway wall, with airway smooth muscle infiltration occurring in patients with asthma, and epithelial infiltration in patients with nonasthmatic eosinophilic bronchitis. Diagnosis is made by the confirmation of eosinophilic airway inflammation usually with induced sputum analysis after the exclusion of other causes for chronic cough on clinical, radiologic, and lung function assessment. The cough usually responds well to treatment with inhaled corticosteroids. The dose and duration of treatment differ between patients. The condition can be transient, episodic, or persistent unless treated, and occasionally patients may require long-term prednisone treatment. CONCLUSIONS: Further study of this condition may improve our understanding of airway inflammation and airway responsiveness, leading to novel targets for therapeutic agents for the treatment of both asthma and nonasthmatic eosinophilic bronchitis.

Biopsy↗
PubMed1982

The addition of an aerosol anticholinergic to an oral beta agonist plus theophylline in asthma and bronchitis. A double-blind single dose study.

In two groups of patients, 15 with asthma and 15 with chronic bronchitis, the bronchodilator effects of ipratropium bromide, of fenoterol plus theophylline, and of the combination of the three drugs, were compared using a double-blind, single-dose, placebo-controlled format. Ipratropium bromide caused rapid bronchodilatation which was not significantly different in asthmatic patients and patients with bronchitis (delta FEV1 = .29 L in one hour in asthmatic patients, .18 L in patients with bronchitis). In contrast, fenoterol plus theophylline induced a considerably greater effect in asthmatic patients (delta FEV1 = .41 L in one hour) than in those with bronchitis (delta FEV1 = .07 in one hour). The use of the three drugs in combination compared with ipratropium bromide alone, or fenoterol plus theophylline alone, resulted in a significant additional bronchodilatation in asthmatic patients. In the patients with bronchitis, the triple combination was clearly superior to fenoterol plus theophylline. A similar trend was present in comparing the triple combination to ipratropium bromide, but the difference did not reach statistical significance. There was no evidence of synergism when ipratropium bromide was combined with fenoterol plus theophylline in that the total bronchodilator effect was approximately additive. Asthmatic patients and the physician were able to distinguish the triple combination from placebo. No such ability was demonstrated with respect to those with bronchitis. All three drugs were well tolerated. Side effects were mostly mild, and none was related to the use of ipratropium.

Administration, Oral↗
PubMed1988

Airway responsiveness to inhaled histamine in chronic obstructive airways disease. Chronic bronchitis vs emphysema.

Airway responsiveness to inhaled histamine was examined in two groups of carefully selected patients with nonasthmatic chronic obstructive airways disease (COAD). Twelve patients with chronic bronchitis and airflow obstruction but little emphysema and 13 with predominantly emphysema and airflow obstruction but little bronchitis were selected based on history, chest roentgenogram, and diffusing capacity for carbon monoxide (Dsb). Emphysema patients had less cough, less sputum, less chronic bronchitis, lower Dsb, and more radiographic evidence of vascular deficiency. There was no difference in anthropometric features, smoking history, atopic skin sensitivity, hemoglobin, blood eosinophilia, PaO2, PaCO2, ECG, lung volumes, or expiratory flow rates. The two groups had similar airway responsiveness to inhaled histamine; the geometric mean provocation concentrations producing a 20 percent FEV1 fall (PC20) was 0.56 mg/ml for the bronchitis patients and 0.28 mg/ml for the emphysema patients (p greater than 0.20). Regression of log histamine PC20 vs percent predicted FEV1 showed a high correlation in both groups (r = 0.73, p less than 0.01 in bronchitis and r = 0.79, p less than 0.001 in emphysema). The regression lines were almost identical. These data suggest that in COAD bronchial responsiveness to inhaled histamine is mainly due to the altered airway geometry, and that there is no difference in histamine responsiveness between patients with emphysematous COAD and nonemphysematous COAD with chronic bronchitis.

Aged↗
PubMed2003

Trends in antimicrobial prescribing for bronchitis and upper respiratory infections among adults and children.

OBJECTIVES: This study examined antimicrobial prescribing patterns for adults and children with bronchitis or upper respiratory infections (URIs) before and after release of nationally disseminated pediatric practice recommendations. METHODS: Data from the 1993, 1995, 1997, and 1999 National Ambulatory Medical Care Survey were used to evaluate prescriptions for antimicrobials for URIs and bronchitis. RESULTS: From 1993 to 1999, the proportion of children receiving antimicrobials after visits for URIs and bronchitis decreased. However, the use of broad-spectrum antimicrobials rose from 10.6% of bronchitis visits to 40.5%. Prescriptions of antimicrobials for adults with URIs or bronchitis showed a decrease between 1993 and 1999. CONCLUSIONS: Although antimicrobial prescribing for URIs and bronchitis has decreased for both children and adults, the prescribing of broad-spectrum antibiotics among children has shown a proportional rise.

Adolescent↗
PubMed2002

Acute exacerbations of chronic bronchitis: a pharmacoeconomic review of antibacterial use.

Chronic bronchitis is a common problem affecting a large proportion of the adult population. People with chronic bronchitis are subject to recurrent attacks of bronchial inflammation called acute exacerbations of chronic bronchitis (AECBs). In patients with AECBs, symptoms may worsen due to a bacterial infection; the exacerbation is then known as an acute bacterial exacerbation of chronic bronchitis (ABECB). ABECBs are thought to be controllable through the use of antibacterial agents. In this paper we review current evidence on the cost of chronic bronchitis and AECBs, the cost effectiveness of antibacterials in the management of ABECB, and the factors that may affect the cost-effectiveness of antibacterials in the management of ABECB. We find that the number of economic evaluations conducted in this area is small. Of the few economic evaluations that have been conducted there has been only one prospective economic evaluation based on a clinical trial. The remainder are simple decision analysis-based modelling studies or retrospective database studies. Our principle findings are as follows: a key factor affecting the cost-effective use of antibacterials in the management of ABECB is the definitive diagnosis of the condition. Unfortunately, diagnosing a bacterial cause of an AECB is difficult, which presents problems in ensuring that antibacterials are not prescribed unnecessarily;current evidence suggests but does not prove that use of more effective but more costly first-line antibacterials may be relatively cost effective and may minimise overall expenditure by reducing the high costs associated with treatment failure;chronic bronchitis and AECB have a significant and negative physical and psychological effect on health-related quality of life. In conclusion, the small number of economic evaluations conducted in this area, coupled with the nature of the design of these studies, precludes a definitive statement recommending which specific antibacterial should be preferred on cost-effectiveness grounds for the management of ABECB. On the basis of our findings we suggest some topics for further research.

Acute Disease↗
PubMedDate not supplied

[Plastic bronchitis in a child with thalassemia alpha].

OBJECTIVE: Plastic bronchitis is an unusual condition in children, associated with formation of mucofibrinous casts and mucous plugging of the tracheobronchial tree. Given that this illness is part of the differential diagnosis of acute respiratory failure, early treatment is important for improved prognosis. The aim of this report is to describe a case of plastic bronchitis in a child with alpha-thalassemia that was treated successfully with endoscopy. DESCRIPTION: A three year old, black, male child, previously healthy, presented with acute respiratory failure and a chest x-ray showing pulmonary atelectasis. There was no evidence of respiratory symptoms or previous allergy state. The diagnosis of plastic bronchitis was made using flexible and rigid bronchoscopy, and confirmed by histopathologic findings. The child progressed well, treatment was based on supportive care and antibiotics were not used. Ten days after discharge, radiographic appearance was normal. Alpha thalassemia was diagnosed through hemoglobin electrophoresis. COMMENTS: Plastic bronchitis is clinically important because has similar presentation to other prevalent diseases, such as foreign body aspiration and asthma. When plastic bronchitis is suspected, endoscopy is indicated in order to confirm diagnosis and define treatment. Plastic bronchitis has been previously described in patients with cystic fibrosis, cardiac surgery and sickle cell disease. In this case, an association with alpha-thalassemia was observed.

Bronchitis↗
PubMed1987

Asthma and wheezy bronchitis in a British national sample.

The relationship between biosocial factors and childhood asthma and wheezy bronchitis in a British national sample was examined. At age 11, 3 1/2% of the children in this sample were reported to have suffered from either asthma or asthma-wheezy bronchitis; an additional 8.8% reported wheezy bronchitis without asthma. Significantly more boys than girls had asthma at this age. The presence of asthma and wheezy bronchitis was found to associate with parental occupation, household amenities, and noncrowding in the home, as well as to vary by geographic region. Discriminant analysis showed that it was possible to differentiate between the three groups comprising asthma and wheezy bronchitis, wheezy bronchitis only, and nonsufferers, due mainly to allergy-related factors such as eczema.

Asthma↗
PubMed2000

Eosinophilic bronchitis: an important cause of prolonged cough.

The recent development of noninvasive techniques to measure airway inflammation has led to the recognition of eosinophilic bronchitis, a condition characterized by a sputum eosinophilia identical to that seen in asthma, but without any of the functional abnormalities associated with asthma. The condition is interesting for a number of reasons. Firstly, eosinophilic bronchitis is a common cause of chronic cough, which is important to recognize as it responds well to corticosteroids. However, recognition is not straightforward because it requires assessment of airway inflammation. Secondly, the natural history of eosinophilic bronchitis is uncertain. Some patients with chronic obstructive pulmonary disease without a history of previous asthma have sputum eosinophilia, thus one possibility is that eosinophilic bronchitis may develop into fixed airflow obstruction. Finally, the difference in the association of eosinophilic airway inflammation to airway dysfunction between eosinophilic bronchitis and asthma is of interest as it is possible that it reflects important differences in the nature or site of the airway inflammation. Further study of this interesting condition may shed light on the relationship between airway inflammation and airway responsiveness, leading to a greater understanding of both eosinophilic bronchitis and asthma.

Algorithms↗
PubMed1981

Wheezing bronchitis in children on a South Pacific Island.

Retrospective and prospective studies were done on children with wheezing bronchitis on the small Pacific island of Niue. Wheezing bronchitis was found to be a common cause of morbidity, but not mortality in these children. Episodes of the disease were most common in children under the age of 4 years and tended to disappear as they became older. A case-control study indicated smoking by the mother (P less than 0.0001), positive stool examination for parasites (P less than 0.001), mother with a history of wheezing bronchitis (P less than 0.01) and father smoking (P less than 0.05) were all correlated with wheezing bronchitis. Skin testing and serologic results indicated that hypersensitivity to house dust mite (Dermatophagoides pteronyssinus) and plantain (Plantago lanceolata) antigens were also associated with having wheezing bronchitis. This study demonstrates the multifactorial etiology of wheezing bronchitis on a Pacific island.

Adolescent↗
PubMed1997

Chronic bronchitis in farmers.

OBJECTIVES: Chronic bronchitis was studied in relation to work time and years of exposure in farming, as well as to production type, dusty occupation outside farming, and the combination of work exposure and smoking, in a population of farmers. METHODS: In 1989 a representative cohort of 10,792 farmers and spouses was selected from a government register and invited to participate in a cross-sectional study in 1991. The total response rate was 80%. There were 33% part-time farmers, and among the men 32% of the full-time and 42% of the part-time farmers had worked in dusty occupations outside farming. Bronchitis symptoms were recorded on a self-administered questionnaire, spirometric data were obtained, and internal reference equations were calculated for forced expiratory volume in 1 s (FEV1.0). RESULTS: The exposure factors of importance for chronic bronchitis were full-time farming versus part-time farming, livestock production types (poultry, dairy, swine, horse and combinations), and occupational dust exposure outside agriculture. The combinations of the work exposure factors were significant and showed a 2- to 3-fold increase in risk for chronic bronchitis. Combinations with smoking showed up to a 6-fold increase in risk. Over the age of 50 years, chronic bronchitis was a risk factor for airway obstruction defined as the standardized residuals for FEV1.0 less than -2 for both nonsmokers (OR 2.8, 95% CI 1.1-6.8) and smokers (OR 8.5, 95% CI 5.1-14.3). CONCLUSIONS: Work exposure factors in farming and other dusty occupations enhance the risk for chronic bronchitis from 2- to 3-fold for farmers. In combination with smoking the risk increases to up to 6-fold.

Adult↗
PubMed1998

[Autopsies of coal workers with chronic bronchitis].

OBJECTIVE: To study the pathological features of chronic bronchitis in coal miners. METHODS: Pathological specimens collected in postmortem examinations for 180 deceased coal miners were analyzed. RESULTS: Among the 180 deceased coal miners, there were 155 cases of chronic bronchitis, with a prevalence rate of 86.1%, mainly affecting bronchia and bronchiole. No correlation between chronic bronchitis and coal worker pneumoconiosis was found. The most apparent features of chronic bronchitis in coal miners include dust deposition and dust cell infiltration on the walls of bronchi at all levels, and dust fibrosis around the bronchial walls, with the most severe pathological change of dust deposition on the respiratory bronchiole. CONCLUSION: Most of the coal miners with chronic bronchitis (accounting for 80.0% of the total) manifested dust deposition and mixture of dust deposition and inflammation. Simple inflammatory bronchitis was rare.

Bronchi↗