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Does acute bronchitis really exist? A reconceptualization of acute viral respiratory infections.

BACKGROUND: Considerable overlap exists in patient presentations and physical findings in viral upper respiratory tract infections (URIs) and acute bronchitis. Our goal was to determine whether there are any clinical cues that could help physicians differentiate between these 2 conditions. METHODS: We performed a retrospective chart audit on 135 patients who had been given a diagnosis of acute bronchitis and a random sample of 409 patients with URIs over a 2.5-year period. Patient and provider characteristics, patient symptoms, and physical findings were compared with bivariate analyses and then entered into a logistic regression model. RESULTS: In bivariate analyses, a number of demographic variables, symptoms, and signs were associated with acute bronchitis. Multivariate analysis showed that the strongest independent predictors of acute bronchitis were cough (adjusted odds ratio [AOR]=21.12; 95% confidence interval [CI], 6.01-74.26), and wheezing on examination (AOR=12.16; 95% CI, 5.39-27.42). Nausea was the strongest independent predictor that the diagnosis would not be acute bronchitis (AOR=0.01; 95% CI, 0.01-0.85). However, there was considerable overlap between the 2 conditions, and the logistic model explained only 37% of the variation between the diagnoses. CONCLUSIONS: We hypothesize that sinusitis, URI, and acute bronchitis are all variations of the same clinical condition (acute respiratory infection) and should be conceptualized as a single clinical entity, with primary symptoms related to different anatomic areas rather than as different conditions.

Acute Disease↗

[Chlamydia pneumoniae infection in patients with acute bronchitis and bronchial asthma].

In this study, a total of 60 patients with acute bronchitis, 71 patients with bronchial asthma and 20 healthy volunteers were serologically and bacteriologically analyzed to investigate whether Chlamydia pneumoniae infection is associated with the onset and the exacerbation with acute bronchitis and bronchial asthma. Antibody titers to Chlamydia pneumoniae were also measured and compared by ELISA method. The antibody-positive rate in the patients with acute bronchitis (88.4%) was significantly higher than that in the patients with bronchial asthma (73.3%) or that in the healthy volunteers (60%). And the levels of the IgA antibody in the patients with acute bronchitis were significantly higher than those in the patients with bronchial asthma or those in the healthy volunteers. The rate of acute C. pneumoniae infection in the patients with acute bronchitis (20%) did not show significantly differences compared with that in the patients with bronchial asthma (15.5%) or that in the healthy volunteers (10%). The cases of acute C. pneumoniae infection had both as a single etiologic agent and as a mixed infection, most often with Streptococcus pneumoniae. Therefore, we demonstrated that the acute C. pneumoniae infection may be associated with the onset and the exacerbation in acute bronchitis and bronchial asthma.

Acute Disease↗

Eotaxin and CCR3 are up-regulated in exacerbations of chronic bronchitis.

BACKGROUND: Eosinophils and T lymphocytes represent constant features in the airways of subjects with exacerbated chronic bronchitis. Eotaxin is the most potent and selective eosinophil chemoattractant which can also attracts lymphocytes. The aim of the study was to evaluate the expression of eotaxin and its receptor, CCR3, in bronchial airways during exacerbation of chronic bronchitis. METHODS: By immunohistochemistry we studied eotaxin and CCR3 expression in the lamina propria of 14 subjects with acute exacerbation of chronic bronchitis. 20 asthmatics, and 8 healthy subjects. We determined the cell types expressing the CCR3 receptor by colocalization experiments. We finally studied the relationship between eotaxin and CCR3 and eosinophils and T lymphocytes. RESULTS: The number of eotaxin+ and CCR3+ cells was significantly higher in exacerbated chronic bronchitis (P<0.003 and P<0.002) and asthma (P<0.002 and P<0.0001) when compared to healthy subjects. CCR3 was mainly expressed by eosinophils and to a lesser extent by CD4+ and CD8+ lymphocytes. In exacerbated chronic bronchitis the number of CCR3+ cells was strongly correlated to the number of eosinophils (P<0.0002. r=0.85) and to the number of CD4+ lymphocytes (P<0.05, r=0.57). CONCLUSION: Our study suggests that eotaxin and CCR3 are up-regulated and could be involved in the eosinophil and CD4+ lymphocyte recruitment into the airways which occur during acute exacerbations of chronic bronchitis.

Adult↗

Bronchitis mimicking opportunistic lung infection in patients with human immunodeficiency virus infection/AIDS.

Purulent bronchitis was identified in 19 of 422 patients undergoing fiberoptic bronchoscopy during a 32-month period because of suspicion of an opportunistic lung infection complicating acquired immunodeficiency syndrome or human immunodeficiency virus infection. Five patients had Pneumocystis carinii pneumonia, but other opportunistic lung infections were excluded in the remaining 14 patients. Characteristics of these 14 patients included fever (greater than 38.3 degrees C), cough, and dyspnea in 14 of 14 patients; purulence of expectorated sputum (11/14); and widened alveolar-arterial oxygen gradient (13/14). Rapid (2 +/- 1.4 days) clinical response (defervescence and resolution of pulmonary symptoms) occurred with antibiotic therapy in 10 of 14 patients. In three patients, there was no improvement, and adult respiratory distress syndrome developed. Bacterial isolates from bronchoalveolar lavage included Streptococcus viridans (n = 12), Haemophilus influenzae (n = 7), Staphylococcus aureus (n = 3). Roentgenographic features of bronchiectasis were present in seven patients. Differential cell counts revealed greater than 50% neutrophils in the bronchial washings of all patients with purulent bronchitis. Neutrophil percentages in bronchoalveolar lavage were as follows: patient with purulent bronchitis without P carinii pneumonia (n = 14), 54.53% +/- 29.18%; patients with purulent bronchitis and concomitant P carinii pneumonia (n = 5), 62% +/- 31.9%. In a control group of 17 patients with P carinii pneumonia who did not have purulent bronchitis, the neutrophil percentage was 6.8% +/- 6.17% (p = less than 0.00001, t-test). Purulent bronchitis appears to be a distinct, treatable entity in patients with HIV infection and may accompany bacterial pneumonia, bronchiectasis, and P carinii pneumonia.

Acquired Immunodeficiency Syndrome↗

Low frequency noise and stress: bronchitis and cortisol in children exposed chronically to traffic noise and exhaust fumes.

A correlation of respiratory diseases to traffic related air pollution and noise was observed in an interview study. Since in that study the exposure was subjectively assessed, in the present field study nitrogen dioxide as indicator for vehicle exhausts and the mean night-time noise level were measured outside the children's windows in representative locations. Based on these measurements each child was placed in one of the following categories: low, medium or high traffic immission (ambient emissions). The physician contacts due to bronchitis of 68 children were assessed retrospectively from the files of the participating paediatricians. Saliva samples were collected from all children and the cortisol concentration was estimated. Children under high noise exposure (L(night, 8h) = 54-70dB(A)) had in comparison to all other children significantly increased morning saliva cortisol concentrations, indicating an activation of the hypothalamus-pituitary-adrenal (HPA) axis. Analysing a subgroup of children without high noise exposure showed, that children with frequent physician contacts due to bronchitis did not have increased morning saliva cortisol. However, multiple regression analysis with stepwise exclusion of variables showed that bronchitis was correlated more closely to morning salvia cortisol than to traffic immissions. On the other hand, the rate of physician contacts due to bronchitis increased in a dose dependent manner and significantly with increasing traffic immissions. From these results it can be concluded that high exposure to traffic noise, especially at nighttime, activates the HPA axis and this leads in the long term to an aggravation of bronchitis in children. This seems to be more important than the effect of exhaust fumes on bronchitis symptoms. The results of the present study should be subjected to further investigation using specially designed studies.

Bronchitis↗

[Use of decamethoxine in the complex treatment of chronic bronchitis].

Seventy-two patients with chronic bronchitis were examined and divided into 3 groups. Group I consisted of patients with chronic catarrhal bronchitis (CCB) group II of those with chronic purulent bronchitis (CPB), group III of subjects with bronchitis associated with purulent destructive pulmonary diseases. All the patients received combined treatment with decamethoxin as an antibacterial modality. It was found that decamethoxin promotes elimination of the infection of the bronchial secretion in 60% of chronic bronchitis suffers, the incidence of microorganisms resistent to several antibiotics reduced 2-fold. Local use of decamethoxin as an antibacterial and antiinflammatory drug in multimodality treatment of chronic purulent bronchitis proved highly effective.

Administration, Inhalation↗

[New aspects of studying the morphofunctional insufficiency of bronchial epithelium in chronic bronchitis].

The paper is concerned with some data on the state of the epithelium in chronic bronchitis from a view-point of its quantitative assessment with plotting models of the epithelium--morphograms reflecting its morphofunctional insufficiency. A total of 137 patients with chronic bronchitis were investigated. Morphofunctional epithelial insufficiency was shown to be an obligatory symptom of chronic bronchitis. Biopsy of the central, lobar bronchi was sufficient for the detection of morphological (quantitative) signs of chronic bronchitis. Results of morphometric investigations can be applied to differential diagnosis of chronic nonobstructive and obstructive bronchitis as well as chronic bronchitis and other types of pulmonary pathology. Morphometry of biopsy specimens is an indispensable and adequate method of therapeutic control.

Atrophy↗

Prevalence and incidence of chronic bronchitis and farmer's lung with respect to the geographical location of the farm and to the work of farmers.

Prevalence and incidence of chronic bronchitis and farmer's lung in the Finnish farming population were studied by cross-sectional and follow-up surveys of 12,056 farmers. Occurrence of both these diseases varied greatly according to geographical location of the farm. The incidence of chronic bronchitis (2,687 new cases annually per 100,000 farmers) was twice as large in southwestern as in northern Finland. Chronic bronchitis was more common among farmers in livestock production than among those in grain production. The definition of farmer's lung adopted confined the occurrence of the disease among farmers engaged in animal tending. In livestock production, chronic bronchitis was strongly associated with swine tending, but farmer's lung with both cattle and swine tending. Use of a harvester with a sack loader turned out to be characteristic of the chronic bronchitis cases, and the number of new cases was largest among farmers who used a batch type cell drier. The farmers with grain driers that use unheated air most frequently suffered from farmer's lung. Of all (147) the characteristics of farming occupation analyzed, the methods of grain handling and drying were the most important factors for predisposing farmers to chronic bronchitis and farmer's lung.

Adult↗

[Pathomorphologic characteristics and classification of bronchitis in miners working on watered faces in coal mines].

The material obtained from the lungs of 83 miners who worked in coal faces for 2-27 years, has been studied. On the basis of pathomorphological data acute and chronic bronchitis were subdivided into three forms each. Acute bronchitis: catarrhal-desquamative, productive-infiltrative, destructive-necrotic; chronic ones: productive-destructive, hypertrophic, atrophic. Each form of acute and chronic bronchitis has its own morphological varieties. The signs of professional bronchitis are not characteristic of acute bronchitis; coal just decreases the resistance of the bronchial mucous membrane. Chronic bronchitis is characterized by a number of distinctive morphological features: hyalinosis of the basal membrane, restructuring of the vascular network of the bronchial tree, and rarely squamous-cell metaplasia of the bronchial epithelium.

Acute Disease↗

[Long-term study of the evolution of chronic bronchitis detected by questionnaire 10 years earlier].

The longitudinal study carried out in a group of inhabitants from Craiova showed that 16,2% of these, classified according to previously filled questionnaires as suffering from chronic bronchitis, and 10,7% of those classified as suffering from minor forms of bronchitis (sporadic symptoms) had died, and one third of them were not found when the investigation was repeated. Re-examination of 106 adults with chronic bronchitis showed that the symptoms had disappeared in two-thirds of them, especially in those who gave up smoking; in 19,8% of them the symptoms had become more severe due to repeated attacks. Bronchial obstruction was present in 36% of the cases, and alterations in the small bronchial ducts were present in two-thirds of the patients. In 18-24% of the patients with minor forms of bronchitis the symptoms were more severe and chronic, and they can be classified as chronically ill patients. Frequently there were altered spirographic values. This study demonstrates that chronic bronchitis may evolve to: a) remission of the symptomatology (especially after suppression of smoking); b) more or less unmodified persistence of symptoms; c) increased severity of the symptoms following repeated acute attacks. Almost 25% of cases with sporadic coughing and expectoration became chronically ill over a period of 10 years. The questionnaire was demonstrated as having retrospective value for making a diagnosis of chronic bronchitis, but cough and expectoration are not sufficient for a differential assessment of the evolution, the spirographic data being of decisive importance.

Bronchitis↗

Continuous and on demand use of bronchodilators in patients with non-steroid dependent asthma and chronic bronchitis: four-year follow-up randomized controlled study.

BACKGROUND: A previous two-year study of continuous and on demand bronchodilator therapy in patients with moderate asthma and chronic bronchitis showed a deterioration in lung function in those on continuous therapy. AIM: A two-year follow-up study was undertaken of patients who had been shown in the previous study to have non-steroid dependent (mild) asthma and chronic bronchitis, in order to investigate the effect of continuous and on-demand treatment with bronchodilator therapy. METHOD: Patients for the study were drawn from 29 general practices in the catchment area of the University of Nijmegen, the Netherlands. A total of 83 patients (27 with asthma and 56 with chronic bronchitis) were selected from a group of 160 patients who had completed the previous two-year bronchodilator trial. During these first two years the selected subjects had been shown to be non-steroid dependent (no rapid decline in lung function and a low number of exacerbations of their condition per year), and they were followed up for another two years of treatment with bronchodilator therapy. At the start of the four-year study, patients were randomly assigned to one of two parallel treatment groups: continuous treatment (dry powder inhalations of either salbutamol 1600 micrograms or ipratropium bromide 160 micrograms daily) or treatment on demand (only during exacerbations or periods of dyspnoea). Outcome parameters were the annual decline in lung function, changes in peak flow rate, bronchial hyper-responsiveness, exacerbation rate, respiratory symptoms and reported health. RESULTS: After correction for possibly confounding variables and for regression to the mean, the decline in lung function was 49 ml year in patients taking bronchodilators continuously and 51 ml year in patients using bronchodilators on demand, irrespective of the drug use. Continuously treated patients, whether suffering from asthma or chronic bronchitis, did not differ from patients treated on demand with respect to mean morning peak flow rate, diurnal (and week to week) variation of the peak flow rate, bronchial hyper-responsiveness, exacerbation rate and reported health. There was no difference between the long-term effects of salbutamol and ipratropium. CONCLUSION: Continuous use of bronchodilators over four years in patients with non-steroid dependent asthma or chronic bronchitis does not increase the decline in lung function which had been observed previously in patients with moderate asthma or chronic bronchitis during two years of continuous treatment with bronchodilators.

Albuterol↗

Changing strategies for treatment of chronic bronchitis.

There has been a recent re-examination of the therapeutic approach to chronic bronchitis, with or without airflow obstruction, partly as a result of intense interest in asthma therapy. Although the mainstay of therapy in chronic bronchitis is still smoking cessation, there has been a shift in importance and use of therapeutic interventions based on pathophysiological considerations. The presence of airway inflammation and bronchial hyperreactivity in chronic bronchitis, analogous to asthma, has spurred interest in the use of anti-inflammatory agents such as inhaled steroids, with the hope that these drugs will have the same favorable effects on airflow obstruction as in asthma. Recognition of the relative importance of cholinergic stimulation in airflow obstruction associated with chronic bronchitis has elevated the role of anticholinergic agents to primary therapy. And lastly, evolving understanding of the role of infectious agents in exacerbations of chronic bronchitis is having an impact on the perceived importance of antibiotics in this setting. This article will discuss the rationale, evidence of efficacy, and current role for each of these treatment modalities in chronic bronchitis.

Administration, Inhalation↗

Smoking habits and chronic bronchitis in Nigerian soldiers.

A survey was carried out in a random sample of soldiers in units in Ibadan to highlight the pattern of cigarette smoking and the prevalence of chronic bronchitis. 804 soldiers were studied using the British Medical Research Council Questionnaire (BMRC) on chronic bronchitis with modifications. There were 128(15.92%) current smokers and 152(18.91%) ex-smokers. Most smokers had low tobacco consumption. The prevalence of chronic bronchitis was 2.24% with the prevalence in smokers being significantly greater than in non-smokers (p < 0.001). An association of chronic bronchitis with "domestic" smoke from firewood used in cooking was also shown (p < 0.005). Peak expiratory flow rate was significantly lower in smokers (p < 0.002) and in those with chronic bronchitis (p < 0.0001). This pilot study shows low consumption levels of tobacco and low prevalence of chronic bronchitis in Nigerian soldiers.

Adolescent↗

Incidence of episodes of acute asthma and acute bronchitis in general practice 1976-87.

The incidence of episodes of acute asthma and acute bronchitis was analysed for an 11-year period and studied in relation to epidemiological data on viral illness and virus isolation data. Between 1976 and 1987, the weekly returns service estimates of the incidence of acute asthmatic episodes in England and Wales increased from 10.2 to 27.1 per 100,000 patients per week (all ages). The increase was most marked in children up to the age of 14 years. Acute bronchitis attack rates (all ages) increased from 78.7 to 111.9 per 100,000 patients over the same period. Because of this rise in rates of acute bronchitis, it is unlikely that labelling shifts contributed to the increase in reported episodes of asthma. These data support the belief that the rise in the prevalence of asthma is real, and also that in the United Kingdom this rise may even be underestimated by partial concealment in the rates of acute bronchitis. In 1987, if 10% of attacks of acute bronchitis were attacks of asthma, this would represent a 41% underestimation of asthma attack rates. Rates for other respiratory illnesses showed a fall over the same period, apart from the common cold which showed an increase. The winter increase in acute bronchitis coincided with viruses with strong seasonal patterns (respiratory syncytial virus, parainfluenza viruses 1 and 2 and influenza A and B), but there was no evidence that these viruses were related to the overall increase in acute asthma attacks over this 11 year period.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

Airway eosinophilia and expression of interleukin-5 protein in asthma and in exacerbations of chronic bronchitis.

BACKGROUND: An increased number of eosinophils in the bronchial mucosa has been demonstrated both in asthma and in exacerbations of chronic bronchitis. OBJECTIVE: To investigate whether the airway eosinophilia present in asthma and in chronic bronchitis during exacerbations is associated with interleukin (IL)-5 protein expression in the bronchial mucosa. METHODS: We obtained bronchial biopsies in 18 subjects with asthma (four intrinsic, seven extrinsic and seven occupational) and in 11 subjects with chronic bronchitis examined during an exacerbation. The findings were compared with those of bronchial biopsies from 10 subjects with chronic bronchitis examined under baseline conditions and from seven normal subjects, taken as controls. By immunohistochemistry, we assessed the expression of IL-5 protein and the number of eosinophils (EG2), mast cells (tryptase), and T-lymphocytes (CD3) in the submucosa. RESULTS: As compared with controls, the number of eosinophils was increased to a similar degree in both asthma (P < 0.001) and in exacerbations of chronic bronchitis (P < 0.001), whereas the number of IL-5 immunopositive cells was increased significantly only in asthma (P < 0.01). No differences were observed in the number of mast cells and T-lymphocytes between the four groups of subjects examined. CONCLUSIONS: This study shows that the degree of airway eosinophilia is similar in asthma and in exacerbations of chronic bronchitis, but only in asthma is it associated with an increased expression of IL-5 protein in the bronchial mucosa.

Adult↗

Determinants of chronic bronchitis prevalence in an elderly sample from south-west of France.

This paper attempts to estimate by means of a cross-sectional study in subjects aged 65 yrs and over the determinants of the prevalence of chronic bronchitis according to age, gender, smoking history, educational level, former occupation and associated morbidity. Data were examined from the third year of a cohort (Personnes àgêes QUID (PAQUID)) and concerned 2,406 subjects. Identification of chronic bronchitis was based on a direct question asking for the presence of phlegm on most days during at least 3 months per year for at least the two previous years. Of the sample, 13% reported chronic bronchitis (20% of males, and 8% of females). A multivariate analysis was performed and showed that chronic bronchitis was linked to sex, smoking history and professional category. Independent of these factors, asthma history and digitalic drug therapy were also closely associated to chronic bronchitis. These results underline the long-term effect of smoking and occupation on chronic bronchitis, and also illustrate the strong association with asthma and cardiac morbidity over 65 yrs of age.

Age Factors↗

[Chronic bronchitis and its sequelae. Therapy--prognosis--insurance medicine aspects].

Chronic bronchitis is of enormous epidemiological, socio-medical and economical importance. The main cause of chronic bronchitis is active but also passive cigarette smoking. Other etiologic factors are: viral or bacterial infections, chronic dust exposure in occupational settings and air pollution. Cease of cigarette smoking is considered the most valuable action in the treatment of the chronic bronchitis. In addition to drug therapy, physical therapy and other measures of rehabilitation may be a supportive benefit. ABout 10-20% of all patients with chronic bronchitis develop airway obstruction and/or lung emphysema. Obstructive bronchitis with or without lung emphysema should be treated with corticosteroids, beta 2-agonists and/or theophylline. Evidence for the socio-economical burden of chronic bronchitis and its complications are the enormous costs for the social economy (direct costs: in- and outpatient treatment; indirect costs: premature pensions, sick leave).

Bronchitis↗

Effects of aerosolized surfactant in patients with stable chronic bronchitis: a prospective randomized controlled trial.

CONTEXT: Chronic bronchitis, estimated to affect more than 13 million adults in the United States, is characterized in part by retention of airway secretions, but no approved or effective therapy for airway mucus retention in patients with chronic bronchitis has been established. Surfactant reduces sputum adhesiveness, which contributes to difficulty in clearing secretions, but surfactant has not been tested in patients with chronic bronchitis. OBJECTIVE: To examine the effects of exogenous surfactant on sputum clearance and pulmonary function in patients with stable chronic bronchitis. DESIGN: A prospective, multicenter, randomized, double-blind, parallel-group, placebo-controlled comparison of the effects of 2 weeks of treatment with 3 doses of aerosolized surfactant (palmitoylphosphadidylcholine [DPPC]) or saline (placebo). SETTING: Four US teaching hospitals. PARTICIPANTS: A total of 87 adult patients with the diagnosis of stable chronic bronchitis. MAIN OUTCOME MEASURES: Pulmonary function, respiratory symptoms, and sputum properties before treatment (day 0), after 2 weeks of treatment (day 14), and 7 days after stopping treatment (day 21). RESULTS: A total of 66 patients were randomized to surfactant treatment and 21 to saline treatment. Patient demographic characteristics between groups were similar at baseline. In patients who received a DPPC dose of 607.5 mg/d for 2 weeks, prebronchodilator forced expiratory volume in 1 second (FEV1) increased from 1.22 L (SEM, 0.08 L) at day 0 to 1.33 L (SEM, 0.09 L) at day 21 (P=.05), an improvement of 11.4%; postbronchodilator FEV1 improved 10.4% by days 14 and 21 (P=.02); and the ratio of residual volume to total lung capacity, a measure of thoracic gas trapping, decreased 6.2% by day 21 (P=.009). In the surfactant groups, there was a dose-dependent increase in the ability of sputum to be transported by cilia in vitro. CONCLUSION: Aerosolized surfactant improved pulmonary function and resulted in a dose-related improvement in sputum transport by cilia in patients with stable chronic bronchitis.

Administration, Intranasal↗