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PubMed2005

Nutritional status, dietary energy intake and the risk of exacerbations in patients with chronic obstructive pulmonary disease (COPD).

Loss of body weight, as a result of imbalance between increased energy demand and/or reduced dietary intake, is a common problem in patients with COPD. The aim of this investigation was to examine the relationship between nutritional intake, change in body weight and the risk of exacerbation in patients with COPD. The study comprised 41 patients who were hospitalised because of an exacerbation of COPD. The follow-up period was 12 months. Weight, height and lung function were measured at baseline. At the 12-month follow-up, weight change and current weight were assessed by an interview and nutritional intake was recorded in a food diary for 7 days. An acute exacerbation was defined as having been admitted to hospital and/or making an emergency visit to hospital, due to COPD during the follow-up period. At baseline, 24% of the patients were underweight (body mass index (BMI)<20 kg/m2), 46% were of normal weight (BMI 20-25 kg/m2) and 29% were overweight (BMI>25 kg/m2). Energy intake was lower than the calculated energy demand for all groups. During the follow-up period, 24 of the 41 patients had an exacerbation. A low BMI at inclusion and weight loss during the follow-up period were independent risk factors for having an exacerbation (P=0.003 and 0.006, respectively). We conclude that, in patients who are hospitalised because of COPD, underweight and weight loss during the follow-up period are related to a higher risk of having new exacerbations.

Aged↗
PubMed2003

Prevalence and prevention of venous thromboembolism in patients with acute exacerbations of COPD.

BACKGROUND: Little information exists on the prevalence and prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients admitted for acute exacerbations of chronic obstructive pulmonary disease (COPD). OBJECTIVE: To review available literature, we performed a Medline search on papers published on this topic between 1966 and 2003. DATA SYNTHESIS: Pulmonary emboli have been frequently found (up to 30% of cases) in autoptic series that included patients who died from acute exacerbation of COPD, while the real incidence of PE during exacerbation has never been prospectively evaluated by large-scale clinical studies. Diagnosis of concomitant PE in these patients is often missed because symptoms of acute exacerbation of COPD may mimic PE, and non-invasive evaluation by pulmonary scintigraphy or CT scan is less specific. Even if not fatal, undetected and untreated PE may lead to long-term morbidity from pulmonary hypertension and predispose to recurrent venous thromboembolism (VTE). DVT of the lower extremities affects about 10% of patients with acute exacerbation of COPD at admission, but the rate is likely to be underestimated. The results of clinical trials conducted on general medical patients, including COPD patients, indicate that unfractionated heparin (UH) and low molecular weight heparin (LMWH) significantly reduce VTE rates. However, subgroup data on COPD patients are generally not available. In a single randomised, controlled trial specifically conducted on COPD patients, nadroparin reduced the rate of DVT from 28% to 15% without affecting mortality. CONCLUSIONS: Despite a substantial lack of consistent data, VTE appears as a major threat to patients admitted for acute exacerbation of COPD, and pharmacologic prophylaxis should be considered in all high risk situations. However, methodologically rigorous studies in this setting are still needed.

Acute Disease↗
PubMed2000

Rationale and design of the OPTIME CHF trial: outcomes of a prospective trial of intravenous milrinone for exacerbations of chronic heart failure.

BACKGROUND: The optimal management of an acute exacerbation of chronic heart failure (CHF) is uncertain. There is little randomized evidence available to support the various treatment strategies for patients hospitalized with an exacerbation of CHF. Inotropic agents may produce beneficial hemodynamic effects, and although they are currently used in these patients, their effect on clinical response and impact on clinical outcome is unclear. We present a unique and simple study designed to determine whether a treatment strategy for CHF exacerbations that includes an intravenous agent with inotropic properties can reduce hospital length of stay and lead to improved patient outcome. METHODS: The OPTIME CHF (Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure) trial is an ongoing multicenter, randomized, placebo-controlled trial of a treatment strategy for patients with acute exacerbations of CHF. The design of this study provides a novel approach to the evaluation of treatment strategies in the care of this population. The OPTIME CHF design uses early initiation of intravenous milrinone as both an adjunct to the best the medical therapy and to facilitate optimal dosing of standard oral therapy for heart failure. Patients with known systolic heart failure requiring hospital admission for a CHF exacerbation are randomly assigned within 48 hours of admission to receive a 48-hour infusion of either intravenous milrinone or placebo. The primary end point of this design is a reduction in the total hospital days for cardiovascular events within 60 days after therapy. Enrollment of 1000 patients began July 7, 1997, at 80 US centers and is projected to conclude in late 1999.

Adolescent↗
PubMedDate not supplied

Premenstrual exacerbation and suicidal behavior in patients with panic disorder.

This study examined the relationship between premenstrual exacerbation and suicidal behavior in patients with panic disorder. Twenty-eight patients who reported a premenstrual exacerbation of panic disorder and 42 patients who reported never having an exacerbation were included in the study. The subjects completed a self-rating instrument assessing the 13 DSM-III-R panic symptoms on a 5-point scale (0 = absent, 1 = mild, 2 = moderate, 3 = severe, and 4 = very intense). They also completed the severity scale of the Clinical Global Impression. The Schedule for Affective Disorders and Schizophrenia (SADS) suicide subscale was used to rate the severity of active suicidality. We found that patients with premenstrual exacerbation of panic disorder had higher SADS suicidality scores than patients with panic disorder without premenstrual exacerbation. They were also more likely to be classified as suicidal than the others. It may be that premenstrual exacerbation is a risk factor for suicidal behavior independent of major depression in patients with panic disorder.

Adult↗
PubMed1990

Clinical manifestations of exacerbations of cystic fibrosis associated with nonbacterial infections.

The purpose of this study was to determine whether acute pulmonary exacerbations of cystic fibrosis associated with nonbacterial infections are clinically distinguishable from other exacerbations. Eighty exacerbations in 54 patients were studied. Exacerbations associated with influenza (n = 8) were compared with those associated with other nonbacterial infections (n = 15) and those in which no nonbacterial infection was detected (n = 57). Patients with influenza had lower Shwachman scores and were more likely to be seropositive for C-reactive protein than patients in the other two groups. Patients with influenza had a mean decrease in forced expiratory volume per second of 26%, compared with test results obtained before the exacerbation. In contrast, the mean decrease in forced expiratory volume per second was 6% for other nonbacterial infections and 12% for the group without nonbacterial infection (p less than 0.05 for both comparisons). The forced expiratory flow in first 25% of vital capacity decreased 44% in the influenza group compared with 13% and 17% in the other two groups, respectively (p less than 0.01 for both comparisons). The influenza group also had a higher proportion of patients with at least a 20% decrease in forced expiratory volume per second and forced expiratory flow in first 25% of vital capacity than the other two groups had (p less than 0.05 for all comparisons). These data suggest that influenza is associated with severe exacerbations in patients with cystic fibrosis and support recommendations for efforts to prevent influenza in this population.

Adolescent↗
PubMedDate not supplied

Combination antibiotic susceptibility testing to treat exacerbations of cystic fibrosis associated with multiresistant bacteria: a randomised, double-blind, controlled clinical trial.

BACKGROUND: We did a randomised, double-blind, controlled clinical trial to prospectively assess whether use of combination antibiotic susceptibility testing improved clinical outcomes in patients with acute pulmonary exacerbations of cystic fibrosis who were infected with multiresistant bacteria. METHODS: 251 patients with cystic fibrosis who were chronically infected with multiresistant gram negative bacteria gave sputum at 3-month intervals for conventional culture and sensitivity tests and for combination antibiotic susceptibility tests using multiple combination bactericidal antibiotic testing (MCBT). Patients who developed an exacerbation of pulmonary disease were randomised to receive a 14-day course of any two blinded intravenous antibiotics chosen on the basis of either results from conventional sputum culture and sensitivity testing or the result of MCBT. The primary outcome was time from randomisation until the patient's next pulmonary exacerbation. Analysis was by intention-to-treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN60187870. FINDINGS: 132 patients had a pulmonary exacerbation and were randomised during the 4.5-year study period. The time to next pulmonary exacerbation was not prolonged in the MCBT-treated group (hazard ratio 0.86 in favour of the conventionally-treated group, 95% CI 0.60-1.23, p=0.40). There was no difference between the groups in treatment failure rate. After 14 days of intravenous antibiotic therapy, changes in lung function, dyspnoea, and sputum bacterial density were similar in both groups. INTERPRETATION: Antibiotic therapy directed by combination antibiotic susceptibility testing did not result in better clinical and bacteriological outcomes compared with therapy directed by standard culture and sensitivity techniques. The non-bactericidal effects of antibiotic therapy might play an important part in determining improvement in patients with cystic fibrosis pulmonary exacerbations.

Acute Disease↗
PubMed1985

Acute exacerbation in hepatitis B e antigen positive chronic type B hepatitis. A clinicopathological study.

During a 6-year (mean 24.5 months) follow-up study of 237 HBeAg-positive patients with biopsy-verified chronic type B hepatitis, 199 episodes of acute exacerbation (SGPT greater than 300 IU/l) were observed in 148 patients. The clinical and laboratory findings of these acute exacerbations were less severe than classic acute viral hepatitis (P less than 0.001) but with remarkable overlapping. The main histological changes of acute exacerbations were those of lobular hepatitis, even with bridging hepatic necrosis which predicted subsequent HBeAg clearance. Anti-HBc IgM was positive in 14.4% of the exacerbations. All of these findings made acute exacerbation of chronic type B hepatitis indistinguishable from acute viral hepatitis aside from chronic clinical history. Hepatitis A virus, delta agent and possibly non-A, non-B virus(es) were responsible for some of the episodes of clinical exacerbations.

Acute Disease↗
PubMed2000

The chronic obstructive pulmonary disease exacerbation.

Chronic obstructive pulmonary disease is the only leading cause of death with a rising prevalence. The medical and economic costs arising from acute exacerbations of COPD are therefore expected to increase over the coming years. Although exacerbations may be initiated by multiple factors, the most common identifiable associations are with bacterial and viral infections. These are associated with approximately 50% to 70% and 20% to 30% of COPD exacerbations, respectively. In addition to smoking cessation, annual influenza vaccination is the most important method for preventing exacerbations. Controlled O2 is the most important intervention for patients with acute hypoxic respiratory failure. Evidence from randomized, controlled trials justifies the use of corticosteroids, bronchodilators (but not theophylline), noninvasive positive-pressure ventilation (in selected patients), and antibiotics, particularly for severe exacerbations. Antibiotics should be chosen according to the patient's risk for treatment failure and the potential for antibiotic resistance. In the acute setting, combined treatment with beta-agonist and anticholinergic bronchodilators is reasonable but not supported by randomized controlled studies. Physicians should identify and, when possible, correct malnutrition. Chest physiotherapy has no proven role in the management of acute exacerbations.

Adrenal Cortex Hormones↗
PubMed2000

Serum ECP and MPO are increased during exacerbations of chronic bronchitis with airway obstruction.

Many studies have demonstrated that, in asthma, serum levels of eosinophil cationic protein (ECP) are related to the activity and severity of the disease and can be used to evaluate the response to steroid treatment. During exacerbations of chronic bronchitis, airway inflammation shows some features of asthmatic inflammatory processes, with recruitment of eosinophils and recovery of significant amounts of ECP in bronchial lavage fluid (BAL). Involvement of neutrophils, with high levels of myeloperoxidase (MPO), is, on the contrary, typical of this latter disease, and not shared with asthma. In spite of the information collected with BAL and bronchial biopsy studies, few data still exist on serum levels of these proteins in chronic bronchitis. The objective of this study was to assess if serum levels of ECP and MPO are specifically increased in exacerbations of chronic bronchitis, as compared to other non-asthmatic acute respiratory disturbances. Serum ECP, MPO and immunoglobulin E (IgE) levels were measured in 17 non-atopic patients with exacerbation of chronic bronchitis with airway obstruction (COPD) and in 11 control subjects seeking emergency medical treatment for unrelated acute respiratory problems. Spirometry was performed in patients able to give the necessary collaboration. All the subjects of this study were recruited from the emergency department. Both ECP and MPO were significantly increased in serum from patients with exacerbated COPD (22.2 +/- 4.1 vs 9.5 +/- 1.4 mcg/L and 853 +/- 168 vs 375 +/- 41 mcg/L) and a strong correlation existed between these two variables (r = 0.782). A further control group was made of 11 patients with stable COPD. These subjects had levels of both ECP (13.1 +/- 2.7 mcg/L) and MPO (469 +/- 71) significantly lower than patients with exacerbated disease and higher than those without COPD. We conclude that serum ECP and MPO are increased during the exacerbations of COPD. These observations can give a basis for further studies aimed to evaluate the utility of these two proteins as markers of activity and severity of COPD.

Aged↗
PubMed2006

[Exacerbations of COPD: An audit of emergency department practice in France].

INTRODUCTION: Exacerbations of COPD are potentially serious events, the recognition and treatment of which appear to be poorly understood by both patients and doctors. The aim of this study is to describe, on the basis of two case histories, the management of exacerbations of COPD in emergency departments, to compare it with the current guidelines and to evaluate the extent of use of non-invasive ventilation in decompensated COPD. METHODS: The study took place between February and June 2004. Two case histories describing one moderate and one severe exacerbation with respiratory failure were written by the authors of the study and submitted to an emergency physician in a university hospital and a district hospital in each region. RESULTS: 110 questionnaires were returned from 20 university hospitals and 25 district hospitals. Only 38% of the episodes were identified correctly. 20% of doctors did not regard dyspnoea as a clinical sign of an exacerbation. 22% of doctors never prescribed bronchodilators, even in severe cases. Finally, non-invasive ventilation (NIPV) was used for only 9% of the moderate and 56% of the severe exacerbations. DISCUSSION: This study, although limited by certain factors, illustrates a number of points in need of improvement in the recognition and treatment of exacerbations of COPD in emergency departments, the use of NIPV, and the collaboration between emergency physicians, intensivists and respiratory physicians.

Emergency Service, Hospital↗
PubMed2003

Infectious exacerbations of chronic obstructive pulmonary disease associated with respiratory viruses and non-typeable Haemophilus influenzae.

Infectious exacerbations of chronic obstructive pulmonary disease (COPD) have been reported to occur with both viral and bacterial pathogens. In this study, 35 exacerbations associated with the isolation of non-typeable Haemophilus influenzae from sputum were identified as part of a prospective longitudinal study. Samples from these patients were subjected to immunoassays to identify a new immune response to the homologous isolate of non-typeable H. influenzae to more accurately assess a bacterial etiology. These patients also were studied carefully for evidence of viral infection using viral culture, serology and polymerase chain reaction-based assays. Sixteen of 35 exacerbations (45.7%) were associated with evidence of acute viral infection and 11 of the 35 exacerbations (31.4%) were associated with the development of new serum IgG to homologous non-typeable H. influenzae. Overall, evidence of infection with a respiratory virus or non-typeable H. influenzae was seen in 24 of 35 exacerbations (68.6%). No association between viral infection and immune response to non-typeable H. influenzae was observed, although a trend toward an immune response to non-typeable H. influenzae and absence of viral infection was seen. The results show that exacerbations in adults with COPD were associated with infection caused by virus alone, non-typeable H. influenzae alone, or virus and non-typeable H. influenzae simultaneously.

Antibodies, Bacterial↗
PubMed1994

Serum eosinophil cationic protein (ECP) in chronic asthma. Relationship to spirometry, flow-volume curves, PC20, and exacerbations.

Serum ECP was measured in a double-blind study in relation to spirometry, flow-volume curves, and histamine PC20 (30-s tidal breathing method, normal value > 32 mg ml-1) in 20 chronic asthmatic patients (five male), mean age 48.9 yr (SD 11.0), once a month and at additional visits due to acute exacerbations over a 6-month period. All patients were on maintenance inhaled corticosteroid therapy. Serum ECP was considered elevated at > or = 20 micrograms l-1. ECP showed significant negative correlations with lung function, especially when ECP was elevated (45/143 observations): r = -0.48, -0.48, and -0.49 for respectively FEV1, PEF, and MMEF (all at baseline and as % predicted, P = 0.001), the best correlation being with FEV1/FVC ratio (r = -0.61, P < 0.001). PC20 only had a weak overall correlation with ECP (r = -0.21, P = 0.015). Eosinophilia at > or = 0.400 x 10(9) cells l-1 (38/143 observations) did not show any significant correlations with the lung function variables. The patients were subdivided into three groups according to exacerbations. Group A consisted of seven patients with suspected infectious exacerbations (mean 1.4), group B of six patients with suspected inflammatory exacerbations (mean 3.2), and group C of seven patients who did not experience any symptomatic exacerbations. A significant difference in mean ECP was found between group B and A (33.1 vs. 10.2, P = 0.003). Group B also differed significantly from group A with respect to lung function and PC20, but not to atopy, lung function and PC20 being lower and variability higher in group B. The findings of this study suggest that serum ECP is a sensitive marker of inflammatory airflow obstruction in chronic asthma. Elevated ECP seems to denote patients at risk from inflammatory exacerbations, resulting in practical implications for the therapeutic management of chronic asthma.

Adult↗
PubMed1991

Coughing can relieve or exacerbate symptoms in asthmatic patients.

From about 1190 to the present day opposing views have been expressed about the effects of coughing in patients with asthma. Some accounts have stated that it brought relief and others that it exacerbated asthma, whereas others thought that it could have both effects. In the present investigation, 187 patients with a clinical diagnosis of asthma were asked whether coughing relieved or exacerbated their asthma. In 41.7% coughing caused exacerbation, in 29.9% it brought relief, in 9.9% it had no effect, and in the remaining 18.7% it sometimes exacerbated their symptoms and sometimes brought relief. When asthma was exacerbated, the most common symptom induced was breathlessness, and then wheezing; chest tightness was the least frequent. When coughing brought relief it was mainly through the expectoration of sputum. However, a small proportion of patients found relief even if there was no expectoration. If coughing exacerbates asthma and persists in the face of treatment with standard medication, then treatment specifically directed at its diminution could reduce morbity considerably.

Asthma↗
PubMed1998

Value of C-reactive protein measurements in exacerbations of chronic obstructive pulmonary disease.

C-reactive protein (CRP) has been shown to be a useful and sensitive indicator of pyogenic infections in many clinical situations, including acute pneumonia and infective pulmonary exacerbations in cystic fibrosis patients. Exacerbations of COPD are often, but not always, associated with demonstrable infection. The value of CRP measurement in this situation has not been assessed. We have evaluated CRP measurement in 50 patients [age 71 +/- 8 (SD) years] who were admitted to hospital with clinical evidence of exacerbation [PaO2 = 7.3 +/- 1.3 (SD) kPa, baseline FEV1 = 0.8 +/- 0.4 (SD) l]. These patients all had serial measurement of CRP [polarizing immunofluorescence (Abbot, TDx)], peripheral white cell count (WCC), body temperature, peak expiratory flow rate, Karnofsky performance status and chest X-ray, in addition to serial sputum bacteriological analysis carried out in a specialized laboratory. CRP was elevated (> 10 mg l-1) in all patients (n = 29) with proven infection [103 +/- 98 (SD) mg l-1]. Levels were markedly elevated in patients infected with Streptococcus pneumoniae (mean 156 mg l-1); there was also a rapid fall in the CRP with therapy. WCC fell with therapy, giving a correlation with CRP level (r = 0.44, P < 0.01). Since CRP elevation was observed in patients having exacerbation with proven infections and also in those where infection was not proven, it is possible that, while it is a marker for COPD exacerbation, it is not necessarily a marker of bacterial infection per se. However, it is evident from our study that it is of value in the assessment of exacerbations of COPD, where routine bacterial culture of sputum is often unreliable, and thus the measurement of serum CRP may provide an additional objective indicator of infection.

Acute Disease↗
PubMed1999

The effect of high-dose fluticasone propionate and budesonide on lung function and asthma exacerbations in patients with severe asthma.

The purpose of this study was to investigate the comparative efficacy and safety of equal doses of inhaled fluticasone propionate (FP) and inhaled budesonide (BUD) using their respective dry powder inhalers in a population of severe asthmatics requiring high doses of inhaled corticosteroid. This double-blind double-dummy parallel-group study compared the effects of 24 weeks of treatment with FP (2000 micrograms daily via a Diskhaler inhaler; Glaxo Wellcome, Evreux, France) and BUD (2000 micrograms daily via a Turbuhaler inhaler; Astra Pharmaceuticals, Rijswijka, Netherlands) on lung function and asthma exacerbations in 395 patients with asthma. FP was statistically significantly superior to BUD with respect to the percentage of symptom-free days (P = 0.02), the incidence of days free from rescue bronchodilator usage (P = 0.02) and the distribution of change in peak expiratory flow (PEF) expressed as a percentage of the predicted PEF (P = 0.04). During the treatment period FP was statistically significantly superior to BUD for change in forced expiratory volume in 1 sec (FEV1) at 8, 16 and 24 weeks, change in the median daytime symptom score during weeks 5-16, for incidence of symptom-free days and incidence of days free from rescue bronchodilator usage during weeks 17-24. There was no significant difference between FP and BUD with respect to the number of patients experiencing one or more asthma exacerbation (33.8 and 28.4% of patients, respectively). There was, however, evidence that the exacerbations were clinically less severe in patients treated with FP, in that the time to resolution was quicker (11.0 vs. 14.7 days; P = 0.035), mean duration of all exacerbations (for an individual patient) tended to be shorter (18.5 vs. 23.6 days; P = 0.12), the time off work was reduced (4.2 vs. 7.6 days; P = 0.012) and the lowest PEF recorded during the exacerbation was higher (301 vs. 263 l min-1; P = 0.07). There were no clinically relevant differences in the safety (serum cortisol levels, markers of bone turnover, adverse events) of FP and BUD at these microgram equivalent doses. The patients recruited into this study, in retrospect, probably had no need for such high doses of inhaled corticosteroid but, irrespective of this, FP at microgram equivalent doses showed evidence of superior efficacy to BUD with respect to lung function and severity of asthma exacerbations without producing any greater adverse systemic effect.

Administration, Topical↗
PubMed2002

Urinary leukotriene levels are increased during exacerbation of atopic eczema/dermatitis syndrome. Relation to clinical status.

BACKGROUND: Leukotrienes are potent mediators of allergic inflammation and their role in the pathogenesis of allergic disorders, particularly asthma, is well established. Their importance in the pathogenesis of atopic eczema/dermatitis syndrome (AEDS) is still unclear. We aimed to compare urinary cysteinyl leukotriene (Cys-LT) levels during exacerbation and remission of AEDS in relation to clinical status, IgE levels, and eosinophil counts. METHODS: Urinary Cys-LTs were measured by direct enzyme immunoassay in 17 adult patients with AEDS and in 17 healthy controls in whom atopy had been excluded. Cys-LTs were compared during exacerbation and remission of AEDS in relation to the clinical status measured by SCORAD. Total IgE levels were measured by enzyme-linked immunoassay (ELISA). RESULTS: Mean clinical score during the exacerbation was 64.3 +/- 3.1 and during remission 22.4 +/- 4 (P < 0.01). Cys-LTs levels were significantly higher during the exacerbation of AEDS than in the control group (230.9 +/- 20.8 vs 123.2 +/- 9.9 pg/mg creatinine; P < 0.005). During the remission, the difference between AEDS patients and the control group was not significant (96.3 +/- 8.7 vs 123.2 +/- 9.9 pg/mg creatinine; P = 0.8). During AEDS exacerbation Cys-LTs levels were significantly correlated with the clinical status (rS = 0.73, P < 0.01) and with eosinophil counts (r = 0.86; P < 0.01) but not with the duration of the disease, age of patients, or IgE levels. CONCLUSIONS: Our results point to enhanced biosynthesis of Cys-LTs during the AEDS exacerbations. Inflammatory cells, e.g. eosinophils are the most probable source of Cys-LTs. A strong correlation between Cys-LT levels and clinical status may in part explain preliminary clinical observations of efficacy of leukotriene antagonists in alleviating symptoms of AEDS.

Adolescent↗
PubMed1999

Energy balance during acute respiratory exacerbations in children with cystic fibrosis.

Acute respiratory exacerbations have been proposed to contribute to the negative energy balance which causes undernutrition in cystic fibrosis. However, no studies have measured their effect on all components of energy balance. The aim of this study was to measure the effect of an acute respiratory exacerbation on energy balance. Fourteen children (six females, eight males, mean+/-SD age 9.9+/-2.4 yrs) were studied when well and during the course of an acute respiratory exacerbation treated with intravenous antimicrobial therapy. The total energy expenditure was measured using the doubly-labelled water method, resting energy expenditure by ventilated hood indirect calorimetry, energy intake by household measures records, and fat malabsorption from measurements of dietary fat intake and faecal fat output. The exacerbation was associated with a significant reduction in energy intake (mean paired difference 47 kJ x kg of body weight(-1) x day(-1), p<0.01). Changes in fat malabsorption and resting energy expenditure were negligible. The absence of significant changes in body weight and composition, together with the trend towards lower total energy expenditure, suggested no marked negative energy balance during the exacerbation. In conclusion, treatment of acute respiratory exacerbation with intravenous antimicrobial therapy represents a relatively minor challenge to energy balance and nutritional status in children with cystic fibrosis.

Acute Disease↗
PubMed1999

N-isobutyrylcysteine, a donor of systemic thiols, does not reduce the exacerbation rate in chronic bronchitis.

N-isobutyrylcysteine (NIC), a new thiol compound that is not rapidly hydrolysed to give higher levels of free thiols in the body than N-acetylcysteine (NAC), was used to test if the effect of NAC on exacerbations in chronic bronchitis was an effect of the unhydrolysed thiol compound. Smokers or exsmokers with chronic bronchitis forced expiratory volume in one second (FEV1) >40% and reversibility < or = 10% predicted were treated with oral NIC 300 mg b.i.d. or placebo for 24 weeks. Steroids, NAC, antibiotics, and nonsteroid anti-inflammatory drugs use were restricted. Exacerbations were recorded by a respiratory symptom diary card and the time to onset of the first exacerbation after the start of treatment was measured using life-table analysis. Spirometry was performed at each visit. Six hundred and thirty-seven patients were randomized to treatment with NIC (n=316) or placebo (n=321). NIC did not prolong the time to first exacerbation (life-table analysis, p=0.59) and no increase in FEV1 or forced vital capacity was observed. Altered taste perception, taste loss and anosmia occurred more often in the NIC group (p<0.001). In conclusion, N-isobutyrylcysteine, a N-acetylcysteine-like drug with a greater bioavailability has, contrary to N-acetylcysteine, no effect on exacerbations in chronic bronchitis. This suggests that the effect of N-acetylcysteine on exacerbations in chronic bronchitis is not due to the relatively low free thiol levels (other than glutathione) produced by N-acetylcysteine therapy.

Administration, Oral↗