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PubMed1995

Frequency of common cystic fibrosis gene mutations in chronic bronchitis patients.

It has been suggested that the delta F508 deletion, the most common mutation in the cystic fibrosis (CF) gene, might be linked to chronic bronchial hypersecretion. We investigated whether such an association could be found in chronic bronchitis, since chronic bronchial hypersecretion is an important and specific element of chronic bronchitis. We screened 100 patients hospitalized for chronic bronchitis with six of the most frequently occurring CF gene mutations: delta F508, R553X, G542X, G551D, N1303K, and 621-1G-->T. Only one patient affected by chronic bronchitis and diffuse bronchiectasis was heterozygous for the deletion delta F508; no other mutations were found. This is not significantly different from the expected frequency of CF carriers in northern Europe, which is 1 in 25. Thus, no association between the most commonly occurring cystic fibrosis genes and chronic bronchitis is likely to exist and routine screening of patients without further signs of cystic fibrosis would seem to be of no benefit in northern Europe.

Aged↗
PubMed1992

Early detection of patients with fast progressive asthma or chronic bronchitis in general practice.

The morbidity and mortality due to asthma and chronic bronchitis are still rising in several countries. The aim of this study was to investigate whether early detection of patients with fast progressive asthma or chronic bronchitis in general practice was possible from a cross-sectional assessment of symptoms, smoking behaviour, quality of life, physical signs of the chest, allergy, and lung function. Data of 162 patients who had participated in a long-term randomized controlled intervention study in general practice were analysed. Fifty-six out of the 162 patients showed fast progressive disease (FPD, a rapid annual decline in FEV1 in combination with a high exacerbation rate). Measurements at the start of the study were used in a logistic regression analysis in order to detect the patients at risk (with FPD). A lower maximal expiratory flow at 50% of expired volume (MEF50) was related to an increased risk of FPD in both asthma and chronic bronchitis (relative risks of 16.8 and 8.0 respectively, p less than 0.05). Most lung function indices, but also quality of life and pack years, were significant predictors of FPD in chronic bronchitis (p less than 0.05). However, it was not possible to detect FPD reliably with these predictors separately or even with the combination of several relevant clinical variables; 18% of the patients with chronic bronchitis and 22% of the patients with asthma were still misclassified. It was concluded from this study that more than one measurement over time (monitoring) is necessary to detect the patients at risk. Monitoring should include assessments of objective ventilatory function indices (PEFR, FEV1 or MEF50).

Adult↗
PubMed2004

Spanish primary healthcare physicians' knowledge of resistance of respiratory germs and antimicrobial treatment in acute bronchitis.

OBJECTIVES: To determine what Spanish primary healthcare physicians consider the rates of pneumococcal resistance to be, the type of antimicrobial treatment they would prescribe on suspicion of high resistance and ascertain in which cases of acute bronchitis these physicians would initiate antibiotic treatment. METHODS: A cross-sectional, observational study was performed with a questionnaire distributed to 1368 physicians on their opinion on the degree of resistance of pneumococci to penicillins and macrolides in Spain. They were also asked which treatment they would recommend in penicillin-resistant pneumococcal infection and to indicate their degree of agreement regarding the use of antibiotics in different clinical situations of acute bronchitis. RESULTS: 843 physicians completed and returned the questionnaire, a response rate of 59.1%. Of the 750 physicians who answered the question concerning pneumococcal resistance, 312 stated resistance to be >30% (41.6%) while only 90 felt it to be <15% (12%). 153 physicians reported resistance to macrolides to be >30% (23%). In cases with suspicion of penicillin-resistant pneumococci, the clinicians stated they would prescribe quinolones (321, 40.3%) and macrolides (251, 31.5%). Of the 784 physicians who answered the questions on bronchitis, 662 preferred antibiotic therapy in acute bronchitis with purulent sputum (84.6%), 610 on uncertain diagnosis (77.8%), 569 in patients with fever over 38 degrees C (72.6%) and 210 on patient request (26.8%). CONCLUSION: Primary healthcare physicians in Spain are more concerned about pneumococcal resistance to penicillins than to macrolides although 35% of the strains isolated are resistant to the latter while only 10% are resistant to aminopenicillins. Furthermore, many physicians believe macrolides to be effective against pneumococcal infections. Despite their lack of efficacy in the treatment of acute bronchitis, many physicians prescribe antibiotics, mainly in cases with purulent expectoration, thus justifying the high consumption of antimicrobial agents in this disease.

Bronchitis↗
PubMedDate not supplied

Calling acute bronchitis a chest cold may improve patient satisfaction with appropriate antibiotic use.

BACKGROUND: Overuse of antibiotics for acute respiratory infections is an important public health problem and occurs in part because of pressure on physicians by patients to prescribe them. We hypothesized that if acute respiratory infections are called "chest colds" or "viral infections" rather than "bronchitis," patients will be satisfied with the diagnosis and more satisfied with not receiving antibiotics. METHODS: Family medicine patients were presented with a written scenario describing a typical acute respiratory infection where they were given one of 3 different diagnostic labels: chest cold, viral upper respiratory infection, and bronchitis, followed by a treatment plan that excluded antibiotic treatment. Data was analyzed for satisfaction with the diagnosis and treatment plan based on the diagnostic label. A total of 459 questionnaires were collected. RESULTS: Satisfaction (70%, 63%, and 68%) and dissatisfaction (11% 13%, and 13%) with the diagnostic labels of cold, viral upper respiratory infection, and bronchitis, respectively, showed no difference (chi(2) = 0.368, P = .832). However, more patients were dissatisfied with not receiving an antibiotic when the diagnosis label was bronchitis. A total of 26% of those that were told they had bronchitis were dissatisfied with their treatment, compared with 13% and 17% for colds and viral illness, respectively, (chi(2) = 9.380, P = .009). Binary logistic regression showed no difference in satisfaction with diagnosis for educational attainment, age, and sex (odds ratio (OR) = 1.09, 1.00, 0.98, respectively), or for satisfaction with treatment (OR = 1.1, 1.02, 1.00, respectively). CONCLUSIONS: Provider use of benign-sounding labels such as chest cold when a patient presents for care for an acute respiratory infection may not affect patient satisfaction but may improve satisfaction with not being prescribed an antibiotic.

Acute Disease↗
PubMed1998

[Analysis of circumstances of the development of chronic bronchitis in patients treated at Bydgoszcz Lung Disease Clinic in 1993-1996].

The fact, that more than 10% people suffer from COPD /chronic obstructive pulmonary disease/, that number of COPD patients increases rapidly all over the world, and at the moment COPD is one from four the most frequent cause of death, makes us to search for effective methods of prevention and treatment. The number and variety of factors cooperating in pathogenesis and development of the disease in contrast to poor knowledge of them was the reason, that the retrospective analysis of some factors of 300 COPD patients, treated in our Clinic from severe exacerbations was carried out. There were analysed the following factors; age, gender, body mass index, profession, the length and duration of the disease, incidence of exacerbations and habits; alcohol drinking and cigarette smoking. The aim of these searches was to establish the factors which most commonly cooperate in initiation and development of COPD in the province of Bydgoszcz. There was established, that chronic bronchitis was more frequent in men. That deference is caused not only by exposure to occupational irritant factors. COPD was also more frequent in smokers /about 70%/, elders, blue collar workers, especially exposed to irritants and/or toxic effects by virtue of their work, persons living in industrialized Bydgoszcz. There were no correlation between COPD incidence and malnutrition or alcohol consumption, but the simple correlation between time of the disease and severity of airway obstruction was seen. The longer time of chronic bronchitis, the more increased airway obstructions, and more frequent respiratory insufficiency. In the course of the disease was growing; the number of malnutritioned patients and the number of exacerbations of chronic bronchitis. The longer time of disease, the shorter free of symptoms intervals. In alcohol consuming patients the exacerbations occurred significantly more frequent and more severe. There was correlation between alcohol and cigarette consumption. The exacerbations of chronic bronchitis in November, December and March were the most frequently seen. In observed group of chronic bronchitis patients the importance of risk factors unconnected with smoking was significantly great, that suggest the growing role of other factors in pathogenesis and development of COPD.

Adolescent↗
PubMedDate not supplied

Impact of reducing antibiotic prescribing for acute bronchitis on patient satisfaction.

CONTEXT: Using a patient and clinician educational intervention, we successfully reduced antibiotic use for uncomplicated acute bronchitis. The impact of this intervention on patient satisfaction is not known. OBJECTIVE: To evaluate whether a strategy for reducing antibiotic use in acute bronchitis affects satisfaction among adult patients. DESIGN: Telephone survey administered 1 to 4 weeks after an office visit for acute bronchitis. SETTING: Two outpatient clinics belonging to a group-model HMO in the Denver, Colorado, metropolitan area. The intervention clinic had received a patient and office-based educational intervention that successfully reduced antibiotic prescribing for acute bronchitis during the previous winter. The control clinic received only the office-based materials, an intervention that did not reduce antibiotic prescribing. OUTCOME: Overall satisfaction with the episode of care. RESULTS: Antibiotics were prescribed to 64% and 85% of survey respondents at the intervention (n = 102) and control clinics (n = 164), respectively (P < 0.001). Patient satisfaction with the visit did not differ between intervention and control clinics (69% of intervention and 63% of control clinic patients reported very good or excellent satisfaction, P > 0.2). After adjustment for patient age, sex, duration of illness before the visit, reason for visit, and clinician specialty, there was no difference between intervention and control clinics in the proportion of patients reporting very good or excellent satisfaction (adjusted relative risk for high satisfaction at the intervention clinic, 1.1 [95% CI, 0.81 to 1.3]). CONCLUSION: A patient- and clinician-oriented educational intervention that reduces antibiotic treatment of adults with uncomplicated acute bronchitis does not appear to reduce satisfaction with care.

Acute Disease↗
PubMed2001

[Epidemiological data on chronic bronchitis in France].

DEFINITIONS: Cough and expectorations present for at least 3 months every year for at least 2 consecutive years are the characteristic feature of chronic bronchitis. Pulmonary emphysema is a permanent distension of the air spaces beyond the bronchioles with destruction of the alveolar walls. Chronic obstructive pulmonary disease (COPD), which often develops after chronic bronchitis, is defined as an obstructive ventilatory syndrome demonstrated by a forced expiratory volume in 1 second/vital capacity (FEV1/VC) ratio below 70%. Acute exacerbation of chronic bronchitis is characterized by worsening cough, expectoration and/or dyspnea. RISK FACTORS: Active smoking is a predominant risk factor for COPD; the decrease in FEV1 is tightly correlated with individual sensitivity to tobacco smoke. Other risk factors have been identified: occupational exposure to airborne contaminants, alpha-anti-tripsin deficiency. EPIDEMIOLOGICAL DATA: A recent survey showed that the prevalence of chronic bronchitis in the adult population in France aged over 25 years is an estimated 1.2 to 2 million people without co-morbidity and an estimated 1.6 to 2.8 million including people with co-morbidity (for instance asthma). The annual death toll reaches 10,000 to 12,000. MANAGEMENT: In patients without co-morbidity, only about 30% of all cases of chronic bronchitis are diagnosed. Medical care is given to about 15%. The impact of acute exacerbations (average 3 episodes per year according to the survey), both in number and in terms of quality of life, would be underestimated.

Acute Disease↗
PubMed2002

Diagnosis and management of acute bronchitis.

Acute bronchitis is one of the top 10 conditions for which patients seek medical care. Physicians show considerable variability in describing the signs and symptoms necessary to its diagnosis. Because acute bronchitis most often has a viral cause, symptomatic treatment with protussives, antitussives, or bronchodilators is appropriate. However, studies indicate that many physicians treat bronchitis with antibiotics. These drugs have generally been shown to be ineffective in patients with uncomplicated acute bronchitis. Furthermore, antibiotics often have detrimental side effects, and their overuse contributes to the increasing problem of antibiotic resistance. Patient satisfaction with the treatment of acute bronchitis is related to the quality of the physician-patient interaction rather than to prescription of an antibiotic.

Acute Disease↗
PubMedDate not supplied

[The characteristics of the humoral response to respiratory syncytial viral infection in adult patients with different forms of bronchitis].

The levels of specific IgG and IgM were determined in 72 patients with verified respiratory syncytial (RS) virus infection: 11 patients with acute delayed bronchitis (ADB), 26 with recurring bronchitis (RB) 35 with chronic obstructive bronchitis (ChOB), by indirect enzyme immunoassay; RS virus was detected by direct immunofluorescent technique. The activity of the inflammatory process in the bronchi was shown to depend upon RS infection activity in cases of ChOB and RB. RS infection was observed to be significantly dependent on obstruction and bronchospasms. The specific humoral response was reduced and delayed in ChOB and RB as compared to acute bronchitis. The possibility of long-term persistence of RS virus antigen in chronic and recurring forms of bronchitis was demonstrated.

Acute Disease↗
PubMedDate not supplied

Acute bronchitis in Australian general practice. A prescription too far?

OBJECTIVE: To quantify how frequently general practitioners in Australia prescribe antibiotics for acute bronchitis, which antibiotics are used, and whether there are subgroups of patients who might benefit from their use. DESIGN AND SETTING: A retrospective descriptive study using 3 sets of data: Australian Sentinel Practice Research Network, the Bettering the Evaluation and Care of Health (BEACH) Program, and the General Practice Research Network (GPRN). RESULTS: Over 50% of all patients with 'acute bronchitis' had either chest or one or more systemic signs on physical examination. The rate of antibiotic prescribing for acute bronchitis was 79.6% of acute bronchitis visits using BEACH data 2001-2002 and varied from 68.6 (95% CI: 62.8-74.5%) in 2001 to 78.7 (95% CI: 72.2-85.2%) in 1999 using GPRN data. Penicillins, followed by macrolides, were the most commonly prescribed antibiotics. DISCUSSION: Australian GPs frequently prescribe antibiotics for 'acute bronchitis' despite guidelines to the contrary. One reason may be that many patients present with chest or systemic signs.

Acute Disease↗
PubMed2004

Predictors of chronic bronchitis in South African adults.

SETTING: National household survey of adults in South Africa, a middle income country. OBJECTIVE: To determine the prevalence and predictors of chronic bronchitis. DESIGN: A stratified national probability sample of households was selected. All adults in the selected households were interviewed. Chronic bronchitis was defined as chronic productive cough. Socio-demographic predictors were wealth, education, race, age and urban residence. Personal and exposure variables included history of tuberculosis, domestic exposure to smoky fuels, occupational exposures, smoking and body mass index. RESULTS: The overall prevalence of chronic bronchitis was 2.3% in men and 2.8% in women. The strongest predictor of chronic bronchitis was a history of tuberculosis (men, odds ratio [OR] 4.9; 95% confidence interval [CI] 2.6-9.2; women, OR 6.6; 95%CI 3.7-11.9). Other risk factors were smoking, occupational exposure (in men), domestic exposure to smoky fuel (in women) and (in univariate analysis only) being underweight. Wealth and particularly education were protective. CONCLUSION: The pattern of chronic bronchitis in South Africa suggests a combination of risk factors that includes not only smoking but also tuberculosis, occupational exposures in men and domestic fuel exposure in women. Control of these risk factors requires public health action across a broad front. The protective role of education requires elucidation.

Adolescent↗
PubMedDate not supplied

[Etiological structure of respiratory infections in different variants of acute bronchitis].

The microbiological and virological examination of 87 acute bronchitis patients (36 patients with the prolonged course and 31 patients with the relapsing course of the disease) was carried out. All forms of bronchitis were characterized by a high degree of infection with respiratory viruses and pneumococci. Haemophilus influenzae (type b) infection was registered rather rarely and only in combination with pneumococcal one. The highest characteristics of viro-bacterial associations were found in patients with acute bronchitis and with prolonged form of acute bronchitis, viral associations--with the prolonged and relapsing forms of the course of acute bronchitis in the presence of the bronchoobstructive syndrome.

Acute Disease↗
PubMed2005

[Effects of comprehensive interventions in community on smoking, chronic bronchitis, and asthma in rural areas of Beijing].

OBJECTIVE: To study the effects of comprehensive interventions in community on smoking, chronic bronchitis, and asthma in rural areas of Beijing. METHODS: Twenty-three villages in rural areas of Beijing were randomly divided into interventional (13 villages) and control villages (10 villages) in 1992. Comprehensive interventions including education of former-smokers and improvement of living environment were carried out in the interventional villages, and none was done in the control villages. In April 2000, surveys on smoking, chronic bronchitis, and asthma were carried out among 34,436 participants aged 15 or more in the interventional and control villages. During the same period, knowledge on prevention from chronic obstructive pulmonary diseases (COPD), living environments, and smoking were assessed among 1658 high-risk individuals of COPD at baseline and following-up period. RESULTS: The scores of knowledge and improvement on living environments in the interventional villages were significantly higher than those in control villages (P < 0.001). The decrease rate of smoking and current smoking rate in the interventional villages were significantly higher than in the control villages (0.4% vs -0.8%, P < 0.001; 2.4% vs 1.3%, P < 0.001) in men, while not different in women (P > 0.05). Among never smokers at baseline, the accumulated incidence of smoking among people aged 15 to 24 from 1993 to 2000 was significantly lower in the interventional villages than in the control villages in men (18.9% vs 23.7%, P = 0.005) and in women (0% vs 0.7%, P = 0.005). Daily cigarettes smoked by smokers in the interventional villages were less than in control villages in both men (14.8 +/- 7.0 vs 17.2 +/- 8.2 cigs daily, P < 0.001) and women (12.8 +/- 6.9 vs 13.4 +/- 7.2 cigs daily, P = 0.088). The increase of prevalence of chronic bronchitis in the interventional villages was less than in the control villages (men: 0.9% vs 1.3%, P = 0.012; women: 0.1% vs 0.3%, P = 0.003). After the age factor is adjusted, odds ratio (OR) for accumulated incidence of chronic bronchitis from 1993 to 2000 in the interventional villages were 0.80 (95%CI: 0.60-1.07) for men, 0.76 (95%CI: 0.45-1.28) in women. The OR for asthma was not significant in both men and women. CONCLUSIONS: Comprehensive interventions in community may improve knowledge of COPD prevention and living environments, decrease the smoking rate, cigarettes smoked per day, and incidence of chronic bronchitis, but have no significant effects on asthma.

Adolescent↗
PubMed2005

[Fenspiride in patients with acute bronchitis].

UNLABELLED: Fenspiride is an anti-inflammatory drug that may have a role in inhibition of histamine receptor H1 and influence a production of archidonic acid metabolites. AIM: The efficacy and tolerance of fenspiride therapy have been performed in patients with acute bronchitis. MATERIAL AND METHODS: 597 patients, 51% females and 49% males, aged 39+/-18 years, were observed because of acute bronchitis. Fenspiride (Eurespal, Servier) was given in a dose of 240 mg per day (80 mg three times daily) for 14 consecutive days. During two following medical examinations - after 7 and 14 days of treatment, clinical symptoms of disease, therapy efficacy and tolerance were determined. RESULTS: Mean duration of acute bronchitis before fenspiride therapy was 2.3+/-1.3 days. In most of the patients (72%) a moderate, and in 27% mild degree of disease was diagnosed. Only 1% of patients were diagnosed as severe. Total evaluation of fenspiride efficacy in examined patients with acute bronchitis showed complete relief of symptoms after 7 days of therapy in 24% and after 14 days in 87% of patients. In 6% of patients after 7 days and in 1% after 14 days of fenspiride therapy no improvement was obtained. 28 adverse reactions were determined in 26 patients (4.3%): vertigo in 7, nausea in 6, somnolence in 5, palpitations in 4, fatigue in 2, abdominal pain in 2 and other symptoms in 2 patients. In 8 patients the therapy was discontinued after 7 days because of adverse reactions. CONCLUSIONS: In performed observations in patients with acute bronchitis the high clinical efficacy of fenspiride therapy. In 12% of patients an antibiotic support was necessary to obtain relief of the symptoms. Very good tolerance of the 14 days therapy was determined and it is recommended for safe clinical application.

Acute Disease↗
PubMed1991

Sputum antimicrobial levels and clinical outcome in bronchitis.

The role of antimicrobials in the treatment of bronchitis remains controversial. Antimicrobials are rarely indicated in acute bronchitis. Antimicrobials are indicated in a subset of patients with acute exacerbations of chronic bronchitis. The efficacy of an antimicrobial agent in bronchitis can be estimated by the ratio of the sputum concentration of the antimicrobial to its in vitro activity against common respiratory pathogens (S/M90). These S/M90 rates are presented in tabular form. However, given the lack of solid data to support antimicrobial treatment for most episodes of bronchitis, use of the S/M90 to select antimicrobial therapy remains theoretical rather than of proven clinical benefit.

Acute Disease↗
PubMed1991

[Morphological diagnosis of chronic bronchitis in patients with tuberculosis of the lungs].

A morphofunctional insufficiency of the bronchial epithelium which is a pathognomonic symptom of chronic bronchitis, was examined in 105 biopsy specimens of the bronchial mucosa of patients with different forms of pulmonary tuberculosis by morphometry. It was found that epithelial changes typical of chronic bronchitis, were observed in 100% of the cases. However, 64.76% of the patients had Stages I and II morphofunctional insufficiency, which corresponded to the presence of chronic nonobstructive bronchitis. The epithelial changes traced in the remaining observations were characteristic of chronic obstructive bronchitis. The presence and the extent of morphofunctional insufficiency were not associated with the form of tuberculosis. The examination of biopsy specimens of the bronchial mucosa taken in the vicinity of the upper bronchus spur is considered to be an adequate and sufficient method of an objective detection of chronic bronchitis in tuberculosis.

Bronchitis↗
PubMed1991

Acute bronchitis in children: building a clinical definition.

Much about acute bronchitis in children is uncertain, even its definition. This study was undertaken to help build a clinical definition to serve as a guide for further research. Charts of 180 children 1 to 12 years old were reviewed. Each had received a diagnosis of acute bronchitis (54 patients), upper respiratory infection with a cough (128 patients), or a new diagnosis of asthma (26 patients) during the previous 12 months. A history of sputum production (odds ration 25.0, p = 0.0001), the finding of rales or rhonchi on examination (OR 11.6, p less than 0.0001), and a past history of lower respiratory illness (OR 3.0, p = 0.01) were associated with a diagnosis of acute bronchitis, but fever and duration of illness were not. In addition, the diagnosis of acute bronchitis was strongly associated with a prescription for an antibiotic. In a child with a cough, acute bronchitis is more likely to be diagnosed if there is a history of sputum production, rales or rhonchi on examination, and a past history of lower respiratory disease.

Acute Disease↗