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PubMed1994

The prognostic significance of chronic bronchitis in the development of reversible and irreversible chronic airflow limitation.

This article reviews the potential significance of chronic bronchitis in the development of reversible and irreversible chronic airflow limitation. Because chronic bronchitis is more prevalent than either asthma or chronic obstructive pulmonary disease (COPD), it has the potential to influence the natural history of these two diseases. However, chronic bronchitis does not cause significant obstructive defects in the absence of small airway disease or emphysema and does not significantly contribute to the decline in pulmonary function seen in COPD. In addition, the bronchial hyperreactivity associated with chronic bronchitis has characteristics that clearly distinguish it from asthma. Hence, chronic bronchitis largely reflects cigarette injury to the bronchial mucosa and develops in tandem with emphysema and small airway disease rather than as an essential precursor.

Airway Resistance↗
PubMed1994

[Diagnosis of chronic obstructive bronchitis].

Cough and mucociliary clearances were investigated in patients with chronic obstructive bronchitis, chronic bronchitis, chronic nonobstructive bronchitis by ciliary activity of the ciliated epithelium and cough intensity according to the formulas, using inulin and tussographic techniques of expectoration testing. The findings above were compared to clinical manifestations of bronchitis, x-ray pictures, bronchial mucosa bronchoscopy and cytology, examination of external respiration. The analysis of the data obtained provided the conclusion that early diagnosis of chronic obstructive bronchitis is valid in ciliary activity of the ciliated epithelium equal or surpassing 1 and cough intensity under 35%.

Adolescent↗
PubMed1993

[Preventive effect of an immunomodulator, OM-85 BV, on acute exacerbations of chronic bronchitis in elderly patients. Preliminary results at six months in 291 patients].

Three hundred fifty six patients aged 65 years or more (mean age 81.8 years) who were suffering from chronic bronchitis were included in a double-blind trial against placebo to assess the preventative effect of OM-85 BV against acute exacerbations of chronic bronchitis. OM-85 BV is an immunostimulant composed of lyophilised factions of 8 bacteria which are most frequently encountered during the course of respiratory tract infections. 291 patients completed the study. In the group treated by OM-85 BV, a significant increase in the number of patients with no episode of acute bronchitis was noted (96 versus 71, p = 0.006). There was a 38.8% reduction in the absolute numbers of episodes of acute bronchitis and a 33% reduction in the number of prescriptions for antibiotics, however there was no difference in the number of pneumonias and bronchopneumonias. These results show the protective effect of OM-85 BV against bronchial superinfections in a large population of elderly patients suffering from chronic bronchitis.

Acute Disease↗
PubMed1993

[Chronic bronchitis and efficiency of lung ventilation in workers of the "Zawadzkie" foundry].

The aim of this study was to determine the influence of smoking habit and occupational exposure to air pollution on the prevalence of chronic bronchitis and lung function efficiency in foundry workers. MRC survey and spirographic measurements were performed in 917 men aged 18-62 years (mean age 38.6). In 455 men (49.6%), occupational exposure to air pollution significantly exceeded the permissible values. In 122 men (13.3%) the exposure was low. Chronic bronchitis was more than twice as frequent in smokers (27.3%) as in nonsmokers (11.0). Cessation of smoking led to an improvement in the symptoms of chronic bronchitis. Chronic bronchitis was slightly more frequent in highly exposed (25.5%) as compared with low-exposed workers (15.6%). Age-related lung function decline was significantly greater in smokers than in nonsmokers. Unlike chronic bronchitis, lung function was still lower after smoking cessation. Among highly exposed workers, age-related FVC and FEV1 declines were significantly larger in smokers than in non-smokers.

Adult↗
PubMed1996

Effectiveness of erythromycin in the treatment of acute bronchitis.

BACKGROUND: Clinical trials have not shown a consistent benefit of treating bronchitis with antibiotics. Many physicians, however, treat acute bronchitis with antibiotics because of the possibility of Mycoplasma pneumoniae or other pathogens. The objectives of this study were to determine the effectiveness of erythromycin treatment in patients with acute bronchitis and to determine whether a newly developed rapid M pneumoniae antibody test is useful in predicting which patients will respond to therapy. METHODS: We conducted a randomized, double-blind, placebo-controlled clinical trial at three primary care centers in North Carolina. A convenience sample of 140 patients presenting with acute bronchitis were tested for M pneumoniae, 91 of whom were treated with either erythromycin 250 mg four times daily for 10 days or an identical-appearing placebo. RESULTS: Patients treated with erythromycin missed an average of only 0.81 +/- 1.1 days of work compared with 2.16 +/- 3.2 days for placebo-treated patients (P < .02). There were no significant differences in cough, use of cough medicine, general feeling of well-being, or chest congestion between the erythromycin and placebo groups. Twenty-five percent of the patients tested positive for M pneumoniae. There were no differences in response to erythromycin based on whether the patient had a positive test for M pneumoniae. CONCLUSIONS: Erythromycin is effective in significantly reducing lost time from work, but it is not effective in reducing cough or other symptoms in patients with acute bronchitis, regardless of the outcome of the M pneumoniae antibody test.

Acute Disease↗
PubMedDate not supplied

Monocyte chemotactic and activating factor/monocyte chemoattractant protein (MCAF/MCP-1) in bronchoalveolar lavage fluid from patients with atopic asthma and chronic bronchitis.

Monocyte chemotactic and activating factor/monocyte chemoattractant protein (MCAF/MCP-1) is a member of the beta (C-C) subfamily of chemokines. The biological roles played by MCAF/MCP-1 in a number of inflammatory and noninflammatory diseases states is not well known. Several studies have confirmed that inflammation is present in the airways of subjects with atopic asthma and with chronic bronchitis. Analysis of bronchoalveolar lavage fluid (BALF) is an effective method of sampling lower respiratory tract inflammation. The aim of this study was to examine associations among MCAF/MCP-1, BALF cells and spirometry parameters and bronchial hyperresponsiveness in patients with atopic asthma and chronic bronchitis. Twenty patients with atopic asthma, 10 patients with chronic bronchitis and 10 patients of the control group, took part in this study. An ELISA test was used to assess MCAF/MCP-1 in BALF. The levels of MCAF/ MCP-1 (mean +/- SEM) were 150 +/- 18.6 pg/ml in patients with atopic asthma, 320 +/- 39.7 pg/ml in chronic bronchitis and 74.9 +/- 3.3 pg/ml in the control group (p < 0.05). When all patients with disease were considered, there was negative correlation with FEF50 (Kendall's correlation coefficient = - 0.4; p < 0.01). Regression analysis has shown that a level of MCAF/MCP-1 over 100 pg/ml was correlated with duration of illness (Pearson's correlation coefficient = 0.7; p < 0.02). In conclusion, MCAF/MCP-1 probably possesses proinflammatory properties in atopic asthma and chronic bronchitis. The elevated level of this chemokine may support the clinical suspicion of specific diagnosis.

Adult↗
PubMed1976

[Silicosis, chronic bronchitis and smoking habits].

In 333 patients suffereing from silicosis the incidence of chronic bronchitis and/or obstruction of the respiratory tract has been correlated with cigarette smoking. The incidence of chronic bronchitis and/or airway obstruction in patients who had acquired either slight or severe silicosis in Switzerland was over 50%. A positive correlation between cigarette smoking and chronic bronchitis and/or airway obstruction could be found only in younger patients with slight silicosis. Chronic bronchitis and/or airway obstruction was not more frequent in foundry-workers suffering from silicosis where they had been exposed to fumes which irritated the respiratory tract. Deformation of the respiratory tract due to silicosis has a greater bearing on the development of chronic bronchitis and airway obstruction than immoderate cigarette smoking.

Adult↗
PubMed1998

Acute bronchitis.

Acute bronchitis is a lower respiratory tract infection that causes reversible bronchial inflammation. In up to 95 percent of cases, the cause, is viral. While antibiotics are often prescribed for patients with acute bronchitis, little evidence shows that these agents provide significant symptomatic relief or shorten the course of the illness. In a few small studies, bronchodilators such as albuterol have been found to relieve some symptoms of acute bronchitis. Increased attention is being given to the role of Chlamydia species in acute bronchitis and adult-onset asthma. Studies in progress may help to clarify the importance of these organisms in acute bronchitis and to determine whether early treatment can prevent or ameliorate asthma.

Acute Disease↗
PubMed1998

Treatment of acute bronchitis in adults. A national survey of family physicians.

BACKGROUND: The purpose of this study was to determine how family physicians in the United States treat acute bronchitis in an otherwise healthy adult. METHODS: A 33-item questionnaire on the diagnosis and treatment of acute bronchitis was mailed to a random sample of 500 physicians who are members of the American Board of Family Practice. RESULTS: Thirty-two of the 500 sampled physicians could not be located by mail; 265 of those who received the questionnaire responded. The response rate was 57% (265/468). Sixty-three percent of responding physicians indicated that antibiotics are their first choice of treatment for the otherwise healthy, nonsmoking adult with acute bronchitis. The decision to use antibiotics as the first choice of treatment did not vary by physician's sex, age, years in practice, practice location, practice type, or percentage of HMO patients. Only 6% of responding physicians reported using beta 2 agonist bronchodilators as their first choice of treatment. Physicians in this study stated that they prescribe an antibiotic 75% of the time in treating nonsmoking patients with acute bronchitis (first choice or otherwise). If the patient is a smoker, physicians reported that they prescribe antibiotics 90% of the time (F = 110.25; df = 1; P > .0001). Physicians reported that for patients who smoke it takes longer for coughs to totally resolve and longer for them to return to a normal activity level than for nonsmokers. CONCLUSIONS: Family physicians report that antibiotics are their most common treatment for acute bronchitis in the otherwise healthy adult. Previous clinical trials have shown only marginal improvement in symptoms when patients with this condition are treated with an antibiotic. With antibiotic resistance emerging as a major global health problem, it is essential that other methods of treatment be evaluated.

Acute Disease↗
PubMed1998

Are antibiotics effective treatment for acute bronchitis? A meta-analysis.

BACKGROUND: Most clinicians prescribe antibiotics for acute bronchitis in spite of recommendations against this practice. Because the results of individual clinical trials have been mixed, we conducted a meta-analysis to determine whether antibiotics are effective treatment for acute bronchitis. METHODS: We conducted a comprehensive search to identify all trials in which patients who had a diagnosis of acute bronchitis were randomly assigned to treatment with an antibiotic or placebo. Patient-oriented outcomes of importance that were reported in at least 3 studies were quantitatively summarized. RESULTS: Nine studies met the inclusion criteria, but not all trials provided data for each outcome. Patients given antibiotics were less likely to have a cough (relative risk [RR] = 0.69; 95% confidence interval [CI], 0.49 -0.98) and be considered unimproved (RR = 0.51; 95% CI, 0.30-0.88) at a follow-up visit; but they were not less likely to have a productive cough (RR = 0.79; 95% CI, 0.60-1.03), activity limitations (RR = 0.59; 95% CI, 0.24-1.44), or feel ill (RR = 0.70; 95% CI, 0.31-1.58). Antibiotic-treated patients had a slightly shorter duration of productive cough (weighted mean difference [WMD] = -0.56 days; 95% CI, -1.09 to -0.04), but not of overall cough (WMD = -0.94; 95% CI, -2.08 to 0.21) or activity limitations (WMD = -0.49; 95% CI, -1.07 to 0.10). Patients treated with antibiotics did not report significantly more adverse effects (RR = 1.47; 95% CI, 0.82-2.65). CONCLUSIONS: Antibiotics may be modestly effective for a minority of patients with acute bronchitis. It is not clear which patient subgroups might benefit, and the failure of some studies to report negative findings may have resulted in overestimates of the benefits of antibiotics. Antibiotics are not necessary for every patient with acute bronchitis.

Activities of Daily Living↗
PubMed2000

The inflammatory response in chronic bronchitis.

Chronic bronchitis is diagnosed clinically by a chronic productive cough and is characterized by a variety of pathological changes, including bronchial gland hyperplasia, goblet cell metaplasia, and peribronchiolar fibrosis. As implied by the term ;;bronchitis,'' chronic airway inflammation is typically found in the central airways in patients with persistent cough and mucus hypersecretion. Although the exact pathogenesis of chronic bronchitis remains unclear, bacterial colonization and the resulting inflammatory response are thought to be of central importance. The generation of proinflammatory cytokines and chemotactic stimuli by the airway epithelium likely plays a central role in propagating the inflammatory response in patients with chronic bronchitis. Typically, an inflammatory mononuclear cell infiltrate is found in the airway wall, and the airway lumen is filled with neutrophils and their products. Further insights into the initiating events and underlying mechanisms that result in the clinical syndrome of chronic bronchitis will likely provide novel opportunities for therapeutic interventions.

Journal Article↗
PubMed1996

Comparison of Two Questionnaires on Respiratory Symptoms in a Nicaraguan Population: Value in Diagnosis of Chronic Bronchitis.

Two questionnaires about respiratory symptoms were evaluated for reliability and ability to diagnose chronic bronchitis in a study population of 129 Nicaraguans (110 workers and 19 patients with chronic bronchitis). The first questionnaire (AQ) had symptom questions that were based on British Medical Research Council (MRC) questions, adapted to local Spanish. The second questionnaire (MRCQ) contained MRC symptom questions translated directly into Spanish. The reliability of the questions was measured in a test-retest procedure. The questionnaire-based diagnosis of chronic bronchitis was compared with the diagnosis made by a physician (for workers) or from the hospital records (for patients). The questions concerning symptoms in both questionnaires were of acceptable reliability. For the diagnosis of chronic bronchitis in workers, the AQ showed similar sensitivity, a somewhat higher specificity, and a substantially higher positive predictive value (90%) than the MRCQ (57%). Among the patients, the AQ identified 17 patients as positive (sensitivity 89%), while the MRCQ identified 15 (sensitivity 79%). respiratory questionnaire; reliability; chronic bronchitis; Nicaragua Hanley & Belfus, Inc. Int J Occup Environ Health 1077-3525 2 2 1996 April/June Chronic Exposure to Cigarette Smoke Inhibits the Stimulating Effects of Mineral Fibers on the Production of Tumor Necrosis Factor by Alveolar Macrophages of Rats 95 98 EN Yasuo Morimoto Department of Environmental Health Engineering, University of Occupational and Environmental Health, Japan 1-1, Iseigaoka, Yahatanishiku, Kitakyushu 807, Japan. Ziro Nambu Hajime Hori Tohru Tsuda Hiroshi Yamato Toshiaki Higashi Yasuyuki Yokosaki Masamitsu Kido Isamu Tanaka The objective of this study was to evaluate the chronic combined effects of mineral fibers and cigarette smoke on the production of tumor necrosis factor (TNF) by alveolar macrophages. The authors chronically exposed ten rats to cigarette smoke in vivo and measured the production of TNF by alveolar macrophages in the presence of mineral fibers in vitro. For smoke exposure, rats were divided into two groups. Five rats were exposed daily to a concentration of 10 mg/m(3) of cigarette smoke for six hours a day, five days a week, for four weeks, and five rats (control) were not exposed to smoke. A broncho-alveolar lavage was performed after the smoke exposure, and the recovered alveolar macrophages were incubated with either chrysotile or ceramic fibers on a microplate for 24 hours. TNF activity in the supernatant was determined by the L929 bioassay. When alveolar macrophages were not stimulated by mineral fibers, TNF production tended to be lower in smoke-exposed alveolar macrophages than in unexposed ones, although the difference was not significant statistically. When alveolar macrophages were stimulated in vitro by chrysotile or ceramic fibers, both fibers stimulated TNF production, but TNF production in smoke-exposed alveolar macrophages was lower than that in unexposed macrophages. These results revealed that long-term exposure to cigarette smoke inhibited the stimulating effect of mineral fibers on the production of TNF.

Journal Article↗
PubMed2000

Chronic bronchitis in rural and industrial areas.

The purpose of the study was the determination of prevalence of chronic bronchitis in people older than 55 years in rural and industrial areas. 569 people over 55 years old living in central Greece were studied. A protocol was completed for each patient that included smoking habits, job, age, weight, drugs used for respiratory system and symptoms. A chest radiograph was taken for each patient. Each patient was submitted to three trials of dynamic spirometry. The best results were used for the study. The patients who complained of expectoration for three months for two continuous years and had obstructive pattern of lung function were diagnosed with chronic bronchitis. 9.6% of the subjects in rural area and 17.1% in industrial area were diagnosed with chronic bronchitis. Half the COPD patients never visited a doctor for this specific problem and were diagnosed for the first time. One out of three examined people had abnormal lung function. Consequently, more than one out of ten people older than 55 years have chronic bronchitis. Industrial exposure seems to double the risk for chronic bronchitis.

Aged↗
PubMed1998

[Long-term atrovent treatment of chronic obstructive bronchitis].

AIM: The study of effects of long-term ipratropium bromide on the course of chronic obstructive bronchitis. MATERIALS AND METHODS: A 3-month atrovent monotherapy (3-6 doses daily) was performed in 19 patients with verified chronic obstructive bronchitis of moderate severity. Monitoring consisted of symptoms registration, pickflowmetry (two times a day), external respiration measurements. RESULTS: Atropen produced a positive trend in all the clinical symptoms, course of viral infections, exercise tolerance, bronchial permeability, respiratory capacity. The highest atrovent efficacy was recorded in patients with chronic bronchitis of smokers and chronic bronchitis in tracheobronchial diskinesia. No side effects were observed. CONCLUSION: Basic atrovent monotherapy modifies the course of chronic obstructive bronchitis and can be recommended for secondary prophylaxis of this disease.

Bronchodilator Agents↗
PubMed2004

Acute bronchitis: state of the art diagnosis and therapy.

In managing acute bronchitis, pneumonia or an exacerbation of underlying chronic bronchitis should be excluded. Simple bronchitis is best treated symptomatically while an exacerbation of chronic bronchitis can be treated with antibiotics. Broad spectrum antibiotics are appropriate in selected patients.

Acute Disease↗
PubMed1983

[Vaccination against infectious bronchitis in young chickens--carriers or not of maternal antibodies].

The immunity to infectious bronchitis afforded by spray vaccination of mycoplasma free two days-old broilers with maternal antibodies to infectious bronchitis virus was tested by comparing zootechnical scores, clinical signs, macroscopical and microscopical changes, frequency of infectious bronchitis virus isolation following challenge at one, three and five weeks of age in vaccinated, unvaccinated, challenged and unchallenged birds. This vaccination gave a very good protection to infectious bronchitis for the most part of broiler economical life; growth delays were especially avoided. However, vaccinated and unvaccinated one-week-old birds were not protected enough. No correlation was observed between haemagglutinating antibodies titres and protection. At last this vaccination caused a notable reaction in specific pathogen free control birds of the same age.

Animals↗
PubMedDate not supplied

Does drug treatment of patients with acute bronchitis reduce additional care seeking? Evidence from the Practice Partner Research Network.

BACKGROUND: Considerable discussion has focused on treatment methods for patients with acute bronchitis. OBJECTIVE: To examine whether antibiotic or bronchodilator treatment is associated with differences in follow-up visit rates for patients with acute bronchitis. METHODS: A retrospective medical chart review was conducted for patients with a new episode of acute bronchitis over a 3-year period in the Practice Partner Research Network (29,248 episodes in 24,753 patients). Primary outcomes of interest were another visit in the next 14 days (early follow-up) or 15 to 28 days after initial treatment (late follow-up). RESULTS: Antibiotics were used more commonly in younger patients (<18 years), whereas older patients (>65 years) were more likely to receive no treatment. Younger patients treated with antibiotics were less likely to return for an early follow-up visit, but no differences were seen in adults and older patients. Late follow-up rates were not affected by the initial treatment strategy. When patients did return for a follow-up visit, no new medication was prescribed to most (66% of younger patients and 78% of older adults). However, compared with patients who did not receive an antibiotic at their first visit, patients initially treated with an antibiotic were about 50% more likely to receive a new antibiotic at their second visit. CONCLUSIONS: Initial prescribing of an antibiotic reduces early follow-up for acute bronchitis in younger patients but seems to have no effect in adults. However, reductions in future follow-up visits might be outweighed by increases in antibiotic consumption because patients who return for a follow-up visit seem to receive additional antibiotic prescriptions. Arch Fam Med. 2000;9:997-1001

Acute Disease↗
PubMed2004

Antibiotics for acute bronchitis.

BACKGROUND: Antibiotic treatment of acute bronchitis, which is one of the most common illnesses seen in primary care, is controversial. Most clinicians prescribe antibiotics in spite of expert recommendations against this practice. OBJECTIVES: The objective of this review was to assess the effects of antibiotic treatment for patients with a clinical diagnosis of acute bronchitis. SEARCH STRATEGY: In this updated review, we searched the Cochrane Central Register of Controlled trials (CENTRAL) (The Cochrane Library Issue 2, 2004); MEDLINE (January 1966 to March 2004); EMBASE (January 2000 to December 2003); SciSearch from 1989 to 2004; reference lists of articles and the authors' personal collections up to 1996, and also wrote to study authors and drug manufacturers. EMBASE has previously been searched from 1974 to 2000). SELECTION CRITERIA: Randomised controlled trials comparing any antibiotic therapy with placebo in acute bronchitis or acute productive cough without other obvious cause in patients without underlying pulmonary disease. DATA COLLECTION AND ANALYSIS: At least two reviewers extracted data and assessed trial quality. Authors were contacted for missing data. MAIN RESULTS: Nine trials involving over 750 patients aged eight to over 65 and including smokers and non-smokers were included in the primary analysis. The quality of the trials was variable. A variety of outcome measures were assessed. Overall, patients receiving antibiotics had better outcomes than did those receiving placebo. At a follow-up visit, they were less likely to have a cough (relative risk (RR) 0.64, 95% confidence interval (CI) 0.49 to 0.85; number-needed-to-treat (NNT) 5; 95% CI 3 to 14), show no improvement on physician assessment (RR 0.52; 95% CI 0.31 to 0.87; NNT 14; 95% CI 8 to 50), or have abnormal lung findings (RR 0.48; 95% CI 0.26 to 0.89; NNT 11; 95% CI 6 to 50); and had shorter durations of cough (weighted mean difference 0.58 days; 95% CI 0.01 to 1.16 days), productive cough (weighted mean difference (WMD) 0.52 days; 95% CI 0.01 to 1.03 days), and feeling ill (WMD 0.58 days; 95% CI 0.00 to 1.16 days). There were no significant differences regarding the presence of night cough, productive cough, or activity limitations at follow up, or in the mean duration of activity limitations. The benefits of antibiotics were less apparent in a sensitivity analysis that included data from two other studies of patients with upper respiratory tract infections with productive cough. There was a non significant trend towards an increase in adverse effects in the antibiotic group, relative risk (RR) 1.22 (95% CI 0.94 to 1.58). REVIEWERS' CONCLUSIONS: Overall, antibiotics appear to have a modest beneficial effect in patients who are diagnosed with acute bronchitis. The magnitude of this benefit, however, is similar to that of the detriment from potential adverse effects.

Acute Disease↗