[General concepts of obstructive bronchial diseases].
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CT was compared to fiberoptic bronchoscopy in a large series of patients to study the value of CT for visualizing bronchial disease. CT scans were available for review in 64 cases in which focal airway disease was identified with fiberoptic bronchoscopy and in 38 patients in whom the airways appeared normal at bronchoscopy. CT was positive in 59 of 64 cases in which lesions were detected endoscopically. If the results are analyzed according to the extent of involvement of individual bronchi, CT successfully identified 88 (90%) of 98 lesions. CT correctly excluded disease in 35 (92%) of 38 cases that were subsequently verified to be normal by fiberoptic bronchoscopy. In no case was the diagnosis of malignancy missed by CT. While extremely accurate in detecting focal lesions, CT was inaccurate in predicting whether a given abnormality was endobronchial, submucosal, or extrinsic (peribronchial). In three cases CT failed to detect submucosal extension into the left mainstream bronchus, which has important implications concerning the value of CT in staging bronchial malignancy. It is concluded that CT is helpful when bronchoscopy is contraindicated or refused. CT may also be used in selected cases when there is low clinical suspicion of endobronchial disease and as a complementary procedure to fiberoptic bronchoscopy for outlining the exact location of major mediastinal and hilar vessels, lymph nodes, and tumor in relation to adjacent airways.
A number of different inhalation appliances are available for the inhalation treatment of chronic obstructive bronchial diseases. Electrical aerosol appliances, aerosols providing measured dosage and dry powder inhalers all show good physical properties for creating aerosol particles with an average aerodynamic mass diameter of 2-9 microns, which is a prerequisite for optimum bronchial deposition. Advantages and disadvantages of the principal appliances available on the market are compared. In an overview the action, indications and side effects of beta-2 sympathomimetics, ipratropium bromide, anti-allergens and inhaled steroids are discussed. Both in chronically obstructive pulmonary diseases (COPD) and in chronic asthma, precise patient instructions and the correct use and combination of bronchial dilating medicines and inhaled steroids in asthma, and of beta-2 sympathomimetics and ipratropium bromide in COPD, are important for optimum effect of inhalation treatment. The literature shows that the widespread fear of side effects of steroids applied in inhalant form is unfounded.
A randomized double-blind cross-over study compared the clinical effectiveness of a 14-day treatment with 400 mg X day-1 of sobrerol and placebo in 23 patients with stable chronic bronchial disease. During the seven week trial, subjective symptoms and findings (cough frequency and severity, difficulty in raising sputum, dyspnoea) were recorded, pulmonary function tests performed and sputum physical characteristics (24-h sputum volume, purulence, cell concentration, protein, sputum dry weight and "apparent" viscosity) determined on a regular basis. Side-effects were closely monitored. Both subjective assessment of overall clinical efficacy as well as statistical analysis of the above mentioned factors failed to show any significant advantage of sobrerol to placebo--except for a transient decrease of the 24-h sputum volume. Sobrerol appears to be another example of an expectorant lacking evidence of clinical effectiveness in the management of chronic bronchial secretions.
A total of 23 patients have been treated endoscopically during the last three and a half years for a variety of diseases in the tracheo-bronchial tree; nine had a tracheal stenosis. Thirteen patients have been treated by resection with a high frequency cutting loop, eleven with a CO2-laser and one with an argon laser. A total of 44 treatments have been performed. Half of the treatments were given because of various malignant diseases. The results of the treatment of this very mixed group of patients were, as a whole, satisfactory with both CO2-laser and cutting loop. A more precise technique can be applied with the CO2-laser than the cutting loop, though the latter is the more efficient and easy to work with. Care must be taken with the loop because of its greater cutting depth. The argon laser has only limited use in the treatment of diseases in the trachea.
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The existence of a relationship between upper digestive tract impairment and respiratory disturbance is generally accepted. The aim of this study was to determine whether pulmonary aspiration, documented by labeled meal and lung scans, could be a contributory factor. Thirty-two patients with chronic respiratory complaints (19 men, 13 women, mean age: 57.8 yr), 29 of whom had an FEV1 below 80 percent of predicted values, and 13 healthy subjects (six men, seven women, mean age 50.9 yr) took part in a prospective study. Scintiscans showed gastroesophageal reflux (GER) in 27 patients (84 percent) and in five control subjects (38 percent). Lung contamination was ascertained in 24 patients (75 percent) and in two control subjects (15 percent) (p less than 0.001) 15 hours after a labeled solid meal. Vegetal fibers were found in sputum smears after mouth rinsing the day after ingestion of 8.5 g wheat bran in 72 percent of patients and in 77 percent of control subjects. Although two associated phenomena are not necessarily causally related, pulmonary aspiration documented by pulmonary scintigraphy did significantly correlate with gastroesophageal reflux, suggesting that aspiration resulting from reflux may perpetuate, if not initiate, chronic bronchial disease.
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