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PubMed1998

Effect of high-frequency oral airway and chest wall oscillation and conventional chest physical therapy on expectoration in patients with stable cystic fibrosis.

STUDY OBJECTIVE: To compare the effect of high-frequency oral airway oscillation, high-frequency chest wall oscillation, and conventional chest physical therapy (CPT) on weight of expectorated sputum, pulmonary function, and oxygen saturation in outpatients with stable cystic fibrosis (CF). DESIGN: Prospective randomized trial. SETTING: Pediatric pulmonary division of a tertiary care center. PATIENTS: Fourteen outpatients with stable CF recruited from the CF center. INTERVENTIONS: Two modes of oral airway oscillation (1: frequency 8 Hz; inspiratory to expiratory [I:E] ratio 9:1; 2: frequency 14 Hz; I:E ratio 8:1), two modes of chest wall oscillation (1: frequency 3 Hz; I:E ratio 4:1; 2: frequency 16 Hz; I:E ratio 1:1, alternating with frequency 1.5 Hz, I:E ratio 6:1), and CPT (clapping, vibration, postural drainage, and encouraged coughing) were applied during the first 20 min of 4 consecutive hours. MEASUREMENTS AND RESULTS: Sputum was collected on an hourly basis for a total of 6 consecutive hours. During the first and the last hour, patients collected sputum without having any treatment and underwent pulmonary function tests (PFTs). Oxygen saturation was measured at 30-min intervals during hours 1 to 6. For the first 20 min of the second to the fifth hour, patients received one of the treatments. To assess the effect of the intervention, the weight of expectorated sputum during hours 2 to 6 was averaged and expressed as percentage of the weight expectorated during the first hour (baseline). For the five treatment modalities, mean sputum dry and wet weights ranged between 122% and 185% of baseline. There was no statistically significant difference among the treatment modalities. As measured by sputum wet weight, all oscillatory devices tended to be less effective than CPT (p=0.15). As measured by dry weight, oral airway oscillation at 8 Hz with an I:E ratio of 9:1 and CPT tended to be more effective than the other treatment modalities (p=0.57). None of the treatment modalities had an effect on PFTs and oxygen saturation and all were well tolerated. CONCLUSION: In outpatients with stable CF, high-frequency oscillation applied via the airway opening or via the chest wall and CPT have comparable augmenting effects on expectorated sputum weight without changing PFTs or oxygen saturation. In contrast to CPT, high-frequency oral airway and chest wall oscillations are self-administered, thereby containing health-care expenses.

Adolescent↗
PubMed1977

[Pharmacological studies on expectorants (author's transl)].

Perry and Boyd's method described in 1941 appears to be the most suitable for evaluating the efficacy of expectorants. In this method, changes in volume of respiratory tract fluid (RTF) collected by postural drainage from animals breathing air kept at a constant temperature and humidity are used as criteria. We attempted to improve on the method and to establish the optimum experimental conditions for rabbits. Accordingly, an air conditioning apparatus and tracheal cannula were re-designed and basic experimental conditions essential for quantitative collection of RTF were studied. Using this method, the effects of drugs on the volume of respiratory tract fluid (VRTF) were determined. Bromhexine and emetine as expectorants increased VRTF, and the former showed far more remarkable effects. Codeine and dextromethorphan as antitussives, isoproterenol, clorprenaline and C-78 as bronchodilators decreased VTRF. On the other hand, fominoben and eprazinone as antitussives increased VRTF. Our findings with application of this new approach indicate that this method is applicable for evaluating not only the efficacy of expectorants which increase VRTF but also that of other drugs which decrease VRTF.

Animals↗
PubMed1981

Effects of expectorants on the canine tracheal ciliated cells.

Many expectorants are clinically effective as they reduce viscosity and facilitate expectoration. There are, however, few reports on effects of expectorants on tracheal ciliated cells. We investigated the effects of N-acetylcysteine, ethylcysteine and bromhexine on the ciliary activities of the canine trachea. Ciliary movement was estimated using a phototransistor, and intracellular electrical activity was measured with a microelectrode method, in vitro. N-Acetylcysteine, ethylcysteine and bromhexine in low concentrations under a low perfusion rate (0.1 ml/min) produced an increase in the amplitude and frequency of ciliary beating, while N-acetylcysteine and ethylcysteine caused a cilio-depression in high concentration. N-Acetylcysteine, ethylcysteine and bromhexine, under a low perfusion rate, did not affect the intracellular electrical activity. On the other hand, these three drugs under a high perfusion rate (1 ml/min) produced no change in the ciliary movement and the intracellular electrical activity in concentrations of 10(-8)-10(-4) M. These results suggest that the increase in ciliary activity produced by the mucolytic drugs is not due to a direct effect on the ciliated cells, but rather to a mucolytic effect on the mucus around the cilia.

Acetylcholine↗
PubMed1996

[Antitussive, expectorant and anti-inflammatory effects of rhizoma Cynanchi stauntonii].

Experiments indicated that the ethanol extract and ether extract from Rhizoma Cynanchi Stauntonii showed obvious antitussive and expectorant effects in mice with stomach administration. The antitussive effect of ethanol extract was stronger than the expectorant effect. The water extract showed a certain expectorant effect but no marked antitussive effect with oral administration. Obvious anti-inflammatory effect was observed on croton oil-caused mouse ear swell with intraperitoneal injection.

Animals↗
PubMed1985

Testing for mutagens in an aluminium plant. The results of Salmonella typhimurium tests on expectorates from exposed workers.

Methanol extracts of hydrolyzed expectorate samples from workers in a Söderberg potroom were evaluated by the Salmonella reversion assay. The expectorates from exposed workers--mostly from smokers, but also to a certain extent from nonsmokers--were mutagenic; however, the control samples from both smokers and nonsmokers were not. The positive results produced by the expectorate samples from the exposed smokers suggest a synergistic relationship between exposure to air pollution of the working atmosphere and smoking.

Aluminum↗
PubMed1989

Mutagenicity of expectorate from workers in a coke plant.

Methanol extracts of hydrolyzed expectorate samples from workers in a coke plant were tested with the Salmonella reversion assay. The expectorates from exposed smokers (but also to a certain extent from exposed non-smokers) were mutagenic; however, the control samples from both smokers and non-smokers were not. The positive results produced by the expectorate samples from exposed smokers suggest a synergistic relationship between exposure to air pollution in the working atmosphere and smoking.

Air Pollutants, Occupational↗
PubMed1994

Effect of addition of exercise to chest physiotherapy on sputum expectoration and lung function in adults with cystic fibrosis.

Promotion of sputum expectoration by chest physiotherapy is an essential part of cystic fibrosis management. The role of exercise in improving sputum expectoration and lung function in these patients is more contentious. We therefore investigated the effect of adding an exercise programme to conventional chest physiotherapy in eight adult subjects (four male) with cystic fibrosis. Subjects were treated on two non-consecutive days of the second week of a course of in-patient antibiotic therapy in a cross-over fashion. On the exercise and physiotherapy day, subjects exercised 60 min before physiotherapy. On the physiotherapy alone day, subjects rested for 60 min instead of exercising. Physiotherapy was administered on both study days (postural drainage, percussion, deep breathing, vibrations, forced expiratory technique and coughing). Lung function tests were performed at baseline, after exercise or rest and again immediately and 30 min after physiotherapy. Sputum weights were measured in the 60 min of exercise or rest (period A) and for the 60 min physiotherapy period and 30 min after physiotherapy (period B). Mean total sputum expectoration (period A and B) was 14 g on physiotherapy alone and 21.5 g (4.8) on exercise and physiotherapy (mean difference 7.5 g, 95% CI 1.4-13.6 g, P = 0.02). Mean sputum weights during period A (i.e. rest vs. exercise) on physiotherapy alone and exercise and physiotherapy were 2.6 and 7 g respectively (mean difference 4.4 g, 95% CI-0.07-8.8 g, P = 0.053).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1997

Comparison of induced versus expectorated sputum for diagnosis of pulmonary tuberculosis by acid-fast smear.

OBJECTIVE: To evaluate the sensitivity of induced versus expectorated sputum for the diagnosis of pulmonary tuberculosis by acid-fast smear. METHODS: We performed a retrospective review of data on patients with cultures from respiratory secretions that were positive for Mycobacterium tuberculosis. We analyzed data on the 114 patients with positive cultures during a 4-year period in an urban tertiary care academic medical center. RESULTS: Sputum samples had been obtained for 103 of the 114 patients with cultures positive for tuberculosis. Forty-four of the 114 patients were HIV seropositive. Overall 33 of 79 patients (42%) had positive acid-fast smears of expectorated sputum, and 6 of 24 (25%) had positive smears of induced sputum (p = 0.21). When data were analyzed for subgroups by HIV serostatus, there was no significant difference in the results. Estimated cost of sputum induction for 1 year was approximately $45,000. CONCLUSIONS: We found sputum induction to be costly, and induced sputum offered no advantage over routine expectorated sputum for the diagnosis of pulmonary tuberculosis.

Coloring Agents↗
PubMed2000

Endobronchial tuberculosis with expectoration of tracheal cartilages.

A case of endotracheal tuberculosis with expectorations of the lateral one-third of the multiple tracheal cartilages is reported. Fibreoptic bronchoscopy revealed caseous materials and loosening of the tracheal cartilages. The patient expectorated cartilaginous material several times before and after fibreoptic bronchoscopy. In spite of the loss of tracheal cartilages, tracheal lumen was maintained with a mild airflow limitation. The remaining two-thirds of the tracheal cartilage rings seemed to be strong enough to support the tracheal lumen opening during the respiratory cycle. Although rare, expectoration of bronchial cartilage can be one of the clinical features of endobronchial tuberculosis.

Adult↗
PubMed1997

Aerosolized amiloride: dose effect on nasal bioelectric properties, pharmacokinetics, and effect on sputum expectoration in patients with cystic fibrosis.

Aerosolized amiloride normalizes the excessive sodium absorption cystic fibrosis (CF) respiratory epithelium. The aims of this study were to assess the dose-effect relationship and the duration for which amiloride inhibits Na+ transport, to determine acute and chronic pharmacokinetics, and to test the effect of acute aerosolized amiloride on the amount of sputum expectorated. The effect of inhaled amiloride was assessed principally by nasal potential difference (PD) measurements. Amiloride serum levels were measured in 23 patients after inhalation of different doses of aerosolized amiloride. Twenty CF patients inhaled amiloride (10(-3)M) or a placebo in a double-blinded, randomized order, and sputum production was quantitated. The results of this study showed that maximal initial PD inhibition was achieved by 6 x 10(-3)M of amiloride. The duration of inhibition of PD (effective time until return to 50% delta PD [ET50] after nasal administration) was dose dependent (10(-3)M, 39 +/- 0.8 minutes; 10(-2)M; 133 +/- 14 minutes). Amiloride serum levels were below 2.5 ng/ml in 20 of 28 patients; levels were above 5 ng/ml only within 4 hours after high dose inhalation (10(-2)M). In the double-blinded, crossover study, more sputum was expectorated after amiloride inhalation as compared with that after a placebo (P < 0.05). In conclusion, the bioelectric effects of amiloride and serum levels after inhalation are dose dependent, and amiloride is effective at inducing sputum expectoration in CF.

Administration, Intranasal↗
PubMed1994

Detection of antibody-coated bacteria in expectorated sputum for diagnosis of lower respiratory infections.

We evaluated antibody-coated bacteria (ACB) in expectorated sputum to discriminate contaminating or colonizing organisms from true pathogens. We examined 60 expectorated sputum samples from 51 patients with lower respiratory infections (chronic obstructive pulmonary disease 25, pneumonia 20, purulent tracheobronchitis 6). All samples were examined with quantitative culture and immunofluorescent demonstration of ACB. From the results of quantitative culture, we divided specimens into pathogen-isolated and pathogen-free samples. Among pathogen-isolated samples, in which we isolated accepted pathogenic organisms at > or = 10(7) colony-forming units per ml, 16 of 23 samples were ACB-positive (69.5%). In contrast, among pathogen-free samples, in which we isolated accepted pathogens at < 10(7) colony forming units per ml or only upper respiratory flora, only 3 of 37 samples were ACB-positive (8.1%). The ACB-positive rate was significantly higher in pathogen-isolated than in pathogen-free samples (P < 0.001). Consequently, detecting ACB in expectorated sputum shows good potential as another criterion for distinguishing contaminating or colonizing organisms from true pathogens.

Adult↗
PubMed1996

Inhaled hypertonic saline increases sputum expectoration in cystic fibrosis.

OBJECTIVE: To determine whether inhalation of hypertonic saline (HS) increases sputum expectoration in patients with cystic fibrosis (CF). METHODOLOGY: Ten adolescents with CF, who were receiving inpatient treatment for a pulmonary exacerbation, were enrolled in a controlled cross-over clinical trial. After inhalation of beta adrenergic drug to prevent possible broncho-constriction, each patient inhaled for 10 min either 0.9% isotonic saline (IS) or 6% HS prior to routine physiotherapy. The following day the patient received the alternative solution. Seven patients undertook a second block after 1-5 days. Outcome measures included weight of sputum, a visual analogue score to assess the subjective feeling of a cleared chest after physiotherapy, and spirometry. RESULTS: Sputum expectoration (median; Q1,Q3) from the beginning of the inhalation of HS or IS to the final spirometry measure 60 min post-physiotherapy was significantly greater after HS than IS [17.2g (11.7, 34.8) vs 11.3g (6.5, 16.1): P = 0.006]. A clinical score of the patient's own judgement of a cleared chest was significantly better after HS than IS. Spirometry results did not change following either of the two inhalations. CONCLUSIONS: These data show that the inhalation of 6% HS prior to physiotherapy can increase sputum expectoration in patients with CF and suggest that HS might be an effective, safe and cheap adjunct to regular physiotherapy in patients with CF.

Administration, Inhalation↗
PubMed1996

Airways obstruction, chronic expectoration, and rapid decline of FEV1 in smokers are associated with increased levels of sputum neutrophils.

BACKGROUND: Smoking may cause inflammation of the airways and impairment of lung function. To determine the relationship between the type and degree of airways inflammation and the decline in lung function, leucocytes in the sputum of smokers and ex-smokers were examined. METHODS: Forty six smokers and ex-smokers of median age 64 years (25%; 75% percentiles 62;66) with a smoking history of 40.1 (31.7;53) pack years were studied with lung function tests and a questionnaire at the end of a 15 year follow up period. Sputum was induced by inhalation of hypertonic saline and differential leucocyte counts were performed on cytospin preparations. RESULTS: Adequate sputum samples were obtained in 38 subjects (78%). The ratio of forced expiratory volume in one second (FEV1) to vital capacity (VC) was 67.1 (60; 72)% and the annual decline in FEV1 was 19.4 (12;30) ml/year. Subjects with airways obstruction (FEV1/VC < 63%) had more neutrophils (77 (50;86)%) than those without airways obstruction (60 (43;73)%). The percentage of neutrophils was also significantly greater (77 (62;85)%) in those with chronic expectoration than in those without expectoration (57 (45;75)%. Increased levels of neutrophils in the sputum were correlated with a rapid decline in FEV1 over the 15 year follow up period. CONCLUSIONS: Airways obstruction and chronic expectoration, as well as accelerated decline in lung function, are associated with increased numbers of neutrophils in the sputum of smokers and ex-smokers which suggests that neutrophilic inflammation of the airways may be involved in the pathogenesis of chronic obstructive pulmonary disease.

Cough↗
PubMed1981

Concentrations of semi-synthetic penicillins in the plasma and in the expectoration, administered by means of intermittent vein perfusion.

We report the levels of concentration of ampicillin, dicloxacillin, and carbenicillin reached in the blood and in the expectoration following the administration of these drugs by rapid venous infusion, once every 24 h. The concentration of ampicillin in the blood serum varied from 150 to 180 micrograms/ml at the end of the infusion and from 30 to 3 micrograms/ml 4 afterwards and the dicloxacillin concentration from 150 to 120 micrograms/ml, and from 24 to 6 micrograms/ml. The concentration of ampicillin in purulent expectoration was 5-7 micrograms/ml and that of dicloxacillin 2.5-4 micrograms/ml. The concentration of carbenicillin in the plasma varied from 1,040 to 130 micrograms/ml, and in the expectoration it was around 15 micrograms/ml. Several cases of acute and chronic lung and bronchial diseases caused by bacteria have been treated by means of venous infusion once every 24 h and results were excellent.

Ampicillin↗
PubMed2004

A short-term comparison of two methods of sputum expectoration in cystic fibrosis.

The aim of this study was to determine whether repeated maximum inspiratory vital capacity manoeuvres against a fixed resistance increased effective short-term sputum clearance in adults with cystic fibrosis (CF). Twenty adults with CF were randomised to receive, on alternate days, either standardised physiotherapy (SP) for 30 min, comprising postural drainage and the active cycle of breathing technique, or a series of resistive inspiratory manoeuvres (RIM) at 80% of their maximum sustained inspiratory pressure developed between residual volume and total lung capacity during the first 4 days of the treatment of an exacerbation of respiratory symptoms. Expectorated sputum was collected during and for 30 min after each treatment and weighed. Total protein, immunoreactive interleukin (IL)-8 and human neutrophil elastase (HNE) concentrations, and the amount of each component expectorated, were determined. Compared with SP, RIM increased sputum weight two-fold, independent of treatment order or day. The concentrations of protein, IL-8 and HNE in sputum were similar for both treatments, while the quantity expectorated was greater with RIM treatment. In conclusion, short-term resistive inspiratory manoeuvres treatment was more effective at clearing sputum and inflammatory mediators than standardised physiotherapy.

Adult↗
PubMed1999

Spontaneous partial expectoration of an endobronchial carcinoid.

Typical pulmonary carcinoid tumors often present as proximal endobronchial masses discovered during the evaluation of cough and/or hemoptysis. We present a case of a carcinoid tumor that presented with spontaneous partial expectoration. A review of the literature revealed 16 cases of expectoration of fragments from various primary and metastatic tumors. Our case appears to be the first report of the expectoration of a carcinoid tumor.

Adult↗
PubMed1990

[Expectoration and inhalation therapy].

We analysed sputum properties based on certain clinical information such as sputum volume, its gross appearance, the diagnosis, and difficulty in expectoration. We also compared sputum properties, clinical information and the effects of inhalation drugs on sputum in vitro, and on this basis evaluated the indications and limitations of inhalation therapy. It appears that inhalation therapy is limited by sputum properties, because the properties of large amounts of sputum, purulent sputum, and sputum expectorated with great difficulty are apparently different from those of other types of sputum. The effect of inhalation drugs on sputum was studied in vitro. Distilled water and normal saline showed as mucolytic agents. Bromhexine was acids in solution. The acidity caused the sputum to gel and reduced its mucolytic effect. Tyloxapole was alkaline in solution. The alkalinity decreased the mucociliary transport rate (MTR). Acetylcysteine had a marked mucolytic effect and decreased the MTR. There was a particular desire to develop drugs which improved MTR, because MTR is impaired by large amounts of sputum and sputum expectorated with great difficulty as well as in the case of sputum from diffuse panbronchiolitis patients.

Administration, Inhalation↗
PubMed1989

[Pulmonary complication after resection of lung cancer--difficulty in expectoration and cough dynamics].

From January 1975 to December 1986, 415 patients were operated for primary lung cancer. Postoperative pulmonary complications were observed in 83 patients and among them 48 patients (57.8%) suffered from difficulty in expectoration. Postoperative expectoration mostly depends on the ability of coughing. To evaluate cough dynamics, expiratory flow-rate and volume at voluntary maximal cough were measured. The more expiratory flow rate and volume a cough has, the more effective it is for expectoration. In those patients with decreased FEV1.0, or respiratory muscle weakness because of emaciation and aging, or severe pain in the wound, the cough dynamics was decreased. By cleaning retained secretions in the respiratory tract, postoperative pulmonary complications would be prevented. However in cases where the decrease in postoperative cough dynamics is predictable, application of limited resection should be considered as well.

Aged↗