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PubMed1993

Randomized placebo-controlled trials of antibiotics for acute bronchitis: a critical review of the literature.

BACKGROUND: Acute bronchitis is a common clinical problem that causes considerable morbidity and presents both diagnostic and treatment dilemmas for the physician. An evaluation of all published randomized controlled trials of antibiotics in the treatment of acute bronchitis was conducted to (1) quantitatively assess methodologic rigor, (2) determine if effectiveness of antimicrobial therapy is known, and (3) analyze strengths and weaknesses of randomized controlled trials in family practice settings. METHODS: A scoring system for the evaluation of randomized controlled trials was adapted for this study. Four raters, who were blinded to which journals published the studies and the type of antibiotic used in each study, assessed the six-randomized clinical trials for treatment of bronchitis identified through a literature search. The trials were rated according to criteria that measured internal validity. RESULTS: Scores for internal validity ranged from 65.5 to 102.5 points with a maximum possible score of 120 points (54.6% to 85.4%). The two trials with the highest scores assessed doxycycline and showed no benefit from use of this antibiotic. Single trials that studied erythromycin and trimethoprim-sulfamethoxazole showed improvement in outcome from use of these drugs; however, of the six trials, these two studies ranked fourth and fifth for internal validity. Low scores resulted from small sample size, possible contamination with other treatment measures, and poor assessment of subjects' compliance with antibiotic regimen. CONCLUSIONS: An evaluation of the current literature does not support antibiotic treatment for acute bronchitis. Further studies of this common illness are indicated. It is hoped that this critical review of randomized control trials will prove useful in the planning of future studies, in placing greater emphasis on methodologic rigor, and in giving greater consideration to the practical constraints of research in the family practice setting.

Acute Disease↗
PubMed1995

Asthma and chronic bronchitis. Can family physicians predict rates of progression?

OBJECTIVE: To investigate whether the progression rate of asthma or chronic bronchitis can be predicted from a cross-sectional assessment of features that can be measured by family physicians. DESIGN: Secondary analysis of data from a 2-year randomized, controlled bronchodilator intervention study in family practice. SETTING: Twenty-nine general practices in the eastern part of The Netherlands. PATIENTS: One hundred sixty patients (101 with chronic bronchitis, 59 with asthma) from the 29 general practices. INTERVENTIONS: Predictors were related to the annual decline in lung function (the forced expiratory volume in one second) by means of multiple analysis of variance, controlling for age, sex, smoking habits, initial FEV1 level, bronchial hyperresponsiveness, reversibility of obstruction, and medication during the study. MAIN OUTCOME MEASURES: Predictors of the annual decline in lung function (FEV1), which is believed to be the most important measure for progression. RESULTS: Only three variables predicted the decline in lung function: having a barrel-shaped chest, experiencing wheezing, and an unusual diurnal peak-flow rate index. Wheezing was the best predictor of the annual decline in lung function. In chronic bronchitis, the decline in FEV1 of wheezing patients was 133 mL/y compared with 62 mL/y for non-wheezing patients (P < 0.05). In asthma with more severe symptoms, wheezing patients had a tendency to decline 156 mL/y compared with 57 mL/y among non-wheezing patients (P = 0.08). CONCLUSIONS: It is nearly impossible to predict the progression rate of asthma or chronic bronchitis from symptoms, physical signs of the chest, and the PEFR. Therefore, patients with a rapid progression rate can probably be detected only by monitoring progression of the disease through repeated lung function testing.

Asthma↗
PubMed1996

[Symptoms and life of patients with chronic bronchitis. Preliminary results].

Improvement in the bronchial obstruction is the aim of treatment for patients with chronic bronchitis. In this work, we attempted to identify subjective psychosocial and neurophysiological factors which are essential for understanding the quality of life in these patients. The study included 77 male patients under 80 years of age who were diagnosed as having chronic bronchitis by their family physician. In all cases, the disease state was stable without any other complication or co-morbidity. Each patient responded to a questionnaire and underwent volume-flow tests. The population was divided into 2 groups by VEMS: VEMS > or = 50% (n = 48) and VEMS < 50 (n = 19). Main component analysis followed by varimax rotation was used to analyse data. A Cronbach coefficient was calculated to measure data skewness. The Pearson correlations were calculated for the different factors. Mean intergroup means were compared with the unpaired t test. Data analysis demonstrated two physical factors: dyspnea and bronchial obstruction; 4 psychological factors: anxiety, impotency/hopeless feeling, depression, fatigue: and one psychological trait. Key symptoms of chronic bronchitis developed in patients with affective states contributing to the patient's subjective description of his disease and influencing therapeutic management. A better understanding of these patients is needed to improve treatment of chronic bronchitis.

Adult↗
PubMed1996

[Chronic obstructive bronchitis in a fodder farming setting].

Respiratory disease in agricultural workers are dominated both in terms of frequency and severity by chronic obstructive long disease. In the Doubs, in dairy cereal farmers, the prevalence of chronic bronchitis in active farm workers is around 10 per cent, and 6 per cent are non-smokers. It is twice the level of the control population of non-exposed subjects. The frequency is most elevated in the men and increases both with age and with altitude. A longitudinal study of male farm workers aged more than 45 has shown that there is an abnormally rapid loss of forced expired volume in one second (FEV1). Two different studies carried out in the Doubs have revealed epidemiological, respiratory function and immunological arguments in favour of immuno-allergic mechanisms. Notably, obstructive chronic bronchitis (OCB) occurs more frequently in agricultural workers with a previous history of farmer's lung or previous sub-acute delayed symptoms in relation to exposure. On the other hand, there are no close links between OCB and the intensity of antigenic exposure (the total quantity of fodder handled). By contrast, there is a relationship between exposure to thermophillic actinomycetes (antigen of farmer's lung) and OCB. The frequency of serum precipitins is most elevated in farm workers with OCB than in asymptomatic agricultural workers. Finally, non-smokers who are suffering from OCB without evidence of farmer's lung, have a respiratory function profile and also alveolar lavage cell pattern characteristic of extrinsic allergic alveolitis after provocation tests to mouldy hay. These arguments are in favour of immuno-allergic mechanisms in the pathogenesis of chronic bronchitis in farm workers which seems to be well differentiated from chronic bronchitis due to smoking.

Actinomyces↗
PubMed1977

[Epidemiological study of chronic bronchitis in a population of workers in a fertilizer factory].

The authors investigated the influence of working conditions--with particular reference to dust and fluorite pollution--on the epidemiology of chronic bronchitis in 197 subjects working in a fertilizer producing plant in Krakow (Poland). The investigation included history, respiratory function tests (VC, TVC), height and weight measurement, rhinolaryngologic examination, nasal mucosa cytology and physical examination. The environmental survey included measurements of the dust respirable fraction and fluorite concentration in the air. The prevalence of chronic bronchitis was found to increase with the length of working activity and to be much higher in smokers than in non-smokers. Furthermore, in subjects working at the sites with the worst environmental situations it proved to be twice as high as in the remainders. Likewise higher proved to be the prevalence of laryngitis and sinusitis. The prevalence of chronic bronchitis was found to be much higher in workmen with more marked spirometric changes. In subjects affected with chronic bronchitis alterations of the nasal mucosa epithelium were also found.

Adult↗
PubMed1996

[Prospects of etiological diagnosis of bronchitis].

Serum antibodies to soft tissue elements, levels of elastase, trypsin, trypsin inhibitor, alpha(2)-macroglobulin were measured to make a differential diagnosis of dust with nonoccupational bronchitis. For dust and nondust bronchitis titers of antibodies to collagen and elastin were different, serum enzymatic activity changed as a result of reduced concentration of trypsin and high elastase in dust bronchitis patients. Using the above results facilitates etiological diagnosis of bronchitis in workers exposed to dust by immunological methods as well as expertise of occupational bronchopulmonary pathology.

Antibodies↗
PubMedDate not supplied

[The prevalence of bronchial asthma, chronic bronchitis and COBP in representative samples of the adult population].

In order to organize the management of asthma bronchiale and chronic bronchitis, in our country, it is compulsory to know the prevalence of these diseases in the autochthonous population. The ECRHS questionnaire (by interview) and lung function tests were applied in three random population samples aged by 18 years and over. The samples were selected from the electoral rolls and coming from three different economic and geographic regions of our country. The questionnaire were administered by trained pneumologists and lung function testing by well trained technicians. The results were stored and processed on computer using the EPI INFO program. The prevalence of asthma bronchiale was: 4.09%, 6.60%, 1.70%. The prevalence of chronic bronchitis was: 12.28%, 10.11%, 7.98%. The prevalence of chronic obstructive bronchitis was: 1.79%, 2.50%, 1.89%. Generally, the prevalence of asthma bronchiale was found close to the values obtained in other studies, of identical conditions. It was particularly close to the results of Italian researchers who studied a population aged by 20 years and over from the northern Italy. The prevalence of chronic bronchitis was near by the value mentioned by Scandinavian epidemiologists. Analytic epidemiology would specify the causes of the variations we founded in the three studied samples.

Adult↗
PubMed1997

[A functional-morphological study of the mucociliary system at stages in the disease in patients with chronic bronchitis].

Combined morpho-functional study of the mucociliary system in patients with chronic bronchitis at different stages of its development was made. Regional mucociliary clearance was evaluated by dynamic aerosol scintigraphy and electron microscopy. Radiography of bronchial biopsies was performed, rheological properties of bronchial content were also determined. Special characteristics of mucociliary main chains were established at each stage of chronic bronchitis development as well as depending on the type of bronchitis, bronchial tree level and phase of the disease. New hypothesis on chronic obstructive bronchitis genesis was substantiated.

Adolescent↗
PubMedDate not supplied

Effect of cytoxan-induced heteropenia on the response of specific-pathogen-free chickens to infectious bronchitis.

Epithelial damage in infectious bronchitis occurs early in the disease process. Heterophil infiltration into the tracheal mucosa is greatest at that time. To determine the contribution of heterophils to tracheal epithelial damage of infectious bronchitis, eight 3-wk-old specific-pathogen-free chickens were made heteropenic by four daily intramuscular injections of cyclophosphamide at 75 mg/kg body weight. Infection with Massachusetts 41 infectious bronchitis virus was timed to coordinate heteropenia with peak tracheal epithelial damage. Heteropenia was monitored by total leukocyte and differential cell counts of peripheral blood. Tissue damage and heterophil infiltrate were monitored by histopathology of tissues taken at termination of the study. Heteropenic birds had lower peripheral blood and tracheal heterophil numbers than nonheteropenic birds. No difference was found in epithelial damage of heteropenic and nonheteropenic birds. Epithelial damage in infectious bronchitis is most likely due to damage by the virus and not due to the infiltrated heterophils.

Animals↗
PubMed1997

[Chemotactic monocyte and activation factor (MCAF/MCP1)in material from bronchoalveolar lavage fluid of patients with chronic bronchitis].

UNLABELLED: The aim of this study was to evaluate concentrations of monocyte chemotactic and activating factor (MCAF/MCP1) in bronchoalveolar lavage fluid (BAL) from patients with chronic bronchitis. 32 patients (aged 46 +/- 2 years) with chronic bronchitis and 14 patients (aged 30.5 +/- 3.4 years) of control group took part in this study. ELISA test (kits from R&D, USA) was used to measure concentrations of this chemokine in BALF. The results indicate for significant increase of MCAF/MCP1 in BALF from patients with chronic bronchitis (mean +/- SEM = 393 +/- 105.9 pg/ml) as compared from those of control group (middle +/- SEM = 36.4 +/- 10.9 pg/ml). CONCLUSION: MCAF/MCP1 may participate in creation of inflammatory changes of airways in patients with chronic bronchitis.

Adult↗
PubMed1998

Chronic bronchitis: primary care management.

Chronic bronchitis is a clinical diagnosis characterized by a cough productive of sputum for over three months' duration during two consecutive years and the presence of airflow obstruction. Pulmonary function testing aids in the diagnosis of chronic bronchitis by documenting the extent of reversibility of airflow obstruction. A better understanding of the role of inflammatory mediators in chronic bronchitis has led to greater emphasis on management of airway inflammation and relief of bronchospasm. Inhaled ipratropium bromide and sympathomimetic agents are the current mainstays of management. While theophylline has long been an important therapy, its use is limited by a narrow therapeutic range and interaction with other agents. Oral steroid therapy should be reserved for use in patients with demonstrated improvement in airflow not achievable with inhaled agents. Antibiotics play a role in acute exacerbations but have been shown to lead to only modest airflow improvement. Strengthening of the respiratory muscles, smoking cessation, supplemental oxygen, hydration and nutritional support also play key roles in long-term management of chronic bronchitis.

Algorithms↗
PubMedDate not supplied

[Anti-RS viral IgE in respiratory syncytial viral infection in adult patients with a complicated course of bronchitis].

In adult patients with different variants of the complicated course of bronchitis (prolonged, relapsing, chronic) respiratory syncytial (RS) virus infections were shown to occur very frequently (37-72%, depending on the form on bronchitis). In 220 cases of RS infection the content of anti-RS-virus IgE in the blood was analyzed. The reaction of specific IgE was more pronounced in RS infection observed in patients with acute of bronchitis, than in those with chronic forms. The occurrence of RS-virus infections and reinfections was shown to be directly related to the presence of the broncho-obstructive syndrome in patients. The direct correlation between high levels of serum anti-RS-virus IgE and the presence of bronchospasms in patients, revealed in this study, was indicative of the possible pathogenetic role of this immunoglobulin: the Pearson association factor (rA) was 0.32, p < 0.01. Depending on the specific features of the clinical course of bronchitis, differences in the dynamics and speed on immune response, in the duration of the preservation of anti-RS-virus IgE in the blood, as well as in the character of the reaction of this immunoglobulin to single and multiple RS-virus lesion, were observed.

Acute Disease↗
PubMed2005

Transcript signatures of lymphocytic bronchitis in lung allograft biopsy specimens.

BACKGROUND: Rejection and obliterative bronchiolitis are barriers to sustained graft function in recipients of transplanted lungs. Early detection is hindered by inadequate tests and an incomplete understanding of the molecular events preceding or accompanying graft deterioration. METHODS: Hypothesizing that genes involved in immune responses and tissue remodeling produce biomarkers of rejection, we measured the expression of 192 selected genes in 72 sets of biopsy specimens from human lung allografts. Gene transcripts were quantified using a 2-step, multiplex, real-time polymerase chain reaction approach in endobronchial and transbronchial biopsy specimens from transplant recipients without acute infections undergoing routine surveillance bronchoscopy. RESULTS: Comparisons of histopathology in parallel biopsy specimens identified 6 genes correlating with rejection as manifested by lymphocytic bronchitis, a suspected harbinger of obliterative bronchiolitis. For example, beta2-defensin and collagenase transcripts in inflamed bronchi increased 37-fold and 163-fold, respectively. By contrast, these transcripts did not correlate with acute rejection in transbronchial specimens. Further, no correspondence was noted between histopathologic bronchitis and parenchymal rejection when endobronchial and transbronchial samples were obtained from the same patient. CONCLUSIONS: Our highly sensitive method permits quantitation of many gene transcripts simultaneously in small, bronchoscopically acquired biopsy specimens of allografts. Transcript signatures obtained by this approach suggest that airway and alveolar responses to rejection differ and that endobronchial biopsy specimens assess lymphocytic bronchitis and chronic rejection but are not proxies for transbronchial biopsy specimens. Further, they reveal changes in airway expression of the specific genes involved in host defense and remodeling and suggest that the measurement of transcripts correlating with lymphocytic bronchitis may be diagnostic adjuncts to histopathology.

Adult↗
PubMed2004

Attachment of mothers and children with recurrent asthmatic bronchitis.

OBJECTIVE: This study on attachment in children with recurrent asthmatic bronchitis and their mothers addresses three issues. The first aim was to test whether children affected by recurrent asthmatic bronchitis more often display an insecure pattern of attachment in comparison with healthy children. The second aim was to verify whether the distribution of adult attachment representations in the mothers of children affected by recurrent asthmatic bronchitis is different from the one shown by the mothers of the healthy comparison group. The third aim was to investigate intergenerational transmission of attachment. METHODS: Sixty Italian children, aged between 2 and 5 years, and their mothers participated in the study. The Adult Attachment Interview and the Attachment Q-Sort were used to assess, respectively, the security of mothers' attachment representations and of mother-child attachment. RESULTS: Children affected by recurrent asthmatic bronchitis appeared to be less secure in comparison with healthy children. Their mothers showed a higher percentage of insecure attachment representations. Finally, the intergenerational transmission of attachment was not influenced by the preclinical condition of the children. CONCLUSIONS: We propose a model of genetic and social transmission of insecure attachments in families struggling with asthma.

Adult↗
PubMed2002

Genome-wide linkage analysis of severe, early-onset chronic obstructive pulmonary disease: airflow obstruction and chronic bronchitis phenotypes.

Familial aggregation of chronic obstructive pulmonary disease (COPD) has been demonstrated, but linkage analysis of COPD-related phenotypes has not been reported previously. An autosomal 10 cM genome-wide scan of short tandem repeat (STR) polymorphic markers was analyzed for linkage to COPD-related phenotypes in 585 members of 72 pedigrees ascertained through severe, early-onset COPD probands without severe alpha1-antitrypsin deficiency. Multipoint non-parametric linkage analysis (using the ALLEGRO program) was performed for qualitative phenotypes including moderate airflow obstruction [forced expiratory volume at one second (FEV(1)) < 60% predicted, FEV(1)/FVC < 90% predicted], mild airflow obstruction (FEV(1) < 80% predicted, FEV(1)/FVC < 90% predicted) and chronic bronchitis. The strongest evidence for linkage in all subjects was observed at chromosomes 12 (LOD = 1.70) and 19 (LOD = 1.54) for moderate airflow obstruction, chromosomes 8 (LOD = 1.36) and 19 (LOD = 1.09) for mild airflow obstruction and chromosomes 19 (LOD = 1.21) and 22 (LOD = 1.37) for chronic bronchitis. Restricting analysis to cigarette smokers only provided increased evidence for linkage of mild airflow obstruction and chronic bronchitis to several genomic regions; for mild airflow obstruction in smokers only, the maximum LOD was 1.64 at chromosome 19, whereas for chronic bronchitis in smokers only, the maximum LOD was 2.08 at chromosome 22. On chromosome 12p, 12 additional STR markers were genotyped, which provided additional support for an airflow obstruction locus in that region with a non-parametric multipoint approach for moderate airflow obstruction (LOD = 2.13) and mild airflow obstruction (LOD = 1.43). Using a dominant model with the STR markers on 12p, two point parametric linkage analysis of all subjects demonstrated a maximum LOD score of 2.09 for moderate airflow obstruction and 2.61 for mild airflow obstruction. In smokers only, the maximum two point LOD score for mild airflow obstruction was 3.14. These observations provide suggestive evidence that there is a locus on chromosome 12p which contributes to susceptibility to early-onset COPD.

Adult↗
PubMed2005

Long-term treatment of plastic bronchitis with aerosolized tissue plasminogen activator in a Fontan patient.

OBJECTIVE: To report the successful treatment of plastic bronchitis with aerosolized tissue plasminogen activator. DESIGN: Case report. PATIENTS: A 4-yr-old boy with congenital heart disease, who developed plastic bronchitis 33 months after a Fontan operation INTERVENTIONS: Long-term treatment with aerosolized tissue plasminogen activator. MEASUREMENTS AND MAIN RESULTS: We describe the case of a boy who developed recurrent episodes of life-threatening airway obstruction secondary to plastic bronchitis. Following the failure of multiple therapeutic interventions, his condition improved significantly with aerosolized tissue plasminogen activator. Several attempts to wean him off this treatment resulted in clinical deterioration. He has remained on long-term aerosolized tissue plasminogen activator. CONCLUSION: Treatment of plastic bronchitis with aerosolized tissue plasminogen activator may benefit patients in whom other therapies have failed.

Administration, Inhalation↗
PubMed1981

A contribution to study of acute obstructive bronchitis and bronchopneumonia in infants.

103 infants with acute obstructive bronchitis and/or bronchopneumonia were studied. IgM and alpha-1-antitrypsin values were determined by single radial immunodiffusion. In each infant the values were studies in eight serum samples. Comparison of the time of clinical recovery and x-ray clearing of the lung and the time of normalization of IgM and alpha-1-antitrypsin was also done. In infants with acute obstructive bronchitis the clinical recovery and X-ray clearing occurred on about the 13th day from the beginning of investigation. However, the normalization of IgM and alpha-1-antitrypsin values, which were significantly increased in all investigated serum samples, did not occur even on the 44th day of investigation. In infants with acute obstructive bronchitis associated with bronchopneumonia the clinical recovery occurred on the 10th day of investigation and X-ray clearing on the 14th day. IgM and alpha-1-antitrypsin values, which were also significantly increased in all investigated serum samples, were normalized on the 44th day of investigation. In group of infants with bronchopneumonia the clinical recovery occurred, approximatively, on the 12th day, whole the x-ray clearing occurred on the 17th day of investigation. IgM and alpha-1-antitrypsin values were normalized on the 18th day of investigation. In infants with acute obstructive bronchitis and/or bronchopneumonia there is significant correlation between IgM and alpha-1-antitrypsin values. This finding could be used to evaluate which of these two disease is dominant if they occur at the same time in infant.

Bronchopneumonia↗
PubMed1982

Daily spirometric variability: normal subjects and subjects with chronic bronchitis with and without airflow obstruction.

To determine the daily variability of spirometry, we performed spirometry on five consecutive days on 15 normal subjects and on 24 patients with chronic bronchitis. The patients with chronic bronchitis were divided into the following two groups: 13 with chronic airflow obstruction (forced expiratory volume in 1 s [FEV1] 80%, FEV1/forced vital capacity [FVC] ratio less than 75%) and 11 without airflow obstruction (FEV1 and FVC greater than 80%0. We attempted to control most of the factors known to affect spirometric variability. Our results indicate that the day-to-day FEV1 has to change by 17% and the FCV by 15% in patients with airflow obstruction before the change should be considered significant. In patients with nonobstructive chronic bronchitis or in normal subjects, a greater than 5% change should occur in FEV1 and FVC before considering the change to be significant.

Adult↗