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PubMed2002

Difference in symptoms suggesting pulmonary tuberculosis among men and women.

Longer delays in diagnosis and lower case-detection of tuberculosis (TB) among women remain a problem in many countries. This study describes reported symptoms of new smear-positive pulmonary TB among men and women, and their association with TB diagnostic delays. All 1,027 new smear-positive pulmonary TB cases aged 15 years or over (757 men and 270 women) diagnosed by 23 district TB units of four provinces in Vietnam during 1996 were interviewed at the time of diagnosis. Among these, 540 patients diagnosed during January-June 1996 were followed up during treatment course. Pattern of symptoms was similar between the sexes. However, symptoms of cough (90.7% women, 94.7% men, P = .021), sputum expectoration (83.6% women, 89.9% men, P = .006), and hemoptysis (27.8% women, 34.9% men, P = .033) were less common among women than among men. Absence of cough and sputum expectoration was significantly associated with increased doctor's delays. Two months after treatment, cough and sputum expectoration recovered significantly more quickly among women compared to men.

Adolescent↗

PubMed2005

How appropriate is asthma therapy in general practice?

High association between burden of asthma and inadequate disease control make asthma management a major public health issue. We studied asthma management practices of general practitioners (GPs) in France to describe drug therapy and more specifically, to identify correlates of antibiotic prescriptions, a marker of inappropriate asthma management. Patients with persistent asthma aged 17-50 years were evaluated in a 12-month retrospective study using a computerized GPs database (Thales) and a patient survey, in which patients reported hospital contacts, use of oral corticosteroids and recent asthma symptoms. Therapy was described and the correlates of antibiotic prescriptions in the previous year were identified using multivariate logistic regression. During the study period, 16.4% of 1038 patients received one or more prescriptions of theophylline, 31.3% long-acting beta-agonists and 61.6% inhaled corticosteroids. Rates of prescription of antibiotics, expectorants, antihistamines, antitussives and nasal corticosteroids were 57.6, 42.0, 33.0, 19.9, and 14.4%, respectively. In parallel, 15% of patients reported at least one hospital contact for asthma and 43.1% used oral corticosteroids. Antibiotic prescriptions were more likely co-prescribed in patients using expectorants [odds ratio (OR) = 13.0, 95% confidence interval (CI) = 8.5-19.8] and antitussives (OR = 6.5, 95% CI = 3.7-11.6). Moreover, patients using courses of oral corticosteroids, and often visiting their GP (more than four times) during the study period were more likely to receive antibiotics. The results were unchanged when analyses were restricted to non-smokers and younger patients (< or = 40 years). Asthma management was sub-optimal among asthma patients treated by general practitioners in France. Antibiotics, expectorants, antihistamines, antitussives and nasal corticosteroids were commonly prescribed while asthma controllers were under-used.

Administration, Inhalation↗

PubMed1983

Isolation of Branhamella catarrhalis from sputum and tracheal aspirate.

Branhamella catarrhalis was suggested by the presence of gram-negative intracellular diplococci and confirmed by quantitative culture of the expectorated sputa of 11 patients with clinical evidence of lower respiratory tract infection. In quantitative culture, more than 20 colonies of B. catarrhalis were seen in each of the liquefied expectorated sputa at a dilution of 10(-7). Transtracheal aspirations were then performed on these 11 patients, and B. catarrhalis was isolated from the lower respiratory tract secretions of 10 of the patients. Of the 10 isolates, 5 produced beta-lactamase. None of the isolates grew on modified Thayer-Martin medium. The presence of gram-negative intracellular diplococci and the growth of B. catarrhalis on quantitative culture of expectorated sputum reliably indicates the presence of B. catarrhalis in the lower respiratory tract.

Culture Media↗

PubMed1987

Impaired tracheobronchial clearance in bronchiectasis.

Tracheobronchial clearance was measured by a radioaerosol technique in 12 patients with bronchiectasis, seven patients with chronic obstructive lung disease expectorating mucoid sputum daily (group X), eight patients with chronic obstructive lung disease but negligible sputum expectoration (group Y), and 10 healthy subjects. The patients with bronchiectasis all expectorated purulent sputum daily (mean wet weight 47 g/day), had reduced forced expiratory volume in one second (FEV1) (mean 47.5% predicted), and were unable to avoid coughing during the six hour observation period. None of the patients with bronchiectasis or the healthy subjects were current smokers. There were five current smokers in group X and six in group Y. The mean FEV1 in group X was 41% predicted and in group Y 52% predicted, both values similar to that of the patients with bronchiectasis. Tracheobronchial clearance in the first six hours after inhalation of radioaerosol was significantly (p less than 0.01) slower in patients with bronchiectasis than in matched healthy subjects despite more proximal deposition of radioaerosol (p = 0.01) and more coughing (p less than 0.01) in the former. Tracheobronchial clearance in patients with bronchiectasis was impaired to a similar degree to that in patients with chronic obstructive lung disease but no bronchiectasis.

Aged↗

PubMedDate not supplied

Airway clearance in bronchiectasis: a randomized crossover trial of active cycle of breathing techniques versus Acapella.

BACKGROUND: The efficacy of a new airway clearance device (Acapella) has not been previously investigated. Active cycle of breathing techniques (ACBT) is the standard airway clearance technique used in patients with bronchiectasis. OBJECTIVE: The objective of this study was to compare the efficacy of ACBT with Acapella as methods of airway clearance in adults with stable, productive bronchiectasis. METHODS: Twenty patients (7 males), age 58 +/- 11 years (mean +/- SD), FEV1 64 +/- 22% predicted with stable (change of not greater than FEV1 10% predicted during 3 months prior to study), productive (history of expectoration of half an egg cup sputum/day) bronchiectasis attended the respiratory clinic on 3 days. Day 1: 40-min training session on ACBT and Acapella. Days 2 and 3: 30-min treatment session of either ACBT or Acapella. Treatment order was determined by a concealed randomization procedure. The following outcomes were measured before and after treatment spirometry, SpO2 and breathlessness by an independent assessor who was blinded to treatment order. Weight of sputum (during treatment plus 30 min after treatment), number of coughs and patient preference were also recorded. RESULTS: No significant differences were found at baseline indicating that patients were stable. No significant differences were found between weight of sputum expectorated with ACBT treatment and weight of sputum expectorated with Acapella treatment--mean difference 0.54 g (95% CI -0.39 to 1.46). A greater proportion of patients preferred Acapella (14/20). CONCLUSION: Acapella is as effective a method of airway clearance as ACBT and may offer a user-friendly alternative to ACBT for patients with bronchiectasis.

Airway Obstruction↗

PubMed2006

Increased salivary fluoride concentrations after post-brush fluoride rinsing not reflected in dental plaque.

The aim of the present study was to assess fluoride concentrations in unstimulated saliva and buccal dental plaque 6 h after an oral hygiene procedure that consisted of brushing with an AmF/SnF2 dentifrice and different post-brush rinsing protocols: expectorating the excess of dentifrice foam and rinsing with tap water, expectorating only, or rinsing with 10 ml AmF/SnF2 mouthwash. The fluoride concentrations in plaque and saliva were increased after all three experimental protocols compared to F-free periods. The increase of the fluoride concentration in saliva was more pronounced after AmF/SnF2 mouthrinse as compared to rinsing with water and expectorating the excess of dentifrice foam. Such an effect was not seen in dental plaque. It is concluded that the potentially beneficial effect of not rinsing or fluoride rinsing after tooth brushing is not reflected in an increased fluoride concentration in newly formed dental plaque 6 h after brushing.

Adult↗

PubMedDate not supplied

Bacterial colonization of the upper respiratory tract of patients with primary lung cancer and nonmalignant lung disease.

We examined the bacterial colonization of the upper respiratory tract of 110 patients with primary lung cancer (PLC), 75 patients with nonmalignant lung diseases (NMLD) and 45 healthy volunteers (HV), comparing the sensitivity of expectorated sputum, and throat and nasal swabs. The frequency of bacterial colonization of the upper respiratory tract was significantly higher in the PLC patients (59.1%) than in NMLD patients (37.3%, p < 0.01) and HV (37.8%, p < 0.01). The frequency of gram-negative colonization was significantly higher in PLC patients than in the other subjects (p < 0.01). Expectorated sputum and nasal swab were the most sensitive for detection of whole bacteria and methicillin-resistant Staphylococcus aureus in the patients with PLC. Our results showed that PLC patients are significantly more frequently colonized by bacteria in their upper respiratory tracts and that a combination culture of expectorated sputum and nasal swab is suitable to estimate the bacterial colonization of the upper respiratory tract in the patients.

Adult↗

PubMed1994

Comparison of intrapulmonary percussive ventilation and chest physiotherapy. A pilot study in patients with cystic fibrosis.

STUDY OBJECTIVE: To compare the intrapulmonary percussive ventilator (IPV) to chest physiotherapy (P&PD) with respect to acute changes in (1) pulmonary function and (2) sputum physical properties in patients with cystic fibrosis (CF). DESIGN: Randomized crossover. SETTING: Community-based CF referral center. PARTICIPANTS: Nine nonhospitalized person (range, 7 to 40 years; median, 12.4 years) with moderate to excellent Shwachman scores. INTERVENTIONS: Three treatment regimens: (1) 2.5 mg albuterol delivered via IPV (internal percussive component activated); (2) 2.5 mg. albuterol delivered via IPV (internal percussive component inactivated), followed by P&PD; and (3) 2.5 mg albuterol delivered via updraft nebulizer, followed by P&PD. MEASUREMENTS AND RESULTS: Outcome measures included pulmonary function testing (PFTs) and quantitative and qualitative sputum analysis. Among the three treatment groups, there were no significant differences in the change in predicted PFTs 1 h or 4 h after treatment, nor in the volume of sputum expectorated in the first 4 or in the subsequent 20 h. Among patients receiving IPV, more serious disease was associated with greater improvement in FEF25-75 1 h after treatment, but these differences disappeared by 4 h. There were no meaningful differences in viscoelastic characteristics of sputum expectorated after each treatments. Participants reported general satisfaction with no adverse effects while using IPV. CONCLUSIONS: This initial pilot study suggests (1) stable patients with CF tolerated one treatment of IPV without adverse sequelae, and (2) IPV was as effective as standard aerosol and P&PD in improving short-term PFT results and enhancing sputum expectoration.

Adolescent↗

PubMed2006

Chronic cough due to chronic bronchitis: ACCP evidence-based clinical practice guidelines.

BACKGROUND: Chronic bronchitis is a disease of the bronchi that is manifested by cough and sputum expectoration occurring on most days for at least 3 months of the year and for at least 2 consecutive years when other respiratory or cardiac causes for the chronic productive cough are excluded. The disease is caused by an interaction between noxious inhaled agents (eg, cigarette smoke, industrial pollutants, and other environmental pollutants) and host factors (eg, genetic and respiratory infections) that results in chronic inflammation in the walls and lumen of the airways. As the disease advances, progressive airflow limitation occurs, usually in association with pathologic changes of emphysema. This condition is called COPD. When a stable patient experiences a sudden clinical deterioration with increased sputum volume, sputum purulence, and/or worsening of shortness of breath, this is referred to as an acute exacerbation of chronic bronchitis as long as conditions other than acute tracheobronchitis are ruled out. The purpose of this review is to present the evidence for the diagnosis and treatment of cough due to chronic bronchitis, and to make recommendations that will be useful for clinical practice. METHODS: Recommendations for this section of the review were obtained from data using a National Library of Medicine (PubMed) search dating back to 1950, performed in August 2004, of the literature published in the English language. The search was limited to human studies, using the search terms "cough," "chronic bronchitis," and "COPD." RESULTS: The most effective way to reduce or eliminate cough in patients with chronic bronchitis and persistent exposure to respiratory irritants, such as personal tobacco use, passive smoke exposure, and workplace hazards is avoidance. Therapy with a short-acting inhaled beta-agonist, inhaled ipratropium bromide, and oral theophylline, and a combined regimen of inhaled long-acting beta-agonist and an inhaled corticosteroid may improve cough in patients with chronic bronchitis, but there is no proven benefit for the use of prophylactic antibiotics, oral corticosteroids, expectorants, postural drainage, or chest physiotherapy. For the treatment of an acute exacerbation of chronic bronchitis, there is evidence that inhaled bronchodilators, oral antibiotics, and oral corticosteroids (or in severe cases IV corticosteroids) are useful, but their effects on cough have not been systematically evaluated. Therapy with expectorants, postural drainage, chest physiotherapy, and theophylline is not recommended. Central cough suppressants such as codeine and dextromethorphan are recommended for short-term symptomatic relief of coughing. CONCLUSIONS: Chronic bronchitis due to cigarette smoking or other exposures to inhaled noxious agents is one of the most common causes of chronic cough in the general population. The most effective way to eliminate cough is the avoidance of all respiratory irritants. When cough persists despite the removal of these inciting agents, there are effective agents to reduce or eliminate cough.

Bronchitis, Chronic↗

PubMed1978

The Philadelphia Pulmonary Neoplasm Research Project. Symptoms in occult lung cancer.

In a prospective study of 6,027 older men screened every six months for ten years by means of chest photofluorograms and questionnaires regarding symptoms, 121 developed lung cancer after the first examination. Eighty-five men with lung cancer had the opportunity to be screened eight times before the tumor was detected by chest x-ray film, but only 33 actually reported that often. These 33 men were compared with matched controls for symptoms before the neoplasm was detected radiologically. The common symptoms of expectoration and chronic cough showed a significant increase in frequency over time in the cases of cancer, while only expectoration showed a slight increase in the controls. Uncommon symptoms more suggestive of lung cancer (hemoptysis and worsening cough) occurred in only four men prior to detection of cancer. Symptoms are seldom useful in the detection of occult lung cancer, but the appearance of expectoration and chronic cough in older male smokers should raise a suspicion of this disease.

Chronic Disease↗

PubMed1985

Effects of suctioning devices on oral fluoride retention.

This study examined the effectiveness of suctioning devices in reducing oral fluoride retention after professional 4-minute applications of a 1.23% fluoride gel. The value of patient expectoration was also evaluated in the child subjects. The suction devices were statistically significant adjuncts in reducing oral-retained fluoride in all cases; however, the oral-retained fluoride doses after the suctioning procedures were still distinct in both adults (10.3 +/- 2.3 mg) and children (7.7 +/- 1.0 mg). These amounts of oral-retained fluoride would result in substantial elevations in body fluid fluoride concentrations. One minute of expectoration after the suctioning procedures in children was a statistically significant method of further reducing oral fluoride retention to a clinically acceptable level (1.6 +/- 0.5 mg). We recommend that suction devices be used during topical fluoride treatments, but most importantly that the patients be requested to expectorate thoroughly after topical treatment.

Adult↗

PubMed1999

[Acute effects of the breathing of industrial waste and of sulfur dioxide on the respiratory health of children living in the industrial area of Puchuncaví, Chile].

This study investigated the acute effect of air pollution on the respiratory health of children living in the industrial area of Puchuncaví, in Region V of Chile. The 114 children studied were from 6 to 12 years old; 57 of them had chronic respiratory symptoms and 57 did not. Each day for 66 days the air was checked for levels of sulfur dioxide (SO2) and of breathable particles that were < 10 microns (PM10). The children were selected and classified according to their susceptibility to chronic respiratory disease by means of a questionnaire used with 882 children living within the area of the emissions from a copper foundry and a thermoelectric plant. Each day, each studied child's peak expiratory flow (PEF) and incidence of respiratory symptoms were checked and recorded. Using regression models (generalized estimation equations), estimates were made of the association of SO2 and PM10 levels with PEF and the incidence of cough, expectoration, episodes of wheezing, dyspnea, and use of bronchodilators. Among the children who were initially symptomatic, an increase of 50 micrograms/m3 in the daily mean level of SO2 caused a reduction of -1.42 L/min (95% confidence interval (95% CI): -2.84 to -0.71) in the PEF of the following day. An increase of 30 micrograms/m3 in the cumulative concentration of PM10 over three days produced a PEF reduction of -2.84 L/min (95% CI: -4.26 to 0.00). With respect to symptoms, an increase of 30 micrograms/m3 in the weekly mean level of PM10 was related with a 26% increase (odds ratio (OR) = 1.26; 95% CI: 1.01 to 1.57) in the incidence of cough and of 23% (OR = 1.23; 95% CI: 1.00 to 1.50) in the incidence of expectoration. An increase of 50 micrograms/m3 in the mean level of SO2 for three days was associated with a 5% increase (OR = 1.05; 95% CI: 1.00 to 1.10) in the incidence of expectoration. An increase of 30 micrograms/m3 in the daily average of PM10 increased the use of bronchodilators two days later by 10% (OR = 1.10; 95% CI: 1.03 to 1.18). Among the initially asymptomatic children, a significant effect from PM10 exposure was found after an increase of 30 micrograms/m3 in the mean daily PM10 level, with a reduction of -1.34 L/min (95% CI: -2.68 to -0.67) in the PEF of the following day. A similar increase in the cumulative exposure over three days was associated with an increase of 9% in the incidence of episodes of wheezing (OR = 1.09; 95% CI: 1.01 to 1.31). It is concluded that high levels of PM10 and SO2 affect the respiratory health of children living in the industrial area of Puchuncaví.

Allergens↗

PubMed1996

A fibrous histiocytoma with a polypoid pattern of growth in a major bronchus.

A 47-year-old man was admitted to our hospital for abrupt onset of hemoptysis and dyspnea. Chest roentgenography revealed a left lower mass shadow with obstruction of the left main bronchus. However, on the third hospital day, he expectorated a coagulum-like substance which resembled bronchial tree, and his symptoms then dramatically subsided. Except for small amounts of bleeding from left B10a, the endobronchus was intact on bronchoscopic examination, and the pathologic diagnosis of the tumor using resected material was fibrous histiocytoma of low-grade malignancy. In addition, given the similarity in histologic findings between the expectorated substance and resected tumor, the expectorated substance was considered to be a part of the tumor which had grown along the endobronchial tree.

Bronchi↗

PubMed1976

Optimal visualization of esophageal varices.

Twelve patients with known esophageal varices and willingness to cooperate were included in the study. Medications administered were placebo, 2 mg of glucagon, and 30 mg of propantheline bromide. All medications were given double-blind and crossover. On the basis of this study the authors believe that for optimal visualization of esophageal varices the following is the procedure of choice: (1) the patient should remain horizontal (this is best done in the left lateral position for comfort and ease of expectoration) for ten minutes after swallowing high density barium; (2) the patient should "clear his throat" frequently and expectorate all saliva (barium sticks to the pharynx and makes the patient want to swallow and "clearing his throat" by forced expiration helps the patient to expectorate this coating and prevents swallowing); (3) filming should be done in expiration in the supine (left posterior oblique to table top) position; and (4) in equivocal cases the examination can be repeated with an anticholinergic drug if the patient has no contraindications to its use. The patient should empty his bladder just before administration of the drug. The intelligent use of these factors should result in a saving of both fluoroscopic time and film, and give the radiologist a safe optimal diagnostic yield.

Adult↗

PubMed1985

Plastic bronchitis: large, branching, mucoid bronchial casts in children.

Expectoration of large, branching, bronchial casts, termed plastic bronchitis, is an uncommon condition in children. Asthma or allergy often is the cause of cast production, but in some instances no etiology is found. Five children produced large, obstructing bronchial casts that either were expectorated or were extracted at bronchoscopy. Four of the children had asthma or allergies and the fifth had congenital tricuspid atresia and chronic pericardial and pleural effusions. In two patients, expectorated casts initially were thought to be aspirated food material. Radiographic findings during periods of cast formation included atelectasis, obstructive emphysema, bronchiectasis, pleural effusion, and pneumomediastinum. Cast formation may be self-limited but generally ceases with appropriate treatment of the causative disorder. Bronchoscopic extraction of casts may benefit some patients.

Asthma↗

PubMed2003

Diagnostic contribution of gastric and bronchial lavage examinations in cases suggestive of pulmonary tuberculosis.

We assessed whether acid fast bacilli (AFB) determination in gastric lavage (GL) and bronchial lavage (BL) contributes to diagnosis in cases radiologically suggestive of pulmonary tuberculosis but with either negative AFB in sputum or the inability to expectorate sputum. Of 129 cases recruited for the study, 22 were excluded due to evaluation as inactive disease or non-tuberculosis disease. The remaining 107 cases were evaluated in 2 groups. Group A consisted of 49 patients that could not expectorate sputum and from whom GL was obtained. In group B, BL was performed in 58 patients that had negative sputum smear. Smear positivity was 61.2% (30/49) and culture positivity was 30.6% (15/49) in group A, 51.7% (30/58) and 81% (47/58), respectively, in group B. Thirteen cases, in whom AFB could not be detected microbiologically but who were radiologically strongly suggestive of tuberculosis, were regarded as tuberculosis according to "from treatment to diagnosis" criteria. In conclusion, detection of AFB positivity in the diagnosis of tuberculosis is important in terms of early initiation of treatment and detection of resistant bacilli. Therefore, we suggest that it would be helpful to obtain GL in cases where the patient is unable to expectorate sputum, and perform BL in cases with negative sputum smear.

Adult↗

PubMed1999

[Duration of anamnesis in patients with hemoptysis].

The duration of anamnesis and its dependence on the amount of expectorated blood and on concomitant complaints was evaluated in 774 patients examined for hemoptysis in the Department of Respiratory Diseases and Tuberculosis, Faculty Hospital, Brno, with the aim to detect the factors hastening the visiting the physician by the patient. The longest anamnesis in average was in patients with COPD (123 days) and lung cancer (58 days). The patients coming too late to the physician originated mostly from these 2 groups as well--the anamnesis was longer than 2 months in 27% out of COPD patients and in 25% out of cancer patients. After including the influence of the amount of expectorated blood and of the concomitant complaints, the conclusion was reached that the bloody expectoration alone especially when streaks of blood only are present in sputum represent in many patients the motive not important enough for consulting the physician.

Female↗

PubMed2001

The causes of massive hemoptysis.

In a group of 656 patients examined for hemoptysis of unknown etiology the average amount of expectorated blood in individual diagnostic groups was evaluated and the patients with massive hemoptysis (> 100 ml/24 hrs) were selected. The hemoptysis was evaluated as massive in 53 patients (8%), being most frequent in patients with chronic anatomical changes of lung parenchyma (22/64) and active tuberculosis (4/26). The fact that massive hemoptysis endangers above all patients with bronchiectasis and other anatomical disorders of the lung parenchyma was evident through the comparison of the average maximal amount of expectorated blood, which was significantly higher in this group (78 ml/24 hrs) than in the majority of other diagnoses (total average 22 ml/24 hrs). In conclusion, the risk of sudden massive hemoptysis should be kept in mind in these patients even if only minimal bleeding occurs and energetic cautionary measures should be implemented right from the onset of bloody expectoration.

Female↗