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PubMed1986

Paranasal sinus pathology in allergic and non-allergic respiratory tract diseases.

Two hundred and seventy patients with asthma and/or rhinitis (162 or 60% allergic, 108 or 40% non-allergic) were studied for sinus pathology by means of standard X-rays and tomograms. Sinus pathology was defined as abnormal sinus X-rays, either on standard or tomography. Fifty-four percent of the X-rays were classified as abnormal based on mucosal thickening, loss of translucency of the cavities of polyps. Asthma was significantly more often associated with sinus X-ray abnormalities (65.1%) than rhinitis and/or chronic cough (44.4%). Loss of translucency of the cavities is more frequent in children, whereas mucosa thickening becomes more frequent with progressing age. Since in this prospective study the taking of X-rays of the sinuses was not dependent on or related to temporarily occurring symptoms which could be attributed to acute sinusitis, the presence of sinus abnormalities on X-rays can be considered as an indicator of the chronicity of airways diseases and might provide an indication for prophylactic therapy of the associated airway disease in a continuous way. The importance of sinus tomograms is stressed, since only 32.5% of the patients with mucosa thickening could be detected on standard X-rays.

Adolescent↗
PubMed1997

[Videothoracoscopy for diagnosis and treatment of respiratory tract diseases].

Low invasive thoracoscopic and telecontrolled surgery is a new direction of modern thoracic surgery, by expanding its capacities. In patients with spontaneous pneumothorax, thoracoscopy and telecontrolled thoracoscopic surgery allow surgeons to make the same surgical interventions, as at open thoracotomy, such as laser thoracotomy and electrocoagulation of bullas, resection of bullous portions of the lung, pleurectomy and different types of pleurodesis, the postoperative period being much smoother. After thoracic and telecontrolled operations, the incidence of recurrences in patients with spontaneous pneumothorax is similar to that after open surgery. However, the less invasiveness and easier tolerance of endothoracic operations make them the method of choice in the treatment of spontaneous pneumothorax. In patients with the first episode of pneumothorax, thoracoscopic and telecontrolled interventions show a nearly 5-fold reduction in the incidence of recurrences as compared to medical treatment. In recurrent pleural exudates of unknown etiology, thoracoscopy may be considered to be the method of choice, providing 87-94% efficiency and a minimal risk, the efficiency of therapeutical pleurodesis being 85-100%. The contraindication for therapeutical pleurodesis are impediments to lung expanding and failure to eliminate them at thoracoscopy. In patients with pleural empyema, thoracoscopic surgery is indicated when a fortnight medical treatment fails and X-ray signs of extensive lung decay are absent. In diffuse lung diseases, thoracoscopic resection biopsy may substitute for open lung biopsy and indicated in inefficient transbronchial biopsy of the lung when a morphological diagnosis should be established. Its contraindications may be only in patients with severe respiratory failure when it is impossible to make anesthesia with exclusion of one lung. A correct definition of indications and contraindications for endothoracic interventions and their accurate performance are essential in preventing the complications following thoracoscopic and telecontrolled operations and in increasing their effectiveness. Timely open surgery in all technically and tactically difficult situations is a pledge of good outcomes and lower incidence rates of complications.

Adolescent↗
PubMed2005

[Quality of life. An important parameter in respiratory tract diseases].

Sinusitis is one of the most frequent diseases in humans. Despite severe complications sinusitis may be considered a non-serious disease compared to other illnesses. Therefore, sinusitis is sometimes erroneously regarded as a banal disorder. It is mostly unknown that patients suffering from sinusitis may have a marked impairment of their quality of life (QOL). The term health-related QOL comprises physical and psychological well-being as well as aspects of daily life and social life from the patient's perspective. Validated measures (questionnaires) are able to quantify the impairment of QOL as well as the influence of therapy on QOL. Especially in the treatment of sinusitis, QOL becomes a relevant additional parameter due to the fact that clinical and subjective, patient-based criteria do not correlate sufficiently. This article provides an overview of available QOL questionnaires on sinusitis, highlights results of QOL studies in sinusitis, and elucidates the relevance of QOL in clinical trials as well as in the relation between the physician and the patient.

Health Status Indicators↗
PubMed2002

Mycoplasma pneumoniae and Chlamydia pneumoniae cause lower respiratory tract disease in paediatric patients.

New studies suggest that Mycoplasma pneumoniae and Chlamydia pneumoniae play a more significant role as causes of lower respiratory tract infections in childhood than was previously thought. In particular, the incidence of infections caused by these pathogens is high in children aged less than 5 years, the infections themselves seem to be a possible cause of wheezing, and may present a more complicated course when not treated with adequate antimicrobial agents. However, despite the increasing pathogenic significance of M. pneumoniae and C. pneumoniae, progress in fighting them is hampered by the lack of rapid and standardized diagnostic methods. This not only makes it practically impossible for practitioners to make a specific microbiological diagnosis, but has also had an adverse effect on treatment trials and has generated some questionable results. Carefully randomized and controlled trials are clearly needed to examine the effectiveness of different antibiotics against M. pneumoniae or C. pneumoniae and the optimal duration of therapy in various patient populations.

4-Quinolones↗
PubMed1993

Kinins and respiratory tract diseases.

Bradykinin and related kinins are peptidic hormones, formed in tissues and fluids during inflammation. Various functional sites have been proposed as mediators of the biological effects of kinins, including the B1, B2 and B3 receptors. The existence of the B1 and the B2 receptor has largely been confirmed, whilst that of the B3 receptor is controversial and needs further confirmation. The role of bradykinin in the pathophysiology of asthma is not well understood, but bradykinin was proposed as a putative mediator of asthma, since asthmatic subjects are hyperresponsive to bradykinin, and since immunoreactive kinins are increased in the bronchoalveolar lavage fluids of asthmatic patients. Kinins could provoke bronchoconstriction by acting directly on smooth muscle and/or indirectly by their inflammatory properties. They may also contribute to the symptomatology of allergic and viral rhinitis, since they are the only mediators detected to date that are generated in nasal secretion during experimental and natural rhinovirus colds. Moreover, they can induce relevant symptoms when applied to airway mucosa. It has also been proposed that coughing during treatment with angiotensin-converting enzyme (ACE) inhibitors is linked to the action of kinins, since ACE is able to degrade kinins, and since the effects of ACE inhibitors are reduced by kinin antagonists. Due to their mitogenic properties, kinins have been proposed to regulate lung carcinoma growth. Their action remains speculative, but some findings are of great interest in order to define their role in these pathologies. Despite many studies in animals and in humans, the mode of action of kinins in airways is still poorly understood.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiotensin-Converting Enzyme Inhibitors↗
PubMedDate not supplied

Furosemide: progress in understanding its diuretic, anti-inflammatory, and bronchodilating mechanism of action, and use in the treatment of respiratory tract diseases.

Accumulated experimental and clinical data suggest that adrenocorticosteroids and/or endogenous ouabain-like substances may play an important role in the mechanism of furosemide diuretic action. It was reported that the drug is highly bound in the adrenals, lungs, kidney, spleen, and liver. In patients with liver cirrhosis, furosemide exerted a markedly decreased natriuretic effect compared with normal subjects, and the plasma levels of circulating endothelin and atrial natriuretic factor (ANF) were significantly elevated. In neonates, after administration of furosemide, the urinary excretion of endothelin-1 and aldosterone increased markedly, and it is known that endothelin may release ANF and aldosterone in a dose-dependent manner. Furosemide was used to stimulate zona glomerulosa, whereas ANF decreased the production of steroids in zona glomerulosa and fasciculata cell culture owing to stimulation by various factors. Because the concomitant use of ANF and furosemide appeared to be diuretically effective in newborns after cardiac surgery, one may suggest that furosemide competes with ANF for its effects on the adrenals. Furosemide administered by inhalation exerted a protective effect on allergic and perennial nonallergic rhinitis and was effective in preventing the postsurgical recurrence of nasal polyposis. The drug can also be used as an antiasthmatic agent. In preterm ventilator-dependent infants with chronic lung disease, aerosolized furosemide improved pulmonary function with no marked effect on diuresis. In adults and children with asthma, furosemide exerted a protective effect against bronchoconstriction induced by several indirect stimuli similar to that of disodium cromoglycate or nedocromil. Aerosolized furosemide had a preventive effect also on bronchoconstriction induced by inhaled lysine acetylsalicylate in patients with aspirin-sensitive asthma. In high-dose beclomethasone-dependent asthma, inhaled lysine acetylsalicylate and furosemide exerted a mutually potentiating antiasthmatic activity, allowing considerable sparing of the inhaled steroid. It is proposed that this effect may be explained by the corticosteroid-sparing action of lysine released from the lysine acetylsalicylate molecule because similar beneficial effects were also obtained after the concomitant use of epsilon-aminocaproic acid (whose chemical structure is almost the same as that of lysine) and prednisone. Furosemide exhibited an anti-inflammatory effect through inhibition of production and release of cytokines interleukin (IL)-6, IL-8, and tumor necrosis factor-alpha from peripheral mononuclear cells, which may have a beneficial effect on local inflamed tissue imbalance in the ratio of different cytokines, thus improving the sensitivity of target cells to endogenous glucocorticosteroids.

Adult↗
PubMed1999

Effect of respiratory tract disease on pharmacokinetics of tilmicosin in rats.

BACKGROUND AND PURPOSE: In rats, murine respiratory mycoplasmosis is caused by Mycoplasma pulmonis. Tilmicosin, a macrolide antibiotic, has good tissue penetration and reaches high concentration in the lungs. Therefore, a model for studying the effects of disease on pharmacokinetics of tilmicosin was developed, using LEW rats. METHODS: Seventy-two LEW rats were assigned at random to two groups: one group was inoculated with M. pulmonis, and the other served as an uninoculated control group. On postinoculation day 31, all rats received a single dose of tilmicosin (20 mg/kg of body weight, subcutaneously). RESULTS: Concentration of tilmicosin in the lungs of both groups of rats was significantly higher than serum tilmicosin concentration at all times. Infected rats had significantly higher lung tilmicosin concentration than did noninfected rats. No correlation was found between pH of the lungs and tilmicosin concentration in the lungs in either treatment group, nor did treatment have any effect on pH of the muscle. CONCLUSION: Tilmicosin accumulates in the lungs, and infection/inflammation further improves its tissue penetration.

Animals↗