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PubMed2002

Suspected pulmonary tuberculosis in rural South Africa--sputum induction as a simple diagnostic tool?

OBJECTIVES: To assess the value of sputum induction (SI) as a diagnostic tool for patients with suspected pulmonary tuberculosis (PTB) who are unable to expectorate or who have a negative sputum smear. DESIGN: Study of an inpatient cohort undergoing SI. SETTING: Mseleni Hospital, a rural district hospital in northern KwaZulu-Natal. SUBJECTS: All adult patients with suspected TB seen at the hospital over a 4-month period. OUTCOME MEASURES: (i) Successful SI; (ii) sputum acid-fast smear result; (iii) change of admission diagnosis as a result of the induction procedure; and (iv) number of patients discharged with a diagnosis other than TB who represented within 4 months with TB. RESULTS: A total of 51 patients (31 female) underwent SI; of these 36 (71%) were able to produce a sputum sample. Fifteen (42%) of those were acid-fast smear-positive (29% of all patients included). The admission diagnosis was changed in 16 (44%) of the patients who were able to give an induced sputum sample as opposed to 4 (27%) who had been unable to expectorate despite an induction attempt (P = 0.38). Three (12.5%) of the 24 patients with a discharge diagnosis other than TB (17 pneumonia, 3 old TB, 2 carcinoma of the lung, 1 bronchiectasis) turned out to have TB within the follow-up period; 2 of those had extrapulmonary TB. CONCLUSION: SI produced a positive smear result in 29% of patients with suspected TB who had previously been smear-negative or unable to expectorate. The method proved an aid to clinical decision making.

Adolescent↗
PubMed2004

Sputum specimens can be obtained from patients with community-acquired pneumonia in primary care.

OBJECTIVE: To improve the aetiological diagnosis in community-acquired pneumonia (CAP) increased efforts were made to obtain expectorated sputum specimens from patients with CAP. DESIGN: A prospective, clinical study. Patients were encouraged to cough spontaneously and to expectorate a sputum specimen. If unsuccessful, they were asked to inhale nebulized hypertonic saline to induce secretion and cough. SETTING: One primary health care centre in Orebro, Sweden. SUBJECTS: Patients attending the Health Centre with acute symptoms of CAP. MAIN OUTCOME MEASURES: Availability and quality of sputum specimen from patients with CAP in primary care. RESULTS: 177 patients were included, 63% were women and the mean age was 51 years. 28% were smokers and 46% showed infiltrates on chest X-ray. Sputum specimens were obtained from 125 patients. Fifty-nine were expectorated spontaneously and 66 were induced. Ninety-one of the specimens were found to be acceptable, whereas 34 were discarded. Potential pathogens were found in 57% of the 91 specimens. CONCLUSION: Acceptable sputum specimens can be obtained with some effort from approximately half of the patients in primary care. Sputum culture might improve the knowledge of the bacterial aetiology of CAP in selected patients and in epidemiological studies.

Adolescent↗
PubMed1992

[Asthma classification by score calculated from clinical findings and examinations. Comparison between clinical diagnosis and score diagnosis].

Asthma classification by clinical symptoms and signs (clinical diagnosis) was compared with the classification by score calculated from clinical findings and examinations (score diagnosis) in 25 patients with bronchial asthma. 1. Ten subjects classified as Ia (simple bronchoconstriction type) by clinical diagnosis were divided into 6 cases with expectoration of less than 49 ml a day and 4 cases with expectoration of between 50 and 99 ml. The level of serum IgE and number of eosinophils in BALF were significantly higher in the latter cases than in the former cases. The cases whose expectoration was from 50 to 99 ml a day were classified as Ib (bronchoconstriction with hypersecretion type) by score diagnosis. 2. The six subjects who were classified as type Ib by clinical diagnosis were also evaluated as type Ib by score diagnosis. 3. Nine of the 10 subjects classified as type II by clinical diagnosis were evaluated as type II by score diagnosis. One case, whose score was under 12 points, was evaluated as questionable type II by score diagnosis.

Adult↗
PubMed1991

[Clinical studies on lung disease due to atypical mycobacteria in our hospital during the past 13 years].

Among the patients with pulmonary diseases admitted to our hospital during a 13-year period from 1977 to 1989, clinical examinations and laboratory data on admission and the following clinical courses of 102 cases where atypical mycobacteria had been identified three times or more in sputum cultures at the time of hospitalization were investigated. 1. The ratio of the number of cases positive for atypical mycobacteria to those positive for acidfast bacilli in sputum cultures tested on admission was fairly constant, 6.0 to 7.8% every year since 1981. In the cases associated with positive sputum cultures for atypical mycobacteria, M. avium complex was observed in 84% of the cases: M. kansasii, M. fortuitum and M. chelonae were found in 13, 2 and 1 cases, respectively, since 1984. 2. A total of 102 cases studied consisted of 66 male and 36 female patients; the mean age was 61.9 years. 3. Sputa became negative on culture in 19 (86.4%) out of 22 cases of primary infection. In all primary infection cases, roentgenographic findings did not worsen and prognosis was extremely good. In secondary infection cases, sputum cultures became negative in 25 (83.3%) out of 30 cases expectorating a small quantity of mycobacteria on admission, where x-ray findings worsened in only one case. In contrast, in 47 cases expectorating a large quantity of the bacilli at the time of admission, negative sputum cultures were attained in only 14 cases (29.8%) and x-ray findings worsened in 10 cases, and their prognosis were poor. 4. In general, sputum cultures turned negative within 3 months after admission. If sputum cultures remained positive thereafter, it was found very difficult to stop expectoration of the bacilli in these patients, and hence their prognosis are supposed to be greatly affected by the bacteriologic findings in early stages of the disease.

Adult↗
PubMed1982

[Bacteriology of bronchial secretions. Proposals for a practical attitude in bacterial respiratory tract infections].

The inadequacy of the standard bacteriological method in the study of expectorations is unanimously accepted. Oropharyngeal contamination of specimens largely explains why this examination is a poor index of the causative organisms in bacterial respiratory infections. In a mixed clinical situation with few or non-specific signs of bacterial infection and of variable severity, the physician should answer two questions: 1) Is it a bacterial infection? 2) What is the causative organism? and their corollary: 1) Should one prescribe an antibiotic? 2) Which one? Only culture of blood or pleural fluid allow an accurate reply to these questions in about 50% of cases and they are the indispensable investigations of reference. Initial efforts undertaken to improve the standard examination of expectorations never overcome the stumbling block of oro-pharyngeal contaminations. The bacterial count of expectorated bacteria, a non traumatic method, represents some real progress. In 50% of cases it enables a predominant pathogen to be identified before any antibiotics are given. Bronchoscopy diminishes contamination, allows direct sampling and the inspection and biopsying of bronchial mucosal lesions and aids drainage in very suppurative disorders. Trans-tracheal puncture avoids oropharyngeal contamination in the majority of cases and appears to provide reliable results much more often. A pragmatic approach is recommended according to the clinical picture. Bronchial and limited alveolar infections which are well tolerated, heal without exception on blind antibiotic therapy. In suppurating infections (bronchiectasis, cavitating pneumonias), the yield and the reliability of the examinations are increased. Serious bacterial infections, by their extent or by their site, justify a more aggressive diagnostic and therapeutic attitude. It should be stressed, however, that death caused by inadequate antibiotic therapy remains the exception when one or two successive courses of antibiotics have been prescribed for the pathogens presumed responsible according to the clinical picture or found after one or more bacterial examinations.

Anti-Bacterial Agents↗
PubMed2004

Ambroxol reduces LPS toxicity mediated by induction of alkaline phosphatases in rat lung.

Alkaline phosphatases (APs) have been suggested to detoxify lipopolysaccharide (LPS) by dephosphorylation. Ambroxol, a bronchial expectorant, is known to accelerate the secretion of pulmonary surfactant particles including AP molecules as a pharmacological action. In the present study, some beneficial effects of ambroxol on LPS toxicity in the rat lung were investigated. In an experiment using the rat lung organ culture, AP activities were enhanced in a time-dependent manner by incubation with 25 microM of ambroxol in both the tissue and the medium. Western blot analysis indicated that AP activity was elevated by the treatment with ambroxol, due to the induction of surfactant proteins (SPs) and AP molecules. In the in vivo experiment, the serum LPS content was markedly increased after LPS administration to rats by intratracheal instillation of 20 mg/kg. However, when the rats were pretreated with oral ambroxol (1.0 mg/kg) at 1 h before LPS challenge, the area under the concentration--time curve (AUC) of serum LPS was significantly decreased. These results suggest that ambroxol inhibits the translocation of LPS from the lung into the circulation as well as its detoxification effect via the elevation of AP activity. Bromhexine, another expectorant, is less effective than ambroxol as an LPS detoxificant. Maintenance of high AP activity level in the lung suggests APs to have physiological significant effects against the inflammatory events induced by LPS.

Administration, Oral↗
PubMed2006

Plant-based formulation in the management of chronic obstructive pulmonary disease: a randomized double-blind study.

BACKGROUND: A randomized double-blind placebo controlled clinical study was undertaken to investigate the safety and efficacy of a plant-based formulation (DCBT1234-Lung KR), which earlier through 2 trials was found to improve FEV1 and the quality of life of COPD patients. OBJECTIVE: The efficacy of DCBT1234-Lung KR was assessed using pulmonary function tests, arterial blood gas (ABG) analyses and the clinical symptoms of COPD in a 6-month study period against a matching placebo and a biomedical drug combination (salbutamol+theophylline+bromhexine). METHODS: One hundred and five subjects aged between 35 and 85 years with a smoking history of more than 20 pack years, showing little or no improvement in FEV1 upon a bronchial challenge of 200 microg of inhaled salbutamol and exhibiting ABG percentage of less than 85% of oxygen saturation were taken up for the study. The study had 3 arms viz., the plant-based formulation (DCBT1234-Lung KR), placebo and salbutamol (12 mg/day) plus theophylline (300 mg/day) plus bromhexine (24 mg/day). The end point of the study was determined as an improvement of FEV1 by 200 mL and/or increased ABG values (>90% PaO2) and clinical symptoms like dyspnoea, wheezing, cough, expectoration, disability, and sleep disturbances. RESULTS: DCBT1234-Lung KR patients showed statistically significant (95% level) improvement in FEV1 and PaO2 in comparison with salbutamol+theophylline+bromhexine and placebo patients. Twenty-three per cent of DCBT1234-Lung KR patients, 19% of salbutamol+theophylline+bromhexine group and 12% of placebo group patients showed the desired 200 mL improvement in FEV1 values in comparison with the other 2 arms. Improved PaO2 was observed in 15.4% of the DCBT1234-Lung KR patients while no improvement was seen with patients in any other arms. Symptoms like dyspnoea, wheezing, cough, expectoration, disability and sleep disturbances also significantly reduced in DCBT1234-Lung KR and the biomedical group patients, but not in the placebo arm. CONCLUSIONS: DCBT1234-Lung KR was equivalent, if not better than the present day treatment with salbutamol, theophylline and bromhexine combination in COPD patients and this was ascertained using FEV1 and ABG values.

Adult↗
PubMed1999

Efficacy and tolerability of myrtol standardized in long-term treatment of chronic bronchitis. A double-blind, placebo-controlled study. Study Group Investigators.

This multicenter, placebo-controlled, double-blind, randomized parallel-group trial was conducted to investigate the efficacy and tolerability of myrtol standardized (MYS, Gelomyrtol forte, 3 x 300 mg) in the long-term treatment of patients with chronic bronchitis during the winter. 246 patients received the investigational treatments (MYS: 122, placebo: 124) for at least 1 month; 215 subjects (110 under MYS and 105 under placebo) were evaluable in terms of efficacy (exacerbation rate, the need for antibiotics, symptom scores and general well-being) for the protocol-defined 6 months of treatment. Statistically significantly (p < 0.01) more patients remained without acute exacerbation in the myrtol standardized group (72%) compared to the placebo group (53%). In the placebo group, there was an evident peak in the incidence of exacerbations during the third month of treatment, which was not observed in the active treatment group. In the MYS group, 51.6% of the patients with an acute exacerbation required antibiotics vs. 61.2% under placebo. 62.5% of the patients treated with antibiotics in the MYS group required them for < or = 7 days, whereas 76.7% of the patients in the placebo group treated with antibiotics for exacerbation needed antibiotics for > 7 days. Well-being (assessed in terms of general health and health impairment by cough and expectoration) was significantly better under treatment with MYS. The overall therapeutic efficacy evaluation scored higher for MYS. Therefore, it is concluded that long-term treatment with MYS is equally well tolerated as placebo but is clearly superior in efficacy in terms of protecting against acute exacerbations in patients with chronic bronchitis: it reduces the frequency and intensity of acute exacerbations, the need of antibiotics for them and the health impairment by cough and expectoration.

Aged↗
PubMed2004

Ephedrine- and guaifenesin-induced nephrolithiasis.

OBJECTIVES: Ephedrine and guaifenesin are herbal supplements that have experienced increased use over the past decade. Ephedrine has been used as a stimulant and weight-loss product, guaifenesin as an expectorant and cough suppressant; both are found in combination in many antitussives and expectorants. This paper reviews the reported cases of ephedrine- and guaifenesin-induced nephrolithiasis, as well as the diagnostic techniques and treatments that have been successfully used for these stones. DESIGN: A systematic review of the literature pertaining to nephrolithiasis and the compounds ephedrine and guaifenesin was conducted. RESULTS: Ephedrine and guaifenesin use results in over 35% of urinary stones that are related to pharmaceutical metabolites, and collectively are present in 0.1% of all urinary stones. These calculi are radiolucent, requiring the use of computerized tomography (CT scan) for diagnosis. Alkalinization therapy offers an alternative to surgical intervention and may have a role in prevention of recurrence. CONCLUSIONS: Ephedrine and guaifenesin have been shown to cause nephrolithiasis in cases of abuse when taken individually or in combination. It is important for the clinician to be aware of the potential for these compounds to cause nephrolithiasis.

Antitussive Agents↗
PubMed1979

Iodine-induced hypothyroidism and its effect on the severity of asthma.

Among 1107 patients with asthma or chronic asthmatic bronchitis and 96 with hypothyroidism we found 12 patients with both diseases. Seven of these patients had hypothyroidism induced by iodine-containing expectorants. Five of 209 patients with hyperthyroidism had coexistent asthmatic lung disease, but none of these five had been taking iodine. The severity of asthma is considered in relation to changes in thyroid function following withdrawal of iodine. Three patients had an exacerbation of their asthma, while another three had no change in their asthma when the iodine treatment was discontinued and the euthyroid state subsequently restored. All six patients had a marked improvement of their general wellbeing when the euthyroid state was re-established. It is concluded that treatment with iodine-containing expectorants causing hypothyroidism is unwise and should be withdrawn even when the patients praise the beneficial effect of iodine on the asthma per se.

Aged↗
PubMed1999

Mucolytic and antitussive effects of erdosteine.

To investigate the influence of erdosteine, a new homocysteine-derived expectorant, on airway clearance we studied the effects of the drug on the viscosity of mucin, on the mucociliary transport rate in quails, on airway secretion in rats and on the cough reflex in guinea-pigs. The active metabolite of erdosteine, M1 (10 microM to 1 mM), significantly reduced the viscosity of porcine stomach mucin. Erdosteine by itself did not reduce viscosity. Erdosteine significantly promoted mucociliary transport in quails and increased airway secretion in rats. The effect was still apparent 24h after administration. Erdosteine significantly suppressed citric acid-induced cough reflexes in guinea-pigs but did not suppress mechanical stimuli-induced cough reflexes. Erdosteine suppressed the reduction of the recovery volume of bronchoalveolar lavage fluid and albumin leakage into the fluid in citric acid-exposed guinea-pigs. These results indicate that erdosteine removes sputum by reducing its viscosity, and by promoting mucociliary transport and sustained enhancement of airway secretion. It also suppressed the chemical stimulation-induced cough reflex and plasma leakage into the airway. These results suggest that erdosteine is an excellent expectorant with several modes of action.

Animals↗
PubMed1980

Continuous determination of tracheobronchial secretory activity in dogs.

We have designed a new method for continuous recording of the output of respiratory tract fluid, the approach representing a modification and combination of the intratracheal electrode and stopper methods which we had employed originally. Electrical resistance change indicated alteration in the output of respiratory tract fluid, without alteration in composition and temperature of fluid, tracheal muscular tone or respiratory movement, at least, within a physiological range. Among the expectorant drugs thus tested, pilocarpine, 100 and 200 micrigrams/kg given intravenously, significantly and in a dose dependent manner augmented the output of the fluid about 5 minutes after the administration. Given orally in a dose of 2 mg/kg, the output of fluid increased in about 20 minutes. Senega syrup, 0.3 ml/kg had no effect when given intravenously, yet, 2 ml/kg given orally increased the output of fluid within 5 minutes, thereby suggesting that the related secretagogic activity is due to a reflex action following stimulation of the gastric mucosa. Emetine, 2 mg/kg given orally increased the output about 20 minutes after administration while glyceryl guaiacolate, 50 mg/kg had no effect. We propose that our method be used to evaluate expectorants for clinical use as the continuous monitoring of the output of respiratory tract fluid apparently provides a more accurate assessment.

Animals↗
PubMed1998

[Clinical and experimental studies in treating infantile acute respiratory tract infection with feiyan chuansou oral liquid].

OBJECTIVE: To study the therapeutical mechanism of Feiyan Chuansou Oral Liquid (FCOL) in treating infantile acute respiratory trct infection. METHODS: Clinical and experimental studies with FCOL in treating infantile acute respiratory tract infection. RESULTS: The clinical result showed that the antitussive, expectorant, anti-asthmatic effect and resolution of dry and moist rale and wheezing of FCOL were significantly better in treatment group than those in the control group (P < 0.05). Animal experimental results also showed that antitussive, expectorant, anti-asthmatic effect of FCOL were significantly better than those of the control group (P < 0.05-0.001). Bacteriostatic test in vitro showed that FCOL could inhibit streptococcus pneumoniae, klebsiella pneumoniae, influenza bacilli and staphylococcus aureus. Antivirologic test showed that FCOL could inhibit completely the influenza A virus and respiratory syncytial virus. CONCLUSION: FCOL is an effective preparation in treating infantile acute respiratory infection.

Acute Disease↗
PubMed1975

[Results of some clinical-pharmacological studies on ambroxol (NA 872)].

In the beginning objects and problems of clinical pharmacology were outlined. Results from experimental studies in animals with the metabolite VIII of bromhexine (N-[trans-4-hydroxy-cyclohexyl]=[2-amino-3,5-dibromo-benzyl]-amine, Ambroxol (NA 842)) are described in order to contribute to the understanding of this substance's mode of action. Hence NA 872 is an expectorant which fully meets all requirements expected from this category of druggs -- increase in sputum amount, easement in breathing, reducing the viscosity, and depression of coughing. The dose-effect rate of the substance was tested in 54 adults and 32 children. The average dose of 45.0 mg/kg for adults was determined as sufficient for the majority of patients. In the following test in 124 patients on dose tolerance and efficacy, the substance proved to be tolerated extremely well, to cause no adverse side effects while achieving good effects particularly with regard to improvement of expectoration. There was no casual relationship between some occurring changes in laboratory data and the application of the substance.

Adolescent↗
PubMed2002

Clinical evaluation of new therapies for treatment of mucus hypersecretion in respiratory diseases.

In the past mucoactive drugs in airway diseases have been identified and profiled in symptom-based animal experiments and in clinical trials along related lines (cough and expectoration). Presently available drugs of this class are not generally accepted by licensing authorities worldwide and no new molecule clinically profiled as a mucoactive drug has been brought to regulatory approval in the past 20 years. Among regulatory guidelines only the CPMP 1999 'points to consider' on drug development in chronic obstructive pulmonary disease (COPD) advises for mucoactive drug development by suggesting that an indication for symptomatic treatment may be established on the basis of a symptom-related primary endpoint that should be justified as for its importance and supported by a co-primary lung function endpoint. Quality and safety of the new drug must be documented in long-term studies and the indication and use clearly described based on established or adequately profiled new primary endpoints in two pivotal studies. Published trials on mucoactive drugs have used a variety of endpoints. These include mucus hypersecretion-related symptoms by questionnaire, expectorated volume and dry weight, and mucus viscosity, elasticity and transportability. Most methods and endpoints are not validated and a positive standard of treatment is not established. New surrogate markers of efficacy for shorter term trials, e.g. induced or spontaneous sputum based assays (cellularity, mucus antigens), exhaled breath (NO), breath condensate (eicosanoids) or airway biopsy are only partially validated and the risk of false positive or negative phase II results is appreciably high. On the other hand, lung function measurements including airway hyper-reactivity assessment and typical phase III (long-term) endpoints like dyspnoea ratings, health status assessments, incidence of exacerbations and lung function decline over time are validated endpoints and offer a high likelihood of regulatory acceptance. Proof for no depression of lung mucociliary clearance is an important safety endpoint.

Anti-Inflammatory Agents↗
PubMed1991

[Chronic obstructive bronchitis. Effect of Gelomyrtol forte in a placebo-controlled double-blind study].

In a double-blind study involving two groups of ten patients with chronic obstructive bronchitis, the expectorant Gelomyrtol forte was tested against placebo for its effectiveness and tolerance. The parameters: amount of sputum, Rt and IGV, together with all the usual clinical laboratory parameters, were determined. In addition, the color of the sputum was always noted. On the basis of patient scores, daily entries on the ability to expectorate, attacks of coughing, general coughing, and shortness of breath were made by the patients for the duration of the 14-day treatment period. On conclusion of the study, the patients were asked to assess the effectiveness of the supplementary medication, and the care-providing physician also assessed effectiveness. All score parameters related to coughing improved, in some cases appreciably, relative to the placebo group. The findings in term of sputum volume and color, were also distinctly better in the Gelomyrtol forte group. Correspondingly, both patients and physicians assessed the effectiveness of Gelomyrtol forte to be distinctly better than that of the placebo. Although the groups are relatively too small and heterogeneous, to establish statistically significant differences, the results do strongly suggest a favorable and major effect in patients with relevant cough symptoms. Both subjective and objective tolerance was excellent.

Cough↗
PubMed1991

[Effects of processing on toxicity and pharmacological action of Phytolacca americana L].

The experimental results have shown that the toxicity of variously processed Phytolacca americana is lower than that of the original rude drug, i.e. the local irritability tends to decrease by 16.7-83.3%; LD50 to elevate by 1.66-10.47 times; expectoration to increase by 1.10-1.57 times; but diuresis mostly to decrease by 16.0-45.0%. This reveals that the main object of processing Phytolacca americana is to lower toxicity, increase expectoration and relieve diuresis to reduce fluid retention.

Animals↗
PubMedDate not supplied

[Therapeutic efficacy and general tolerability of 4-carbomethoxythiazolidine chlorohydrate in adult patients with hypersecretory bronchopulmonary diseases].

40 patients suffering from acute hypersecretive bronchopulmonary disorders were treated for a period of 6-9 days. They have been administered 4-carbomethoxythiazolidine both in capsules and in granular form at a dosage of 400 mg/day. At the beginning of the treatment with 4-carbomethoxythiazolidine (basal stage) after 3-4 days and at the end (final stage) the following clinic parameters have been registered: presence and quantity of the expectoration, difficulty in expectoration, signs of bronchial hypersecretion detectable by thorax auscultation, cough. At the basal and final stages the haematochemical parameters have been determinated such as: haemoglobin, azotemia, SGOT, SGPT, read corpuscles. They did not show individual or average variation over the values registered at the basal stage. At the end of the experiments collected data, biometric elaboration by Wilcoxon test has been carried out. The conclusive judgement on the efficacy of 4-carbomethoxythiazolidine, has been positive in 95% of the cases.

Bronchial Diseases↗