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PubMed1995

Heat and moisture exchangers as a treatment option in the post-operative rehabilitation of laryngectomized patients.

A multi-institutional, prospective clinical study was undertaken to investigate whether the use of a heat and moisture exchanger (HME) in the period following total laryngectomy could prevent the development or reduce the severity of respiratory symptoms. Fifty-nine patients from three hospitals were provided with HMEs, either immediately post-surgery or, in the case of post-surgical radiotherapy, upon completion of the radiotherapy. For the total sample (n = 59) statistically significant improvements over time (between 3 and 6 months) could be found in forced expectoration (P < 0.05), in the perceived voice quality (P < 0.001), social anxiety (P < 0.001), social interactions (P < 0.001) and in feelings of anxiety and depression (P < 0.05). Repeated measures analysis of variance indicated statistically significant group differences over time in forced expectoration and stoma cleaning (P < 0.05). No statistically significant differences over time were noted between the regular and non(regular) HME user groups in voice quality or in various aspects of daily living.

Humans↗
PubMed2006

Pharmacotherapeutic management of COPD patients in Greece--adherence to international guidelines.

BACKGROUND: International guidelines for Chronic Obstructive Pulmonary Disease (COPD) propose the most cost-effective management of the disease. However, the management of COPD differs between countries and between clinics within the same country. OBJECTIVE: To examine prescription trends for COPD by Lung Specialists (LS) and Primary Care Physicians (PCP) in Greece and to study prescription adherence to international guidelines. METHODS: A retrospective analysis of COPD prescriptions, obtained from pharmacies located all over the country, was performed between 1997 and the beginning of 2003. The data collected were compared with those of other European countries. A subgroup analysis was carried out for prescriptions issued by PCP and LS. RESULTS: Between 1997 and 2003, LS and PCP used different pharmacological interventions for the management of COPD. Only the LS prescriptions showed a tendency to guideline adherence. Differences in preferences for different pharmacological drug classes were noted. Thus, LSs were found to generally prefer inhaled corticosteroids (ICSs), followed by anticholinergic drug + a beta(2)-short-acting agonist combinations, long-acting beta(2)-agonists, xanthines, short-acting beta(2)-agonists and expectorants. In contrast, PCPs used mostly short-acting beta(2)-agonists followed by xanthines, ICSs, expectorants, anticholinergic drug + beta(2)-short-acting agonist combinations and long-acting beta(2)-agonists. CONCLUSIONS: It appears that compliance to international COPD management-guidelines in force at the time of the study increased between 1997 and 2003 only for LSs but not for PCPs.

Bronchodilator Agents↗
PubMed1994

[Clinical investigation of obstructive pneumonia with lung cancer].

Nineteen episodes (18 patients) of obstructive pneumonia occurring in 247 patients with lung cancer were clinically examined, and the following findings were obtained. 1) All 18 patients were male smokers, with an average of 64 years. 2) Body temperatures stood above 37 degrees C in 95% of the 19 episodes. Leukocytosis was detected in 41%, and neutrophilia was observed in 69%. CRP values were positive in all episodes. 3) The frequency of obstructive pneumonia according to the site of lung cancer was 13.2% in proximal tumors and 1.7% in peripheral tumors. Pathologically, the frequency was 5.2% in adenocarcinomas 7.6% in squamous cell carcinomas, 15.6% in small cell carcinomas and 9.1% in large cell carcinomas. Squamous cell carcinomas even in Stage I led to obstructive pneumonia at the rate of 13.0%. In contrast, higher frequency was observed in adenocarcinomas in Stage II or later and small cell carcinomas in Stage IIIB or later. 4) Obstructive pneumonia was detected at the time of discovery of lung cancer in 48% of the 18 patients, and during treatment and in the terminal stage in 26% respectively. 5) Chest X-ray examinations showed that 42% of the pneumonia cases were lobar pneumonia and 11% had pleural effusion. 6) In expectorated sputum, 50% of bacteria isolated were gram-negative, 10% were gram-positive and 40% were unknown. 7) Most of the bacteria isolated from expectorated sputum showed a good susceptibility to antimicrobial agents, but those proved clinically ineffective. 8) The prognosis of obstructive pneumonia was significantly affected by performance status and levels of total protein and choline-esterase.

Aged↗
PubMed2001

[Pathogenetic study on bronchopulmonary infections in 1,416 patients by transtracheal aspiration method].

We have performed transtracheal aspiration (TTA) in 1,416 patients, who were suspected to have bronchopulmonary infection, in order to collect non-contaminated specimens directly from the lower airway. The overall isolation rates in 1,416 TTA were 68.7% for any microorganisms. Aerobes had a high incidence but many kinds of microorganisms were associated with bronchopulmonary infections. Haemophilus influenzae was the major pathogen in patients with acute bronchitis. Streptococcus pneumoniae was the most important pathogen and mycoplasma was often isolated in patients with community-acquired pneumonia. Major pathogens of nosocomial pneumonia consisted of alpha-streptococcus spp., anaerobes and Pseudomonas aeruginosa. Anaerobes were isolated from transtracheal aspirates in 20 of 33 episodes of lung abscesses. H. influenzae and P. aeruginosa were the main persistent pathogens and H. influenzae, S. pneumoniae and anaerobes were important exacerbated pathogens in patients with chronic lower respiratory tract infection. S. pneumoniae was isolated more from TTA than expectorated sputa. Oropharyngeal flora bacteria were easily isolated in the culture of expectorated sputa. We assessed the final diagnosis or causative factor in 443 patients whom no microorganism was isolated from transtracheal aspirates. The final diagnosis was infectious diseases in 52 patients (11.7%) and non-infectious diseases in 80 patients (18.1%), respectively. The causative factor was unsuited TTA sample in 81 patients (18.3%), preceding antimicrobial chemotherapy in 95 patients (21.4%) and unknown in 135 patients (30.5%), respectively. The pathogenesis of bronchopulmonary infections is complex and various microorganisms are associated with pathogens of bronchopulmonary infections. Therefore, we should accurately diagnose the pathogens in patients with bronchopulmonary infections. TTA is one of the useful methods that we can accurately detect the respiratory pathogens.

Adolescent↗
PubMed1986

Acid-fast bacilli in sputum: a case of Legionella micdadei pneumonia.

Legionella micdadei has been implicated as a cause of nosocomial pneumonia. There are no reports of L. micdadei pneumonia diagnosed by acid-fast stain of expectorated sputum. We report a case of L. micdadei pneumonia in which expectorated sputum harbored acid-fast bacteria that reacted specifically with fluorescent antiserum to L. micdadei, confirmed by culture. In a patient at risk for nosocomial infection, the differential diagnosis of a positive sputum stain for acid-fast bacilli should include L. micdadei in addition to mycobacteria. Therapy for L. micdadei infection should be considered pending confirmation of the diagnosis.

Aged↗
PubMed1991

Comparison of monoclonal antibody and calcofluor white stains for the detection of Pneumocystis carinii from respiratory specimens.

Three monoclonal antibody staining kits, from Genetic Systems, Disease Detection International, and Meridian Diagnostics, were compared with calcofluor white for the direct detection of Pneumocystis carinii in respiratory specimens. Of the 150 specimens tested, 23 were found positive for P. carinii by any of the four stains; 13 were bronchoalveolar lavage, 7 were induced sputum and 3 were expectorated sputum specimens. All stains detected the positive bronchoalveolar lavage specimens, the Genetic Systems stain detected six induced sputum specimens, and the other stains each detected four induced sputum specimens. The monoclonal antibody stains detected all three expectorated specimens, while the calcofluor stain detected only one. Overall, the sensitivities of the stains were 96% for Genetic Systems, 87% for both Disease Detection International and Meridian Diagnostics, and 78% for calcofluor.

Antibodies, Fungal↗
PubMed2000

Myeloperoxidase and protein oxidation in cystic fibrosis.

Cystic fibrosis (CF) is associated with chronic pulmonary inflammation and progressive lung dysfunction, possibly associated with the formation of neutrophil myeloperoxidase (MPO)-derived oxidants. Expectorated sputum specimens from adult CF patients were analyzed for MPO characteristic protein modifications and found to contain large amounts of active MPO as well as high levels of protein-associated 3-chlorotyrosine and 3,3'-dityrosine, products that result from MPO activity, compared with expectorated sputum from non-CF subjects. Sputum levels of nitrite (NO(2)(-)) and nitrate (NO(3)(-)), indicating local production of nitric oxide (NO. ), were not elevated but in fact were slightly reduced in CF. However, there was a slight increase in protein-associated 3-nitrotyrosine in CF sputum compared with controls, reflecting the formation of reactive nitrogen intermediates, possibly through MPO-catalyzed oxidation of NO(2)(-). CF sputum MPO was found to contribute to oxidant-mediated cytotoxicity toward cultured tracheobronchial epithelial cells; however, peroxidase-dependent protein oxidation occurred primarily within sputum proteins, suggesting scavenging of MPO-derived oxidants by CF mucus and perhaps formation of secondary cytotoxic products within CF sputum. Our findings demonstrate the formation of MPO-derived oxidizing and possibly nitrating species within the respiratory tract of subjects with CF, which collectively may contribute to bronchial injury and respiratory failure in CF.

Adult↗
PubMed2005

Plant-based formulation for bronchial asthma: a controlled clinical trial to compare its efficacy with oral salbutamol and theophylline.

BACKGROUND: Plant-based medicine is the 3rd most popular choice of both adults (11%) and children (6%) suffering from Asthma. While several plant-based formulations have been reported for the treatment of asthma in the past, many authors have published their reservations on clinical trials carried out using complementary and alternative medicines. OBJECTIVES: The authors desired to eliminate the shortcomings of the earlier clinical trials carried out by many investigators in a structured study. Therefore, a 12-week randomized double-blind placebo-controlled clinical study was conducted to investigate the efficacy of a plant-based formulation (DCBT4567-Astha-15) in comparison with oral salbutamol, salbutamol + theophylline and a matching placebo in patients with reversible asthma. METHODS: Ninety-four patients between 15 and 50 years of age, showing 15% improvement in forced expiratory volume in 1 s (FEV(1)) 15 min after a bronchial challenge of inhaled salbutamol (200 microg) were recruited, and the end point of the study was determined as a 15% improvement in FEV(1) and clinical symptoms like dyspnoea, wheezing, cough, expectoration, disability, sleep disturbances and respiration rate. RESULTS: DCBT4567-Astha-15, salbutamol and salbutamol + theophylline patients showed statistically significant improvement in FEV(1), while placebo patients did not show any improvement. Fifty percent of DCBT4567-Astha-15, 48% of salbutamol, 58% of salbutamol + theophylline and 26% of placebo patients showed the desired 15% improvement in FEV(1). Improved mean FEV(1) values at the end of the trial indicated that the salbutamol - theophylline combination was superior followed by salbutamol and DCBT4567-Astha-15. Clinical symptoms like dyspnoea, wheezing, cough, expectoration, disability, and sleep disturbances were significantly reduced in DCBT4567-Astha-15 patients compared to patients of the other three arms. CONCLUSIONS: DCBT4567-Astha-15 was as efficacious as salbutamol (12 mg/day) or salbutamol (12 mg/day) in combination with theophylline (200 mg/day) in the treatment of reversible asthmatics. Quality of life of patients also improved with DCBT4567-Astha-15 drug treatment.

Administration, Oral↗
PubMed1983

1-second forced expiratory volume and density dependence in early airflow limitation.

Density dependence variables (helium-to-air difference in forced expiratory flows at 50 and 25% vital capacity and volume of isoflow) were compared with spirographic performance (vital capacity, FEV 1.0) in 76 men aged 33-56 years. The group included nonsmokers, asymptomatic smokers, subjects with chronic expectoration, but normal ventilatory function and subjects with chronic expectoration and minimal obstructive ventilatory impairment. Low-level correlations were found (coefficients of less than 0.3) between delta He25% or volume of isoflow on one side and FEV1.0 or FEV1.0/VC. Some possibly confounding factors for these correlations are discussed. We conclude that density dependence variables are not consistently related to the FEV1.0 in subjects 'at risk' or with minimal airflow limitation.

Adult↗
PubMed1992

Lung abscess due to Pseudallescheria boydii in the course of acute leukaemia. Report of a case and review of the literature.

We report a case of lung infection by Pseudallescheria boydii, which appeared during therapeutic aplasia in a patient with acute leukaemia. The association of sudden chest pain and fever with negative blood cultures and haemoptysic expectoration first suggested a diagnosis of pulmonary aspergillosis, in particular because evidence of lung abscesses appeared very rapidly and large mycelial filaments were found on direct examination of the expectoration. Pseudallescheria boydii was identified by culture. Investigations in vitro of the effects of antimycotics showed that the micro-organism was resistant to amphotericin B and sensitive to imidazoles. The clinical and radiological outcome after treatment with ketoconazole was favourable.

Adolescent↗
PubMed1995

Effect of a modified toothpaste technique on approximal caries in preschool children.

A 3-year, double-blind caries trial was conducted to evaluate the caries-reducing effect of a modified technique to use toothpaste. At the outset, 369 children, 4 years of age, were randomly assigned to four groups. At the end of the study, when the children were 7 years old, 281 (76%) had completed the trial. Two of the groups (test groups, n = 131) were given the following instructions regarding 'toothpaste technique': (1) to spread the paste evenly on the teeth prior to brushing, (2) not to expectorate more than necessary during brushing, (3) to filter the remaining dentifrice foam in the dentition, together with a sip of water, by active cheek movements for 1 min before expectorating, and (4) not to carry out any further water rinsings afterwards, and not to eat or drink for 2 h after brushing. The children in the other two groups (control groups, n = 150) were not given any instruction how to use the dentifrice and how to rinse after the brushing, but were, as the children in the test groups, encouraged to use the test dentifrice and to brush their teeth twice daily. Two commercial fluoride dentifrices (A and B) were compared: one of the test groups and one of the control groups used each product. Approximal carious lesions were scored on bite-wing radiographs at baseline and at the end of the study on the distal surface of the first and on the mesial surface of the second primary molars. No difference in caries increment was found between toothpastes A and B. The children in the two test groups developed a mean of 1.14 new dfs during the 3 years compared to 1.55 in the two control groups (p < 0.05). Thus, the results indicate that the modified toothpaste technique reduced approximal caries in preschool children by an average of 26%.

Analysis of Variance↗
PubMed1991

Predictive value of oropharyngeal cultures for identifying lower airway bacteria in cystic fibrosis patients.

Identifying lower respiratory pathogens in young, non expectorating cystic fibrosis (CF) patients has been problematic. Bronchial secretions are difficult to obtain, and little is known about lower airway flora in these patients. We collected simultaneous bronchial and oropharyngeal specimens in 43 CF patients in optimal respiratory status, including both expectorating (17) and nonexpectorating (26) patients, to determine the predictive value of oropharyngeal cultures for identifying lower airway pathogens. An additional goal was to characterize the lower respiratory flora of these patients. Predictive values were defined as the proportion of oropharyngeal culture results that accurately reflected the results of bronchial cultures. Predictive values of positive oropharyngeal cultures in nonexpectorating patients were 83% (95% confidence interval 36 to 100%) for Pseudomonas aeruginosa and 91% (59 to 100%) for Staphylococcus aureus. Predictive values of negative oropharyngeal cultures were lower: 70% (48 to 86%) for R aeruginosa and 80% (52 to 96%) for S. aureus. A relatively high proportion of nonexpectorating CF patients less than 10 yr old had R aerusginosa (11 of 24, 46%) or Klebsiella species (5 of 24, 21%) in their lower airways. The isolation of Klebsiella was associated with younger age (p = 0.03) and recent administration of antistaphylococcal antibiotics (p = 0.05). Our results suggest that oropharyngeal cultures yielding R aeruginosa or S. aureus are highly predictive, but such cultures lacking these organisms do not rule out the presence of these pathogens in the lower airways of CF patients.

Bacterial Infections↗
PubMed1991

Descriptive study of prognostic factors influencing survival of compensated silicotic patients.

The objective of this study was to assess survival and the prognostic influencing survival of compensated silicotic patients. All workers compensated for silicosis in the Province of Quebec from 1938 to 1985 (n = 1,165) were included. Clinical data were those collected during the exam that led to a compensation decision. Due to missing data, a subcohort of 961 patients was used for multivariate analysis of clinical prognostic factors with the Cox proportional hazards model. The following factors made an independent contribution to survival: age at compensation, smoking, dyspnea, expectoration, abnormal breath sounds, radiographic appearance, and vital capacity. On the basis of the model, patients with small opacities alone on their chest radiograph and who did not have dyspnea, expectoration, or abnormal breath sounds had a survival similar to the average Quebec man; other patients had a poorer survival. We conclude that it is possible to identify at the time of compensation, silicotic patients who are likely to have a life expectancy similar to that of the general population. Symptoms and physical signs as well as radiographic and lung function abnormalities appear to be useful prognostic indicators in compensated silicotic patients.

Dyspnea↗
PubMed1993

Theophylline in oral mucosal transudate. A practical method for monitoring outpatient therapy.

We tested the utility of a novel collection system that allows measurement of theophylline in oral mucosal transudate (OMT) to calculate serum theophylline concentrations. In 25 adult patients, theophylline levels in OMT correlated better than expectorated saliva with serum theophylline (r = 0.927 for OMT versus r = 0.831 for expectorated saliva, each p < 0.0001). In a subsequent study of 128 patients (118 adults and 10 children aged 4 to 12 yr), OMT and serum theophylline were measured and polynomial regression analysis performed to allow calculation of serum level for any given OMT level. Theophylline levels calculated from OMT values closely followed measured serum theophylline in two normal subjects after administration of either intravenous or oral theophylline. OMT samples collected by 24 patients at home were mailed to the laboratory for testing. Theophylline values from the home collection samples correlated closely (r = 0.930, p < 0.0001) with serum theophylline levels obtained at the same dose of theophylline. These findings suggest that once the relationship of serum to OMT theophylline is established in a given laboratory, the latter can be used to monitor outpatient theophylline therapy in adults (and possibly children) at times of the day otherwise inaccessible to serum sampling.

Adult↗
PubMed1984

Efficacy and tolerability of oral acetylcysteine (Fabrol) in chronic bronchitis: a double-blind placebo controlled study.

This multicentre, double-blind, placebo controlled, between-patient study in general practice in the United Kingdom examined the effect of oral N-acetylcysteine (Fabrol) on the symptomatology of patients with chronic bronchitis over a 3-month period. Although improvement in subjective symptoms (sputum viscosity and character, difficulty in expectoration and cough severity) occurred in both treatment groups over the trial period, improvements in difficulty in expectoration and cough severity were greater in patients receiving N-acetylcysteine compared to matching placebo. Trial medication was well tolerated, with a greater number of side-effects attributed to therapy occurring in patients receiving placebo.

Acetylcysteine↗
PubMed1991

Lidocaine absorption and metabolism after oropharyngeal application in young and young-elderly adults.

The purpose of this study was to evaluate the effect of age on lidocaine absorption and metabolism after application to the oropharynx and vocal cords in a manner similar to preparation for flexible fiberoptic bronchoscopy. Five healthy volunteers were studied in each of two age groups: from 25 to 37 and 60 to 68 years of age. Each volunteer had a total of lidocaine 300 mg administered as a gargle, gel, or directly to the vocal cords. Blood samples and expectorant were collected to determine concentrations of lidocaine and its metabolites, monoethylglycinxylidide (MEGX) and glycinxylidide (GX). No differences in peak plasma lidocaine concentrations, 2.09 +/- 1.28 mumol/L (1 microgram/mL = 4.27 mumol/L) in young subjects, and 2.35 +/- 0.85 mumol/L in young-elderly subjects, or lidocaine AUC were seen between the two age groups. Lidocaine recovered in expectorant ranged from 96 to 168 mg. This study suggests that, over the age range studied, increased age does not impair lidocaine absorption from the oropharynx or lidocaine metabolism when topical lidocaine is used during flexible fiberoptic bronchoscopy.

Absorption↗
PubMed1999

Physiotherapy and bronchial mucus transport.

Cough and expectoration of mucus are the best-known symptoms in patients with pulmonary disease. The most applied intervention for these symptoms is the use of chest physiotherapy to increase bronchial mucus transport and reduce retention of mucus in the airways. Chest physiotherapy interventions can be evaluated using different outcome variables, such as bronchial mucus transport measurement, measurement of the amount of expectorated mucus, pulmonary function, medication use, frequency of exacerbation and quality of life. Measurement of the transport rate of mucus in the airways using a radioactive tracer appears to be an appropriate outcome variable for short-term studies. Evaluation of chest physiotherapy only with pulmonary function tests appears to be inadequate in short-term studies. The popularity of using pulmonary function tests is probably based more on the availability of the instruments than on a theoretical basis related to the question of chest physiotherapy improving mucus transport. Quality of life and progression of the disease are not often used as outcome variables, but it may be worthwhile to use these in the future.

Bronchi↗
PubMed2004

Is nebulized saline a placebo in COPD?

BACKGROUND: Many trials of nebulized therapy have used nebulized saline as a "placebo". However, nebulized isotonic saline is sometimes used to assist sputum expectoration and relieve breathlessness in COPD patients. We designed this study to establish if nebulized saline had a placebo effect or a clinical effect. METHODS: 40 patients were studied following hospital admission for exacerbated COPD (mean FEV1 30% predicted). Patients were randomised to single-blind administration of either 4 mls of nebulized isotonic saline using an efficient nebulizer (active group n = 20) or an inefficient nebulizer (placebo group n = 20). Spirometry and subjective breathlessness scores (Modified Likert Scale) were measured before nebulized treatment and 10 minutes after treatment. RESULTS: There was no significant change in FEV1 after active or placebo nebulized saline treatment. Patients reported a 4% improvement in mean breathlessness score following placebo (Wilcoxon test; p = 0.37) compared with 23% improvement following active nebulized saline (p = 0.0001). 65% of patients given active nebulized saline but only 5% of the placebo group reported that mucus expectoration was easier after the treatment. CONCLUSIONS: This study lends support to the current use of nebulized saline to relieve breathlessness (possibly by facilitating sputum clearance) in COPD patients. Lung function was not affected. Nebulized saline can therefore be used as a placebo in bronchodilator studies involving COPD patients but it cannot be used as a placebo in trials assessing symptom relief.

Clinical Trial↗