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PubMed2004

Airway clearance in bronchiectasis: a randomized crossover trial of active cycle of breathing techniques (incorporating postural drainage and vibration) versus test of incremental respiratory endurance.

OBJECTIVES: The purpose of this study was to compare the efficacy of the test of incremental respiratory endurance (TIRE) with active cycle of breathing techniques (ACBT) [incorporating postural drainage (PD) and vibration] as methods of airway clearance in adults with bronchiectasis. DESIGN: A randomized crossover study in which a single session of ACBT (incorporating PD and vibration) was compared to a single session of TIRE was carried out in 20 patients (14 female) with stable, productive bronchiectasis. MEASUREMENTS: Weight of sputum (treatment plus 30 min) was the primary outcome measure recorded. Pre- and post-treatment measures of lung function and SpO2 were also recorded. RESULTS: All 20 patients were stable during the study period. Sputum weight expectorated during and 30 min post-ACBT (incorporating PD and vibration) treatment was significantly greater than the sputum weight expectorated during and 30 min post-TIRE treatment [mean difference 2.44 g (95% CI 0.43-4.45)]. CONCLUSION: ACBT (incorporating PD and vibration) is a more effective method of airway clearance in bronchiectasis than TIRE during single treatment sessions.

Bronchiectasis↗
PubMed1986

[Effects of ambroxol on pulmonary surfactant--analysis of the fatty acid composition of phosphatidylcholine in the sputum and normal respiratory tract fluid in rabbits].

The mechanism of action of secretagogic expectorants (ex., ambroxol) has not been clarified. Recently, attention has been directed to the relationship of their action to pulmonary surfactants. In the present study, the fatty acid (FA) composition of phosphatidylcholine (PC), which is the main physiological surfactant, was investigated using sputum, respiratory tract fluid, mucin-like substance, lung washings and lung tissue of rabbits. Effects of ambroxol (20 mg/kg, i.s.) on several parameters such as output volume, FA contents of PC, protein content and viscosity of respiratory tract fluid of rabbits were also investigated. In respiratory tract fluid, lung washings and mucin-like substance of rabbits, saturated FA, especially C16:0, were predominant components of PC; while in sputum and lung tissue of rabbits and respiratory tract fluid of hens, unsaturated FA, especially C18:1 and C18:2, were more predominant components in comparison with those in the above specimens. Ambroxol significantly increased the contents of C16:0, saturated FA and total FA of PC, and it also increased protein content with an increase in the viscosity of respiratory tract fluid. These results suggest that in the respiratory tract fluid of rabbits, PCs are pulmonary surfactants, and the increasing secretion of pulmonary surfactant is likely to be involved in the expectorant action of ambroxol.

Ambroxol↗
PubMed1995

Chronic cough with a history of excessive sputum production. The spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy.

STUDY OBJECTIVE: To determine (1) the spectrum and frequency of causes of chronic cough with a history of excessive sputum production (CCS) and (2) the response of these causes to specific therapy. STUDY DESIGN: Prospective study utilizing the anatomic diagnostic protocol originally developed to diagnose chronic cough. PATIENTS: Seventy-one immunocompetent adults who complained of expectoration of greater than 30 mL of sputum per day. LOCATION: University hospital pulmonary outpatient clinic. RESULTS: Patients were seen an average of 4.2 times over 4.6 months before a specific diagnosis was made. The cause of CCS was determined in 97%. It was due to one cause in 38%, 2 in 36%, and three in 26%. Postnasal drip syndrome (PNDS) was a cause 40% of the time, asthma 24%, gastroesophageal reflux disease (GERD) 15%, bronchitis 11%, bronchiectasis 4%, left ventricular failure 3%, and miscellaneous causes 3%. Among patients with a normal chest radiograph who were nonsmokers and not taking an angiotensin converting enzyme inhibitor; CCS was due to PNDS, or asthma, or GERD, or all three in 100% of cases. Chest radiograph, methacholine inhalation challenge, 24-h esophageal pH monitoring, bronchoscopy, and spirometry with bronchodilator each had a sensitivity and negative predictive value of 100%. Chest radiograph and barium swallow had positive predictive values of only 38% and 30%, respectively. CONCLUSIONS: (1) The anatomic diagnostic protocol for cough is also valid for CCS; (2) the major causes of chronic excessive sputum production and chronic cough are so similar that CCS should be considered a form of chronic cough; (3) the evaluation of CCS is more complicated and takes longer than the evaluation of chronic cough; (4) the major strength of the laboratory diagnostic protocol is that it reliably rules out conditions; (5) the outcome of specific therapy is almost always successful; and (6) the term "bronchorrhea" can be misleading if it is applied to excessive sputum production before a specific diagnosis of its source is made since the most common cause of excessive sputum that is expectorated (PNDS) is a disorder of the upper respiratory tract. Therefore, nonspecific therapies theoretically aimed at reducing mucus production in the lower respiratory tract are not likely to be helpful.

Adolescent↗
PubMed1997

A comparison of peak sputum tobramycin concentration in patients with cystic fibrosis using jet and ultrasonic nebulizer systems. Aerosolized Tobramycin Study Group.

STUDY OBJECTIVE: To determine whether adequate concentrations of a new formulation of tobramycin could be delivered to the lower respiratory tract of patients with cystic fibrosis (CF) using a jet nebulizer delivery system. DESIGN: A multicenter, open-label, randomized, crossover study. SETTING: Ten tertiary care, university-affiliated, teaching hospitals in the United States. PATIENTS AND CONTROL SUBJECTS: Sixty-eight patients recruited from 10 CF Foundation centers and who were at least 8 years of age, had a diagnosis of CF, and expectorated daily sputum. No control subjects enrolled. INTERVENTIONS: Each patient received one administration of aerosolized tobramycin from each of the three nebulizer systems in random order. Each administration was separated by a minimum of 48 h. The two jet nebulizer systems tested were the Sidestream (Medic-Aid; Sussex, UK), and the Pari LC (Pari Respiratory Equipment; Richmond, Va), with a DeVilbiss Pulmoaide compressor (DeVilbiss Health Care; Somerset, Pa), both administering 300 mg tobramycin in 5 mL of 1/4 normal saline solution (NS). Patients were also administered 600 mg tobramycin in 30 mL of 1/2 NS with the UltraNeb 99/100 (DeVilbiss). MEASUREMENTS: Sputum and serum tobramycin concentration and pulmonary function were monitored. An adequate peak sputum tobramycin concentration was defined as > 128 microg/g sputum at any of three time points (10, 60, or 120 min) after completion of treatments. RESULTS: The peak tobramycin concentrations in expectorated sputum were 687+/-663 microg/g (mean+/-SD) with the Pari LC and 489+/-402 microg/g with the Sidestream. Adequate peak sputum tobramycin concentration was achieved in 93% of the patients with the Sidestream, and in 87% of the patients with the Pari LC. Peak sputum concentrations were found to be substantially higher when patients received tobramycin administered with the UltraNeb 99/100, 1,498+/-1,331 microg/g with 30% of patients having levels exceeding 2,000 microg/g. Serum tobramycin concentrations were < or = 4 microg/mL for all patients following administration with each nebulizer. CONCLUSIONS: Adequately high sputum tobramycin concentrations were documented in sputum in > 85% of patients following the administration of 300 mg/5 mL formulation of tobramycin aerosolized by the two jet nebulizer delivery systems, Sidestream and Pari LC. The single tobramycin administration delivered by these two systems is well-tolerated.

Adolescent↗
PubMed1979

Physiologic effects of chest percussion and postural drainage in patients with stable chronic bronchitis.

The effects of a 30-minute period of chest percussion and postural drainage were compared to a sham treatment (infrared lamp) in 35 patients with stable chronic bronchitis and to a period of directed coughing in 11 of these same patients. There were no differences in subjective responses or arterial blood gas levels following therapy. Spirometric studies showed small improvements over baseline values following either treatment but no difference between active and sham treatments. The volume of sputum expectorated during percussion and drainage was significantly greater than during the infrared warming (5.5 vs 1.4 ml) or during the directed coughing (9.0 vs 3.5 ml). Although chest percussion and postural drainage are effective in augmenting the volume of expectorated sputum, no significant alternations in air flow or gas exchange after two hours were demonstrated.

Adult↗
PubMed1987

Lack of effect of hydration on sputum production in chronic bronchitis.

Patients with chronic lung disease productive of sputum are generally encouraged to drink a large amount of fluid to facilitate sputum production. This clinical practice has not been tested systematically. Twelve outpatients with chronic obstructive pulmonary disease in clinically stable condition who had daily sputum production were asked in random sequence: 1) to drink one glass of fluid every waking hour after supper and upon waking the next morning (hydration), 2) to drink no fluid after supper and upon waking the next morning (dry), and 3) to drink fluid ad lib (ad lib). Each morning sputum collection was started upon waking and continued for four hours. The differences in volume, elasticity of sputum, respiratory symptoms, and ease of expectoration were not significant. We conclude that moderate hydration and dehydration have no effect on volume expectorated, the elasticity of sputum, respiratory symptoms or forced expiratory volume in one second.

Aged↗
PubMed1990

Estimation of dental plaque levels and gingival inflammation using a simple oral rinse technique.

A simple, non-invasive test (the Oratest) has recently been proposed, which provides an estimate of oral microbial levels based on the rate of oxygen depletion in expectorated milk samples. Following 30 seconds of vigorous rinsing with sterilized milk, 3 ml of the expectorate is added to a test tube containing the redox indicator, methylene blue, and the time required for a color change from blue (i.e., aerobic conditions) to white (anaerobic conditions) at the bottom of the test tube is recorded. In the present study, Oratest scores were compared to clinical parameters (Plaque Index [PI] and Gingival Index [GI]) in a group of 49 volunteers. Significant correlations were found between the logarithm of Oratest results and PI (r = -0.58; P = 0.001) as well as GI (r = -0.66; P = 0.001). The data indicate that the Oratest provides a reliable estimate of gingival inflammation, thus extending the previously reported strong correlations between Oratest scores and microbial counts. The data suggest that the Oratest may have potential as a clinical and research tool.

Adult↗
PubMedDate not supplied

Secretory IgA(S-IgA) levels in sera from patients with diffuse panbronchiolitis.

The serum S-IgA levels of 33 patients with diffuse panbronchiolitis (DPB) were compared with those of 13 patients with chronic bronchitis (CB) and 24 patients with bronchiectasis (BE), to obtain information on differences in the pathologic states in DPB and other chronic bronchial diseases. The S-IgA levelw as elevated in all three bronchial diseases, being significantly higher in DPB than in CB, and intermediate in BE. Persistent bacterial infections developed in most of the patients with DPB and two-thirds of those with BE, but in few of those with CB. Serum S-IgA levels were especially high in patients expectorating Pseudomonas aeruginosa-positive sputum, who constituted two-thirds of the patients with DPB and about one-third of those with BE. The highest levels over (100 micrograms/ml) were observed in far-advanced patients with DPB who expectorated P. aeruginosa-positive sputum. The increase in the serum level of IgA was less than that of S-IgA in all three diseases. These results indicate that the marked elevation of the serum S-IgA level in patients with DPB is due to extensive, chronic infection of the airways of the lungs, especially the peripheral airways, and that serum S-IgA is a useful marker for determining the clinical stage and the pathologic state of patients with diffuse peripheral airway diseases.

Adult↗
PubMed1999

Effects of the flutter device on pulmonary function studies among pediatric cystic fibrosis patients.

PURPOSE: Previous studies have shown that the Scandipharm Flutter airway clearance device has increased the ability of cystic fibrosis patients to expectorate mucus. Studies that show the effects of the Flutter on pulmonary function among the pediatric cystic fibrosis patients are limited. Thus, we embarked on a study to assess the device's effectiveness. METHODS: The long-term effect of the Flutter on pulmonary function tests (PFTs) was studied and compared with other airway clearance techniques, such as chest physiotherapy (CPT) and Vital Signs, Inc. 9000 PEP positive expiratory pressure (PEP) therapy for cystic fibrosis patients of five to 17 years of age with mild to moderate disease. Of the 15 patients who qualified, six completed the study. The patients were evaluated using PFTs and a respiratory assessment at the beginning and end of each new therapy. Duration of each therapy was one month. RESULTS: No respiratory assessment parameters changed between the therapies studied. All patients who used the Flutter preferred it over the other two therapies. The patients stated they felt better clinically, were able to expectorate mucus more easily, and felt more in control of their therapies. Paired t-test statistical analysis from the PFT data indicated no significant changes in forced expiratory volume in the first second of expiration (FEV1), forced expiratory flow from 25 percent to 75 percent of the loop (FEF25-75), airway resistance (Raw), or specific airway conductance (sGaw) among the three therapies studied. CONCLUSION: This study has shown no significant change in respiratory assessment parameters or pulmonary function. Further studies involving multicenter trials are warranted to evaluate the effects of the Flutter on pulmonary function.

Adolescent↗
PubMed1998

[A prospective study on etiologic bacteria in 200 patients with pneumonia].

The etiologic agents in 200 patients with pneumonia were studied by the bacterial culture of sputums obtained from the protected single catheter brush or quantitative expectoration at one morning or three-morning expectoration. Two hundred patients were divided into 3 groups. Group 1 was Nosocomial pneumonia (NP patients). Group 2-1 and Group 2-2 were community acquired pneumonia (CAP patients). All cases in Group 1 and Group 2-2 suffered from significant underlying diseases while Group 2-1 did not. Gram-negative bacilli(GNB) were isolated from the specimens in Group 1 (87%) and Group 2-2 (75%), respectively. Pseudomonas (30.8%) and klebsiella (20.5%) were the predominant bacteria (in Group 1 and pseudomonas bacteria) in Group 1 and pseudomonas (27.3%), acinetobacter (23%) and kledsiella (18%) were the major etiologic agents in Group 2-2. The commonest pathogens in Group 2-1 were gram-positive cocci (75%), in which streptococcus (38%) and staphylococcus aureus (25%) were the dominant agents. Compared with Group 2, Group 1 suffered from more mixed bacteria and the agents presented severer drug-resistant. The prognosis was worse in Group 2-2 than in Group 2-1. The results showed that the GNB pneumonia was more common in the cases who had underlying disease, no matter whether the pneumonia was NP or CAP. These patients had more trouble on their antibiotic therapy. Thus it is important that doctors should use vigorous antibiotics timely while treating these patients' underying diseases.

Adult↗
PubMed2000

[Evaluation and symptomatic treatment of surinfectious exacerbations of COPD: preliminary study of antibiotic treatment combined with fenspiride (Pneumorel 80mg) versus placebo].

UNLABELLED: Exacerbations of chronic obstructive pulmonary disease (COPD) have an inflammatory component in addition to the possible infectious component. The antiinflammatory properties of fenspiride (Pneumorel(R) 80 mg) should be evaluated in this frequent clinical situation. OBJECTIVES: Assess the supplementary therapeutic benefit provided by fenspiride administered in combination with antibiotics in COPD patients presenting an episode of bronchial infection. PATIENTS AND METHODS: A preliminary randomized placebo-controlled double-blind study was conduced in 7 centers. Patients under 80 years of age of both sexes were included. All patients had COPD and presented a bronchial infection defined as the presence of at least 2 of the 3 criteria defined by Anthonisen. Patients were randomly assigned to group F or group P. Group F received an antibiotic therapy from day 1 to day 11 plus fenspiride (3 x 80mg/d from day 0 to day 30). Group P received the same antibiotic therapy plus placebo. Amoxicillin 500mg plus clavulanic acid 125, 3 tablets/day, was administered in both groups. RESULTS: Thirty-nine patients were included (group F 19 patients, group P 20 patients; 6 women and 33 men; mean age 61.1 +/- 9.8 years). The 3 Anthonisen criteria were present in 79% and 75% of the patients in group F and P respectively (NS). On day 11, expectoration resolved in 39% and 32% (NS) and cough in 44% and 16% (NS) of the patients in groups F and P respectively. Lung auscultation returned to normal in 83% of the patients in group F compared with 47% in group P (p=0.05). A composite clinical score including expectoration cough and auscultation findings showed that 28% of the patients in group F were symptom-free on day 11 compared with 0% in group P (p=0.04). On day 30, the two groups were comparable. CONCLUSION: In this preliminary study of patients with COPD presenting a bronchial superinfection, there was a significant improvement in lung auscultation and in the composite clinical score in patients given fenspiride. Fenspiride was thus found to provide an early clinical benefit.

Acute Disease↗
PubMed2000

[Efficacy of the FLUTTER VRP1 device for physiotherapy patients with chronic pulmonary disease].

Respiratory physiotherapy is essential to the treatment of all acute or chronic respiratory disorders which expectoration difficulties are major problem. The Flutter VRP1 is an easy to use physiotherapy device; combines safe endobronchial positive expiratory pressure with vibratory effects. Flutter is a useful device for sputum expectoration and markedly improvement of lung parameters.

Aged↗
PubMed2000

[The hormonal factors regulating water-electrolyte exchange in the pathogenesis of the hemodynamic disorders in pre-eclampsia].

Study of indices of different endocrine links of female organisms with gestosis of the 2nd half of pregnancy with the search of degree of taking part of this hormones in the forming of basic syndromes of hestosis and guiding line to fundamental approach in medicinal practice with gestosis. Decrease of natrium content in CBV at the same time with decrease of intravascular volume of it and decrease of excretion of it with urine in the dynamics of gestosis confirms hestosis development and retention of natrium in the expectorant women's organism with primary delay of it in tissues. Energization of renin-angiotensin-aldosterone-tromboxane system, changes of prostaglandin-tromboxane link in blood contributed to forming of arterial hypertension and edema. With taking into account revealed changes of hormonal levels at the background of progressive hypovolemia, decrease of speed of excretion of natrium with urine and speed of glomerular filtration, differentiate approach in prescription for hypotensive and diuretic agents is recommended for the avoidance of possible hardening of state of expectorant woman with gestosis.

Adaptation, Physiological↗
PubMed1999

Pharmacy Distribution of Advice, Symptomatic Treatment and Antimicrobial Drugs to Patients with Cough.

It is an accepted fact that, in many countries, pharmacies are the predominant source of medical advice over-the-counter drugs, and supplies of "prescription-only" drugs for sale without a prescription. To assess the activities conducted by pharmacists or pharmacy counter assistants in response to a common health problem, a cross-sectional study was done at 114 pharmacies in Porto Alegre, Brazil. A fictitious case-history of cough was used by trained personnel entering the pharmacy and the subsequent activities by the pharmacist or pharmacy counter assistant were analyzed. Some kind of medication was provided in 101 (88.5%) of the pharmacies. Pharmacists gave medication in 80% of pharmacies, and pharmacy assistants in 95.5% (p<0.03). The class of medication most frequently dispensed was the expectorants (97 times, 92.4%), however, systemic antibiotics were provided in 11 pharmacies (10.5%). Of note, the pharmacists provided antibiotics more frequently than did pharmacy assistants (p=0.016). We conclude that pharmacy advice and symptomatic medical care (expectorants) are very common and that pharmacy assistants are more likely than pharmacists to provide medication. Of concern, when pharmacists were the drug dispensers of antibiotics which should be provided by prescription only, drugs were provided without proper diagnosis, and often in incorrect dosages. This reflects a potentially dangerous practice in need of careful evaluation, education and supervision.

Journal Article↗
PubMedDate not supplied

[Evaluation of autodrainage methods in a selected group of cystic fibrosis patients with home environment factors taken into consideration].

The aim of the study was an estimation of effectiveness of selected autodrainage methods used in the treatment of children with cystic fibrosis and an assessment of patients' preference in relation to investigated methods. We also estimated the patients and their families' relation to chest physiotherapy methods, which have been used at home for many years. We studied 17 patients, aged 10-18 (x 13.35), who were hospitalised in the Institute of Mother and Child Paediatric Clinical Dept. We compared four autodrainage methods: 1- force expiratory technique, 2- Flutter(R), 3- Flutter (R) with relaxation, 4- PEP system. Every investigated drainage methods were tested by each patient according to a determined procedure. The following indices were measured: weight of coughed up sputum, oxygen saturation (SaO2) before, during and after drainage, peak expiratory flaw (PEF) before and after drainage. Patients' relation to autodrainage methods was estimated on the ground of their subjective assessment in 0-5-point scale. The results showed that the force expiration technique and the Flutter(R) with relaxation are the most efficient autodrainage methods determined by their coughed up sputum weight. Patients using these methods coughed up x 1.36g and x 1.319 g sputum. Using Flutter(R) without relaxation, patients expectorated 1.199 g sputum. PEP system turned out the least effective. Patients using the PEP system coughed up x 0.87 g sputum. In comparison, patients using postural drainage with clapping expectorated x 0.63g sputum. We observed that the PEF decreased during every investigated drainage methods. There were no significant differences in SaO2 values before and after drainage. Concerning the patients' preference in relation to the investigated methods, patients appreciated the most force expiratory technique (68 points). The least appreciated was the PEP system (33 points). For comparison, postural drainage with clapping has been estimated at 48.87 points.

Adolescent↗
PubMed2000

[A patient with dysphagia treated successfully and discharged without nutritional support].

One of the main targets of medical care provided in our ward, which specializes in the cooperative practice of hospital- and home-doctors, is to maintain the quality of patients' lives after they are discharged from our hospital through home medical care by home-doctors. Intravenous hyperalimentation and tube-feeding at home are suitable solutions for some patients with dysphagia after cerebral infarction. However, the difficulties faced in their management are the burden on the families, which tends to be an obstacle for at-home-practice. We describe herein a case of severe dysphagia treated successfully through our rehabilitation program and discharged without nutritional supports. An 82-year-old man was admitted to our hospital suffering from pyrexia and dysbasia. The man, who lives with his wife and his son's family, was diagnosed with aspiration pneumonia and multiple cerebral infarctions. The test for swallowing reflex revealed an impaired first phase reflex and intravenous hyperalimentation was performed for his nutritional support. He was still suffering from dysphagia but had the desire to eat orally after his dysbasia and aspiration pneumonia were cured. A rehabilitation program was scheduled with the aims of 1) recovery of ingestion and 2) sufficient expectoration, with an ongoing teaching program for the management of intravenous hyperalimentation. After one month of rehabilitation (ice-massaging, muscle rehabilitation of the tongue and neck and expectoration training in a prone position and after gorging), his ability to swallow was gradually recovered. With the frequent confirmation of absence of aspiration, special forms of diets were served and upgraded from jelly, paste-like-food to soft-cooked steamed rice. The patient is now at home without any nutritional support. Nutritional management without intravenous hyperalimentation or tube-feeding is important or even essential for some families providing home-care for patients. The problem of aging requires us to reduce the burden that families (who may be also getting older) should carry. We try to support patients and families for better home-care through cooperation with society and home-doctors.

Aged↗
PubMed2000

Comparative yield of different respiratory samples for diagnosis of Pneumocystis carinii infections in HIV-seropositive and seronegative individuals in India.

Respiratory specimens were prospectively examined for Pneumocystis carinii from 53 patients. The majority of specimens were comprised of expectorated sputum, induced sputum, broncho-alveolar lavage (BAL), and tracheal aspirates. In only four patients Pneumocystis carinii (P. carinii) was detected. All the samples were produced by broncho-alveolar lavage. Candida spp and Aspergillus spp were also identified in a small number of patients. Acid-fast-bacilli were not detected in any of the cases under study. There were no sex-related differences in distribution. The present prospective study was undertaken in order to determine P. carinii infections in human immunodeficiency virus (HIV) seropositive and seronegative individuals. Expectorated sputum samples were probably the major limiting factor in low positivity for detection of P. carinii and study of BAL specimens would be more useful for better results.

AIDS-Related Opportunistic Infections↗
PubMed1998

[Clinical and experimental studies on treating infantile pneumonia with Feiyan Mixture].

OBJECTIVE: To explore the effect of Feiyan Mixture (FYM) in treating infantile pneumonia and its mechanism. METHODS: One hundred and twenty-eight patients were treated with FYM, the effect was observed and compared with those treated with antibiotics as control. Systematic clinical observation and animal experimental studies on the FYM were carried out. RESULTS: The effective rates of FYM and antibiotics were 89.0% and 94.73% respectively and no significant difference was found between two groups, chi 2 = 2.838, P > 0.05. Experimental study showed that FYM was effective in anti-inflammation, antitussiveness, expectoration and spasmolysis. CONCLUSIONS: FYM has obvious effect of anti-inflammation, antitussiveness, expectoration and spasmolysis.

Adolescent↗