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PubMed1997

Decreased C4 complement component serum levels correlate with the degree of emphysema in patients with chronic bronchitis.

Patients with COPD who fulfill the diagnostic criteria of chronic bronchitis have been shown to exhibit lower serum levels of complement components C3 and C4 than healthy subjects, and this may indicate sustained complement activation as a result of recurrent respiratory tract infections. Since activation of complement leads to influx of inflammatory cells into the lung parenchyma with subsequent release of elastases and oxidants that cause damage to elastic lung tissue, we postulated that there might be a quantitative relationship between complement consumption and degree of elastic tissue destruction. In this study, we tried to investigate possible correlations between serum levels of C3 and C4 and degree of emphysema among patients with COPD of the bronchitic type. We studied 20 patients with chronic bronchitis aged 68+/-1 years (mean+/-SEM) without significant fluctuations of serum C3 and C4 levels over a 3-month period by performing detailed lung function tests, recording of emphysema score in chest radiogram, and the incidence of infective exacerbations during the past 3 years. Measured C3 and C4 serum levels were 124+/-9 and 28.5+/-2 mg/dL, respectively, lower than the respective levels in control subjects (141+/-3 and 39+/-2 mg/dL, respectively). Significant correlations were observed between levels of C4 and (1) incidence of respiratory tract infections during the past 3 years (r=-0.747, p<0.001), (2) radiologic emphysema score (r=-0.936, p<0.001), and (3) various functional indexes, such as midexpiratory flow rate, percent of predicted (r=0.629, p<0.01), forced expiratory flow rate at 50% of vital capacity, percent of predicted (r=0.606, p<0.01), residual volume/total lung capacity ratio (r=-0.651, p<0.01), and the exponential constant of static pressure-volume curve (r=-0.606, p<0.01). These results suggest that patients with chronic bronchitis with the lowest levels of C4 are those experiencing more frequent respiratory infections, tend to have more signs indicative of emphysema in their chest radiograph, have a more prominent small airways dysfunction and gas trapping, and present a greater defect in lung elastic recoil.

Aged↗
PubMed2002

Spirometric abnormalities associated with chronic bronchitis, asthma, and airway hyperresponsiveness among boilermaker construction workers.

STUDY OBJECTIVES: In a 2-year longitudinal study of boilermaker construction workers, we found a significant association between working at oil-fired, coal-fired, and gas-fired industries during the past year and reduced lung function. In the present study, we investigated whether chronic bronchitis, asthma, or baseline methacholine airway responsiveness can explain the heterogeneity in lung function response to boilermaker work. DESIGN: This study is part of an ongoing prospective cohort study of boilermakers. Exposure was assessed with a work history questionnaire. Spirometry was performed annually to assess lung function. A generalized estimating equation approach was used to account for the repeated-measures design. SETTING: Boilermaker union members. PARTICIPANTS: One hundred eighteen boilermakers participated in the study. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Self-reported history of chronic bronchitis and asthma were associated with a larger FEV1 reduction in response to workplace exposure at coal-fired and gas-fired industries. Although we found a high prevalence (39%) of airway hyperresponsiveness (provocative concentration of methacholine causing a 20% fall in FEV1 of < 8 mg/mL) among boilermakers, we did not find a consistent pattern of effect modification by airway responsiveness. CONCLUSIONS: Although chronic bronchitis and asthma were associated with a greater loss in lung function in response to hours worked as a boilermaker, and therefore they acted as effect modifiers of the exposure-lung function relationship, airway hyperresponsiveness did not. However, the high prevalence of airway hyperresponsiveness found in the cohort may be a primary consequence of long-term workplace exposure among boilermakers.

Adult↗
PubMed2002

Passive smoking exposure: a risk factor for chronic bronchitis and asthma in adults?

OBJECTIVE: The effects of passive smoke exposure on respiratory health are still under debate. Therefore, we examined the risk of respiratory symptoms related to passive smoke exposure among German adults within the European Community Respiratory Health Survey. METHODS: The questionnaire data of the population-based sample (n = 1,890) were analyzed. Multiple logistic regression models were carried out for current asthma (asthma symptoms or medication), chronic bronchitis (cough with phlegm for > or = 3 months per year), and wheezing as dependent variables, and self-reported exposure to passive smoke at home and at the workplace as independent variables after adjusting for city, age, gender, active smoking, and socioeconomic status as well as occupational exposure to dusts and/or gases. RESULTS: The relative odds for chronic bronchitis were significantly higher in subjects reporting involuntary tobacco smoke exposure in the workplace (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.16 to 3.11). Likewise, the adjusted OR for asthma was slightly elevated (OR, 1.51; 95% CI, 0.99 to 2.32). The risk of chronic bronchitis (OR, 3.07; 95% CI, 1.56 to 6.06), asthma (OR, 2.06; 95% CI, 1.07 to 3.97), and wheezing (OR, 2.12; 95% CI, 1.25 to 3.58) increased significantly with a daily exposure of > 8 h. CONCLUSION: The control of passive smoke exposure in the workplace might reduce the risk of respiratory symptoms independently of exposure to other airborne contaminants.

Adult↗
PubMed2002

Improved sputum expectoration following a single dose of INS316 in patients with chronic bronchitis.

UNLABELLED: Uridine 5'-triphosphate (UTP) is a naturally occurring agonist for P2Y(2) receptors on the apical surface of ciliated respiratory epithelium. UTP stimulates salt and water transport and cilia beat frequency in human airway epithelium in vitro. Single, inhaled doses of UTP stimulate mucociliary clearance in conscious, intubated sheep and in patients with mild chronic bronchitis (smokers and former smokers), suggesting that UTP may be useful for obtaining deep-lung sputum specimens suitable for diagnostic purposes. STUDY OBJECTIVE: UTP is being developed for the cytologic diagnosis of lung cancer under the compound number INS316 Solution for Inhalation (Inspire Pharmaceuticals; Durham, NC). Its ability to improve the quality of expectorated sputum was tested in the current study. DESIGN: Placebo-controlled, double-blind, escalating two-period cross-over study. SETTING: Outpatient volunteers. PATIENTS OR PARTICIPANTS: Twenty-six patients with mild chronic bronchitis. INTERVENTION: Patients attempted to expectorate a specimen spontaneously, following a single inhaled dose of INS316 (10 to 180 mg), and following placebo. MEASUREMENTS AND RESULTS: Sputum weight, sputum cell content, spirometry, and oxyhemoglobin saturation. Only 28% of these patients were able to expectorate a macrophage-containing, deep-lung specimen spontaneously or following inhalation of placebo. In contrast, 85% of the patients were able to produce a specimen following inhalation of INS316. The average weight of the sputum expectorated was increased fourfold by placebo and 10-fold by INS316. A mild transient decrease in pulmonary function was observed following INS316 administration. CONCLUSION: A single dose of INS316 safely improves the ability of patients with mild chronic bronchitis to expectorate a deep-lung sputum specimen suitable for cytologic evaluation.

Adult↗
PubMed1977

Bronchodilator action of the anticholinergic drug, ipratropium bromide (Sch 1000), as an aerosol in chronic bronchitis and asthma.

Ipratropium bromide (also known as Sch 1000) is a new atropine-like bronchodilator drug whose mechanism of action is via an anticholinergic pathway and may decrease cyclic guanosine monophosphate. Although of established efficacy in asthma, there are no studies of the use of ipratropium in patients with chronic bronchitis. The single metered aerosol doses of 10 mug, 20 mug, 40 mug and 80 mug of ipratropium bromide, 75 mug and 150 mug of isoproterenol, and placebo were studied in 20 adult patients, half with asthma and half with chronic bronchitis. To qualify, all patients demonstrated at least 20% improvement in the forced expiratory volume in one second while in the drug-free state when tested with isoproterenol. All subjects were tested for six hours with each agent in a double-blind crossover design. The dose-response aspects of the study indicate that in bronchial asthma the optimal range of dosage is 40 mug to 80 mug of ipratropium bromide. These doses are superior to isoproterenol in duration of action. In chronic bronchitis, all doses of ipratropium showed prolonged efficacy, but 80 mug was superior. Isoproterenol lacked this sustained efficacy. No significant alteration in pulse or blood pressure was observed. Ipratropium appears to be an important addition to the bronchodilator agents used in isoproterenol-responsive obstructive pulmonary disease.

Aerosols↗
PubMed1977

Evaluation of cardiac size in chronic bronchitis and pulmonary emphysema.

The accuracy of interobserver variability of roentgenographic analysis for cardiac size in patients dying with chronic bronchitis and pulmonary emphysema were correlated with pathologic data derived from special studies. Three trained observers were able to accurately and consistently diagnose chronic bronchitis and pulmonary emphysema and to detect cardiomegaly on the chest x-ray film. The best criteria for chronic bronchitis and pulmonary emphysema were those of overinflation; however, none of the roentgenographic criteria usually suggested for the specific diagnosis of right ventricular or left ventricular hypertrophy were found to be reliable. The inaccuracy and interobserver variability in the detection of enlargement of specific chambers make it evident that the usual criteria are not valid and that roentgenographic appraisal of cardiac size in these patients in limited to findings of normalcy or cardiomegaly.

Autopsy↗
PubMed1983

Nutritional status and lung function in patients with emphysema and chronic bronchitis.

This study compared the nutritional status of patients with emphysema and chronic bronchitis and examined the relationship between lung dysfunction and nutritional depletion in patients with emphysema. There was no evidence of nutritional depletion in patients with chronic bronchitis (n = 4). In contrast, patients with emphysema (n = 14) were somatically depleted. They exhibited lower values for percent ideal body weight (%IBW), arm muscle circumference (AMC), and triceps skin fold thickness (TSF) (p less than 0.05) than did patients with chronic bronchitis. The creatinine height index (CHI) was also lower in this group, but the difference was not significant (p = 0.08). In patients with emphysema, there was a good correlation between the degree of airflow obstruction and of somatic depletion (FEV1 vs %IBW, r = 0.699, p less than 0.001). The single-breath diffusing capacity (DCO) also correlated well with %IBW (r = 0.6052, p less than 0.019). These results confirm that patients with emphysema are frequently nutritionally depleted and suggest that nutritional depletion contributes to lung dysfunction in emphysema.

Aged↗
PubMed1983

Symptoms and experiences in chronic bronchitis and emphysema.

A heterogeneous group of 146 patients with chronic bronchitis and emphysema were asked to rate the frequency with which 89 symptoms and experiences occurred during their breathing difficulties. Normative values and the reported frequency of occurrence for the 11 symptom categories are presented. As expected, symptoms of dyspnea were the most frequently reported during breathing difficulties. In decreasing order, symptoms of dyspnea were followed by symptoms of fatigue, sleep disturbance, congestion, irritability, anxiety, decathexis, helplessness-hopelessness, poor memory, alienation. Separation of the patients into subgroups revealed that women reported more anxiety and helplessness-hopelessness than men. Younger patients reported more irritability and anxiety than older patients. Patients with mixed disease reported more dyspnea than those with chronic bronchitis or emphysema, although patients with emphysema reported more loss of interest in life than patients with chronic bronchitis. Self-ratings of functional incapacitation were clearly related to the symptom reports. Relationships among the symptom categories were discussed, as was the potential usefulness of symptom patterns in exploring coping styles in respiratory disease.

Adult↗
PubMed1988

Variability of the pulmonary vascular response to acute hypoxia in chronic bronchitis.

Hypoxic pulmonary vasoconstriction is considered as one of the factors leading to pulmonary hypertension in patients with chronic bronchitis, but the magnitude and the variability of the pulmonary vascular response to hypoxia in these patients have not been well established. We investigated the pulmonary hemodynamic changes induced by breathing two hypoxic mixtures (FIO2 = 0.15 and 0.13) in 26 patients with chronic bronchitis with airway obstruction (FEV1/VC = 49 +/- 14 percent). Results show that there is a wide variability of the pulmonary vascular response to acute hypoxia in chronic bronchitis patients, but it is not possible to say whether such differences play a role in the natural history of the disease.

Blood Pressure↗
PubMed1989

Prevalence of chronic bronchitis and respiratory function in a group of dairy farmers in the French Doubs province.

We used a questionnaire combined with medical history and spirometric studies to compare symptoms and respiratory function in two groups of subjects living in the French province of Doubs. A group of 250 dairy farmers was compared with 250 control subjects, matched with regard to sex, age, height, and smoking habits. The prevalence of acute bronchial infections and dyspnea was identical in the two groups. Among dairy farmers, 30 (12 percent) had chronic bronchitis vs 15 (6 percent) in the control group (p less than 0.05). Chronic bronchitis was more common in patients aged over 40 years (p less than 0.001) and in nonsmokers (p less than 0.001). All respiratory function parameters measured (expressed as a mean percentage of values measured in comparison with theoretic values) were lower in the dairy farmer group than in the control group. With regard to degree of bronchial obstruction, the difference between the two groups was more marked in patients aged 40 years and over and in nonsmokers. Dairy farmers' occupation is a risk factor of chronic bronchitis and bronchial obstruction, in particular in patients aged 40 years and over and in nonsmokers.

Adult↗
PubMed1990

Airway carcinoembryonic antigen concentrations in patients with central lung cancer or chronic bronchitis.

To determine the clinical utility of airway carcinoembryonic antigen (CEA) concentrations to distinguish malignant from inflammatory airway disease in patients undergoing bronchoscopy, we determined CEA concentrations by enzyme immunoassay in bronchial washings recovered in 48 subjects, including 20 patients with central lung cancer, 18 patients with chronic bronchitis, and ten nonsmoking patients with a diagnosis of pneumonia or peripheral granuloma. Concentrations of CEA in bronchial washings were standardized by using the total protein concentration in recovered fluid (CEA/TP). Concentrations of CEA were significantly increased in bronchial washings recovered from both patients with chronic bronchitis and lung cancer compared with patients with pneumonia or granuloma (252 +/- 47 ng/mg and 199 +/- 64 ng/ml vs 62 +/- 11 ng/mg, SEM, p less than 0.005). Airway CEA concentrations in patients with chronic bronchitis were somewhat increased compared with concentrations recovered from a cancer-involved airway (252 +/- 47 ng/ml vs 199 +/- 64 ng/mg, SEM, p less than 0.05). Measurement of airway CEA concentrations is not useful in distinguishing malignant from inflammatory airway disease as airway concentrations of CEA may be markedly increased in patients with both conditions.

Bronchitis↗
PubMed2005

Antibiotic prescribing for children with nasopharyngitis (common colds), upper respiratory infections, and bronchitis who have health-professional parents.

OBJECTIVE: Antibiotic resistance might be reduced if patients could be better informed regarding the lack of benefits of antibiotics for children with viral infections and avoid antibiotic prescriptions in these circumstances. This study investigated whether children having health professionals as parents, a group whose parents are expected to have more medical knowledge and expertise, are less likely than other children to receive antibiotics for nasopharyngitis (common colds), upper respiratory tract infections (URIs), and acute bronchitis. METHODS: Retrospective analyses were conducted by using National Health Insurance data for children of physicians, nurses, pharmacists, and non-health personnel, who had visited hospital outpatient departments or physician clinics for common colds, URIs, and acute bronchitis in Taiwan in 2000. A total of 53733 episodes of care for common colds, URIs, and acute bronchitis in a nationally representative sample of children (aged < or =18 years) living in nonremote areas were analyzed. RESULTS: The study found that, after adjusting for characteristics of the children (demographic, socioeconomic, and health status) and the treating physicians (demographic, practice style, and setting), children with a physician (odds ratio [OR]: 0.50; 95% confidence interval [CI]: 0.36-0.68) or a pharmacist (OR: 0.69; 95% CI: 0.52-0.91) as a parent were significantly less likely than other children to receive antibiotic prescriptions. The likelihood of receiving an antibiotic for the children of nurses (OR: 0.91; 95% CI: 0.77-1.09) was similar to that for children in the comparison group. CONCLUSIONS: This finding supports our hypothesis that better parental education does help to reduce the frequency of injudicious antibiotic prescribing. Medical knowledge alone, however, may not fully reduce the overuse of antibiotics. Physician-parents, the expected medically savvy parents, can serve as a benchmark for the improvement potentially achievable in Taiwan through a combination of educational, regulatory, communication, and policy efforts targeted at more appropriate antibiotic prescribing in ambulatory settings.

Anti-Bacterial Agents↗
PubMedDate not supplied

The economic impact of acute exacerbations of chronic bronchitis in the United States and Canada: a literature review.

BACKGROUND: Acute exacerbations of chronic bronchitis (AECB) are recurrent and potentially severe medical events for the 13 million people in the United States who have chronic bronchitis. Medical resource use associated with AECB can have a substantial economic impact on the patients, health care system, and society overall. OBJECTIVE: To evaluate literature on the economic impact of AECB in terms of cost of illness, cost of treatments, and cost-effectiveness. METHODS: A MEDLINE literature search was conducted for studies of chronic bronchitis and costs. Reference lists of identified articles were also retrieved for review. RESULTS: Eight published studies were identified: 2 cost-of-illness studies, 1 comparative cost study, and 5 cost-effectiveness studies. Important drivers of costs associated with AECB include hospitalization and choice of antibiotics. In mild to moderate AECB, patient adherence with therapy is essential to consider when selecting treatment. The antibiotic with the lowest acquisition cost has not been shown to be the most cost effective, as adherence and clinical outcomes, particularly rehospitalization rates, differ. CONCLUSION: Further research in these areas is needed to guide clinical decision making and the conduct of disease management programs.

Aged↗
PubMed2001

Novel mechanistic targets for the treatment of sub-acute and chronic bronchitis.

Sub-acute and chronic bronchitis (SACB) are among the least well studied major medical problems that exist today. While much research and novel drug discovery have focused on asthma, comparatively little has been performed on chronic bronchitis, the fourth or fifth most frequent disease (4 to 6% of the population over 45 years of age), or on sub-acute bronchitis, the persistent symptoms of a respiratory infection which is the major reason Americans visit a physician (20%). This lack of attention is largely due to difficulties associated with modeling the pathophysiology of SACB in vitro, in situ, in organs or in animals as well as the presumption that drugs developed for asthma would also be effective in SACB. Data with bronchodilators (anti-cholinergics versus beta2-adrenergic agonist) and corticosteroids have strongly dismissed that premise. In this review of potential novel mechanistic targets directed specifically at SACB, an emphasis is given to recent data, gathered most convincingly from tissues and patients with cystic fibrosis, that have led to an appreciation of the critical role respiratory epithelial dysfunction plays in the pathophysiology and symptoms of these diseases. Mechanistic targets that restore (normalize or accelerate) airway 'cleansing' (enhance host defense) by accelerating mucociliary clearance are described and given preference over anti-inflammatory mechanisms that could further impair host defense.

Adrenal Cortex Hormones↗
PubMed1981

Bronchographic features of chronic bronchitis in normal men.

As part of a study of mucous transport in the airways, tantalum bronchography was performed on 13 normal, asymptomatic men who had normal findings on pulmonary function studies. Most of the subjects demonstrated some of the bronchographic features which have been regarded as specific for chronic bronchitis. Eight men showed opacification of the ducts of mucous glands; 12 had visible secretions in the airways; three had moderate-to-marked irregularity of airways. The clearance of tantalum from the airways in all but two subjects was more rapid than anticipated and thus could not be correlated with the bronchographic features of chronic bronchitis. Two subjects who previously had symptoms of respiratory tract infection showed markedly delayed peripheral airway clearance of tantalum. The bronchographic features of chronic bronchitis can be seen in normal subjects or may indicate airway abnormalities that are not manifested functionally.

Adult↗
PubMedDate not supplied

Deposition and clearance in large and small airways in chronic bronchitis.

Tracheobronchial clearance was studied twice in 16 patients with chronic obstructive bronchitis after inhalation of 6 microns (aerodynamic diameter) monodisperse Teflon particles labeled with 111In. At one exposure the particles were inhaled at an extremely slow flow, 0.05 L/s; at the other they were inhaled at a normal flow, 0.5 L/s. Theoretical calculations and experimental data in healthy subjects indicate particle deposition mainly in the smallest ciliated airways using 0.05 L/s, i.e., in the bronchiolar region, and an enhanced deposition in larger airways using 0.5 L/s. Lung retention was measured at 0, 24, 48 and 72 h. Clearance was significantly every 24 h for both exposures (p < .05). The fractions of retained particles were significantly larger for particles inhaled at 0.05 L/s compared to 0.5 L/s at all points of time (p < .001). Compared to healthy subjects, the retained fractions of deposited particles were larger in patients with bronchitis breathing at 0.05 L/s, but smaller with breathing at 0.5 L/s (p < .01). Significant relationships were found between lung retentions and airway resistance (Raw) at 0.5 L/s, r = -.68 (p < .01), but not at 0.05 L/s, and between lung retention at 24 h and weight of expectorated sputum at 0.05 L/s, r = -.50 (p < .05). There was, furthermore, an almost significant relationship between sputum volume and rate of tracheobronchial clearance between 0 and 24 h (in percentage of the total amount cleared during 72 h) at 0.05 L/s, r = .42 (p = .05). The results indicate that in patients with chronic bronchitis overall clearance of particles in small airways is incomplete, as compared to larger airways. An increased amount of mucus, however, seemed to improve clearance of peripherally deposited particles, possibly by making cough more effective in small airways.

Adult↗
PubMed1997

Acute bronchitis in adults. How close do we come to its aetiology in general practice?

OBJECTIVE: To investigate how close we can come to the aetiology of acute bronchitis in adults in a primary care setting. DESIGN: Prospective study. SETTING: General practice population in Gardabaer district, south-western Iceland. SUBJECTS: 140 patients > or = 16 years old who were diagnosed as having acute bronchitis during a two-year period (1992-1993). MAIN OUTCOME MEASURES: Laboratory investigations (twice with a minimum four-week interval), used in general practice to analyse respiratory tract infections. They included serology for Chlamydia pneumoniae, Mycoplasma pneumoniae, respiratory tract viruses, and the level of C-reactive protein. RESULTS: Of a total of 140 patients, two blood samples were taken on scheduled time in 113 patients. Serology confirmed recent infection in 18 (16%) of these patients. Only two (2%) had a bacterial infection (one C. pneumoniae, one M. pneumoniae). The others (84%) did not have a significant increase in antibody titres. Only four (4%) had C-reactive protein levels higher than 48 mg/l. CONCLUSIONS: The study indicates that it is difficult to come close to a precise aetiology with respect to infectious agents of acute bronchitis in general practice. We conclude that the disease is rarely caused by atypical bacteria such as C. pneumoniae and M. pneumoniae, and rarely caused by bacterial infections severe enough significantly to increase the level of C-reactive protein.

Acute Disease↗
PubMed1994

Seasonal variation in the function of blood monocytes obtained from healthy nonsmokers, asymptomatic smokers, and smokers with chronic bronchitis.

The present study focused on two questions: What effects do cigarette smoking and chronic bronchitis have on the function of the precursors of alveolar macrophages, the blood monocytes? Can seasonal variations affect the function of these cells? Phagocytic activity (the proportion of yeast-ingesting cells and the mean number of yeast particles per ingesting cell) and metabolism of arachidonic acid [secretion of prostaglandin E2 (PGE2) and leukotriene B4 (LTB4) in zymosan-stimulated cultures] were studied as markers of monocyte function during three seasons: spring (May-June), autumn (November-December), and winter (February). Smokers with chronic bronchitis (SCBs) and asymptomatic smokers (ASs) had a lower proportion (p < 0.05) of ingesting monocytes than healthy nonsmokers (HNSs) during spring, but not during the other two seasons. The secretion of PGE2 was highest during autumn and lowest during spring in the monocytes of all three groups. In autumn, LTB4 secretion was increased in the monocytes of HNSs (p < 0.05) but not in those of ASs and SCBs. LTB4 secretion was similar in all groups during the other two seasons. Cigarette smoking and chronic bronchitis seem to impair the function of monocytes and may thereby affect the systemic host defense activity. Cells collected during autumn were generally more active than those sampled in spring, indicating marked seasonal variation in the function of monocytes from all three groups.

Arachidonic Acid↗