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PubMed2002

[Clinicopathological analysis of patients with idiopathic pulmonary fibrosis which became acutely exacerbated after video-assisted thoracoscopic surgical lung biopsy].

Nine patients undergoing video-assisted thoracoscopic surgical (VATS) lung biopsy over a five-year period from 1997 to 2001 with the ultimate diagnosis of usual interstitial pneumonia without underlying connective tissue disease were identified. In two of nine patients, acute exacerbation occurred six days after VATS lung biopsy. We reviewed the clinical records and pathology of all nine cases, and found that the two cases of exacerbation had higher peripheral white blood cell counts and KL-6, lower PaO2, VC and FEV 1, and a longer inhalation of FIO 2 = 1.0 during VATS, and needed a longer period of chest drainage after VATS. Abundant inflammatory cell infiltration and fibroblastic foci were observed in the exacerbation cases. Thus, patients with usual interstitial pneumonia of the idiopathic type, who have high disease activity and low pulmonary function, may be at high risk of acute exacerbation following VATS lung surgery.

Biopsy↗
PubMed2003

[Efficacy of anti-inflammatory treatment with benacort in exacerbations of chronic obstructive lung disease].

AIM: To determine a course and prognostic effectiveness of corticosteroid therapy of chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS: Long-term therapy with broncholytics (berodual) and benacort was given to 25 patients in non-infectious exacerbation, 20 patients received broncholitics of 45 COPD patients with mild and moderate ventilation disorders. Follow-up lasted for 2.5 years. Treatment effectiveness was judged by clinical indices, external respiration function, parameters of systemic immunity, cytogram of induced sputum and concentration of inflammatory markers in the sputum. RESULTS: An immediate effect of two-month therapy with benacort of COPD exacerbations manifested with positive clinical dynamics and relief of endobronchial inflammation. Prognostic efficacy--with a significant reduction of the frequency of COPD exacerbations and of their mean duration more than 3-fold. CONCLUSION: The results of long-term follow-up support validity of inhalation corticosteroids use for eradication and prevention of noninfectious exacerbations of COPD.

Acute Disease↗
PubMed2003

[Therapy of exacerbated COPD. How long ambulatory treatment?].

Acute exacerbation of COPD impacts negatively on the prognosis, and is associated with a significant motality rate. Accordingly, every case of COPD exacerbation requires intensified treatment of the underlying disease. This usually ecompasses the use of inhalative and possibly also systemic bronchodilators, and systemic glucocorticosteroids at appropriate doses. Evidence of infection (purulent sputum) indicates the need for an antibiotic, the choice of which must be determined by the severity of the underlying disease. Respiratory insufficiency requires the additional use of oxygen and, where necessary, mechanical ventilation. In such cases, non-invasive ventilation via a mask has resulted in an appreciable reduction in the complications associated with invasive ventilation, and a significant reduction in the associated high mortality rates. Successful treatment of COPD exacerbation must be followed by suitable measures aimed at reducing future episodes of exacerbation. These includes smoking cessation, optimal medical treatment and vaccination against influenza, together with appropriate patient instruction.

Ambulatory Care↗
PubMed2004

Metered dose inhaler with spacer versus dry powder inhaler for delivery of salbutamol in acute exacerbations of asthma: a randomized controlled trial.

BACKGROUND: Delivery of various drugs by aerosol inhalation is the mainstay of treatment of asthma. Many delivery systems have been developed for children, each having its own advantages and disadvantages. Studies comparing the clinical efficacy of metered dose inhalers (MDI) and dry powder inhalers (DPI) in the treatment of acute exacerbations of asthma in children are limited. We conducted a study to compare the response to salbutamol inhalation delivered by metered dose inhaler with a spacer versus rotahaler (DPI) in children presenting with mild or moderate acute exacerbations of asthma. METHODS: Children in the age group of 5-15 years who presented with a mild or moderate acute exacerbation of asthma were randomized to receive 400 micrograms salbutamol by either a MDI with spacer or a DPI. The changes in the wheezing and accessory muscle scores, SaO2, and PEFR were recorded and subjected to statistical tests for significance. RESULTS: One hundred and fifty three children were studied; 78 were assigned to the MDI-spacer group and 75 to rotahaler (DPI) group. After receiving treatment, the PEFR improved by about 11% in both the groups. The oxygen saturation increased by 2% in both the groups. Within each group, the improvement in PEFR, SaO2, wheeze and accessory muscle score after the treatment was statistically significant. In both the groups the children co-operated equally well. CONCLUSION: Metered dose inhaler with spacer and dry powder inhaler have equal efficacy in delivering salbutamol in therapy of mild to moderate acute exacerbations of bronchial asthma in children between 5-15 years of age.

Acute Disease↗
PubMed2003

[Exacerbations of chronic obstructive pulmonary disease].

Chronic obstructive pulmonary disease is characterised by a progressive decline in lung function, reduced exercise performance, and worsening of health status. Exacerbations are important clinical events in chronic obstructive pulmonary disease and are defined as sudden worsening of respiratory symptoms and function requiring medical intervention. The most common causes of chronic obstructive pulmonary disease exacerbations are bacterial or viral infections, but comorbidity may be important. A major issue is the decision regarding home management or hospital management of exacerbations. Because of exacerbations, a frequent assessment of severity of chronic obstructive pulmonary disease is required for targeting pharmacological therapy.

Humans↗
PubMed2004

[Implication of cytokines and role of biliary-pancreatic reflux in mechanisms of exacerbation and chronicity of recurrent pancreatitis].

AIM: To evaluate the role of some pro- and anti-inflammatory cytokines, acute phase proteins and biliary-pancreatic reflux in pathogenesis of development and recurrence of chronic recurrent pancreatitis (CRP) and alcohol chronic pancreatitis (ACP). MATERIAL AND METHODS: IL-8, IL-4, IL-10, TNF-alpha, lactoferrin (LF) and cerruloplasmin were estimated by a standard enzyme immunoassay in 186 CRP and 32 ACP patients. RESULTS: The levels of proinflammatory cytokines, TNF-alpha and IL-8 as well as anti-inflammatory cytokines IL-4 and IL-10 in CRP patients reached their maximum on exacerbation day 5-7 while in ACP--on day 1-2. High cytokines levels correlate with exacerbation severity. In transition to remission, the levels of cytokines and acute phase proteins (lactoferrin, ceruloplasmin) went down. In remission some patients showed episodes of rising IL-8 and TNF-alpha to the level typical for exacerbation but without clinical manifestations. This may point to latent recurrences. TNF-alpha rose in remission most frequently in patients with biliary-pancreatic reflux. Antiinflammatory treatment of duodenitis (papillitis) lowered basal pressure of Oddi's sphincter stopping biliary-pancreatic regurgitation and leading to breaking the pathogenetic chain of CRP exacerbations. CONCLUSION: Proinflammatory cytokines TNF-alpha and IL-8 promote development of CRP. This should be taken into consideration while planning combined therapy.

Bile↗
PubMed2004

Protective effect of a bacterial extract against acute exacerbation in patients with chronic bronchitis accompanied by chronic obstructive pulmonary disease.

BACKGROUND: Immunostimulating agents made from bacterial extracts represent a class of medications that contains antigens derived from several bacterial strains and their potential ability to prevent bacterial infections results from the stimulation of the nonspecific component of the immune system. The present study investigated the effect of the oral immunostimulant Broncho-Vaxom, which includes material from eight different species of bacteria that are frequently present in the lower respiratory tract, on the frequency and severity of acute exacerbation in patients with chronic bronchitis accompanied by chronic obstructive pulmonary disease (COPD). METHODS: Ninety patients with chronic bronchitis complicated with COPD were randomly divided into groups A and B. Forty-nine subjects in group A received oral capsules containing 7 mg Broncho-Vaxom, while 41 patients in group B received similar placebo capsules. Both groups took one capsule daily for the first 10 days of each month for 3 consecutive months. The frequency of acute exacerbation, symptom scores, and lung function were recorded for the following one year period. RESULTS: There was a significant decrease in the incidence, duration, and severity of acute exacerbation, as well as a reduction in the course of antibiotics administered and in the dosage of bronchodilator and mucolytic agent in group A, as compared to group B (P < 0.05, respectively). Symptom scores for cough, sputum, dyspnea, as well as symptoms observed upon auscultation of the chest also improved significantly in group A as compared to group B (P < 0.05, respectively). The bacterial clearance rate in sputum cultures from patients who received no antibiotics for the first 3 months was also significantly higher in group A compared to group B (P < 0.01). CONCLUSIONS: Orally administered Broncho-Vaxom is associated with a decrease in the incidence of acute exacerbation and a decrease in the need for antibiotics and symptomatic relief medications in patients with chronic bronchitis accompanied by COPD. Broncho-Vaxom is also associated with a decrease in symptom scores. Without causing any apparent adverse effects, this drug may also help to eradicate pathogenic bacteria in the airways.

Adjuvants, Immunologic↗
PubMed2004

[Treatment of bronchial asthma exacerbation].

The purpose of this study was to present the actual possibilities of bronchial asthma exacerbation control. The role of viral infection, especially, human metapneumovirus infection may be a leading cause of disease exacerbation in children population. Prevalence of gastroesophageal reflux had been detected in 24% of asthmatic patients, in some cases as a cause of asthma exacerbation. Glucocorticosteroid therapy is accepted as cardinal in asthma exacerbation, but some adverse effects create a control limit.

Adrenal Cortex Hormones↗
PubMedDate not supplied

[Induced sputum in children and adolescents with asthma: safety, clinical applicability and inflammatory cells aspects in stable patients and during exacerbation].

OBJECTIVES: To determine the safety of sputum induction in asthmatic children and adolescents, to characterize sputum inflammatory cells while clinically stable and during exacerbation and to correlate sputum inflammatory cells with peripheral blood eosinophils, serum IgE and the degree of bronchial obstruction. METHODS: Ninety-six asthmatic patients aged 6 to 18 years were recruited for the present cross-sectional study. Spirometry was performed before and after administration of a bronchodilator. Sputum was collected spontaneously or after induction by the inhalation of saline solution at increasing concentrations. Blood samples were obtained for serum IgE and eosinophil quantification. RESULTS: Sputum samples adequate for analysis were obtained from 68 (70.8%) of the patients recruited. No relevant bronchoconstriction was observed during induction. The presence of a larger number of eosinophils in sputum did not correlate with more clinically severe asthma. No correlation was observed between the degree of bronchial obstruction, measured based on FEV1, and inflammatory cells in sputum, peripheral blood eosinophils or serum IgE. Larger numbers of neutrophils were observed in the asthma exacerbation group (p < 0.05). CONCLUSIONS: Sputum induction was found to be a safe procedure for obtaining clinical samples from children and adolescents even during exacerbations, allowing for clinical and functional limitations. The 67% induction success rate was considered satisfactory. In this group of patients, receiving inhaled corticosteroids, eosinophil quantification did not distinguish between the clinical and functional severity of asthma and was independent of the degree of airway obstruction. A proportional predominance of neutrophils was observed in the sputum of patients with asthma exacerbation.

Adolescent↗
PubMed2005

Serum magnesium levels and acute exacerbation of chronic obstructive pulmonary disease: a retrospective study.

A decrease in serum Mg(+2) is associated with airway hyper-reactivity and impaired pulmonary function. The purpose of this study was to determine if decreased serum Mg(+2) levels in patients with chronic obstructive pulmonary disease (COPD) are associated with acute exacerbations. In a retrospective study, the charted serum Mg(+2) levels in 100 COPD patients were examined. These included 50 patients who presented with an acute exacerbation of COPD and 50 stable patients. Chart review was sequential within both groups. Serum Mg(2+) levels in the stable COPD patients averaged 0.91+/- 0.10 mmol/L (mean+/- SD) with a 95% CI of 0.88 - 0.94 mmol/L. Patients undergoing an exacerbation had significantly lower serum Mg(+2) levels (0.77+/- 0.10 mmol/L; CI, 0.74 - 0.79; p<0.0001). Logistic regression of the dichotomous outcomes as a function of serum Mg(+2) concentration demonstrated a highly significant association (chi(2)=41.26; p<10(-5)). These data were subjected to receiver-operator characteristic (ROC) analysis for decision levels (DL) and the area under the ROC curve was determined to be 0.85+/- 0.04 (CI, 0.78 - 0.93). The optimum DL was determined to lie between 0.80 mmol/L (OR=14.33; sensitivity 70%; specificity 86%) and 0.84 mmol/L (OR=11.16; sensitivity 84%; specificity 68%). These data suggest that at the lower range of the reference interval, serum Mg(+2) levels are associated with an increased risk of exacerbation of symptoms in COPD patients. Furthermore, they suggest a DL that is useful for predicting clinical outcomes in these patients and serving as a target value for therapy.

Aged↗
PubMed2006

[Study of the quasispecies dynamics of serum hepatitis B virus in a patient with acute exacerbations of chronic hepatitis B].

OBJECTIVES: To investigate the quasispecies dynamics of hepatitis B virus (HBV) during the course of exacerbation and resolution of chronic hepatitis B in a patients. METHODS: Five serum samples were collected from a patient with two episodes of exacerbation and resolution of chronic hepatitis B. A method of PCR-TA cloning-conformation sensitive gel electrophoresis (CSGE)-sequencing was performed to study the dynamic changes of HBV quasispecies in basal core promoter (BCP), precore and core regions of HBV genome. RESULTS: Quasispecies complexity was 10 and 12 at the points of exacerbations, and 14 and 17 at the points of resolutions (t = 3.133, P < 0.05). Ratio of dominant quasispecies in HBV population was high (42.4% and 51.5%) during exacerbations and low (30.3% and 21.2%) during resolutions (t = 3.295, P < 0.05). All dominant quasispecies, except the one during the second resolution, carried core P5T, L60V, S155T, and precore G1896A mutations. CONCLUSION: The composition of HBV quasispecies changes due to the change of host immune status, and immune pressure might lead to the selection of immune escape mutants.

Adolescent↗
PubMed2006

The significance of a rapid cold hemagglutination test for detecting mycoplasma infections in children with asthma exacerbation.

BACKGROUND AND PURPOSE: Mycoplasma pneumoniae infection is a frequent cause of community-acquired respiratory infections in children and adults. However, standardized, rapid, specific methods for its diagnosis are lacking. The relationship between M. pneumoniae infection and asthma exacerbation has been recently discussed in the literature. We investigated the accuracy of rapid detection of mycoplasma infection by cold hemagglutination test compared to conventional enzyme immunoassays. The clinical characteristics of mycoplasma infection seen during emergent visits in asthmatic children were reviewed. METHODS: We retrospectively reviewed medical records of patients with asthma exacerbation visiting the Department of Pediatric Emergency, National Taiwan University Hospital, over a 12-month period. Subjects 2-18 years of age diagnosed with asthma at our outpatient clinic were included in this study. Patients with immunodeficiency, congenital anomalies, neurological diseases and irregular follow-up were excluded. RESULTS: A total of 269 children (174 males and 95 females) with a mean (+/- standard deviation) age of 6.15 +/- 3.08 years were included. The prevalence of asthma exacerbation in regular follow-up patients was 13.4%, and as many as 19.6% of cases (74/378 person-times) required hospitalization. Asthma attacks were most prevalent during December. 126 patients had both rapid cold hemagglutination testing and mycoplasma immunoglobulin M titers determined using acute blood samples drawn in the emergency room; 46 (36.5%) of these patients demonstrated mycoplasma infection. Sensitivity and specificity of the rapid cold hemagglutination test was 78.3% and 41.3%, respectively. The positive predictive value was 43.4%. Comparison of patients with or without mycoplasma infection revealed no differences in gender, age, chest X-ray findings, and most symptoms/signs and laboratory data, except that more signs of fever and auscultatory rales were seen in the non-mycoplasma infection group. CONCLUSIONS: Mycoplasma infections could be an exacerbating factor for asthma, and the rapid cold hemagglutination test should not be a guideline for prescribing macrolides in the emergency room.

Antibodies, Bacterial↗
PubMed2005

[Analysis of maintenance therapy in hospitalized patients with exacerbation of bronchial asthma: a six-year observation].

The subjects of the study were 504 patients with bronchial asthma (BA) exacerbation, hospitalized in Saint Petersburg Hospital #32 in 1997 - 2004; the maintenance therapy in these patients was analyzed. Severe exacerbations were diagnosed in 256 (51%) of the patients, moderate--in 200 (40%), and mild--in 48 (9%). The study revealed that 78% of patients had been given instructions on their preventive anti-inflammatory therapy, informed about the doses of medications and the duration of the therapy. However, only 13% of the patients received anti-inflammatory therapy that was adequate to the severity of the illness, and only 32% of all the patients demonstrated correct technique of using meter dose inhalers. Correlations (p < 0.05) were established between these factors and poorer asthma control (R = -0.07) and the severity of the exacerbations (R = -0.41). Seventy-seven per cent of BA patients hospitalized for severe exacerbations either did not received inhaled glucocorticosteroids (IG) or received them irregularly, and only 8% of the patients received adequate anti-inflammatory therapy. The main causes of inadequate therapy were low compliance (46%) and poor level of patients' knowledge (22%). Unavailability of medications was reported only by 29% of the patients. The main cause of poor compliance was fear of corticosteroid therapy side effects; and the most common scenario of not following physician's recommendation was premature discontinuation of IG therapy. In conclusion, the rational way of the maintenance therapy optimization is correct choice of preventive anti-inflammatory medications and adequate inhalation delivery systems, patients' education, and overcoming of poor compliance at hospital stage. This is of particular importance in frequently hospitalized patients with BA.

Acute Disease↗
PubMed2006

[Noninvasive positive pressure ventilation in patients with acute exacerbations of pulmonary tuberculosis sequelae].

To clarify whether noninvasive positive pressure ventilation (NPPV) is effective in patients with acute exacerbations of pulmonary tuberculosis sequelae (PTS), 50 PTS patients (66 episodes) without long-term domiciliary noninvasive ventilation were studied, retrospectively. The average values (SD) of their pulmonary function tests and arterial blood gases were as follows; %predicted VC = 31.4 (8.4)%, pH = 7.29 (0.06), PaCO2 = 91.8 (19.7) mmHg, and PaO2 = 64.2 (20.3) mmHg. The probability of avoiding endotracheal intubation and recovering from an acute exacerbation with NPPV (NPPV success rate) was 92% as a whole. NPPV success rates according to the causes of deterioration were as follows; 96% in 26 episodes with only a simple right heart failure, 93% in 29 episodes with airway infectious diseases, 75% in eight episodes with pneumonia and/or acute respiratory distress syndrome. Moreover, the NPPV success rate of eight episodes in coma or semicoma was 88%. Most patients were treated in respiratory wards rather than intensive care units. Out of 46 patients who recovered from an acute exacerbation, 41 finally received domiciliary NPPV. In facilities where staff are well-trained for an acute NPPV, patients with exacerbations of PTS can be treated as successfully with NPPV as patients with COPD.

Aged↗
PubMed2006

[Comparison of clinical outcome between patients continuing and discontinuing lamivudine therapy in acute exacerbation after viral breakthrough during lamivudine therapy in chronic hepatitis B].

BACKGROUNDS/AIMS: Continuation of lamivudine therapy is controversial for patients with chronic hepatitis B when viral breakthrough occurs. Moreover, the effect of continuous lamivudine therapy is unknown in patients with acute exacerbation after viral breakthrough. We assessed clinical course of acute exacerbation after viral breakthrough in patients who continued and discontinued lamivudine therapy. METHODS: Medical records of 109 patients with viral breakthrough during lamivudine therapy were reviewed. Of 40 patients with acute exacerbation (ALT level > 5 x ULN), adefovir dipivoxil was unavailable in 38 patients. These 38 patients (mean age 42.6 years; male/female, 34/6) were divided into continuation (n=21) and discontinuation (n=17) groups. Clinical courses of the 2 groups were compared. RESULTS: During follow-up period (mean, 27 months; range, 6-60 months), ALT levels decreased to < 2 x ULN in 11 patients (52%) of continuation group and 9 patients (53%) of discontinuation group, varied from 2 x to 5 x ULN in 9 (43%) and 5 (29%), respectively, and increased to > 5 x ULN in 1 (5%) and 3 (18%), respectively, with no statistical significance (P=.417). CONCLUSIONS: When acute exacerbation of ALT levels occurs after viral breakthrough during lamivudine administration in patients with compensated chronic hepatitis B, continuation of lamivudine may have no advantage over discontinuation.

Acute Disease↗
PubMed1988

Clinical significance of immunoglobulin A antibody to hepatitis B core antigen of polymeric and monomeric forms in chronic type B liver disease with acute exacerbation.

Serum immunoglobulin A (IgA) hepatitis B core antibody (anti-HBc) was measured by a solid-phase enzyme immunoassay using monoclonal antibodies in sera from chronic carriers of hepatitis B surface antigen (HBsAg). To reinforce the clinical significance of IgA anti-HBc, levels of IgA subclasses and molecular characterization of IgA anti-HBc in sera of 13 patients in the acute exacerbation phase and the remission phase were compared. IgA anti-HBc was significantly higher in sera in the acute exacerbation phase than in the remission phase (p less than 0.025); in particular, more significant changes were observed in IgA2 anti-HBc (p less than 0.0025) and in secretory IgA anti-HBc (p less than 0.001). Analysis of molecular size distribution of IgA anti-HBc by high performance liquid chromatography showed that the elevation of polymeric IgA anti-HBc was significantly greater than that of monomeric IgA anti-HBc in the acute exacerbation phase (p less than 0.05), although there was an increase in both monomeric and polymeric IgA anti-HBc. Thus, the elevation of polymeric IgA anti-HBc suggests that the focal immune response against HBcAg in the liver and secretory IgA anti-HBc is an important marker of acute exacerbation in patients with HBsAg-positive chronic liver disease.

Carrier State↗
PubMed1979

Exacerbation of psychosis by tricyclic antidepressants in delusional depression.

The authors describe three patients with delusional unipolar depression whose delusional thinking worsened markedly following administration of tricyclic antidepressant drugs. The patients had met Research Diagnostic Criteria for major depressive episode and had no evidence of schizophrenia or mania. Since tricyclic antidepressants are known to exacerbate psychosis in schizophrenic patients, it is sometimes suggested that the exacerbation of psychotic thinking in depressed patients indicates schizophrenia. The authors suggest that such an exacerbation does not in itself indicate schizophrenia but may occur in patients with an affective disorder who are prone to depressive delusions. The authors discuss the use of antipsychotic medication in this patient group and present a neurochemical hypothesis to explain the interaction of the drug with the illness, which results in exacerbation of psychotic thinking.

Antidepressive Agents, Tricyclic↗
PubMed1984

Exacerbation of murine cutaneous leishmaniasis by adoptive transfer of parasite-specific helper T cell populations capable of mediating Leishmania major-specific delayed-type hypersensitivity.

The effect of adoptive transfer of in vitro-propagated Leishmania major-specific T cell populations on the course of experimentally induced cutaneous leishmaniasis was studied in mice. The L. major-specific T cells expressed the T helper/inducer phenotype and were able in vitro to a) mount a specific proliferative response, b) provide specific helper activity for antibody responses, c) activate parasitized macrophages resulting in L. major destruction, and d) secrete macrophage-activating factors as tested in a tumoricidal assay. These T cells were also found capable of transferring parasite-specific delayed-type hypersensitivity responses to normal syngeneic mice. Results indicated that the i.v. transfer of these L. major-specific T cell populations into normal syngeneic mice exacerbated cutaneous lesions induced by infection with L. major. This effect on the disease process appeared to be dependent upon recognition of parasite antigens by the injected T cells because no exacerbation of the disease process was seen after the transfer of similar T cell populations specific for an antigen unrelated to the parasite, namely ovalbumin. However, the inclusion of ovalbumin in the L. major infecting inoculum resulted in an exacerbating effect of ovalbumin-specific T cells on cutaneous leishmaniasis. These unexpected results were supported by observations showing that immunization of mice with L. major antigens in complete Freund's adjuvant 7 days before infection with L. major led to exacerbated lesions. A similar aggravation of L. major-induced cutaneous lesions was also observed in mice previously immunized with an unrelated antigen provided that this antigen was included in the L. major infecting inoculum.

Animals↗