[Patient seminars in ambulatory management of obstructive respiratory tract diseases].
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Chronic bronchitis, lung emphysema and bronchial asthma are the most frequently encountered pneumological diseases. Most patients with chronic bronchitis and emphysema are smokers, therefore the development of the disease is closely related to self responsible habits. In asthmatics bronchial hyperresponsiveness favours a pathologic airway response induced by polluted air. SO2 is believed to only induce airway obstruction in patients with preexisting airway diseases. NO2 and ozone, however, have been shown to induce airway hyperresponsiveness in healthy subjects.
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Changes in the bronchial musculature in patients with chronic obstructive lung disease, were submitted to a systematic electron-microscopic investigation. A marked interstitial fibrosis with degenerative changes affecting the muscle cells was observed. The formal pathogenetic course of these changes can be reconstructed on the basis of numerous individual findings. The muscle cells are progressively "ensheathed" in a disorderly fine-filamentous basic structure (matrix), and in collagenous fibres. As a result, the contact surfaces between the muscle cells are disturbed, and the nerve endings "displaced" from the muscle cells. This fibrosis is associated with a protracted "shrivelling" of the individual muscle cells. The changes involving the muscles of the bronchial wall are comparable with those seen in the smooth muscles of blood vessels involved in arteriosclerosis. The morphological changes to the muscles of the bronchi described in this paper strongly suggest that protracted fibrosis formation, coupled with the degradation of muscle cells, contribute to a loss of elasticity of the bronchial wall in chronic obstructive lung disease.
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In 2 clinical studies we tested the efficacy of ketotifen in allergic rhinitis and allergic bronchial asthma. Ketotifen was demonstrated to have a convincing effect not only upon the typical inhalation allergens, such as pollen, house dust mite or animal hair, but also upon allergens ingested via the gastrointestinal tract (food). As even long-term administration has thus far not shown toxic side-effects, ketotifen, based on appropriate indication, can already in childhood be successfully applied.
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The attachment of bacteria to mucosal surfaces is the initial event in the pathogenesis of infectious diseases. The authors present a study about the adherence of strain of S. pyogenes isolated in subjects with recurrent tonsillitis. A correlation was found between the adherence ability of the bacterium and the number of episodes per year. The study about the SIgA, the infection development and the bacterium adherence showed a direct correlation between SIgA levels and the number of phlogistic episodes. The importance of the role assumed by bacterial adherence in the genesis of the phlogistic process is to be emphasized yet again.
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