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PubMed1998

[Better at home: a continuous health care program for patients with advanced chronic respiratory disease].

The objective of this study was to analyze the effect of continuous health care on the frequency of readmissions of patients with advanced chronic respiratory disease. The study was prospective, enrolling 26 patients (16 with COPD, 7 with bronchiectasis and 3 with pachypleuritis) who had been admitted at least 3 times within the past year. The patients were assigned to 3 groups: group A was the ambulatory monitoring group, with 8 patients who were able to travel to the hospital for monthly outpatient checkups; group B was the ambulatory pulmonary rehabilitation group, with 10 patients who were able to travel to the hospital and who needed rebreathing training (one weekly group session); and group C was the home care group, with 8 patients who were unable to travel to the hospital and who received weekly or biweekly house calls. All patients had telephone contact with the program team. Mean lung function values for the whole population were FVC 40 (11)%, FEV1 23 (7)% of reference, PaO2 55 (7) and PaCO2 55 (10) mmHg. A significant decrease in number of admissions (79 versus 18, p < 0.0001) was observed in both the first and second halves of the year in all three treatment groups: A, 25 to 2; B, 28 to 8; and C, 26 to 8 (p < 0.001). The reduction in health care costs over the previous year's expenditure was calculated to be 22,751,402 pesetas. We conclude that specialized health care that is continuous and personalized reduces the number of hospital readmissions of patients with advanced chronic respiratory disease. Moreover, the overall cost of care, without the need to make house calls to all patients.

Aged↗
PubMed1989

Carbon dioxide as a short-term restraint anaesthetic in rats with subclinical respiratory disease.

The use of carbon dioxide (CO2) with, and without, oxygen (O2) as a short-term restraint anaesthetic for Wistar rats in which subclinical respiratory disease was endemic, was assessed in 3 separate experiments. In the first, rats were placed in a CO2 atmosphere generated from solid CO2 chips in a 70 l plastic bin, and removed at time intervals ranging from 0 to 120 s after disappearance of the pedal reflex. Eight of 25 rats died, including 2 which were removed immediately the pedal reflex disappeared; it was concluded that CO2 without O2 was not a suitable short-term anaesthetic for rats. In a second study, rats were anaesthetized in atmospheres of 50:50 and 80:20 (CO2:O2) provided from commercially available cylinders, in 2 different environments--a 3.41 glass jar and a 17 l plastic bin. Rats became excited in the plastic bin but not the glass jar. Rats in the glass jar displayed visible depression and cessation of whiskers movement significantly more quickly in the 80:20 (CO2:O2) than in the 50:50 mixture (4.2 +/- 0.98 s, n = 6, and 66.0 +/- 4.9 s, n = 6 vs 13.8 +/- 2.77 s, n = 5 and 152.0 +/- 20.8 s, n = 5, respectively). Rats in the 17 l plastic bin lost their pedal reflexes in a mean 41.5 +/- 4.55 s (n = 11) in the 50:50 mixture and in a mean 30.9 +/- 6.38 s (n = 11) in the 80:20 (CO2:O2) group. Those left in the 50:50 mixture for 60 s and 180 s after disappearance of their pedal reflexes, recovered these reflexes in 20.2 +/- 0.44 s and 21.5 +/- 7.23 s respectively after removal from the gas. Respiration and heart beat ceased in one rat remaining in the 50:50 mixture after 13 min 10 s. No untoward effects occurred in rats left in the 50:50 mixture for 180 s after disappearance of the pedal reflex, but 2 died when left for an equivalent period in the 80:20 mixture. In the third study, examples of the practical use of a 50:50 mixture as a short term restraint anaesthetic are described. It was concluded that this mixture was a cheap, safe, and effective means of short-term restraint for rats with subclinical respiratory disease, when the minimal time of exposure to the gases was employed.

Anesthesia↗
PubMed1991

Indications for spirometry in outpatients with respiratory disease.

It has been suggested that spirometry should be incorporated into the routine examination of every patient, analogous to obtaining vital signs. To determine the impact of spirometry on the management of outpatients with respiratory disease, spirometry was performed on 150 consecutive patients (123 men and 27 women, mean age 57 +/- 12 years) seen in our pulmonary disease outpatient clinics. Patients with obstructive (n = 75), restrictive (n = 31), mixed (n = 26) or other respiratory diseases (n = 18) were initially assessed by history and physical examination and classified as improved, stable, or worse compared to previous visits. A clinical management plan (CMP) was formulated based on this initial evaluation. Spirometric results were then made available to the examiner who could then make changes in the proposed CMP. The addition of spirometric results caused alteration of the CMP in only eight (5 percent) patients; in the remaining 142 patients, results did not affect the CMP. Two clinical findings identified those patients whose CMP was most likely to be altered by spirometry: severity of lung dysfunction (determined from previous spirometry) and deterioration of clinical status (judged by history and physical examination). Of the eight patients whose CMP was changed after review of spirometry, six (75 percent) had previous severe ventilatory dysfunction (FEV1 or FVC less than or equal to 40 percent of predicted or FEV1/FVC ratio less than or equal to 0.40). In 6 of 38 patients (16 percent) with severe ventilatory dysfunction, CMP was altered after spirometry while only 2 of 112 patients (1.8 percent) with mild or moderate dysfunction had changes in their CMP. Patients who were clinically assessed as worse compared to their previous visit were more likely to have their CMP altered after review of spirometry when compared to those considered improved or stable by a ratio of 6:1. These results suggest that spirometry is most likely to supplement the physician's history and physical examination in the management of outpatients with pulmonary disease when the initial evaluation suggests that the patient has clinically deteriorated since the previous clinic visit, or when he or she has previous severe ventilatory dysfunction.

Asthma↗
PubMed2006

Systematic review of the association between respiratory diseases and oral health.

BACKGROUND: The purpose of this review was to investigate evidence for a possible etiological association between oral health and pneumonia or other respiratory diseases. METHODS: The following data sources were used: Ovid MEDLINE (In-Process & Other Non-Indexed Citations, Daily Update, and OLDMEDLINE); Cumulative Index to Nursing & Allied Health Literature; Evidence Based Medicine of Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Database of Abstracts of Reviews of Effects; EMBASE; Health and Psychosocial Instruments; HealthSTAR; International Pharmaceutical Abstracts; PubMed; and Google Scholar from the earliest record until July 2005. Studies were selected from randomized controlled clinical trials and longitudinal, cohort, case-control, and epidemiological studies. Searches were limited to English language and human studies. RESULTS: A total of 728 articles were searched for relevancy, determined by article title, abstract, and full copy, resulting in a yield of 19 studies that met our inclusion criteria. These articles were read and scored independently by the reviewers to obtain the evidence for this review: 1) the potential risk factors for pneumonia were identified as the presence of cariogenic and periodontal pathogens, dental decay, and poor oral hygiene in five studies; 2) a weak association between periodontal disease and chronic obstructive pulmonary disease (COPD) was identified in four poor to fair studies; and 3) 10 studies were retained providing evidence that interventions aiming to improve oral health reduced the progression or occurrence of pneumonia. CONCLUSIONS: 1) There is fair evidence (II-2, grade B recommendation) of an association of pneumonia with oral health (odds ratio [OR]=1.2 to 9.6 depending on oral health indicators). 2) There is poor evidence of a weak association (OR<2.0) between COPD and oral health (II-2/3, grade C recommendation). 3) There is good evidence (I, grade A recommendation) that improved oral hygiene and frequent professional oral health care reduces the progression or occurrence of respiratory diseases among high-risk elderly adults living in nursing homes and especially those in intensive care units (ICUs) (number needed to treat [NNT]=2 to 16; relative risk reduction [RRR]=34% to 83%).

Adult↗
PubMed2004

Duration of immunity of a quadrivalent vaccine against respiratory diseases caused by BHV-1, PI3V, BVDV, and BRSV in experimentally infected calves.

Several laboratory studies assessed the duration of immunity of a quadrivalent vaccine (Rispoval 4, Pfizer Animal Health) against bovine respiratory diseases (BRD) caused by bovine herpes-virus type-1 (BHV-1), parainfluenza type-3 virus (PI3V), bovine viral-diarrhoea virus type 1 (BVDV), or bovine respiratory syncytial virus (BRSV). Calves between 7 weeks and 6 months of age were allocated to treatment and then were injected with two doses of either the vaccine or the placebo 3 weeks apart. Six to 12 months after the second injection, animals were challenged with BHV-1 (n=16), PI3V (n=31), BVDV (n=16), or BRSV (n=20) and the course of viral infection was monitored by serological, haematological (in the BVDV study only), clinical, and virological means for > or =2 weeks. Infection induced mild clinical signs of respiratory disease and elevated rectal temperature in both vaccinated and control animals and was followed by a dramatic rise in neutralising antibodies in all treatment groups. Titres reached higher levels in vaccinated calves than in control calves after challenge with BHV-1, BVDV, or BRSV. On day 3 after PI3V challenge, virus shedding was reduced from 3.64 log10TCID50 in control animals to 2.59 log10TCID50 in vaccinated animals. On days 6 and 8 after BRSV challenge, there were fewer vaccinated animals (n=2/10 and 0/10, respectively) shedding the virus than control animals (n=8/10 and 3/10, respectively). Moreover, after challenge, the mean duration of virus shedding was reduced from 3.8 days in control animals to 1 day in vaccinated animals in the BVDV study and from 3.4 days in control animals to 1.2 days in vaccinated animals in the BRSV study. The duration of immunity of >or =6 months for PI3V, BHV-1 and BVDV, and 12 months for BRSV, after vaccination with Rispoval 4, was associated mainly with enhanced post-challenge antibody response to all four viruses and reduction of the amount or duration of virus shedding or both.

Animals↗
PubMed1999

Association between mast cell chymase genotype and atopic eczema: comparison between patients with atopic eczema alone and those with atopic eczema and atopic respiratory disease.

BACKGROUND: It has remained unclear whether genetic background of patients with atopic eczema (AE) alone is identical to that of patients with both AE and atopic respiratory disease. OBJECTIVE: We aimed to assess whether there is a genetic difference between these two groups of AE patients. METHOD: We determined the genotype with regard to an allelic polymorphism in the gene for mast cell chymase (MCC; a serine protease secreted from mast cells) in 169 AE patients. RESULTS: MCC genotype was significantly associated with pure AE patients who did not have a predisposition to atopic respiratory disease and whose serum IgE concentration was < 500 IU/mL. The distribution of MCC genotypes also differed significantly between the latter patients and those AE patients with bronchial asthma and a serum IgE concentration of > 2000 IU/mL. CONCLUSION: These results suggest that pure AE is associated with genetic variants of MCC, and that the genetic basis of pure AE differs from that of AE associated with atopic asthma.

Adolescent↗
PubMed1989

Ultrastructure of bronchial submucosal glands in children with chronic respiratory diseases.

The ultrastructure of bronchial submucosal glands in 4 children with chronic respiratory diseases was studied. Based on their ultrastructure the glandular secretory cells were divided into four categories: 1. mucous cells packed with large electron-lucent coalescing granules with fibrogranular matrix, 2. mucous-like cells with abundant granular endoplasmic reticulum and fewer smaller electron-lucent granules, 3. serous cells containing small to moderately large membrane-bound electron-dense granules with homogenous matrix and prominent granular endoplasmic reticulum, 4. sero-mucous cells similar to the serous ones but containing granules of either serous or mucous morphology. In our patients the mucous and mucous-like cells prevailed, forming 54.6%-100% of the glands' secretory area. Only in 2 children all four types of secretory cells were detected. Signs of pathological alteration were discovered in secretory cells of all patients. The system of intra- and interlobular ducts was lined by tall mucous cells.

Adolescent↗
PubMed1991

Stigmata of atopic constitution in patients with atopic eczema or atopic respiratory disease.

In the diagnosis of atopic eczema, minor physical markers (stigmata) frequently provide valuable clues. The prevalence of nine stigmata (dry skin, hyperlinearity of the palms or soles, infraorbital fold, white dermographism, facial pallor, orbital darkening, Hertoghe's sign, low hairline) was evaluated in 34 atopic eczema patients without atopic respiratory disease, in 16 patients with allergic rhinitis and/or asthma without atopic eczema, and in 23 controls without atopic respiratory or eczematous disease, and with negative results at prick testing with three common aeroallergens. Compared with controls, all features except Hertoghe's sign were significantly (p less than 0.01) more frequent in atopic eczema, and, except for Hertoghe's sign, dry skin and white dermographism, they were significantly (low hairline, p less than 0.05; others, p less than 0.01) more frequent also in respiratory disease. The prevalence of most stigmata did not differ significantly (p greater than 0.05) in cutaneous vs. respiratory atopic disease, only dry skin being more frequent in atopic eczema (p less than 0.05). Although not specific, most stigmata are characteristic markers not only of atopic eczema, but of atopy as such.

Adolescent↗
PubMed1983

Risk factors for childhood respiratory disease. The effect of host factors and home environmental exposures.

Standardized respiratory disease questionnaires (ATS-DLD-78-C) were completed by the parents of 4,071 children 5 to 14 yr of age, and risk factors for respiratory symptoms were evaluated by logistic analysis. Younger age, male sex, and lower socioeconomic status (SES) were independent risk factors for most respiratory symptoms and illnesses. All respiratory outcomes were significantly more prevalent in children with a physician's diagnosis of asthma. Asthma was more prevalent in male (4.5%) than in female (2.6%) children, and the greater prevalence of most respiratory symptoms in males did not persist in children with the same asthma status. Children whose questionnaires were completed by their fathers were reported to have significantly fewer respiratory symptoms than children with mother-completed questionnaires. We postulate that fathers underreport symptoms for their children. A positive parental history of allergy or respiratory illness was an independent predictor of respiratory symptoms and illnesses in the children. Chest illness before 2 yr of age and chest illness in the past year showed a significant positive linear trend with the number of parental smokers, and these effects of passive smoking were confirmed in the logistic analysis. The use of gas cooking stoves, inversely associated with SES, was not an independent risk factor for any respiratory symptoms or illnesses.

Adolescent↗
PubMed1994

[Mortality and lethality of influenza and acute respiratory diseases].

Analysis of mortality and lethality rates due to influenza, acute respiratory disease (ARD), and acute pneumonia in adults has revealed a higher proportion in an old-age group (over 60 years) than in younger-age ones (15-30-year olds). Moreover, these figures have been found to have increased twice in the old-age group in the last two decades. At the same time the lethality rates due to acute pneumonia have been reported to be 8-12 times higher in inpatients over 60 years of age (a high-risk group) than those in younger adults and 3-4 times higher than those in the middle-age group. The extremely severe course of pneumonia-associated influenza characterized by toxicosis, pulmonary and cardiovascular insufficiency has been observed in most death victims.

Acute Disease↗
PubMed2002

The increase in allergic respiratory diseases: survival of the fittest?

The prevalence of allergic respiratory diseases, asthma and allergic rhinoconjunctivitis, has increased since the advent of industrialization. The inverse relationship between the number of infections early in life and atopy has been interpreted as the "hygiene hypothesis." That is, many infections early in life promote the development of T helper type 1 cytokines, while fewer infections early in life favor the development of T helper type 2 (Th2) cytokines and atopy. An alternate interpretation of the same data, that atopy is protective against infections early in life, is rarely considered. With epidemiologic, historical, and immunologic data, I suggest that human evolution has favored individuals with an atopic predisposition. Th2 immune responses promote parity, and ensure successful pregnancy and term birth; provide the infant protection against infections and the inflammation induced by common pathogens in the first years of life until the immune system matures; and protect young adults exposed to viral respiratory pathogens. These traits are of particular value with the advent of industrialization, especially so in the era prior to the development of antibiotics. This theory contradicts the assumption that there is no biological or evolutionary advantage for allergic disease to exist in humans and has significant implications for our current and future treatments of allergic diseases.

Adolescent↗
PubMed2003

Traffic related air pollution and acute hospital admission for respiratory diseases in Drammen, Norway 1995-2000.

The aim of this study was to estimate the associations between seven ambient air pollutants [particulate matter (PM10), nitrous dioxide (NO2), sulfur dioxide (SO2), ozone (O3), benzene, formaldehyde and toluene] and acute hospital admissions for respiratory diseases in Drammen, Norway 1995-2000. Time-series analysis of counts was performed by means of generalized additive models with log link and Poisson distribution. The results showed that benzene was the pollutant having the strongest association with respiratory diseases for the total study period, the relative risk of an interquartile increase of benzene was 1.095 with 95% confidence interval: 1.031-1.163. The corresponding results were 1.049 (0.990-1.112) for formaldehyde, 1.044 (1.000-1.090) for toluene, 1.064 (1.019-1.111) for NO2, 1.043 (1.011-1.075) for SO2, 0.990 (0.936-1.049) for O3 and 1.022 (0.990-1.055) for PM10. Dividing the total study period into two 3-year periods, there was a substantial reduction in the exposure levels of the volatile organic compounds (benzene, formaldehyde and toluene) from the first to the second period. Separate analyses for the second time period showed weaker association between these pollutants and the health outcome. This study provides further evidence for short-term respiratory health effects of traffic related air pollution.

Acute Disease↗
PubMed1988

Cyanide and thiocyanate blood levels in patients with renal failure or respiratory disease.

Whole blood cyanide and plasma thiocyanate were measured by a headspace gas chromatographic method and a colorimetric method, respectively, in 16 healthy subjects, in 10 patients with respiratory disease and in 12 patients on chronic dialysis for renal failure. In healthy subjects, whole blood cyanide and plasma thiocyanate concentrations were significantly higher in smokers (1.8 +/- 0.4 mumol/l; 206 +/- 74 mumol/l) than in non-smokers (0.8 +/- 0.4 mumol/l; 74 +/- 19 mumol/l). In renal failure patients on hemodialysis, no difference was noted in cyanide levels (0.6 +/- 0.4 mumol/l), but there was a significant increase in plasma thiocyanate levels during the interdialysis period (62 +/- 24 mumol/l; 91 +/- 24 mumol/l). No difference in cyanide and thiocyanate levels of patients with respiratory disease was seen, in agreement with a weak pulmonary elimination of cyanide.

Cyanides↗
PubMed1998

[Estimated numbers of patients with intractable respiratory diseases].

To estimate the number of patients with intractable respiratory diseases, we conducted a two-stage nationwide epidemiological survey in 1997. The first survey was performed at randomly sampled hospitals to identify the number of patients treated. The second survey sought detailed clinico-epidemiological data on the patients reported in the first survey. The response rates were 54% for the first survey and 62% for the second. Based on the survey findings, we derived the following nationwide estimates: 450 patients (95% confidence interval: 360-530) with chronic thromboembolic pulmonary hypertension; 230 (200-260) with primary pulmonary hypertension; 180 (150-210) with obesity-associated hypoventilation syndrome; 40 (30-50) with primary alveolar hypoventilation syndrome; 160 (140-180) with histiocytosis X; and 190 (150-230) with juvenile pulmonary emphysema.

Chronic Disease↗
PubMed2001

[Characteristics of nasopharyngeal carriage of Streptococcus pneumoniae in children during acute respiratory disease].

Streptococcus pneumoniae is an important cause of pediatric morbidity and its main reservoir is the nasopharynx, from which it can disseminate and cause invasive disease. From November 1997 through March 1998, nasopharyngeal carriage of S. pneumoniae was evaluated in 250 children under the age of 36 months: 123 Jews and 127 Bedouins with acute respiratory disease and in 980 healthy control children (852 Jews and 128 Bedouins). Carriage rate was higher among sick children. Among Jewish children it was 57% and 35% of sick and healthy children respectively (p < 0.01), and among Bedouin children it figured as 80% and 67% respectively (p = 0.01). The difference in carriage rate was most prominent in infants under the age of 5 months: among Jewish children it was 60% and 27% of sick and healthy children respectively (p < 0.001) and among Bedouins it was 82% and 65% respectively (p = 0.05). Higher carriage rate of penicillin resistant pneumococci (PRP) was also detected in sick children, with no relation to antibiotic treatment in the month prior to sampling. In Jewish children PRP was detected in 12%, 28% (p < 0.001) and 36% (p < 0.001) of healthy children, sick children with previous antibiotic treatment and sick children with no treatment, respectively. The seroypes included in the newly developed 7-valent conjugate vaccine: 4, 6B, 9V, 14, 18C, 19F, 23F, that are highly pathogenic and often antibiotic resistant contributed 74% of isolates in sick Jewish children who had previous antibiotic treatment and 39% of isolates in healthy children (p < 0.001). In Bedouin children vaccine types carriers rate among the sick children was not higher than in healthy children. Acute respiratory disease increases the risk of pneumococcal carriage in general and carriage of resistant pneumococci in particular. Previous antibiotic treatment increases the risk of carring one of the pathogenic serotypes included in the 7-valent vaccine. The impact of disease is most prominent in infants under 5 months, since they are usually less exposed to S. pneumoniae carriers than older children. Since the increase in carriage rate during illness is mostly due to the serotypes included in the newly developed conjugate vaccine, future immunization programme may decrease not only morbidity rate but also nasopharyngeal carriage rate of pneumococci in general and of antibiotic-resistant pneumococci in particular.

Acute Disease↗