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PubMedDate not supplied

[Recurrent asthmatic bronchitis in the first years of life: a 3-year follow-up].

The natural history of asthma is not well known; its origin may go back to just after the birth. The aims of this study are: 1) studying the evolution of the symptomatology of a group of children suffering from recurrent asthmatic bronchitis of a moderate-severe level in the first two years of life; 2) inquiring some risk factors conditioning the evolution of it. One hundred children, aged from 16.6 to 53.4 months, suffering from moderate to severe recurrent asthmatic bronchitis, have been checked at the follow-up at the Broncopneumologic and Allergic Pediatric Unit of the SS Annunziata Hospital (Naples). Among the 100 children checked, 25 have been dropped at the follow-up; the difference between the sample checked and the one dropped at the follow-up is not statistically relevant. Four are variables examined: age, allergic medical history, number of asthma episodes, breast feeding, association or not of atopic dermatitis. The evolution of the symptomatology has not been propitious, as, at the end of three years of analysis, 73.3% of the 5-year-old patients had still persistent asthma. The risk factors of asthma recurrence are: parents smoking habits with a relative risk of 18 times more in patients with disadvantageous evolution (R.R. = 18) and at a less measure the overcrowding of the bedroom (R.R. = 1.5). The age at the onset in of the symptomatology, the positive familiar medical history for allergic illness, the breast feeding and the atopic dermatitis have not resulted statistically different between the group with advantageous evolution and the one with disadvantageous outcome. Passive smoking is a very disadvantageous prognostic factor; it may contribute to the disadvantageous evolution of the moderate to severe asthmatic bronchitis in the early childhood towards the recurrent or chronic bronchial asthma of the late childhood.

Acute Disease↗
PubMed1998

Challenging questions in treating bronchitis.

Whatever facts we gather and no matter how many we have, you and I must eventually put the journal down and pick up our stethoscope, pen, and prescription pad and go to work. Hopefully we can do better than, "Therapy is not uniform and specific antibiotic regimens are usually selected based on local tribal custom." We can discard an old paradigm, "The absence of data bears no relation to the strength of opinion." Personally, I have used these new scientific data before I reached my conclusion. I have developed 10 points to structure my new approach. I invite you to compare my conclusions to yours. 1. In acute bronchitis, in otherwise healthy adults, my preference is to not prescribe an antibiotic. If I do, it is not over the phone. You should want to see and examine the patient. If there are no helpful hints to etiology, I choose a newer macrolide for those under age 50 and use a short course, five-seven days. For patients over age 50, especially if they are "healthy smokers," consider a short course of cefuroxime. (You can see, even in these acute bronchitis patients, you want an antibiotic effective against today's pathogens.) 2. In all chronic bronchitis patients, prevention of further damage to the airways should be attempted by instituting a program of smoking cessation and appropriate immunizations against influenza and pneumococcus. 3. Treatment outcomes will also improve if we recognize that in some patients the progressing SOB, cough, and increasing sputum production are due to congestive heart failure and not due to infection. I try to think about congestive heart failure in all of my patients, but especially in those with known heart disease and cardiomegaly on their chest x-ray. 4. Routine pulmonary function testing is important in smoking patients. Physicians underestimate the degree of obstruction present when they rely on physical exam alone. Hopefully long before the patient's acute illness you have established whether or not obstruction is present. This information helps identify the high risk patient for not only recurrent bouts of infection but also those at increased risk for lung cancer. 5. We will have more success in treating AECB when we elect to use an antibiotic only for patients with at least two of the following three cardinal symptoms: increased dyspnea, increased sputum production, and increased purulent sputum. COPD patients have many days when they feel more SOB. To use this or any one sign as the sole indication for starting an antibiotic has been proven not to make a statistically significant difference in outcome in most patients. Also, the value of prophylactic antibiotic therapy has not been established. 6. When airflow obstruction is moderately severe or more pronounced, AECB should usually be treated with oral steroids. Other measures such as chronic bronchodilator therapy, supplemental and home oxygen use, and pulmonary rehabilitation have been extensively reviewed elsewhere.

Acute Disease↗
PubMed2006

A systematic review of Chinese medicinal herbs for acute bronchitis.

OBJECTIVES: To assess the effectiveness and safety of Chinese medicinal herbs for treating uncomplicated acute bronchitis. DATA SOURCES: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which includes the Cochrane Acute Respiratory Infections Group's specialized register; The Chinese Cochrane Centre's Controlled Trials Register; MEDLINE; EMBASE; and the Chinese Biomedical Database (CBM). METHODS: We only included randomized controlled trials. At least two authors extracted data and assessed trial quality. MAIN RESULTS: Four trials reported the time to improvement of cough, fever, and rales associated with bronchitis and showed that patients treated with Chinese herbs had a shorter duration of signs and symptoms. Two trials reported the proportion of patients with improved signs and symptoms at follow-up and showed that Chinese herbs were beneficial in terms of relief of signs and symptoms. Thirteen (13) trials analyzed the data on physician global assessment of improvement at follow-up. Nine (9) of 13 trials showed that Chinese herbs were superior to routine treatment and the other four trials showed a similar effect to routine treatment. In general, Chinese herbs appeared beneficial. Only one trial reported adverse effects during treatment. CONCLUSIONS: There are insufficient quality data to recommend the routine use of Chinese herbs for acute bronchitis. The benefit found in this systematic review could be due to publication bias and study-design limitations of the individual studies. In addition, the safety of Chinese herbs is unknown due to the lack of toxicological evidence on these Chinese herbs, though adverse events are rarely reported.

Journal Article↗
PubMed2001

Exacerbations of Bronchitis: bronchial eosinophilia and gene expression for interleukin-4, interleukin-5, and eosinophil chemoattractants.

Eosinophilia has been reported during exacerbations of bronchitis, but the mechanisms of tissue recruitment of eosinophils are unclear. We quantified eosinophils and the concurrent expression of cytokines and chemokines probably responsible for the tissue eosinophilia in bronchial biopsies obtained from three groups of nonatopic subjects: (1) healthy nonsmokers (n = 7; FEV1 % predicted = 108 +/- 4 [mean +/- SEM]); (2) nonasthmatic smokers with chronic bronchitis (CB) in a stable phase of their disease (n = 11; FEV1 % predicted: 75 +/- 5); and (3) nonasthmatic subjects with CB who sought medical advice for an exacerbation of their condition (n = 9; FEV(1) % predicted: 61 +/- 8). We applied anti-EG2 antibody and immunostaining to detect and count eosinophils. We performed in situ hybridization to visualize and enumerate cells expressing the genes for interleukin (IL)-4 and IL-5 and the eosinophil chemokines eotaxin, monocyte chemoattractant protein (MCP)-4, or regulated on activation, normal T-cell expressed and secreted (RANTES). We confirmed an increase in EG2-positive eosinophils in patients with CB in exacerbation. We found messenger RNA (mRNA) positivity for IL-4 and IL-5 in CB, but the between-group differences were not statistically significant. However, the numbers of lymphomononuclear cells expressing eotaxin mRNA were significantly greater in the smokers with CB than in the healthy nonsmokers without CB (p < 0.01). Following an exacerbation, RANTES expression was upregulated and this chemokine was strongly expressed in both the surface epithelium and in subepithelial lymphomononuclear cells: only RANTES showed a significant positive correlation with the increasing number of EG2-positive cells (r = 0.51; p < 0.03). In conclusion, an allergic profile of inflammation can also occur in CB: the marked upregulation of RANTES in the epithelium and subepithelium most likely accounts for the increased eosinophilia associated with an exacerbation of bronchitis.

Adult↗
PubMed2002

[Apoptosis peripheral of T lymphocytes in patients with acute exacerbration of chronic bronchitis]

OBJECTIVE: To compare peripheral T lymphocyte apoptosis of chronic bronchitis during an acute episode with that during a stable period. METHODS: Seventeen Chronic Btonchitis patients who presented to the ER with an acute episode were compared with 10 stable Chronic Bronchitis patients seen in the out-patient clinic. Peripheral venous blood was obtained from each patient and T lymphocytes were separated by fluorescent monoclonal antibodies. CD3, CD95 and CD25 were measured by flow cytometry. RESULTS: In the acute episode patients, the total quantity of T lymphocytes with CD3 was (42.63 +/-16.37) and with CD95 (14.15 +/-11.06). In the stable group T lymphocyte CD3 was (64.22 +/-23.90) and CD95 (34.88 +/-8.92) (t=-4.238, P <0.001; t=-8.796, P <0.001). The total quantity of Lymphocyte CD25 did not differ significantly between the two groups (P > 0.05). Total quantity of active T lymphocytes with CD3/CD25 was lower in the acute episode group (6.26 +/-3.94) compared to the stable group (10.52 +/-3143) (t=-1.068, P <0.05). CONCLUSION: T lymphocyte apoptosis increased in Chronic Bronchitis patients who presented with an acute episode. They also experienced a significant disturbance in immune function.

Journal Article↗
PubMed2006

Neither the RNA nor the proteins of open reading frames 3a and 3b of the coronavirus infectious bronchitis virus are essential for replication.

Gene 3 of infectious bronchitis virus is tricistronic; open reading frames (ORFs) 3a and 3b encode two small nonstructural (ns) proteins, 3a and 3b, of unknown function, and a third, structural protein E, is encoded by ORF 3c. To determine if either the 3a or the 3b protein is required for replication, we first modified their translation initiation codons to prevent translation of the 3a and 3b proteins from recombinant infectious bronchitis viruses (rIBVs). Replication in primary chick kidney (CK) cells and in chicken embryos was not affected. In chicken tracheal organ cultures (TOCs), the recombinant rIBVs reached titers similar to those of the wild-type virus, but in the case of viruses lacking the 3a protein, the titer declined reproducibly earlier. Translation of the IBV E protein is believed to be initiated by internal entry of ribosomes at a structure formed by the sequences corresponding to ORFs 3a and 3b. To assess the necessity of this mechanism, we deleted most of the sequence representing 3a and 3b to produce a gene in which ORF 3c (E) was adjacent to the gene 3 transcription-associated sequence. Western blot analysis revealed that the recombinant IBV produced fivefold less E protein. Nevertheless, titers produced in CK cells, embryos, and TOCs were similar to those of the wild-type virus, although they declined earlier in TOCs, probably due to the absence of the 3a protein. Thus, neither the tricistronic arrangement of gene 3, the internal initiation of translation of E protein, nor the 3a and 3b proteins are essential for replication per se, suggesting that these proteins are accessory proteins that may have roles in vivo.

Animals↗
PubMed1976

Variant infectious bronchitis virus isolated from Indiana chickens.

Infectious bronchitis virus (IBV) associated with a catarrhal tracheitis, sudden decline in egg production, and reduced shell quality was isolated from an Indiana White Leghorn breeder flock. It was found to be serologically different from Massachusetts, Connecticut, Iowa 97, Iowa 609, Florida, Arkansas 99, JMK, Holte, Gray and SE 17 IBV serotypes. Two different Massachusetts vaccine strains protected chickens from respiratory signs but not against virus infection using the isolant for challenge in laboratory trials. The isolant was passed through a 0.22 mu. filter. It was heat (56 C), acid pH (3.0), ether and chloroform labile. In embryos it produced deaths or lesions of infectious bronchitis in one to five days after inoculation. It is suggested that this IBV isolant be designated Indiana-type.

Animals↗
PubMed1976

The proposed international standard for infectious bronchitis vaccine (live).

An H-120 strain of infectious bronchitis virus was prepared in a form suitable to serve as an international standard for Infectious Bronchitis Vaccine (live). Accelerated degradation studies carried out on this vaccine showed it to be of suitable stability to serve as a standard. Results from a collaborative assay involving ten laboratories demonstrated that the proposed standard reduced the variation in virus titrations both within and between laboratories. This assay also showed that firstly the proposed standard could be used as a reference vaccine for the different safety tests described by the collaborating laboratories, and secondly as a reference vaccine in the different potency tests.

Animals↗
PubMedDate not supplied

Isolation of infectious bronchitis virus from broiler chickens in Chile.

An infectious-bronchitis-like virus was isolated from 6-week-old broiler chickens unvaccinated with infectious bronchitis virus (IBV). The isolate produced lesions in embryonating chicken eggs (ECE) and clinical signs in birds characteristic of IBV. Serum-neutralization and agar-gel diffusion tests demonstrated the serological relationship of this isolate to IBV.

Animals↗
PubMed1988

Efficacy of infectious bronchitis virus vaccines against heterologous challenge.

Twenty-four-week-old white Leghorn layers were inoculated subcutaneously with a killed Newcastle disease-infectious bronchitis (Massachusetts type) virus (MIBV) vaccine. Twenty-eight weeks after vaccination, the birds were challenged intraocularly with the Arkansas strain of infectious bronchitis virus (AIBV) to determine the effects of heterologous virus exposure on egg production, egg quality and serum antibody response of the birds. The challenged hens laid significantly (P less than 0.005) fewer eggs than the unchallenged layers. Eggs laid by the unchallenged groups weighed significantly more (P less than 0.005) than those laid by the challenged groups. Further, the internal quality (Haugh units) and shell quality of eggs laid by the AIBV-challenged hens was significantly (P less than 0.005) inferior to those from the unchallenged hens. In addition, the AIBV-challenged hens laid more soft-shell, misshapen and small eggs than the unchallenged hens. The Arkansas serum haemagglutination inhibition (AIBV-HI) titres of AIBV challenged birds increased up to four weeks after challenge. The corresponding MIBV haemagglutination-inhibition (MIBV-HI) titres decreased during the same period. The study indicates that killed MIBV vaccine offered no protection to birds exposed to heterologous AIBV.

Animals↗
PubMed1993

Treatment of stable chronic bronchitis with iodinated glycerol: a double-blind, placebo-controlled trial.

In a double-blind trial, 29 patients were treated for stable, chronic bronchitis with iodinated glycerol (Organidin, 60 mg four times daily; n = 16) or placebo (n = 13). The study consisted of a 2-week single-blind lead-in period, followed by a 6-week double-blind treatment period, and assessed a total of 50 response variables. In this set of patients, treatment with iodinated glycerol was associated with statistically significant (P < 0.05) and/or positive trend (P < 0.1) toward improvement in cough frequency, cough severity, difficulty in raising sputum, sputum thickness, sputum stickiness, forced expiratory flow at FVC25%-75%, cell concentration in sputum, and several measures of physician assessment of patient condition. Iodinated glycerol was well tolerated during the 6-week treatment period; no adverse effects were reported and no patient receiving iodinated glycerol withdrew from the study prematurely. In conclusion, this study demonstrates that iodinated glycerol, 60-mg tablets given in a total daily dose of 240 mg, is safe and effective therapy for reducing symptoms in patients with stable, chronic bronchitis.

Adult↗
PubMed2001

Persistent adenoviral infection and chronic obstructive bronchitis in children: is there a link?

Chronic obstructive bronchitis with inadequate response to inhaled steroid and bronchodilator therapy is a rather rare disorder in children. Persistence of an adenoviral infection has been described as a possible cause of unremitting airway obstruction. We studied a group of 11 children with the clinical feature of chronic bronchial obstruction. A high-resolution computed tomography (HR-CT) scan was performed and typically showed hyperinflation and ground-glass-like opacities. All children underwent either bronchoscopic transbronchial or open lung biopsy. Biopsy specimens were stained with monoclonal antibodies detecting adenoviral antigen and analyzed by light-microscopy. Bronchoalveolar lavage (BAL) fluid was cultured for adenovirus, and antigen detection tests were performed. While some children had a history of proven adenoviral infection at the onset of their disease, in none of the cases could a persistence of adenovirus be shown. We conclude that adenoviral infection might act as a starter of chronic obstructive bronchitis in children, but that pathogenetic mechanisms other than persistent infection must be responsible for the chronicity of the disease.

Adenoviridae Infections↗
PubMed2006

Plastic bronchitis caused by neoplastic infiltrates in a child.

We report on a case of a 7-year-old girl admitted for pneumonia not responding to oral antibiotics. During hospitalization, her pulmonary status deteriorated as a result of significant atelectasis. An extensive workup revealed an anaplastic large-cell lymphoma with neoplastic cells, found in both a biopsied lymph node and pleural fluid aspirate. Bronchoscopic examination showed nearly complete obstruction of the left side by bronchial casts composed of tumor cells, fibrin, and necrotic material, consistent with plastic bronchitis. Neoplastic infiltration of the bronchi should be considered in the differential diagnosis of disease entities causing plastic bronchitis in children.

Bronchitis↗
PubMed2001

Effect of sulfur dioxide and particulate pollutants on bronchitis in children--a risk analysis.

The general morbidity is being influenced to a great extent by diseases of the respiratory tract. Since their incidence and prevalence have been increasing, the identification of causal factors, especially of environmental origin, is of importance, not just in view of implementing preventive control strategies. Primary irritative gaseous [like sulfur dioxide (SO2)] as well as particulate pollutants (like TSP) can be regarded as causal constituents. Using the opportunity of changing levels of ambient air pollution in East Germany since 1989, the impact of SO2 and TSP on bronchitis was investigated over the last 10 years as part of several intervention studies in a locally defined homogenous population, children. The data suggest a significant association between SO2 and the prevalence of bronchitis in children but not for TSP. Considering the findings of other studies with respect to air pollution and the epidemiology of adverse health effects (especially respiratory disease), these results would amend the hypothesis put forward in a review of the literature as TSP < ultrafine particles (SO4(2-)) = SO2. Although these data show a significant association with only SO2, this does not imply that ultrafine particles, such as SO4(2-), do not contribute to the association with the observed adverse health effects. Nevertheless, the findings suggest that TSP seems less likely to be a predictor in the association with respiratory diseases, particularly not in the presence of high SO2.

Adolescent↗
PubMed1994

Chronic bronchitis, emphysema, and low-level air pollution in Helsinki, 1987-1989.

The effects of low levels of air pollution and weather conditions on the number of patients admitted to hospitals for exacerbation of chronic bronchitis or emphysema (n = 2807) was studied in Helsinki during a 3-year period, 1987-1989. The daily number of admissions via the emergency room was significantly associated with prevailing levels of sulfur dioxide (SO2) and nitrogen dioxide (NO2) in Poisson regressions controlled for weather, season, time trends, and day of the week, whereas the total number of admissions (via the emergency room and otherwise) was not significantly associated with these pollutants. The effect of SO2 was observed only among those under 65 years old; a significant peak of admissions was seen during the same day (RR, 1.31 for a 2.7-fold increase in SO2; 95% CI, 1.01-1.70; P = 0.039), and another after a 3-day lag (RR, 1.39; 95% CI, 1.05-1.86; P = 0.021). The effect of NO2 was strongest after a 6-day lag and was significant only among those over 64 years old (RR, 1.31; 95% CI, 1.03-1.66; P = 0.022). The average of mean 24-hr concentrations of NO2 was 39 micrograms/m3 (0.021 ppm) and that for SO2 was 19 micrograms/m3 (0.0067 ppm). No relationship was found between admissions and the concentrations of total suspended particulates (TSP) or ozone (O3), the temperature, or the relative humidity. However, the number of admissions among those over 64 years of age was significantly lower, irrespective of temperature, during the summer than during other seasons. The mean daily concentration of O3 was fairly low (22 micrograms/m3 or 0.011 ppm), but that of TSP was high, 76 micrograms/m3. the mean temperature was low, +4.7 degrees C. These results suggest that SO2 and NO2 concentrations lower than those given as guidelines in many countries, and lower than previously shown, may increase the incidence of symptoms in some patients with chronic bronchitis or emphysema.

Adult↗
PubMed1999

A multiplex PCR for Massachusetts and Arkansas serotypes of infectious bronchitis virus.

Infectious bronchitis virus (IBV), the prototype of the coronavirus family, is an enveloped, single-stranded RNA virus with a genome size of approximately 27.6 kilobase. Infectious bronchitis virus causes an acute, highly contagious respiratory and urogenital disease of chickens which results in significant economic losses in commercial broilers, layers and breeders. A rapid, highly sensitive and specific method is needed in the differential diagnosis of infections of different serotypes. A multiplex polymerase chain reaction (PCR) method was developed and optimized to simultaneously detect Massachusetts (Mass) and Arkansas (Ark) serotypes of IBV. One common primer and two serotype specific primers were chosen from the S1 gene sequences of IBV and used in one PCR reaction. Under optimized PCR conditions, two serotype specific PCR products, 1026 bp for Mass and 896 bp for Ark, respectively, were amplified and detected by agarose gel electrophoreses. The specificity of the technique was verified by using 20 different strains and isolates of IBV, and other avian bacterial and viral pathogens. Using a serial 10-fold dilution of the artificial mixture of both Mass and Ark samples, the detection limit was found to be 5 pg RNA after 35 cycles of PCR. The multiplex PCR was able to detect and differentiate both serotypes in embryonated eggs that were co-infected with different EID50virus titers of Mass 41 and Ark 99. The multiplex PCR developed in this study will be valuable for rapid identification, differential diagnosis, and epidemiological studies of these two serotypes of IBV infections.

Animals↗
PubMed2000

Cost-effectiveness analysis of oral N-acetylcysteine as a preventive treatment in chronic bronchitis.

UNLABELLED: Chronic bronchitis has a prevalence of approximately 11% in the population aged over 35 years and its frequent acute exacerbations (AECBs) are an important cause of morbidity and costs in health-care resources. Oral N -acetylcysteine (NAC) is administered during the winter months as a way of reducing AECBs. This cost-effectiveness analysis was done from the payers' point of view in the Swiss health-care system, based on a retrospective analysis of published placebo-controlled studies. The pooled data show that continuous administration of 400 mg day(-1)per os of NAC leads to a significant reduction in the number of AECBs (NAC: 16.2 vs 25.2% AECBs per month); a significantly smaller percentage of days of sick leave (NAC: 3.6 vs 5.3%) and a lower rate of hospitalizations (NAC: 1.5 vs 3.5% over a period of 6 months). Taking into account the poor compliance of these patients, calculations assumed a compliance of 80%. Direct costs were those of an NAC treatment, the management of an AECB (biological tests in 59%, X-rays in 65% and pulmonary function tests in 45%; antibiotics 70%, bronchodilators in 89%, corticosteroids in 24% and 'others' in 25% of the patients), and of hospitalizations (estimated at 10 days per case). Based on these figures, the mean direct costs of an untreated patient were CHF 869 vs CHF 700 in the NAC-treated patient. Univariate sensitivity analysis indicated that cost neutrality is reached with 0.6 (<0.25-1. 94, 95% CI) AECBs per 6 months. Indirect costs (based on sick leave) were also significantly different; the mean in untreated patients was CHF 1324 vs CHF 779 in the NAC-treated patients. CONCLUSION: Treating chronic bronchitis patients with NAC during the winter months is cost-effective both from the payer's and a social point of view.

Acetylcysteine↗
PubMed1993

Parental smoking and other risk factors for wheezing bronchitis in children.

A population-based case-control study was performed to investigate etiologic factors for wheezing bronchitis and asthma in children up to four years of age. A total of 199 children hospitalized for the first time with these diagnoses at a major hospital in Stockholm in 1986-1988 constituted the cases, 351 children from the catchment area of the hospital were used as controls. Information on known and suspected risk factors was obtained through home interviews with a parent. Parental smoking was associated with a relative risk of 1.8 (95% confidence interval 1.3-2.6) corresponding to a population attributable proportion of 27%. The strongest association was seen for maternal smoking and children below 18 months of age. Other major risk factors included atopic heredity, recurrent upper respiratory tract infections and breast-feeding less than 3 months, which appeared to interact multiplicatively with parental smoking. The environmental factors had a stronger influence in the youngest age group, and the overall attributable proportion associated with parental smoking, short breast-feeding period and exposure to pets in the household was 43%. It is clear that successful primary prevention could dramatically reduce the incidence of wheezing bronchitis in children.

Adult↗