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PubMed1975

Agglutinin response to bacterial infection in acute exacerbations of chronic bronchitis.

Agglutinin titres to Haemophilus influenzae, Streptococcus pneumoniae, Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Proteus vulgaris in the serum of patients with acute exacerbations of chronic bronchitis, patients producing mucoid sputum, and healthy controls were determined. Serological evidence of infection with H. influenzae was found in 38 of 57 patients with acute exacerbations, and Str. pneumoniae infection in 10 of the 57 patients, but was generally absent from healthy control subjects and from patiens producing mucoid sputum. No serological evidence of infection with other organisms named above was found to be associated with exacerbations of chronic bronchitis. Ten patients with acute exacerbations were without serological evidence of infection by any of the bacteria tested.

Agglutination Tests↗
PubMed1989

The intrauterine and early postnatal origins of cardiovascular disease and chronic bronchitis.

Geographical differences in mortality from cardiovascular disease and chronic bronchitis within England and Wales are closely related to past differences in infant mortality. This paper examines the separate relations of mortality during 1968-78 with neonatal and post-neonatal mortality during 1911-25. These divisions of infant mortality are indicators of the intrauterine and early postnatal environments respectively. Stroke is related to neonatal mortality and therefore to the intrauterine environment. Prenatal determinants of blood pressure levels may be one mechanism underlying this. Bronchitis is related to postnatal mortality and therefore to the postnatal environment. This may reflect the long term effects of lower respiratory tract infection in early childhood. Ischaemic heart disease is related to both neonatal and post-neonatal mortality and therefore to the intrauterine and postnatal environments. The links may include blood pressure and as yet unknown processes established in early postnatal life.

Bronchitis↗
PubMed2006

Chronic bronchitis and urban air pollution in an international study.

OBJECTIVES: The chronic effects of urban air pollution are not well known. The authors' aim was to investigate the association between the prevalence and new onset of chronic bronchitis and urban air pollution. METHODS: Subjects from the general population randomly selected for the European Community Respiratory Health Survey (ECRHS I) during 1991-93 in 21 centres in 10 countries were followed up from the years 2000 to 2002 (n = 3232 males and 3592 females; average response rate = 65.3%). PM2.5 and elements, with the same equipment at centre level, and home outdoor NO2 in 1634 individuals were measured. Hierarchical models were used. RESULTS: The prevalence and new onset of chronic phlegm during follow up were 6.9% and 4.5%, respectively, 5.3% in males and 3.5% in females. Smoking, rhinitis, poor education, and low social class were associated with (prevalence and new onset of) chronic phlegm in both genders, and occupational exposures in males and traffic intensity (adjusted odds ratio for constant traffic, OR = 1.86; 95% CI 1.24 to 2.77) as well as home outdoor NO2 (OR > 50 microg/m3v < 20 microg3 = 2.71; 95% CI 1.03 to 7.16) among females. PM2.5 and S content at centre level did not show any association with prevalence or new onset of chronic phlegm. Similar results were obtained with chronic productive cough. CONCLUSION: Individual markers of traffic at household level such as reported intensity and outdoor NO2 were risk factors for chronic bronchitis among females.

Adult↗
PubMed1977

An investigation of renal function in chronic bronchitis.

An investigation has been made into various parameters of renal function in patients with chronic bronchitis and in a group of hypoxic controls. Abnormalities of glomerular filtration rate and of water handling have been demostrated in chronic bronchitic patients but not in hypoxic controls. The abnormalities are related to the arterial Pco2. A hypothesis is presented as to the role of CO2 in causing abnormalities of renal function in chronic bronchitis.

Adult↗
PubMed2002

Effect of sputum processing with dithiothreitol on the detection of inflammatory mediators in chronic bronchitis and bronchiectasis.

BACKGROUND: Sputum analysis is used increasingly to assess airway inflammation in patients with chronic obstructive pulmonary disease, including those with chronic bronchitis and bronchiectasis. However, it is not known whether dithiothreitol (DTT), a reducing mucolytic agent regularly used to homogenise sputum, affects the detection of inflammatory mediators in the sputum soluble phase from such patients. METHODS: Thirty two spontaneous sputum samples were collected from 13 patients with chronic bronchitis and 17 with bronchiectasis. An aliquot from each sample was treated with either freshly prepared 0.1% DTT plus normal saline (NaCl) or NaCl alone, then ultracentrifuged to obtain the sputum sol phase. Interleukin (IL)-1beta, IL-6, IL-8, leukotriene B(4) (LTB(4)), secretory leukoprotease inhibitor (SLPI), alpha-1-antitrypsin (alpha(1)-AT), and tumour necrosis factor alpha (TNFalpha) were measured by ELISA, and neutrophil elastase (NE) and myeloperoxidase (MPO) by chromogenic substrate assay. The effect of DTT on the detection of assay standards was also determined. RESULTS: Median levels of IL-1beta, IL-6, IL-8, SLPI, and NE were similar in the DTT and NaCl treated samples. There was a significant reduction in median (IQR) levels of detectable TNFalpha (0.07 (0.00-0.47) pM v 0.90 (0.06-6.98) pM, p<0.001), LTB(4) (1.67 (1.31-2.64) nM v 2.29 (0.95-4.22) nM, p<0.05) and MPO (0.00 (0.00-0.00) mg/l v 4.48 (0.00-33.66) mg/l, p<0.001) and a small increase in the median alpha(1)-AT concentration (0.05 (0.03-0.08) nM v 0.03 (0.02-0.08) nM, p<0.01) in the DTT treated samples. DTT had no effect on the assay standards for IL-1beta, IL-8 or TNFalpha, but at higher concentrations it did affect IL-6, SLPI, NE, and LTB(4) standards (43%, 70%, 76% and 643% of control value for top standard, respectively) and at all concentrations DTT completely abolished MPO activity. CONCLUSIONS: Sputum processing with DTT significantly reduces the detectable concentration of TNFalpha, LTB(4) and MPO, and produces a small but significant increase in median alpha(1)-AT levels. To avoid this problem we recommend that an untreated aliquot of sputum be retained for cytokine analysis, unless the assay has been specifically validated.

Bronchiectasis↗
PubMed2003

Resolution of bronchial inflammation is related to bacterial eradication following treatment of exacerbations of chronic bronchitis.

BACKGROUND: Recent studies of the role of bacteria in chronic bronchitis have shown that bacterial colonisation is associated with enhanced inflammation and that purulent acute exacerbations of chronic bronchitis (AECB) are associated with bacteria and characterised by increased inflammation. Changes in bronchial inflammation in response to the success or failure of bacterial eradication following AECB were therefore studied. METHODS: Bacterial quantitative culture and sputum markers of inflammation (myeloperoxidase (MPO), neutrophil elastase, leukotriene B4 (LTB4), sol:serum albumin ratio, and secretory leukoprotease inhibitor) were measured in patients presenting with culture positive purulent AECB and repeated 10 days and 2 months later. 41 patients provided sputum sufficient for both bacteriology and assessment of inflammation at baseline and day 10, and 46 provided sufficient sample for bacteriology, 40 of which could also be analysed for inflammation at 2 months (when clinically stable). RESULTS: At day 10, 17 of the 41 patient samples had a positive bacterial culture. In the stable state, 18 of the 46 samples had a positive culture, but with a significantly lower bacterial load than at presentation. Although there was no difference between the groups at presentation, the concentration of MPO was lower (p<0.05) in those in whom bacteria were eradicated by day 10 than in those with persisting bacteria. The LTB4 concentration was similarly lower (p<0.001) in those in whom bacteria were eradicated than in those with persistent bacteria. In the stable clinical state the concentrations of both MPO and LTB4 were lower in those in whom bacteria were eradicated than in patients with persisting bacteria. CONCLUSION: Resolution of bronchial inflammation following AECB is related to bacterial eradication. Those in whom bacteria continue to be cultured in their sputum have partial resolution of inflammation which may reflect continued stimulation by the reduced bacterial load.

Adult↗
PubMed2006

Antibiotic treatment and factors influencing short and long term outcomes of acute exacerbations of chronic bronchitis.

BACKGROUND: The MOSAIC study compared moxifloxacin with three standard antibiotic regimens in patients with Anthonisen type 1 acute exacerbations of chronic bronchitis (AECB). Further exploratory analyses were performed to identify prognostic factors of short and long term clinical outcomes and their value for clinical research. METHODS: Outpatients aged > or =45 years were screened between AECB episodes, randomised to treatment upon presenting with an AECB, assessed 7-10 days after study treatment, and followed monthly until a new AECB or for up to 9 months. Logistic regression assessed the predictive factors for clinical cure (return to pre-AECB status) and clinical success (cure or improvement), and a stepwise Cox regression model time to a composite event (failure of study treatment, new AECB, or further antibiotic treatment for AECB). RESULTS: In multivariate analyses, clinical cure was positively influenced by treatment with moxifloxacin (odds ratio (OR) 1.49; 95% CI 1.08 to 2.04) while cardiopulmonary disease (OR 0.59; 95% CI 0.38 to 0.90), forced expiratory volume in 1 second (FEV1) <50% predicted (OR 0.48; 95% CI 0.35 to 0.67), and > or =4 AECBs in the previous year (OR 0.68; 95% CI 0.48 to 0.97) predicted a poorer outcome. For clinical success, treatment with moxifloxacin had a positive influence (OR 1.57; 95% CI 1.03 to 2.41) while cardiopulmonary disease (OR 0.41; 95% CI 0.25 to 0.68) and use of acute bronchodilators (OR 0.50; 95% CI 0.30 to 0.84) predicted a poorer outcome. The occurrence of the composite event was influenced by antibiotic treatment (hazard ratio (HR) 0.82; 95% CI 0.68 to 0.98), age > or =65 years (HR 1.22; 95% CI 1.01 to 1.47), FEV1<50% predicted (HR 1.27; 95% CI 1.05 to 1.53), > or =4 AECBs in previous year (HR 1.63; 95% CI 1.34 to 1.99), and acute bronchodilator use (HR 1.48; 95% CI 1.17 to 1.87). For the composite event the beneficial effect of moxifloxacin was primarily seen in patients aged > or =65 years. CONCLUSION: Despite selection of a homogeneous population of patients with chronic bronchitis, between group differences relating to antibiotic treatment could still be confounded by factors related to medical history, severity of disease, and use of concomitant medications. The design of future clinical trials should take these factors into account.

Acute Disease↗
PubMed1978

Prevalence of chronic bronchitis in Rhodesian Africans.

The prevalence of chronic bronchitis in the African population of a small township in Rhodesia was estimated using two questionnaires, both based on those of the British Medical Research Council. The first, a screening questionnaire, was put to 9768 subjects aged 5 years and above and the second, a more detailed questionnaire, to random selections of these grouped according to their replies. Repeat interviews were used to assess the accuracy of the questionnaires. The overall prevalence of chronic bronchitis was 1.12%. This is much lower than most other surveys elsewhere. There was little evidence of an increase in prevalence with age, and rates were not significantly different in the two sexes. The prevalence of complications and of other chest symptoms was correspondingly low. The proportion of bronchitics who smoked was not significantly higher than in the controls. Amounts smoked, however, were generally much lower than in other populations, and this, together with low levels of pollution, probably account for the prevalence findings.

Adolescent↗
PubMed1979

Bronchodilatation and the site of airway resistance in severe chronic bronchitis.

Twenty-one patients with severe chronic bronchitis and emphysema (FEV1 less than 1 1) inhaled 80 microgram of the atropine-like agent ipratropium or placebo in a double-blind study and three hours later inhaled 200 microgram salbutamol. After 80 microgram ipratropium, mean FEV1 was significantly greater than after 200 microgram salbutamol (P less than 0.025), but the difference was only 40 ml and the clinical significance of this difference is unproved. There was no correlation between the patient's response to ipratropium and the response to salbutamol. When salbutamol was administered three hours after ipratropium, the FEV1 rose to higher levels than after either agent alone (P less than 0.01). Studies breathing 80% helium/20% oxygen suggest that ipratropium dilates both large and small airways. There was no correlation between the response to helium/oxygen and the response to either bronchodilator. The results suggest that in severe chronic bronchitis and emphysema ipratropium is at least as effective as salbutamol, and that such patients should have reversibility studies with salbutamol alone, ipratropium alone, and after both agents together. The combination of ipratropium and salbutamol may be clinically useful.

Aged↗
PubMed1979

Low frequency breathing at rest and during exercise in severe chronic obstructive bronchitis.

The effect of low frequency breathing compared with spontaneous breathing was examined at rest and during exercise (40 watts) in 12 patients suffering from severe chronic obstructive bronchitis. At rest low frequency breathing improved significantly the alveolar ventilation and the tensions of oxygen and carbon dioxide in the arterial blood. There was no significant change in ventilation minute volume. During exercise low frequency breathing significantly decreased ventilation minute volume, and there was no significant improvement in gas exchange. The decrease in ventilation during low frequency breathing at 40 watts compared with spontaneous breathing at the same lung volume was due to expiratory flow limitation. The findings suggest that this technique may impair exercise tolerance in patients with severe chronic obstructive bronchitis.

Bronchitis↗
PubMed1981

Serum, saliva, and sputum levels of metronidazole in acute exacerbations of chronic bronchitis.

We have evaluated the absorption and the penetration of metronidazole into the bronchial secretions and saliva in acute infective exacerbations of chronic bronchitis. Seventeen patients were given 400 mg orally three times daily for seven days and "steady state" levels were measured in serum, saliva, and sputum on the last day of treatment. Mean levels in the three biological fluids were not significantly different. Higher metronidazole levels in sputum tended to occur in patients with higher serum levels. In all but one patient, levels in serum and saliva were well within the therapeutic range. We conclude that this oral regimen results in therapeutic tissue levels in acute exacerbations of chronic bronchitis.

Absorption↗
PubMed1981

Effect of oral salbutamol and slow-release aminophylline on exercise tolerance in chronic bronchitis.

In a double-blind placebo-controlled trial in 24 patients fulfilling the MRC criteria for chronic bronchitis, oral salbutamol 4 mg and slow-release aminophylline (Phyllocontin) 450 mg produced similar and significant (p less than 0.05) mean increases in forced expiratory volume in one second (FEV1). A significantly greater increase in mean FEV1 and forced vital capacity (FVC) was seen when both drugs were given although there was no statistical evidence of synergistic interaction. Salbutamol significantly increased the mean distance walked in 12 minutes (12MD) (p less than 0.02) by 56 metres and a similar increase of 54 metres (p less than 0.001) was seen after Phyllocontin. With both drugs in combination mean 12MD increased by 51 metres (p less than 0.02 cf placebo), a change not significantly different from that observed with either drug alone. Oral salbutamol and Phyllocontin improve exercise tolerance in chronic bronchitis. The significantly greater changes in FEV1 and FVC resulting from simultaneous administration of the two drugs are not associated with further improvement in exercise tolerance.

Adult↗
PubMed1981

Follow-up study of disability among elderly patients discharged from hospital with exacerbations of chronic bronchitis.

Chronic bronchitis is a common reason for admitting an old person to hospital. Government statistics measure the impact of admission only in terms of mortality. A follow-up study of disability among the elderly admitted to hospital wih an exacerbation of chronic bronchitis is described. One month after discharge about 30% of patients were unable to walk as far on the flat or climb as many steps as they did before admission and 90% were unable to do all previous household chores or social activities. After a further two months, although the proportion of patients unable to do all previous household chores or social activities had decreased significantly the proportion with restricted ambulation or ability to climb stairs had not decreased. The proportion of patients admitting to anxiety or depression and being dissatisfied with their progress also remained high. We conclude that there is a need for graduated rehabilitation programmes, which have been shown to increase the walking distance of elderly bronchitics, to be extended to cover all aspects of disability and for home rehabilitation to become an integral part of the care of all elderly bronchitics discharged from hospital.

Activities of Daily Living↗
PubMed1982

Radiological pituitary fossa changes in chronic bronchitis.

Fourteen male patients with chronic bronchitis and hypoxia had a lateral radiograph of the pituitary fossa. Nine of the 14 had definite or probable abnormalities, a significantly higher frequency (p less than or equal to 0.01) than is represented by the two out of 14 age-matched men from a control group with head injuries. The most common change was thinning or erosion of the lamina dura. Patients with hypercapnia were no more prone to such abnormalities than were those with normocapnia, a finding that conflicts with a previous paper. We confirm that radiological pituitary fossa changes do occur in chronic bronchitis, that they are unrelated to steroid treatment, and that they are probably not solely due to the chronically raised intracranial pressure associated with hypercapnia. Other possible mechanisms are discussed--in particular hypoxia, which might produce changes on account of the increased cerebral blood flow and engorged intracranial blood vessels.

Adult↗
PubMed1984

A dose response study of oxitropium bromide in chronic bronchitis.

In a dose response study 12 patients with chronic bronchitis and airflow obstruction received inhaled placebo and incremental doses of oxitropium bromide. Significant improvements in peak expiratory flow rate, forced expiratory volume in one second, and forced vital capacity were recorded at all times up to 10 hours after all doses of oxitropium bromide. Oxitropium bromide is an effective bronchodilator in chronic bronchitis with an optimal dose of 400-600 micrograms.

Aged↗
PubMed1985

"Invalidity" due to chronic bronchitis and emphysema: how real is it?

Hospital discharges and deaths attributed to chronic bronchitis and emphysema have fallen in recent years while the number of those receiving invalidity benefit for these conditions has remained constant. One hundred and fifty seven such persons were invited to take part in this study, in which the diagnosis, degree of respiratory impairment, and other factors contributing to disability were reviewed. The scope for rehabilitation was considered. One hundred subjects agreed to take part; 96 were men and 70 were over 60 years. In only 67 was the main diagnosis chronic bronchitis and emphysema. There was a bimodal distribution of functional impairment, most being severely disabled, but in 20 the FEV1 was within the normal range. Among these asthma was more common and psychological factors were important. Economic factors contributed to "invalidity," especially among those with a normal FEV1. For 32 of the 57 who had declined to take part some information was available from hospital records. The findings in this group were similar. There was little scope for rehabilitation in the group as a whole as motivation was poor. Less than half had ever seen a chest physician. Specialist assessment before invalidity benefit is claimed is probably desirable.

Aged↗
PubMed1985

Differences in responsiveness to hyperventilation and methacholine in asthma and chronic bronchitis.

In a previous study on 27 patients with chronic bronchitis we found that only three developed bronchoconstriction in response to hyperventilation of cold, dry air despite an increased responsiveness to methacholine inhalation. We therefore investigated bronchial responsiveness to hyperventilation with cold, dry air and methacholine in 27 patients with stable asthma who had a similar range of baseline FEV1 values but who developed bronchoconstriction that could be reversed to give an FEV1 more than 70% of the predicted value. Baseline FEV1 was 0.88-3.98 l (37-114% predicted). All but one subject developed bronchoconstriction in response to hyperventilation. There was a linear relationship between baseline FEV1 and response to methacholine (r2 = 0.37, p less than 0.001) and the relationship was significantly different from that found in the bronchitic subjects (F2.50 = 24.94, p less than 0.001). In general, the response to methacholine was greater in the asthmatic than in the bronchitic subjects for any baseline FEV1. The results suggest that there are different mechanisms underlying the increased responsiveness to methacholine in asthma and chronic bronchitis.

Adolescent↗