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PubMedDate not supplied

Improving quality or shifting diagnoses? What happens when antibiotic prescribing is reduced for acute bronchitis?

BACKGROUND: A quality improvement project in an academic practice demonstrated a reduction in antibiotic prescribing for acute bronchitis. However, it was unclear whether this represented a reduction in antibiotic use or whether physicians assigned new diagnoses to the same patients to avoid scrutiny and continue to use antibiotic therapy. OBJECTIVE: To examine whether a substantial amount of diagnostic shifting occurred while antibiotic prescribing for acute bronchitis decreased during a 14-month period (from January 1, 1996, to February 28, 1997). METHODS: All patient diagnoses of acute bronchitis, acute sinusitis, upper respiratory tract infection, and pneumonia were determined for the 14 months of the acute bronchitis intervention. The relative distribution of patients among these 4 diagnostic categories was compared to determine if the percentage of patients with acute bronchitis decreased while those with acute sinusitis and pneumonia increased during the acute bronchitis intervention. RESULTS: The percentage of patients with the diagnosis of acute bronchitis remained unchanged during the 14-month period while antibiotic use for this condition decreased from 66% of cases to less than 21% of cases. Instead of the patients being assigned a different diagnosis such as acute sinusitis so that antibiotic prescribing would not be scrutinized, as we hypothesized, the relative number of diagnoses for acute sinusitis compared with acute bronchitis actually declined during the 14 months. No change was noted in the relative frequency of acute bronchitis cases compared with pneumonia cases. CONCLUSION: During a 14-month period when an intervention was successful at reducing antibiotic use for acute bronchitis, there was no evidence that physicians shifted patients from the diagnosis of acute bronchitis to other diagnoses.

Acute Disease↗
PubMed1995

IL-5, IL-8 and GM-CSF immunostaining of sputum cells in bronchial asthma and chronic bronchitis.

BACKGROUND: Granulocyte-macrophage colony stimulating factor (GM-CSF) and interleukin (IL)-5 or IL-8 have been suggested to play an important role in the pathogenesis of eosinophilic airway inflammation in bronchial asthma or neutrophilic airway inflammation in chronic bronchitis, respectively, However, GM-CSF and IL-8 have biological activities to either eosinophils or neutrophils. OBJECTIVE: To investigate the contribution of these cytokines to airway inflammation, we compared the cellular differential and immunolocalization of GM-CSF, IL-5 and IL-8 in sputum cells from patients with bronchial asthma and chronic bronchitis. METHODS: Cytospins of sputum cells from 12 patients with bronchial asthma and 12 with chronic bronchitis were subjected to cellular differential counting and immuno-cytochemistry with anti-human GM-CSF, IL-5 and IL-8 antibody. RESULTS: The predominant cells in bronchial asthma were eosinophils and lymphocytes, while those in chronic bronchitis were neutrophils. All cytokines examined were detected in either bronchial asthma or chronic bronchitis, although the percentage of GM-CSF and Il-5 positive cells in bronchial asthma (53.4 +/- 6.0 [mean +/- SEM]% and 9.7 +/- 2.8%, respectively) was significantly higher than that in chronic bronchitis (11.4 +/- 2.5%; P < 0.001 and 1.7 +/- 0.3%; P < 0.007, respectively). In contrast, the percentage of IL-8 positive cells in chronic bronchitis (23.8 +/- 7.0%) was significantly higher than that in bronchial asthma (7.& +/- 1.9%; P < 0.04). The cells positive for IL-5 were lymphocytes in bronchial asthma and chronic bronchitis. The cells positive for GM-CSF in bronchial asthma were predominantly eosinophils, while those in chronic bronchitis were monocytes/macrophages and neutrophils. In contrast, neutrophils are mainly positive for IL-8 in chronic bronchitis, while monocytes/macrophages and bronchial epithelial cells are positive for IL-8 in bronchial asthma. CONCLUSION: The immunochemical comparison of GM-CSF and IL-8 localization in sputum cells between bronchial asthma/chronic bronchitis suggests the differential regulation and roles of these cytokines in eosinophilic vs neutrophilic airway inflammation, resulting in the development of different types of airway inflammation.

Adult↗
PubMed2001

Exposure to cold and draught, alcohol consumption, and the NS-phenotype are associated with chronic bronchitis: an epidemiological investigation of 3387 men aged 53-75 years: the Copenhagen Male Study.

OBJECTIVES: This study was performed to estimate the strength of association between chronic bronchitis and lifetime exposure to occupational factors, current lifestyle, and the NS-phenotype in the MNS blood group among middle aged and elderly men. METHODS: The study was carried out within the frameworks of the Copenhagen Male Study. Of 3387 men 3331 men with a mean age of 63 (range 53-75) years could be classified by prevalence of chronic bronchitis. As well as the completion of a large questionnaire on health, lifestyle, and working conditions, all participants had a thorough examination, including measurements of height and weight and blood pressure and a venous blood sample was taken for the measurement of serum cotinine and MNS typing; 16.5% of the men had the NS-phenotype. Chronic bronchitis was defined as cough and phlegm lasting 3 months or more for at least 2 years; 14.6% had chronic bronchitis. RESULTS: Smoking and smoke inhalation were the factors most strongly associated with prevalence of chronic bronchitis. There were three major new findings: (a) long term (>5 years) occupational exposure to cold and draught was associated with a significantly increased prevalence of chronic bronchitis; compared with others, and adjusted for confounders, the odds ratio (OR) with 95% confidence interval (95% CI) was 1.4 (1.1 to 1.7), p=0.004; (b) a significant J shaped association existed between alcohol use and bronchitis, p<0.001, with the lowest prevalence found among moderate users; (c) a significant gene by environment association existed between smoking and the NS-phenotype in the MNS blood group; only among smokers was the NS-phenotype associated with a significantly decreased risk of chronic bronchitis, OR 0.67 (0.47-0.97), p=0.02. Other well known associations between dust, fumes, and even exposure to solvents and bronchitis were confirmed. CONCLUSION: The results emphasise the multifactorial nature of chronic bronchitis, and show some hitherto unrecognised associations between cold and draught exposure, alcohol consumption, and the NS-phenotype and chronic bronchitis.

Aged↗
PubMed1993

Etiologic factors of chronic bronchitis in dairy farmers. Case control study in the Doubs region of France.

Relationships were investigated between chronic bronchitis and plant dust exposure assessed by quantification of barn threshing and cattle foddering and chronic bronchitis and acute respiratory syndromes after plant mold dust exposure. Two groups of male dairy farmers were studied in the Doubs region, France: 197 with chronic bronchitis and 163 control subjects without chronic bronchitis. There was no relationship between chronic bronchitis and exposure. Thirty-three chronic bronchitis patients had semidelayed respiratory syndromes (SDRS) vs two control subjects. Twenty-seven times out of 33 (16 of 17 in the nonsmokers), the SDRS preceded chronic bronchitis. Past history of acute respiratory syndromes during barn threshing (RSBT) was more frequent in chronic bronchitis; RSBT always preceded chronic bronchitis. It is concluded that host factors are important in chronic bronchitis and that acute effects after exposure may be predisposing factors to chronic bronchitis.

Adult↗
PubMed2006

Thirty-year cumulative incidence of chronic bronchitis and COPD in relation to 30-year pulmonary function and 40-year mortality: a follow-up in middle-aged rural men.

PURPOSE: To describe the 30-year cumulative incidence of chronic bronchitis and COPD in relation to smoking habits. The effect of chronic bronchitis on pulmonary function and mortality was also examined. METHODS: Middle-aged men belonging to two rural Finnish cohorts of the Seven Countries Study (n = 1,711 in 1959) were followed up for up to 40 years until 2000. Standard questionnaires were used to measure chronic bronchitis, and repeated spirometry was used to evaluate pulmonary function during the 30 years. Forty-year mortality data were examined. RESULTS: The cumulative incidence of chronic bronchitis and COPD was 42% and 32%, respectively, in continuous smokers, compared to 26% and 14% in ex-smokers and 22% and 12% in never-smokers. During the follow-up, subjects with chronic bronchitis had on average 252 mL (95% confidence interval, 211 to 293 mL) lower forced expiratory volume than those without it. The decrease in forced expiratory volume attributable to chronic bronchitis was most pronounced in those with persistent symptoms and in smokers. In subjects with chronic bronchitis, all-cause mortality was increased by a hazard ratio of 1.30 (95% confidence interval, 1.02 to 1.65). Smokers with chronic bronchitis who decreased their daily cigarette consumption increased their median life span by 2.4 years. CONCLUSIONS: The lifetime risk of chronic bronchitis among smokers is approximately two in five, and almost one half of smokers who have chronic bronchitis also acquire COPD. Chronic bronchitis is related to earlier death, also in never-smokers, probably partly through a rapid decline in pulmonary function.

Adult↗
PubMed1999

[A study of airway reactivity and nature of chronic asthmatic bronchitis].

OBJECTIVE: To observe the airway reactivity with methacholine provocation and exercise challenge of chronic asthmatic bronchitis and to assess preliminarily the nature of chronic asthmatic bronchitis. METHODS: 42 patients with bronchial asthma, 29 with simple chronic bronchitis and 27 with chronic asthmatic bronchitis were selected. The study protocol consisted of inhalation challenge with methacholine and exercise challenge. Count of blood eosinophil cells and level of blood total IgE were studied. Serum eosinophil cationic protein (ECP) concentration was measured in the asthmatic bronchitis group. RESULTS: The positive ratio to methacholine response was 77.8% in chronic asthmatic bronchitis group, whereas the ratios were 100.0% and 41.4% in bronchial asthma and simple chronic bronchitis groups respectively. According to the response to exercise challenge, patients with chronic asthmatic bronchitis were divided into positive and negative groups. The cumulative dose of methacholine producing a 20% fall in FEV(1) (PD(20)-FEV(1)) was different between the two groups. In the positive group (9 patients), none was negative with methacholine response and PD(20)-FEV(1) being similar to the bronchial asthma group. The blood total IgE and ECP levels were significantly higher in the positive than in the negative group. CONCLUSION: The characteristics of airway reactivity in chronic asthmatic bronchitis are midway between bronchial asthma and simple chronic bronchitis. The nature of chronic asthmatic bronchitis may be different in different patients.

Adult↗
PubMed1990

[Chronic bronchitis and related disorders].

Chronic bronchitis was a disease which attracted much attention in the U.K. in the 1950's. It was classified into three forms known as simple chronic bronchitis, recurrent or mucopurulent bronchitis, and chronic obstructive bronchitis and it was thought that the disease progressed from one form to the next in accordance with their order as listed here. Later, however, it was realized that the disease did not progress according to this order and that chronic bronchitis actually included three kinds of the disease. Furthermore, in the U.K., with the prohibition of the use of coal and the reduction of air pollution and with the decline of infectious disease in child age, recurrent or mucopurulent bronchitis underwent an extreme reduction. Chronic obstructive bronchitis is known to be caused by smoking and is now called chronic bronchitis and emphysema or COPD. Simple chronic bronchitis may in fact be only a simple physical response to smoking. Now in Japan the disease called chronic bronchitis is often recognized when written on receipts for health insurance, but patients of chronic bronchitis as were seen in the U.K. in the 1950's are extremely rare. Diffuse panbronchiolitis is seen in Japan but is a disease not found in the West. Diffuse bronchiectasis and its differentiation become the point of question for this disease. With the effectiveness of erythromycin, we can expect a decline in the number of patients and an improvement in prognosis.

Bronchiolitis↗
PubMed1995

Persistence and new onset of asthma and chronic bronchitis evaluated longitudinally in a community population sample of adults.

BACKGROUND: Some patients with chronic obstructive pulmonary disease may share the clinical characteristics of those with asthma; their disease is sometimes called "asthmatic bronchitis." Whether there is a difference between asthmatics who do and do not develop chronic bronchitis is not yet clear. We investigated whether asthma and chronic bronchitis may share some "allergic" phenotypes and whether asthmatic individuals who develop chronic bronchitis subsequently have steeper declines in lung function. METHODS: Known risk factors for decline in lung function were analyzed in a representative community population of adults followed up longitudinally since 1972 in Tucson, Ariz, in groups with persistent, newly developed, and past diagnoses of asthma and chronic bronchitis. We evaluated contributions of initial level of forced expiratory volume in 1 second (FEV1), reversibility with isoproterenol hydrochloride nebulized aerosol bronchodilator treatment, percentage of blood eosinophils to determine eosinophilia, and IgE level. RESULTS: The concurrence of chronic bronchitis and asthma is associated with a steeper decline in FEV1 than is asthma as the sole diagnosis. Asthmatics (those with persistent asthma with and without chronic bronchitis) had the greatest prevalence of increased reversibility with isoproterenol therapy and with eosinophilia. The prevalence of eosinophilia was also high in those with newly diagnosed chronic bronchitis without asthma; however, this was not the case in those with persistent chronic bronchitis without asthma. Larger bronchodilator responses were related to steeper declines in FEV1, both in persistent asthma and in chronic bronchitis. CONCLUSIONS: Bronchodilator response and eosinophilia are generally believed to be hallmarks of asthma. We show that these characteristics may be present in chronic bronchitis as well. The presence of a large (> 25%) bronchodilator response is associated with a steeper decline in FEV1.

Adult↗
PubMed2003

Hypothalamic digoxin, hemispheric chemical dominance, and chronic bronchitis emphysema.

The isoprenoid pathway produces three key metabolites--endogenous digoxin (membrane sodium-potassium ATPase inhibitor, immunomodulator, and regulator of neurotransmitter/amino acid transport), dolichol (regulates N-glycosylation of proteins), and ubiquinone (free radical scavenger). This was assessed in patients with chronic bronchitis emphysema. The pathway was also assessed in patients with right hemispheric, left hemispheric, and bihemispheric dominance to find the role of hemispheric dominance in the pathogenesis of chronic bronchitis emphysema. All the 15 patients with chronic bronchitis emphysema were right-handed/left hemispheric dominant by the dichotic listening test. In patients with chronic bronchitis emphysema there was elevated digoxin synthesis, increased dolichol, and glycoconjugate levels, and low ubiquinone and elevated free radical levels. There was also an increase in tryptophan catabolites and a reduction in tyrosine catabolites. There was an increase in cholesterol:phospholipid ratio and a reduction in glycoconjugate levels of RBC membrane in patients with chronic bronchitis emphysema. The same biochemical patterns were obtained in individuals with right hemispheric dominance. Endogenous digoxin by activating the calcineurin signal transduction pathway of T-cell can contribute to immune activation in chronic bronchitis emphysema. Increased free radical generation can also lead to immune activation. Endogenous synthesis of nicotine can contribute to the pathogenesis of the disease. Altered glycoconjugate metabolism and membranogenesis can lead to defective lysosomal stability contributing to the disease process by increased release of lysosomal proteases. The role of an endogenous digoxin and hemispheric dominance in the pathogenesis of chronic bronchitis emphysema and in the regulation of lung structure/function is discussed. The biochemical patterns obtained in chronic bronchitis emphysema is similar to those obtained in left-handed/right hemispheric chemically dominant individuals by the dichotic listening test. But all the patients with chronic bronchitis emphysema were right-handed/left hemispheric dominant by the dichotic listening test. Hemispheric chemical dominance has no correlation with handedness or the dichotic listening test. Chronic bronchitis emphysema occurs in right hemispheric chemically dominant individuals and is a reflection of altered brain function. Hemispheric chemical dominance can play a role in the regulation of lung function and structure.

Analysis of Variance↗
PubMed1997

Chronic bronchitis in textile workers.

BACKGROUND: Exposure to cotton is known to produce a specific occupational disease known as byssinosis. A large population of textile workers was investigated to determine whether such exposure was also associated with chronic bronchitis once other possible aetiological factors had been accounted for. METHODS: A total of 2991 workers were investigated for the presence of symptoms compatible with chronic bronchitis. An MRC adapted respiratory questionnaire and MRC definition of chronic bronchitis were used for diagnostic labelling. Current and lifetime exposure to dust was estimated by personal and work area sampling, and the use of records of retrospective dust levels previously measured over the preceding 10 years. Airborne endotoxin exposure was measured using a quantitative turbidometric assay. Lung function tests were performed to measure forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). A control group of workers exposed to man-made fibre textiles was identified. The comparative prevalence of chronic bronchitis in the two populations was assessed, allowing for sex, age, smoking habit, and ethnic origin. Two case referent studies were also performed; cases of chronic bronchitis were separately matched with controls from the cotton and control populations to determine the effect of the symptomatic state on lung function. RESULTS: After controlling for smoking (pack years), workers in a cotton environment were significantly more likely to suffer from chronic bronchitis and this was most marked in workers over 45 years of age (odds ratio 2.51 (CI 1.3 to 4.9); p < 0.01). Regression analysis of all possible influencing parameters showed that cumulative exposure to cotton dust was significantly associated with chronic bronchitis after the effects of age, sex, smoking, and ethnic group were accounted for (p < 0.0005). In the intra-cotton population case control study a diagnosis of chronic bronchitis was associated with a small decrement in lung function compared with controls: percentage predicted FEV1 in cases 81.4% (95% CI 78.3 to 84.6), controls 86.7% (84.9 to 88.5); FVC in cases 89.9% (95% CI 87.0 to 92.9), controls 94.6% (92.8 to 96.4). After controlling for cumulative past exposure and pack years of smoking the effect of the diagnostic state remained significant for both FEV1 (p < 0.01) and FVC (p < 0.05). CONCLUSIONS: Chronic bronchitis is more prevalent in cotton workers than in those working with man-made fibre and exposure is additive to the effect of smoking. The diagnosis of chronic bronchitis is associated with a small but significant decrement in lung function.

Adult↗
PubMed2003

Pharmacy-based intervention to reduce antibiotic use for acute bronchitis.

BACKGROUND: Intervention programs can reduce inappropriate antibiotic use for the treatment of acute bronchitis in a closed health maintenance organization model. OBJECTIVE: To evaluate the impact of a pharmacy-based intervention program intended to reduce antibiotic use in the treatment of acute bronchitis in a community-based physician group model. SUBJECTS: Adult and pediatric patients with an office or urgent care visit for acute bronchitis during the baseline and study periods were included in the study. The clinicians were primary care physicians, nurse practitioners, and physician assistants in a suburban community-based physician group setting. METHODS: All patients treated for acute bronchitis from January 1 through June 30, 1998, were evaluated for initial receipt of antibiotics and use of clinic resources (office visits, additional antibiotics). From September through December of 1998, physicians were provided literature from the Centers for Disease Control and Prevention (CDC), cough and cold package inserts, and newsletters intended to educate the providers regarding the inappropriateness of antibiotics in the treatment of acute bronchitis. Patient-directed literature from the CDC was placed in the examination rooms and clinic waiting areas beginning September 1998. From January 1 through June 30, 1999, all patients treated for acute bronchitis were assessed for receipt of antibiotics and use of clinic resources. A separate geographic clinic site served as a control during both study periods. RESULTS: During 1998, 888 of 1840 patients (48.3%) received antibiotics for treatment of acute bronchitis; this total decreased to 924 of 2392 (38.6%; p < or = 0.001) in 1999, a reduction of 20%. The rate of antibiotic prescribing in control patients was unchanged during the concomitant time periods (142/446, 31.8% vs. 102/321, 31.8%). The rate of subsequent physician visits was similar (8% vs. 9%) between patients receiving antibiotics and those who did not. However, significantly more patients initially receiving antibiotics required a subsequent antibiotic prescription (45/1812, 2.5% vs. 24/2420, 1.0%; p < or = 0.001). CONCLUSIONS: A pharmacy-based intervention program reduces the incidence of inappropriate antibiotic use in the treatment of acute bronchitis. Reduced antibiotic prescribing does not increase consumption of healthcare resources; patients who receive antibiotics for acute bronchitis are more likely to subsequently require additional antibiotic prescriptions. While a significant decrease in antibiotic use was realized, other interventions are required to further reduce the prevalence of antibiotic use in acute bronchitis.

Acute Disease↗
PubMed2003

Wheezy bronchitis in childhood: a distinct clinical entity with lifelong significance?

BACKGROUND: Historically, clinicians have recognized the existence of the clinical syndrome of childhood wheezy bronchitis. In the late 1960s, children with this syndrome were relabeled as having asthma, and the term wheezy bronchitis was abandoned. In a 1989 study of a cohort that originally had been studied in 1964, we reported that those who had childhood wheezy bronchitis had as adults attained lung function similar to that of healthy control subjects and had less significant symptoms than did those who had experienced childhood asthma, in whom lung function was reduced. In this study, we reexamined these subjects 12 years later to determine whether the improved outcome of the wheezy bronchitis group had been maintained. METHODS: In 2001, we followed up the 283 participants of the 1989 study, who were now aged 45 to 50 years. In interviews, respiratory symptoms and smoking status were assessed. Spirometry was measured. RESULTS: One hundred seventy-seven subjects (63%) completed the study. After adjusting for age, height, gender, socioeconomic status, smoking status, and number of pack-years smoked, the current FEV(1) in the childhood asthma group (mean, 2.45 L; 95% confidence interval, 2.29 to 2.62) was significantly lower than the wheezy bronchitis group (2.78 L, 95% confidence interval, 2.64 to 2.91; p < 0.01) and the control group (2.96 L; 95% confidence interval, 2.83 to 3.1; p < 0.01). The difference between the wheezy bronchitis group and the control subjects was not significant (p = 0.06). Between 1989 and 2001, both the childhood wheezy bronchitis group (p < 0.01) and the childhood asthma group (p = 0.01) had greater declines in FEV(1) than did the control group (asthma group decline, - 0.75 L [95% confidence interval, - 0.66 to - 0.84]; wheezy bronchitis group decline, - 0.75 L [95% confidence interval, - 0.68 to - 0.83]; control group decline, - 0.59 L [95% confidence interval, - 0.52 to - 0.67]). In 2001, the asthma group had more symptoms than did the wheezy bronchitis group (p < 0.01), who were more symptomatic than the control group (p < 0.01). CONCLUSION: Those with childhood wheezy bronchitis, having achieved normal lung function in earlier adulthood, now show a more rapid decline in lung function than did control subjects. If this rate of decline persists, these subjects may develop obstructive airways disease in later life.

Adolescent↗
PubMed2002

Assessment of the value of pHmetry results in diagnostics of gastroesphageal reflux as a cause of obstructive bronchitis in children.

BACKGROUND: The study assessed the incidence of pathologic gastroesophageal reflux in children with obstructive bronchitis and analyzed the correlation of pHmetric parameters with the incidence of obstructive bronchitis according to age groups. MATERIAL/METHODS: 109 children aged from 4 months to 17 years with the history of at least two documented incidents of obstructive bronchitis during the period of one year were examined. Each patient underwent 24h esophageal pHmetry. The analyzed patients were divided into 3 age groups: I - 4 months-2 years, II - 3-9 years, III - 10-17 years; each of the obtained groups was divided into 2 subgroups according to the frequency of obstructive bronchitis (a - 2-4 times a year and b - over 4 times a year). RESULTS: Gastroesophageal reflux was diagnosed on the basis of pHmetry in 62.4% of patients. It was demonstrated in own material that gastroesophageal reflux is more frequent in boys (64.7%) than in girls (35.3%). Comparison of pHmetric parameters in children suffering from obstructive bronchitis more and less frequently did not demonstrate higher pHmetric parameters in children with more frequent occurrence of obstructive bronchitis in any of the age groups. Although gastroesophageal reflux occurred frequently in children with obstructive bronchitis, no proportional correlation was found between the pHmetric parameters and frequency of obstructive bronchitis CONCLUSIONS: Esophageal pHmetry should be performed in children with obstructive bronchitis in order to confirm or exclude gastroesophageal reflux as a cause of recurrent obstructive bronchitis.

Adolescent↗
PubMed1986

Chronic bronchitis: prevalence, smoking habits, impact, and antismoking advice.

Although the prevalence of chronic bronchitis has been measured in several populations, its impact on quality of life has not been assessed. We report the prevalence and impact of chronic bronchitis (defined as having phlegm on most days for at least 3 months during the previous year) among 4,708 adults ages 20 to 69 representative of the nonaged U.S. population. Men reported chronic bronchitis more frequently than women (12 vs 8%); smokers, regardless of age and sex, reported chronic bronchitis more frequently than former or never smokers. Among both men and women 35 years of age or older, current smokers--as opposed to ex- or never smokers--with chronic bronchitis had the poorest forced expiratory volume in 1 sec (FEV1). The most commonly reported impact of chronic bronchitis was worry, followed by pain and restricted activity days, regardless of age, sex, or smoking habits. Of those current and ex-smokers who had seen a physician about their chronic bronchitis, 65% of men and 44% of women had decreased or stopped smoking. Among those current and ex-smokers with chronic bronchitis who did not consult a physician, the proportion of those who had decreased or stopped smoking was 29% for men and 37% for women. Finally, only 43% of male current smokers and 55% of female current smokers who had chronic bronchitis reported that a physician had advised them to decrease or stop smoking.

Adult↗
PubMed1995

Bronchial inflammation in chronic bronchitis assessed by measurement of cell products in bronchial lavage fluid.

BACKGROUND: Bronchial inflammation in chronic bronchitis has not been characterised as well as in asthma. The present study was undertaken to assess whether a characteristic pattern of bronchial inflammatory markers could be found in patients with chronic bronchitis. METHODS: Bronchoscopy with bronchial lavage was performed in 42 patients with chronic bronchitis and in 13 healthy controls. Twenty three of the patients had non-obstructive chronic bronchitis and 19 had chronic bronchitis and chronic obstructive pulmonary disease (COPD). Eighteen of the patients with bronchitis had recurrent infective exacerbations and 24 did not. Intrabronchial bacterial cultures were taken with a protected specimen brush. RESULTS: Increased activity of neutrophils, fibroblasts, and eosinophils was found in the patients with chronic bronchitis as assessed by the levels of myeloperoxidase (MPO) and interleukin-8 (IL-8), hyaluronan, and eosinophil cationic protein (ECP), respectively. The levels of tryptase did not differ from the controls. High correlations were found between the levels of MPO and IL-8, as well as ECP and IL-8. No differences were found between the patients with COPD and those with non-obstructive chronic bronchitis. CONCLUSIONS: Recruitment and activation of both neutrophils and eosinophils seem to be a characteristic of chronic bronchitis. This activation is associated with IL-8. The patients with intrabronchial cultures of Streptococcus pneumoniae had the highest individual levels of MPO, ECP, and IL-8 of all subjects in the study, indicating that colonisation with S pneumoniae could promote bronchial inflammation.

Adult↗
PubMed2002

Clinical features of eosinophilic bronchitis.

BACKGROUND: Eosinophilic inflammation of the airway is usually associated with airway hyper-responsiveness in bronchial asthma. However, there is a small group of patients which has the eosinophilic inflammation in the bronchial tree with normal spirometry and no evidence of airway hyper-responsiveness, which was named eosinophilic bronchitis. The objectives of this study are 1) to investigate the incidence of eosinophilic bronchitis in the chronic cough syndrome and 2) to evaluate the clinical features and course of eosinophilic bronchitis. METHODS: We evaluated 92 patients who had persistent cough for 3 weeks or longer. In addition to routine diagnostic protocol, we performed differential cell count of sputum. Eosinophilic bronchitis was diagnosed when the patient had normal spirometric values, normal peak expiratory flow variability, no airway hyper-responsiveness and sputum eosinophilia (> 3%). RESULTS: The causes of chronic cough were post-nasal drip in 33%, cough variant asthma in 16%, chronic bronchitis in 15% and eosinophilic bronchitis in 12% of the study subjects. Initial eosinophil percentage in the sputum of patients with eosinophilic bronchitis was 26.8 +/- 6.1% (3.8-63.7%). Treatment with inhaled steroid is related with a subjective improvement of cough severity and a significant decrease of sputum eosinophil percentage (from 29.1 +/- 8.3% to 7.4 +/- 3.3%). During the follow-up period, increase in sputum eosinophil percentage with aggravation of symptoms were found. CONCLUSION: Eosinophilic bronchitis is one of the important cause of chronic cough. Assessment of airway inflammation by sputum examination is important in investigating the cause of chronic cough. Cough in eosinophilic bronchitis is effectively controlled by inhaled corticosteroid, but may follow a chronic course.

Adult↗
PubMed1999

Body position, membrane diffusing capacity and pulmonary capillary blood volume in chronic bronchitis and pulmonary emphysema.

BACKGROUND: The effect of body position on diffusing capacity and its components, membrane diffusing capacity (Dm) and pulmonary capillary blood volume (Vc), in patients with chronic obstructive pulmonary disease (COPD) has remained elusive. This study was designed to evaluate the effect of body position on diffusing capacity for carbon monoxide (DLco), Dm and Vc in male patients with chronic bronchitis and pulmonary emphysema. METHODS: Pulmonary function tests including spirometry and lung volume were assessed in the erect position, and DLco, Dm and Vc were measured in the erect and supine positions in a random order in 17 men with chronic bronchitis and 19 men with pulmonary emphysema. RESULTS: Spirometry results and lung volumes were comparable between both groups of patients; however, significantly lower values of DLco and Kco (DLco corrected by alveolar volume, VA) were observed in the emphysema than in the bronchitis group. In the bronchitis group, Kco and Vc were significantly higher in the supine than in the erect position, but Dm was significantly lower in the supine position. Alternation of body position did not significantly affect DLco and its components in the emphysema group. DLco, Kco and Vc in both the erect and supine positions were significantly higher in the bronchitis than in the emphysema group. Vc-SE (SE, the data in the supine minus those in the erect position) was also significantly higher in the bronchitis group. In the bronchitis group, DLco-SE was significantly correlated with Dm-SE and Vc-SE. However, Kco-SE was highly correlated with Dm-SE. In the emphysema group, DLco-SE and Kco-SE were highly correlated with Vc-SE only. CONCLUSIONS: An increase in Vc in the supine position may account for the postural effect on Kco in bronchitis patients. In patients with pulmonary emphysema, decreased DLco and an absence of postural effect on DLco and its components may be due to a widespread abnormality of the pulmonary capillary bed. These findings may be of value in elucidating the difference in mechanisms of impaired gas exchange between patients with chronic bronchitis and pulmonary emphysema.

Aged↗
PubMed1975

Course and severity of bronchial asthma and chronic bronchitis in a local Swedish population sample.

A population sample between 35 and 54 years of age with chronic obstructive lung disease was investigated. The material consisted of 86 persons with bronchial asthma (without chronic bronchitis), 69 with chronic bronchitis (without asthma) and 30 with a combination of chronic bronchitis and bronchial asthma. Of the 116 asthmatics 51 had reaginic bronchial allergy. Twenty-three subjects developed bronchoconstriction on exercise testing: 14 of these had asthma, one bronchitis and eight had a combination of the two. Onset of disease before 15 years of age was unusual in pure bronchitis (9%), although more common in pure asthma and in asthma with bronchitis (23-29%). The mean number of days of incapacity during the preceding 12 months was only 6, both in pure asthma and pure bronchitis, but it was more frequent, 22-26, in asthma with bronchitis and in exercise-induced bronchoconstriction. In asthma the multiple regression analyses showed that impaired spirometric values before or after taking a bronchodilating drug were correlated with the duration of incapacity in days and with exercise-induced bronchoconstriction. In bronchitis, impaired spirometric values were found to be correlated with the number of symptomatic days (during the preceding 12 months) and with smoking.

Adult↗