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PubMed1999

[A study on tumor necrosis factor alpha, macrophage inflammatory protein-2 and myeloperoxidase in blood, broncho-alveolar fluid and lung tissues of rat chronic bronchitis model].

OBJECTIVE: To study the nature and mechanisms of airway inflammation in chronic bronchitis and observe the effects of inhaled glucocorticoids on inflammatory indices. METHODS: Rat chronic bronchitis model was established by intratracheal instillation of small dose of lipopolysaccharide (LPS, 1 g/L). Experiments were performed in 28 male Sprague-Dawley rats, which comprised four groups in random, i.e. chronic bronchitis model group, normal saline treated group, dexamethasone treated group and healthy control group. The levels of myeloperoxidase (MPO) of blood and lung tissues, and tumor necrosis factor (TNF)alpha and macrophage inflammatory protein-2 (MIP-2) of plasma, broncho-alveolar fluid (BALF) and lung tissues were determined by biochemical and ELISA methods. Total and differential white blood cell counts of BALFwere carried out. RESULTS: (1) The levels of TNFalpha and MIP-2 in BALF and lung tissues, and MPO in lung tissues of chronic bronchitis model group were significantly increased than those of control group (P < 0.05). (2) More significant increase in total white blood cell count and neutrophils in BALF was found in rat chronic bronchitis group than in control group (P < 0.001). (3) Significant positive correlations were observed between the level of MPO and MIP-2 of lung tissues, the level of MPO and TNFalpha of lung tissue and the total cell counts and the level of MIP-2 of BALF and lung tissue. (4) More significant decrease in total cell counts and neutrophils of BALF and levels of MPO in lung tissue was found in dexamethasone-treated group as compared to those of chronic bronchitis group. CONCLUSION: Recruitment and activation of neutrophils seem to be the characteristics of chronic bronchitis. TNFalpha and MIP-2 may be involved in the process of chemotaxis and activation in airway inflammation in chronic bronchitis. Inhaled steroids might have some effects on chronic bronchitis by limiting the airway inflammation.

Animals↗
PubMedDate not supplied

Allergic pathogenesis in chronic bronchitis.

Chronic bronchitis is a disease related to numerous etiologic factors: infections, climate influence, air pollution, cigarette smoking, etc. From a pathogenetic point of view, chronic bronchitis is generally considered as the phlogistic resultant of various irritative conditions, with a characteristic neutrophil component in the phlogistic pattern. Microbic involvement has up to now been considered a very important factor, with consequent wide utilization of antibiotic agents in basic therapy. Considerations of clinical nature induced us to consider unsatisfactory such pathogenetic concepts based on neutrophil phlogosis, while the involvement of an allergic mechanism became more acceptable. In order to solve this problem, we have carried out hitological studies on postmortem material from the respiratory tract of individuals whose death was attributable to chronic bronchitis or to concurrent chronic bronchitis. Results of our study conducted up to now on 60 cases may be summarized as follows: Bronchitis with lymphomonoplasmacytoid phlogosis of immunoallergic type (60%), bronchitis with neutrophil phlogosis of irritative-infective type (20%); bronchitis with mixed allergic-neutrophil phlogosis (20%). Lymphocytes, monocytes and plasma cells are directly involved in allergic tissue reactions, both of immediate and delayed type because they release active substances such as hsitamine, bradyquinine, quinine, etc., which will their multiple pharmacodynamic actions are responsible of various anatomic and functional changes in hypersensitivity. Infiltration of the bronchial mucosa with lymphomonoplasmacytary cells in chronic bronchitis, has a pattern of mixed allergic phlogosis of immediate and delayed type. Prophylaxis and management of chronic bronchitis should therefore be set up on new bases, with the various treatments used for hyperactive pathology.

Adult↗
PubMed1989

[Disorders of immune reactivity in chronic bronchitis].

The cytologic and immunologic analysis of bronchoalveolar washing offs and of peripheral blood was made in 45 patients with chronic bronchitis. Of these, 27 patients suffered from catarrhal bronchitis without infection signs and 18 were affected with purulent bronchitis with superinfection. It has been shown that discovery of a considerable number of neutrophils in the bronchoalveolar washing offs promotes the establishment of the infectious etiology of chronic bronchitis. The immunologic analysis of the washing offs was found to be of great informative value in the study of the mechanism of the disease development. Pronounced dysfunction of the immune system and its manifestations common to catarrhal and purulent bronchitis were demonstrated. It is concluded that dystrophic processes predominate in the lungs of the patients with chronic purulent bronchitis whereas catarrhal bronchitis is marked by the high local immune reactivity in the lungs. The characteristic features revealed are regarded as criteria of the differential diagnosis between the given bronchitis patterns. It has been disclosed that impairment of the mechanisms of cellular immunity is one of the properties shared by both the disease patterns. The authors discuss the prospects of the use of the combined immunologic analysis of the bronchoalveolar washing offs and peripheral blood in patients with chronic bronchitis.

Adolescent↗
PubMed1997

Diagnosis of acute bronchitis in adults: a national survey of family physicians.

BACKGROUND: The purpose of this study was to determine how family physicians in the United States diagnose acute bronchitis in otherwise healthy adults. METHODS: A 33-item questionnaire on the diagnosis and treatment of acute bronchitis was mailed to a random sample of 500 physicians who are members of the American Board of Family Practice. RESULTS: Two hundred sixty-five physicians responded. Of those who did not respond, 32 could not be located. Of those who did respond, 10 were either retired or were practicing in another specialty. The net response rate was 56% (255/458). Responding physicians stated that character of cough and sputum production are the most important items used in diagnosing acute bronchitis. Fifty-eight percent indicated that the cough should be productive, and 60% stated that the sputum should be purulent. Seventy-two percent of respondents did not feel that wheezing or rhonchi need to be present. Younger physicians and those who selected antibiotics as their first treatment choice were more likely to define acute bronchitis as the presence of a productive cough with purulent sputum (P < .05). Physicians from an academic setting were more likely to define acute bronchitis as a productive cough (P < .05). Thirty-six percent of physicians from practices serving populations with > or = 60% managed care patients included wheezing or rhonchi in the definition of acute bronchitis, compared with 26% of all others (P < .05). CONCLUSIONS: Variations in the diagnosis of acute bronchitis in otherwise healthy adults can be attributed to physician age, treatment choice, and practice setting. A significant number of family physicians did not require a productive cough as part of the diagnostic criteria for acute bronchitis. This finding needs to be considered in studies evaluating treatment. Additional qualitative studies are necessary to identify other factors involved in diagnosing acute bronchitis.

Acute Disease↗
PubMed2005

Measuring the quality of antibiotic prescribing for upper respiratory infections and bronchitis in 5 US health plans.

OBJECTIVE: To develop and test the validity of a quality-of-care performance measure that examines antibiotic prescribing rates in children diagnosed as having upper respiratory infection (URI) or bronchitis. DESIGN AND METHODS: The measure developed examines the annual rate of antibiotic prescribing to children aged 3 months to 18 years with an episode of URI or bronchitis. Administrative data from 5 US health plans were used to identify episodes of URI or bronchitis using International Classification of Diseases, Ninth Revision, codes 460, 465, 466, and 490. Pharmacy data (National Drug Codes) were used to determine whether antibiotics were prescribed for the URI or bronchitis episode. Medical record abstractions were performed on a random sample of 465 cases to assess percentage agreement with pharmacy claims data for antibiotic prescribing. RESULTS: For the 84,166 children and adolescents aged 3 months to 18 years who had at least 1 episode of URI or bronchitis during the measurement year, 31% received antibiotics. Prescribing rates for URI and/or bronchitis varied widely among the 5 participating health plans (2%-75%; P < .001). Inappropriate antibiotic prescribing occurred most frequently for bronchitis episodes, with 4 of 5 health plans prescribing antibiotics in 60% of such cases (range, 60%-80%). Percentage agreement between administrative and medical records data for antibiotic prescribing was 88%. CONCLUSIONS: This quality measure is feasible to implement at the health plan level and validly assesses antibiotic prescribing rates using administrative data. Improvements in adhering to judicious use guidelines for antibiotic prescribing in children with URI and bronchitis are warranted.

Adolescent↗
PubMed1996

Treatment of acute bronchitis in adults without underlying lung disease.

OBJECTIVE: To determine whether antibiotic and bronchodilator treatment of acute bronchitis in patients without lung disease is efficacious. DESIGN: A MEDLINE search of the literature from 1966 to 1995 was done, using "Bronchitis" as the key word. Papers addressing acute bronchitis in adults were used as well as several citations emphasizing pediatric infections. A manual search of papers addressing the microorganisms causing acute bronchitis was also done. Data were extracted manually from relevant publications. SETTING: All published reports were reviewed. Papers dealing with exacerbations of chronic bronchitis were excluded in this review. RESULTS: Although acute bronchitis has multiple causes, the large majority of cases are of viral etiology. Mycoplasma pneumoniae, Chlamydia pneumoniae, and Bordetella pertussis are the only bacteria identified as contributing to the cause of acute bronchitis in otherwise healthy adults. Nine double-blind, placebo-controlled trials were reviewed. Four studies showed no advantage for doxycycline and one study showed no advantage for erythromycin. One study using erythromycin and one study using trimethoprim and sulfamethoxazole showed that these antibiotics were slightly better than placebo. Two other studies showed an impressive superiority for liquid or inhaled albuterol when compared with erythromycin. CONCLUSIONS: Most studies showed no significant difference between drug and placebo, and the two studies that did showed only small clinical differences. Albuterol had an impressive advantage over erythromycin. Antibiotics should not be used in the treatment of acute bronchitis in healthy persons unless convincing evidence of a bacterial infection is present.

Acute Disease↗
PubMed1999

Chronic bronchitis and chronic obstructive pulmonary disease: Finnish National Guidelines for Prevention and Treatment 1998-2007.

1. A national recommendation for the promotion of prevention, treatment and rehabilitation in relation to chronic bronchitis and COPD from 1998 to 2007 has been prepared on the basis of extensive collaboration by order of the Ministry of Social Affairs and Health. The Programme needs to be revised as necessary, because of rapid developments in medical knowledge, and in drug therapy in particular. 2. COPD is a disease characterized by slowly progressing, irreversible airways obstruction. Over 5% of the population suffer from symptomatic forms of the disease. It is estimated that a further 5% of the population may suffer from latent COPD. Most patients (75%) suffer from mild forms of the disease. The disease is often preceded by chronic bronchitis. A total of 400,000 Finns suffer from chronic bronchitis or COPD. Occurrence of these diseases in future will be particularly affected by decreased smoking by men, increased smoking by the young and by women, and aging of the population. 3. In 1997, the annual treatment costs of chronic bronchitis and COPD were estimated to be FIM 1.5 thousand million, total costs FIM 5 thousand million. Without intensification of measures to prevent and treat the diseases, costs will rise significantly. Costs arising from severe COPD (5% of patients with COPD) account for roughly 65% of costs overall and are primarily related to hospitalizations. 4. The goals of the Programme for the Prevention and Treatment of Chronic Bronchitis and COPD are as follows: (a) to decrease the incidence of chronic bronchitis; (b) to ensure that as many patients as possible with chronic bronchitis recover; (c) to maintain capacity for work and functional capacity of patients with COPD; (d) to reduce the percentage of patients with moderate to severe COPD; (e) to decrease the number of hospitalization days of COPD patients by 25% overall; and (f) to decrease annual costs per patient. 5. The following means are suggested for achieving the goals: (a) reduction in smoking; (b) reduction in work-related and outdoor air pollutants and improvement of quality of indoor air; (c) enhancement of knowledge about risk factors and treatment of the diseases is in key groups; (d) promotion of early diagnosis and active treatment, in smokers in particular; (e) improvement of guided self-care; (f) early commencement of rehabilitation, individual planning and implementation, primarily as an element in treatment; and (g) encouragement of scientific research. 6. COPD and exacerbation of its symptoms can be prevented through choices relating to life habits, such as not smoking, maintaining good general condition, and protection against exposure to dusts. The Programme gives examples of such measures and appeals to various authorities and voluntary organizations to increase their cooperation. Preventive methods should be individualized, and based on due consideration. 7. Chronic bronchitis and COPD should be diagnosed at early stages, and treated appropriately from the outset. Treatment consists of: (a) treatment according to causes, such as stopping smoking and work hygiene; (b) early rehabilitation such as patient education and guided self-care: (c) drug therapy; (d) hospital treatment; and (e) rehabilitation. 8. The hierarchy of referrals in the treatment of COPD should be revised to accord a greater role to the primary health care sector. Good exchanges of information and cooperation between the primary health care and specialized medical care sectors will all be necessary if this hierarchial model is to have the desired effect. 9. Hospital districts and health centres should ensure that different levels of the health-care system are capable of fulfilling the tasks assigned to them appropriately. One specialist in each hospital district should be given charge of prevention and assembly of know-how relating to treatment, and of quality of treatment at regional level. (ABSTRACT TRUNCATED)

Bronchitis↗
PubMed1998

Factors associated with antibiotic use for acute bronchitis.

OBJECTIVES: To describe the clinical features of adults diagnosed with acute bronchitis, and to identify clinical variables associated with antibiotic treatment of acute bronchitis. DESIGN: Prospective, cohort study. SETTING: Primary care office practices at a group-model HMO in the Denver metropolitan area. PATIENTS/PARTICIPANTS: Patients were adults seeking care for acute respiratory illnesses. Participating clinicians included internists, family medicine physicians, nurse practitioners, physician assistants, and registered nurses. MEASUREMENTS AND MAIN RESULTS: Clinicians voluntarily completed encounter forms for patients presenting with acute respiratory illnesses between February and May, 1996. Acute bronchitis was the primary diagnosis in 16% of acute respiratory illness visits (n = 1,525). The most frequent symptoms of acute bronchitis were cough (92%), phlegm production (63%), "runny nose" (50%), and throat pain (50%). The most frequent physical examination findings were pharyngeal erythema (45%), cervical lymphadenopathy (19%), wheezes (18%), and rhonchi (17%). Antibiotics were prescribed to 85% of patients diagnosed with acute bronchitis. Purulent nasal discharge by patient report, and sinus tenderness on physical examination were moderately associated with antibiotic treatment (p = .06 and .08, respectively). Antibiotic prescription rates did not vary by patient age or gender, duration of illness, days of work lost due to illness, or clinician type. CONCLUSIONS: Acute bronchitis is frequently treated with antibiotics in ambulatory practice. The clinical factors we identified to be associated with antibiotic use for acute bronchitis appear to play a minor role in explaining the excessive use of antibiotics for this condition. These findings suggest that clinicians use the diagnosis of acute bronchitis as an indication for antibiotic treatment, despite clinical trials and expert recommendations to the contrary.

Acute Disease↗
PubMed2006

Efficacy and tolerability of a fluid extract combination of thyme herb and ivy leaves and matched placebo in adults suffering from acute bronchitis with productive cough. A prospective, double-blind, placebo-controlled clinical trial.

STUDY OBJECTIVE: To assess the efficacy and tolerability of a fixed fluid extract combination of thyme and ivy leaves (thyme-ivy combination) and matched placebo in patients suffering from acute bronchitis with productive cough. METHODS: In a double-blind, placebo-controlled, multicentre Phase IV study 361 outpatients with acute bronchitis and > or =10 coughing fits during the day, onset of bronchial mucus production with impaired ability to cough up at a maximum of 2 days prior to recruitment, and a Bronchitis Severity Score (BSS) > or =5 score points were randomly assigned to an 11-day treatment (5.4 ml three times daily) with either thyme-ivy combination syrup (Bronchipret Saft; N=182) or placebo syrup (N=179). After the baseline examination (Visit 1 = Day 0), 2 control examinations were scheduled (Visit 2 = Day 4; Visit 3 = Day 10/end of treatment). The efficacy of study treatment on acute bronchitis was evaluated by the patient's daily counting of coughing fits during the daytime (manual counter), assessment of acute bronchitis related symptoms and by the investigator's assessment of the most important symptoms of acute bronchitis using the BSS. Evaluation of tolerability was based upon adverse event (AE) monitoring, measurement of vital signs as well as the Primary outcome was the change in frequency of coughing fits during daytime on days 7-9 according to patient's accurate daily recording with a manual counter and documentation in the diary. Treatment effects were analysed by analysis of variance (ANOVA) adjusted for centre effects. Due to significant deviation from the "preconditions" of the ANOVA, the Wilcoxon test (stratified by centre) was carried out additionally. RESULTS: The mean reduction in coughing fits on days 7 to 9 relative to baseline was 68.7% under thyme-ivy combination compared to 47.6 % under placebo (p < 0.0001). In the thyme-ivy combination group, a 50% reduction in coughing fits from baseline was reached 2 days earlier compared to the placebo group. The symptoms of acute bronchitis (BSS) improved rapidly in both groups, but regression of symptoms was faster and the responder rates (p < 0.0001) compared to placebo were higher at Visit 2 (83.0% vs 53.9%) and Visit 3 (96.2% vs. 74.7%) under the treatment of thyme-ivy combination. Treatment was well tolerated with no difference in the frequency or severity of AEs between thyme-ivy combination and placebo groups. Severe or serious AEs were not reported. CONCLUSION: Oral treatment of acute bronchitis with thyme-ivy combination for about 11 days was superior to pla-

Adult↗
PubMedDate not supplied

Ultrastructural characteristics of the alveolar phagocytic cells from patients with various forms of chronic bronchitis.

Development of chronic bronchitis is accompanied by progressive fibrosis of the bronchial wall. Synchronously, reactivity of phagocytic cells of the alveolar tissue changes. During early (chronic catarrhal bronchitis) and developed (chronic granulating bronchitis, chronic purulent bronchitis, and chronic catarrhal-fibrotic bronchitis) stages in the development of chronic bronchitis, structural signs of activation of phagocytic cells, and an increase of proliferative and metabolic activity of the alveolar macrophages were noted. However, this activation is followed by their depression in chronic fibrotic bronchitis. Data obtained show that in the development of chronic bronchitis, activation followed by depression of cell effectors takes place in the respiratory tissue.

Bronchi↗
PubMed1999

Chronic bronchitis in Icelandic males: prevalence, sleep disturbances and quality of life.

OBJECTIVE: To study the prevalence of chronic bronchitis in Iceland and some aspects of quality of life among those suffering from chronic bronchitis. DESIGN: Postal questionnaires. SETTING, SUBJECTS: All Icelandic males born in the years 1913 and 1943 who were alive on 1 November 1993. Altogether 1175 (69.7%) responded. MAIN OUTCOME MEASURES: Physical symptoms of chronic bronchitis, stress symptoms, symptoms of dyspnea and sleep disturbances. RESULTS: 7.1% of those 50 years old and 16.7% of those 80 years old and a history of daily sputum expectoration for at least 3 months during the preceding 2 years. These individuals with chronic bronchitis had a higher prevalence of other respiratory symptoms than did the others, such as "wheezing or whistling" (59.6% vs. 7.2%), and "awakened by breathlessness" (35.2% vs. 6.0%). Complaints of dyspnea were more common among those with symptoms of chronic bronchitis, e.g. "dyspnea when walking" (19.4% vs. 1.4%) and "stops walking because of dyspnea" (22% vs. 1.6%). They also complained more often of insomnia and daytime sleepiness and found themselves more stressed than those without chronic bronchitis. These symptoms were all more common among the 80-year-old men. CONCLUSION: Our study indicates that chronic bronchitis is a frequent illness among Icelandic males. Men with chronic bronchitis often have decreased quality of life, difficulties in moving and frequently sleep complaints.

Aged↗
PubMed1987

Atopy, smoking, and chronic bronchitis.

The aim was to test the hypothesis that atopy increases the occurrence of chronic bronchitis. Relations between atopy, smoking, and chronic bronchitis were studied in farmers. The data were from two successive postal surveys and a skin prick tested subsample. The cross-sectional study consisted of 9017 farmers. Those 6899 farmers who did not have chronic bronchitis at the beginning and who continued farming were followed for three years. A sample of 150 farmers was skin-tested with 36 allergens. The prevalence of chronic bronchitis (rate per 1000), standardised for age and sex, was 41 in non-atopic non-smokers, 101 in atopic non-smokers, 106 in non-atopic smokers, and 257 in atopic smokers (effect of atopy: p less than 0.001; effect of smoking: p less than 0.001). The standardised incidence rates of chronic bronchitis (per 1000 farming years) were 14, 34, 36, and 50, respectively (atopy: p less than 0.001; smoking p less than 0.001). The relative risk of chronic bronchitis, calculated from the incidence data adjusting for the effects of age, sex, smoking or atopy by logistic regression analysis was 2.2 for atopy (95% confidence interval 1.8-2.7) and 2.3 for smoking (1.8-2.9). Only 20 farmers had chronic bronchitis in the skin-tested subjects; the results were consistent with the findings in the surveys but did not reach statistical significance for atopy. In conclusion, atopy and smoking have independent and additive effects on the occurrence of chronic bronchitis at least in dusty farming work.

Adult↗
PubMed1987

Determinants of chronic bronchitis and lung dysfunction in Western Australian gold miners.

The relation of chronic bronchitis and respiratory dysfunction to age, tobacco smoking, and occupational exposure to surface and underground mining operations were examined in a cross sectional survey of 1363 men employed in the Kalgoorlie mining industry in 1985. Overall, the prevalence of chronic bronchitis was 14%. Eleven per cent of the workers had obstructive lung disorder (FEV1/FVC less than 0.70) and 9% had restrictive lung disorder (FVC less than 0.80 of predicted for height and age). There was little change in the prevalence of chronic bronchitis from that observed in a survey of the same industry in 1961-2. Only 1% of the workers in 1985 had radiographic signs of silicosis compared with 22% in 1961-2. Age, smoking, and underground mining experience all exerted strong effects on the development of chronic bronchitis with or without associated respiratory function abnormalities. After control of confounding by age and smoking, it was estimated that compared with a lifetime non-miner, the odds ratio (OR) of chronic bronchitis was 1.8 (95% confidence interval, 1.0-3.3) for one to nine years underground mining gold, 2.5 (1.2-5.2) for 10-19 years, and 5.1 (2.4-10.9) for 20 or more years. Underground mining of minerals other than gold was also associated with chronic bronchitis (OR = 5.1; 95% CI, 1.1-25.0) whereas exclusive surface mining had only a small empirical effect (OR = 1.3; 95% CI, 0.6-2.5). It is estimated that the proportion of cases of chronic bronchitis in working underground miners due to occupational factors is 50%. The results support the existence of an industrial cause of chronic bronchitis, although caution must be exercised in generalising the results to miners with progressive and sever respiratory impairment.

Adolescent↗
PubMed1998

Chronic bronchitis, work related respiratory symptoms, and pulmonary function in welders in New Zealand.

OBJECTIVES: A cross sectional study of respiratory symptoms and lung function in welders was performed at eight New Zealand welding sites: 62 current welders and 75 non-welders participated. METHODS: A questionnaire was administered to record demographic data, smoking habit, and current respiratory symptoms. Current and previous welding exposures were recorded to calculate a total lifetime welding fume exposure index. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF) were measured before the start of the shift. RESULTS: There were no significant differences in ethnicity, smoking habits, or years of work experience between welders and non-welders. Symptoms of chronic bronchitis were more common in current welders (11.3%) than in non-welders (5.0%). Of those workers with a cumulative exposure index to welding fume > or = 10 years, 16.7% reported symptoms of chronic bronchitis compared with 4.7% of those with a cumulative exposure index < 4 years (odds ratio (OR) 4.1, 95% confidence interval (95% CI) 0.90 to 17.6). Workers with chronic bronchitis had significantly lower measures of baseline PEF (p = 0.008) and FEV/FVC ratio (p = 0.001) than workers without chronic bronchitis. Multivariate analysis showed that current smoking (OR 9.3, 1.0 to 86.9) and total exposure index to welding fumes > 10 years (OR 9.5, 1.3 to 71.9) were independent risk factors for chronic bronchitis. The report of any work related respiratory symptom was more prevalent in welders (30.7%) than non-welders (15.0%) and workers with these symptoms had significantly lower FEV, (p = 0.004) and FVC (p = 0.04) values. Multivariate analysis identified a high proportion of time spent welding in confined spaces as the main risk factor for reporting these symptoms (OR 2.8, 1.0 to 8.3). CONCLUSION: This study has documented a high prevalence of symptoms of chronic bronchitis and other work related respiratory symptoms in current welders. Also, workers with chronic bronchitis had reduced PEF and FEV/FVC compared with those without chronic bronchitis. These symptoms related both to cigarette smoking and a measure of lifetime exposure to welding fume.

Adolescent↗
PubMed1979

Respiratory viral infection and wheezy bronchitis in childhood.

The role of respiratory viral infection in wheezy bronchitis was studied in 163 children, aged 0-12 years, in a London general practice. Virological investigations were also performed when these same children had acute upper respiratory illness without wheeze. A virus was isolated in 146 (26.4%) of 554 episodes of wheezy bronchitis, rhinoviruses accounting for almost half of the isolations. The relative frequency with which individual viruses were isolated in wheezy bronchitis was similar to that in acute upper respiratory illness in 180 other children who had never had wheezy bronchitis. The large number of isolations of rhinoviruses in wheezy bronchitis is probably due to their numerous serotypes and the absence of cross-immunity between them. Our findings have confirmed that infection by respiratory viruses can provoke wheezy bronchitis in certain children, in whom host factors are an important predeterminant. In children with a previous history of wheezy bronchitis infection by rhinoviruses was associated significantly more often with such an episode than with upper respiratory illness. The maturation of protective mechanisms, including the acquisition of specific immunity to a progressively larger number of viruses, could explain the fall in the age-incidence of wheezy bronchitis.

Age Factors↗
PubMed1984

Prevalence of chronic bronchitis in a rural community of the Hill Region of Nepal.

A house to house survey of everyone aged 20 years and above living in a rural community in the Hill Region of Nepal, situated about 16 km outside Kathmandu city, was conducted to determine the prevalence of chronic bronchitis and cor pulmonale. Of the total eligible population, 2826 (95.5%) were interviewed. Chronic bronchitis was diagnosed according to the British Medical Research Council criteria, and emphysema and cor pulmonale according to the World Health Organisation expert committee criteria. The crude prevalence of chronic bronchitis was found to be 18.3%. The prevalence rate of chronic bronchitis was similar in men and women, whereas in most parts of the world much lower rates have been recorded in women. Study of a random sample of 85 individuals with chronic bronchitis showed that 57.4% had evidence of airways obstruction, whereas 15.8% of a representative sample (n = 111) of the surveyed population (excluding those with chronic bronchitis) showed evidence of airway obstruction. Of 516 subjects diagnosed as having chronic bronchitis, 382 were subsequently investigated in hospital, 134 having declined further investigation. The diagnosis was confirmed in most of the patients (93.2%) who were investigated. Other diseases played an insignificant part in the production of the observed high prevalence rates of chronic bronchitis. Of the 382 patients studied in hospital, 87 had emphysema and 42 had cor pulmonale, yielding overall prevalence rates for these two conditions of at least 3.1% and at least 1.5% respectively.

Adult↗
PubMed1999

Domestic biomass fuel combustion and chronic bronchitis in two rural Bolivian villages.

BACKGROUND: Chronic bronchitis is an important public health problem worldwide. A study was undertaken to examine the association between exposure to air pollution from domestic biomass fuel combustion and chronic bronchitis in two rural Bolivian highland villages: a village in which cooking is done exclusively indoors and a village in which cooking is done primarily outdoors. Apart from this difference, the villages were virtually identical in terms of socioeconomic status, climate, altitude, access to health care, and other potential confounders. METHODS: Pollution exposure was assessed by combining information on concentrations of particulate matter of <10 microm diameter (PM(10)) in 12 randomly selected households in each village in all potential microenvironments of exposure with time allocation information. The prevalence of chronic bronchitis was assessed using the British Medical Research Council's questionnaire on individuals >20 years of age in both villages (n = 241). RESULTS: Daily pollution exposure was significantly higher in the indoor cooking village (range for adults: 9840-15 120 microg-h/m(3)) than in the outdoor cooking village (range for adults: 5520-6240 microg-h/m(3)) for both seasons and for men and women. The overall prevalence of chronic bronchitis was 22% and 13% for the indoor and outdoor cooking villages, respectively. Logistic regression analysis, which excluded the few smokers present in the population, showed a 60% reduced risk of chronic bronchitis in the outdoor cooking village compared with the indoor cooking village (OR 0.4; 95% CI 0.2 to 0.8; p = 0.0102) after adjusting for age and sex. Individuals aged >40 years were 4.3 times more likely to have chronic bronchitis than the younger age group (OR = 4.3; 95% CI 2.0 to 9.3; p = 0.0002). There was no significant difference in the prevalence of chronic bronchitis in men and women. CONCLUSIONS: The results of this study suggest an association between chronic bronchitis and exposure to domestic biomass fuel combustion, but further large scale studies from other areas of the developing world are needed to confirm the association. Results from this and other studies will assist the development of culturally acceptable and feasible alternatives to the high exposure cooking stoves currently being used by most people worldwide.

Adult↗
PubMed1998

A 1-year community-based health economic study of ciprofloxacin vs usual antibiotic treatment in acute exacerbations of chronic bronchitis: the Canadian Ciprofloxacin Health Economic Study Group.

OBJECTIVE: To evaluate the costs, consequences, effectiveness, and safety of ciprofloxacin vs standard antibiotic care in patients with an initial acute exacerbation of chronic bronchitis (AECB) as well as recurrent AECBs over a 1-year period. DESIGN: Randomized, multicenter, parallel-group, open-label study. SETTING: Outpatient general practice. PATIENTS: A total of 240 patients, 18 years or older with chronic bronchitis, with a history of frequent exacerbations (three or more in the past year) presenting with a type 1 or 2 AECB (two or more of increased dyspnea, increased sputum volume, or sputum purulence). MAIN OUTCOME MEASURES: The assessment included AECB symptoms, antibiotics prescribed, concomitant medications, adverse events, hospitalizations, emergency department visits, outpatient resources such as diagnostic tests, procedures, and patient and caregiver out-of-pocket expenses. Patients completed the Nottingham Health Profile, St. George's Respiratory Questionnaire, and the Health Utilities Index. The parameters were recorded with each AECB and at regular quarterly intervals for 1 year. These variables were compared between the ciprofloxacin-treated group and the usual-care-treated group. RESULTS: Patients receiving ciprofloxacin experienced a median of two AECBs per patient compared to a median of three AECBs per patient receiving usual care. The mean annualized total number of AECB-symptom days was 42.9+/-2.8 in the ciprofloxacin arm compared to 45.6+/-3.0 days in the usual-care arm (p=0.50). The overall duration of the average AECB was 15.2+/-0.6 days for the ciprofloxacin arm compared to 16.3+/-0.6 days for the usual-care arm. Treatment with ciprofloxacin tended to accelerate the resolution of all AECBs compared to usual care (relative risk=1.20; 95% confidence interval [CI], 0.91 to 1.58; p=0.19). Treatment assignment did not affect the interexacerbation period but a history of severe bronchitis, prolonged chronic bronchitis, and an increased number of AECBs in the past year were associated with shorter exacerbations-free periods. There was a slight, but not statistically significant, improvement in all quality of life measures with ciprofloxacin over usual care. The only factors predictive of hospitalization were duration of chronic bronchitis (odds ratio=4.6; 95% CI, 1.6, 13.0) and severity of chronic bronchitis (odds ratio=4.3; 95% CI, 0.8, 24.6). The incremental cost difference of $578 Canadian in favor of usual care was not significant (95% CI, -$778, $1,932). The cost for the ciprofloxacin arm over the usual care arm was $18,588 Canadian per quality-adjusted life year gained. When the simple base case analysis was expanded to examine the effect of risk stratification, the presence of moderate or severe bronchitis and at least four AECBs in the previous year changed the economic and clinical analysis to one favorable to ciprofloxacin with the ciprofloxacin-treated group having a better clinical outcome at lower cost ("win-win" scenario). CONCLUSIONS: Treatment with ciprofloxacin tended to accelerate the resolution of all AECBs compared to usual care; however, the difference was not statistically significant. Further, usual care was found to be more reflective of best available care rather than usual first-line agents such as amoxicillin, tetracycline, or trimethoprim-sulfamethoxazole as originally expected. Despite the similar antimicrobial activities and broad-spectrum coverage of both ciprofloxacin and usual care, the trends in clinical outcomes and all quality of life measurements favor ciprofloxacin. In patients suffering from an AECB with a history of moderate to severe chronic bronchitis and at least four AECBs in the previous year, ciprofloxacin treatment offered substantial clinical and economic benefits. In these patients, ciprofloxacin may be the preferred first antimicrobial choice.

Adolescent↗