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[Organisation of bronchitis dispensaries-problems and present situation in the north-eastern region of the GDR (a pilot study of the bronchitis dispensary of the Pediatric Clinic, University of Greifswald) (author's transl)].

The dator on the care of children with CNSLD obtained from pediatricians working at out-patient departments in 15 districts of the Rostock and Neubrandenburg counties (in the north-eastern region of the GDR) are analyzed in a pilot study. This survey shows that there are 6 standard bronchitis dispensaries and on additional dispensary with highly specialized diagnostic equipment (Pediatric Clinic of the University of Greifswald) in 7 of the districts. In the remaining districts care of these children is provided within the framework of general medical outpatient care. 2% of the children having CNSLD only 36% receive medical treatment, which is a rather low percentage. This situation will be improved on the basis of better cooperation with the family doctors and the out-patient departments for lung diseases.

Adolescent

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

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

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

Prevalence of chronic bronchitis in an industrial population in North India.

A survey for the prevalence of chronic bronchitis in an industrial population in North India is reported. The prevalence of chronic bronchitis is 12.5 percent in 473 subjects between the ages of 17 and 64 years. The prevalence rate of chronic bronchitis is comparable to that observed in areas of low community air pollution in Europe and North America. There is no age-related rise in the frequency of respiratory symptoms. The consumption of tobacco in these subjects is low and is comparable to tobacco consumption of light smokers. The prevalence of chronic bronchitis in smokers is five times the prevalence in non-smokers and is similar to the values reported for light smokers in other surveys. These observations suggest that cigarette smoking is associated with the development of chronic bronchitis, and the differences in the prevalence rate of chronic bronchitis between this survey and other surveys conducted in Europe and North America are mainly due to differences in smoking habits. Air pollution has a minor effect only and ethnic differences do not appear to play any part. Forced expired volume in one second shows a negative correlation with age. It is lower in asymptomatic smokers than in non-smokers and is lower in chronic bronchitis than in controls.

Adolescent

Ventilatory capacity, working capacity and exercise-induced bronchoconstriction in a population sample of subjects with bronchial asthma or chronic bronchitis.

We have studied a representative population sample comprising 185 persons, aged 35-54 years, having certain respiratory symptoms and considered to have chronic bronchitis and/or bronchial asthma. There were 86 with bronchial asthma (without chronic bronchitis), 69 with chronic bronchitis (without asthma) and 30 with both chronic bronchitis and bronchial asthma. Fifty-one of the 116 asthmatics had reaginic bronchial allergy. In the groups with chronic bronchitis or bronchial asthma, the mean ventilatory capacities were slightly below the normal, being 89 and 91%, respectively, of the predicted values for FEV1 and 85 and 87% of those for MVV40. In the group of persons with both diseases, the mean FEV1 was 77% and the mean MVV40 84% of that predicted. Of the 21 persons with a mean FEV1 below 70% of that predicted 10 had both asthma and bronchitis. Exercise-induced bronchoconstriction, defined as a 15% fall of PEF after exercise, occurred in 22 of the 116 asthmatics and in one of the 69 persons with chronic bronchitis without bronchial asthma. In the asthmatics there was a significant correlation between resting PEF or the difference in PEF before and after orciprenaline inhalation on the one hand, and exercise-induced bronchoconstriction on the other hand. This was taken as an indication of increased bronchial hyperreactivity.

Adult

Relation between lung cancer, chronic bronchitis, and airways obstruction.

Since cigarette smoking is an important cause of lung cancer and chronic bronchitis both conditions should occur together more often in cigarette smokers than would result from chance. If they do commonly occur together then severe airways obstruction, which is often associated with chronic bronchitis, should also be often associated with lung cancer. To discover whether this were so three groups of patients were studied at the London Chest Hospital. Two hundred men and 43 women who presented with lung cancer provided information on the prevalence of defined chronic bronchitis and airways obstruction in those suffering from lung cancer. The third group consisted of 233 men presenting with defined chronic bronchitis who were kept under observation to discover how many would die from lung cancer. The results suggested that simple bronchitis and lung cancer often occur together but that obstructive bronchitis and lung cancer do not often occur together. The lack of association between lung cancer and severe airways obstruction requires an explanation.

Adult

Studies of the familial aggregation of chronic bronchitis and obstructive airways disease.

The familial aggregation of chronic bronchitis and obstructive airways disease was investigated in a propositus population of 430 persons aged 45-54 years and 1340 of their first (1 degree), second (2degrees) and third (3 degrees ) order relatives. All subjects were screened in their homes using a modified British MRC respiratory disease questionnaire and a portable spirometer. 1 degree relatives of propositi with either chronic bronchitis or obstructive airways disease demonstrated up to a two-fold excess prevalence of chronic bronchitis when compared to 1 degree relatives of non-affected propositi. This excess prevalence of chronic bronchitis was independent of sex, cigarette smoking patterns, respiratory illness history, residence in a common household, geographical distribution within the study community and the presence of alpha1-antitrypsin Pi variants. The prevalence of chronic bronchitis in 1 degree relatives of diseased propositi was also greater than in 2 degrees relatives of diseased propositi, in whom the prevalence approximated that of the general population.

Adolescent

Industrial bronchitis.

For many years there has been much argument whether workers in the dusty trades are prone to chronic bronchitis. In 1966 the Medical Research Council issued a report of a Select Committee which concluded that occupationally induced bronchitis did not play a significant part in the aetiology of airways obstruction in dust-exposed men. Since then epidemiological studies have demonstrated that the prolonged inhalation of dust leads to an increase in prevalence of cough and sputum. Furthermore, new physiological techniques have demonstrated a slight decrement in ventilatory capacity as a result of industrial bronchitis, and which is related to lifetime dust exposure. Unlike bronchitis induced by cigarette smoke, the predominant effect of industrial bronchitis is on large rather than small airways and the condition is not accompanied by emphysema.

Airway Obstruction

Sputum eosinophilia in chronic bronchitis and asthma.

The occurrence of sputum eosinophilia was investigated in 115 patients with chronic bronchitis and asthma. They were clinically divided into four groups; those with asthma only, those with asthma of equal or greater duration than chronic bronchitis, those with chronic bronchitis recently complicated by asthma and those with chronic bronchitis only. Although sputum eosinophilia was more common in the asthmatic groups there was no significant difference between the groups in the degree of sputum eosinophilia. When the groups were subdivided on the basis of methacholine and isoprenaline response (asthma subgroup, greater than or equal to 20% response to isoprenaline or greater than or equal to 40% response to methacholine; chronic-bronchitis subgroup, less than 10% response to isoprenaline plus less than 20% response to methacholine), there was a significant difference between the groups in the degree of sputum eosinophilia. However, sputum eosinophilia still occurred in the chronic bronchitics. In the asthmatic patients, there appeared to be no difference in the degree of sputum eosinophilia in those with positive skin tests, or on steroid medication, compared with those with negative skin tests or not on steroids.¿

Asthma

Risk estimates for chronic bronchitis in smokers: a study of male-female differences.

Data from a study of chronic bronchitis and obstructive airway disease prevalence in an urban population were used to obtain estimates of the risk of these diseases in smokers and to detail the effect of cigarette smoking on the observed male: female ratio of these diseases. Standard questionnaires and measures of pulmonary function were used. Eighty-two per cent of the observed prevalence of chronic bronchitis could be attributed to cigarette smoking, and 66% of the over-all population rate was attributed to smoking. Both men and women showed a linear increase in chronic bronchitis prevalence with increased smoking. The risk of chronic bronchitis was greater for men than women in all smoking categories, but no differences in decrease in pulmonary function could be observed. Data from comparable studies were assessed and were shown to corroborate the observation that men appear to be at a greater risk for chronic bronchitis, but less clearly so for obstructive airway disease. This excess risk does not appear to be due to a difference in cigarette consumption.

Adolescent

Chronic bronchitis and bronchial asthma in a rural community in Israel: relation to socioenvironmental factors.

Prevalence rates of chronic bronchitis and asthma in a rural community in Israel in 1976 were 2.5 and 2.1%, respectively. The relationships with age, sex, country of origin, marital status, number of children, household crowding, education, occupation and cigarette-smoking habits were studied. A number of significant univariate associations were found. A multiple regression analysis showed a significant independent association between chronic bronchitis and age. Age alone accounted for 4.6% of the variance in chronic bronchitis. Five other variables were significantly associated with chronic bronchitis. Together, these accounted for an additional 1.3% of the variance in chronic bronchitis. The multivariate analysis showed that only one variable--the number of children--had an independent relationship with asthma. It accounted for 0.8% of the variance. All the variables together accounted for 1.3% of the variance observed in bronchial asthma.

Adult

[Morphological investigations of bronchial biopsy material in chronic bronchitis and asthma bronchiale (author's transl)].

Morphological investigations (light microscopy, enzyme histochemistry, immunopathology) were carried out in cases with asthma bronchiale and chronic bronchitis. According to the histological picture no additional parameters were found with enzyme histochemical and immunopathological methods to specify the diagnosis asthma bronchiale and chronic bronchitis. The most important diagnostic factors in chronic bronchitis are hyperplasy of mucous bronchial glands and atrophy of serous bronchial glands with a loss of activity of acid phosphatase. Diffuse thickenings of basal membrane were more often in asthma bronchiale, localized thickenings more often in chronic bronchitis. Hypertrophy of goblet cells, infiltrations with round cells and metaplasia are found both in asthma bronchiale and chronic bronchitis in different degree. Correlations exist between the activity of leucine aminopeptidase in the stroma of the bronchus and degree of cellular infiltration with lymphocytes and plasma cells.

Asthma