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PubMed1989

The prevention of severe lower respiratory infections in chronic bronchitis.

Chronic bronchitis remains as a serious medical problem for many adults and a smaller proportion of children in the United States. The frequency of severe lower respiratory infections in patients with chronic bronchitis is quite variable. The infectious agents most likely responsible for severe lower respiratory disease include pneumococci, nontypable Haemophilus influenza, Mycoplasma pneumoniae, and Branhamella catarrhalis among the bacteria, and influenza A and B viruses, with parainfluenza and adenoviruses less common. Prophylactic antibiotics, particularly tetracycline and derivatives, were the only drugs suggesting efficacy in controlled trials for decreasing exacerbation, but many studies failed to show efficacy. Killed influenza vaccines should be used annually in any patient with chronic bronchitis. Pneumococcal vaccine has had questionable benefit for bronchitics but should nevertheless be considered for use because of its low cost and proven safety. The antiviral drug amantadine may be useful in bronchitics unable to take influenza vaccines.

Adult↗
PubMed1985

The effects of chronic bronchitis and chronic air-flow obstruction on lung cell populations recovered by bronchoalveolar lavage.

Bronchoalveolar lavage is used to evaluate parenchymal inflammation in patients with diffuse lung disease. Normal values for lavage cell counts and proteins are derived primarily from young subjects who are free from lung disease; however, older patients who undergo bronchoalveolar lavage often have used cigarettes for long periods of time and have developed variable degrees of chronic bronchitis and/or chronic air-flow obstruction. Therefore, we evaluated the effects of cigarette use, chronic bronchitis, and chronic air-flow obstruction on lavage cell populations by performing bronchoalveolar lavage in 48 male patients who were undergoing diagnostic fiberoptic bronchoscopy. Sixteen patients (33%) had elevated percentages of neutrophils (greater than or equal to 10%) in lavage fluid. Fourteen of these (87.5%) had chronic cough and/or phlegm production, but only 9 (64.3%) met criteria for definite chronic bronchitis. Patients with moderate or severe air-flow obstruction, defined spirometrically, had significantly greater percentages of lavage neutrophils and lower percentages of macrophages than did patients with mild or no air-flow obstruction. The first lavage aliquot contained the greatest proportion of neutrophils and the smallest proportion of macrophages. The percentage of neutrophils declined and the percentage of macrophages increased in sequential aliquots. The data indicate that patients with chronic cough and/or phlegm production and chronic air-flow obstruction may have increased proportions of neutrophils in bronchoalveolar lavage fluid in the absence of diffuse parenchymal lung disease or infections. These variables must be taken into account when interpreting lavage cellular analyses.(ABSTRACT TRUNCATED AT 250 WORDS)

Bronchi↗
PubMed2006

Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease.

BACKGROUND: Individuals with chronic bronchitis or chronic obstructive pulmonary disease (COPD) may suffer recurrent exacerbations with an increase in volume and/or purulence of sputum. Because of the personal and healthcare costs associated with exacerbations, any therapy that reduces the number of exacerbations is useful. There is a marked difference between countries in terms of prescribing of mucolytics depending on whether or not they are perceived to be effective. OBJECTIVES: To assess the effects of oral mucolytics in adults with stable chronic bronchitis or COPD. SEARCH STRATEGY: We have searched the Cochrane Airways Group Specialised Register and reference lists of articles on four separate occasions, the most recent being in June 2005. This is the third major update. SELECTION CRITERIA: Randomised trials that compared oral mucolytic therapy with placebo for at least two months in adults with chronic bronchitis or COPD. Studies of people with asthma and cystic fibrosis were excluded. DATA COLLECTION AND ANALYSIS: One reviewer extracted data. Study authors and drug companies were contacted for missing information. MAIN RESULTS: Twenty six trials were included (7335 participants). Compared with placebo, there was a significant reduction in the number of exacerbations per patient with oral mucolytics (weighted mean difference (WMD) -0.05 per month, 95% confidence interval -0.05, -0.04). Using the annualised rate of exacerbations in the control patients of 2.6 per year, this is a 20% reduction. The number of days of disability also fell (WMD -0.56, 95% confidence interval -0.77, -0.35). A recent study has shown that the benefit may apply only to those patients not already receiving inhaled corticosteroids. The number of patients who remained exacerbation-free was greater in the mucolytic group (OR 2.13 (95% CI 1.86 to 2.42)). There was no difference in lung function or in adverse effects reported between the treatments. AUTHORS' CONCLUSIONS: In subjects with chronic bronchitis or COPD, treatment with mucolytics was associated with a small reduction in acute exacerbations and a reduction in total number of days of disability. Benefit may be greater in individuals who have frequent or prolonged exacerbations, or those who are repeatedly admitted to hospital with exacerbations with COPD. They should be considered for use, through the winter months at least, in patients with moderate or severe COPD in whom inhaled corticosteroids (ICS) are not prescribed.

Adult↗
PubMed2006

[Risk factors for increased cost of exacerbations of chronic bronchitis and chronic obstructive pulmonary disease].

OBJECTIVE: To identify what variables characterizing the patients, exacerbations, and treatment of chronic bronchitis and chronic obstructive pulmonary disease (COPD) are associated with a higher direct health cost. METHOD: Observational pharmacoeconomic study of exacerbations of chronic bronchitis and COPD (of probable bacterial etiology, defined as Anthonisen types I or II). Direct health costs were assessed during 30 days of follow-up. Logistic regression was employed for statistical analysis, with calculation of the adjusted odds ratios (OR). An exacerbation cost greater than 150 euros was defined as the dependent variable. RESULTS: Data on 1164 patients were collected by 252 physicians. Pharmacoeconomic data were complete in 947 patients (82.6%). In the first 30 days, 206 sought medical attention because of unsatisfactory response to treatment (21.8%), 69 (7.3%) attended the emergency room, and 22 (2.3%) were admitted to hospital. Overall, 101 exacerbations (10.7%) were classified as high cost (> 150 euros). Continuous oxygen therapy (OR = 7.58) and previous hospitalization (OR = 2.6) were associated with high-cost exacerbations, whereas diagnosis of chronic bronchitis (OR = 0.41) and treatment of the exacerbation with moxifloxacin or amoxicillin-clavulanic acid as opposed to clarithromycin (OR = 0.38) were associated with low-cost exacerbations. CONCLUSION: Treatment failure was reported for 21.8% of the patients with exacerbations of chronic bronchitis and COPD. Repeated medical visits and requests for complementary tests were the main factors responsible for increased cost. Variables associated with high-cost exacerbations were continuous oxygen therapy, previous hospitalization, and treatment with clarithromycin as opposed to moxifloxacin or amoxicillin-clavulanic acid.

Aged↗
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↗
PubMedDate not supplied

[Contrast baths in the rehabilitation of patients with chronic bronchitis].

Chronic bronchitis with obstructive syndrome was treated in 91 patients with contrast baths. The latter produced good results in 80.3% of the patients. This treatment is analysed as to clinical efficacy, the effect on the external respiration, right heart hemodynamics, inflammation activity, changes in immunity system. Principal contraindications are defined. A differential approach to contrast baths in chronic bronchitis after treatment is advocated.

Adult↗
PubMed1988

Leukocyte function and chronic bronchitis.

Chronic bronchitis is a condition of mucous hypersecretion. It represents an interface between airway structures, cigarette smoke, and inflammatory cells. Chronic bronchitis is a late complication of smoking, typically occurring after 30 pack years. Stable patients have mucous hypersecretion and little evidence of acute inflammation. In contrast, during acute attacks of bronchitis, an intense accumulation of neutrophils occurs in the airways. Mechanisms of injury to airway structures include chemicals and reactive oxygen species within cigarette smoke, and secreted products of recruited neutrophils. Recent studies demonstrate that secreted products of polymorphonuclear leukocytes (PMNs) can cause secretory cell metaplasia and increase mucous production. Thus, the role of the PMN in chronic mucous hypersecretion appears to be a significant one. Cessation of cigarette smoking remains a most important aspect of caring for patients with chronic mucous hypersecretion.

Animals↗
PubMed1996

Substance P content and preprotachykinin gene-I mRNA expression in a rat model of chronic bronchitis.

Chronic exposure of rats to high concentrations of SO2 gas induces a syndrome similar to human chronic bronchitis. The aim of these studies was to determine if substance P (SP) content in the trachea or lungs was elevated in this animal model of chronic bronchitis, and whether an increase in SP content was associated with an increase in preprotachykinin gene-I (PPT) mRNA expression. Rats were exposed to air (controls) or 250 ppm SO2 gas, 5 h per day, 5 days per week, for a period of 4 wk. Animals were killed and the lungs and trachea were frozen in liquid nitrogen for measurement of SP content by enzyme-linked immunosorbent assay. The SP content of the tracheas from SO2-exposed rats was 3-fold greater than controls (8.9 +/- 1.2 and 3.0 +/- 0.7 pmol/g tissue, respectively; P=0.0005), whereas the SP content of the lungs was not different (SO2 = 4.8 +/- 0.8 and air = 3.0 +/- 0.7 pmol/g tissue, respectively; P = 0.06). In order to determine whether SP synthesis in the cell bodies of the C-fibers innervating the trachea and lungs accompanied a change in SP levels, thoracic dorsal root ganglia and nodose ganglia were removed and PPT mRNA quantitated by Northern analysis. There was no difference in PPT mRNA between control and SO2-exposed rats in nodose or dorsal root ganglia. These results suggest a post-transcriptional mechanism of PPT regulation. Elevated SP levels could play a protective role in the responses of the airways to chronic exposure of inhaled irritants.

Animals↗
PubMed1984

[Effect of levamisole on cellular immunity indices in chronic bronchitis and chronic pneumonia patients].

Based on the study of the immune status in 133 subjects of whom 85 suffered from chronic bronchitis and chronic pneumonia and 50 comprised the group of normal subjects it could be established that patients with chronic bronchitis and chronic pneumonia showed a reduction in the blood of T and B lymphocytes. Administration of levamisole to patients with chronic pulmonary diseases led to an increase of the initially reduced T and B lymphocyte counts. The clinical improvement of patients induced by levamisole correlated with a positive time-course of changes in immunological characteristics. It is desirable that levamisole should be received by patients with low T lymphocyte counts.

Adult↗
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↗
PubMed1999

[Treatment of chronic bronchitis and chronic pulmonary obstructive disease in primary care].

In spite of the recent publication of various guidelines for the treatment of chronic bronchitis and chronic obstructive pulmonary disease (COPD), no studies have investigated whether or not they are being implemented by caregivers. Our aim was to determine what treatment protocols for patients with chronic bronchitis and COPD are most commonly applied by general practitioners in Spain and to identify factors associated with the prescription of certain drugs. A standardized questionnaire was administered to 268 general practitioners working in the 17 autonomous communities of Spain. The stratified sample of respondents was selected to reflect the population of each community. Valid information on 2,414 patients was collected. Men accounted for 74% of the patients. Mean age was 67 years (SD = 10). Lung function data were available for 1,130 (47%) and mean FEV1 was 1,523 ml (56% of the theoretical reference value). Patients without lung function data in spite of having signs of severe symptoms had suffered more acute exacerbations and generated more visits to the emergency room and to their primary care doctors in the preceding year than had patients who had undergone lung function testing (p < 0.03; p < 0.001; p < 0.003, respectively). The treatments most often prescribed were short-acting inhaled beta-2 agonists (56%), inhaled corticoids (47%), theophylline-containing drugs (43%), and long-lasting beta-2 agonists (41%). Patients who had not undergone function tests received more mucolytics (47% versus 27%, p < 0.001) and fewer anticholinergics (20% versus 35%, p < 0.001). The factor most highly associated with prescription of all drugs was severity of disease measured by dyspnea. Treatment protocols for chronic bronchitis and COPD in general practice in many aspects show differences from current guidelines. Noteworthy is the extensive use of inhaled corticoid therapy and long-lasting beta-2 adrenergic agonists and the infrequent prescription of anticholinergics. The lack of lung function data is associated with poor pharmacologic management of disease and higher rates of morbidity.

Aged↗
PubMed2002

[N-acetylcystein in the therapy of chronic bronchitis].

Chronic bronchitis (CB) shows an increasing global morbidity and mortality with major impact on socioeconomics. N-Acetylcysteine (NAC), previously used as a mucolytic compound in CB, has also antioxidative effects. Furthermore it influences intrabronchial bacterial colonisation. In a randomised pilot study of 24 patients (16-male, 8 female, mean age 66 +/- 10 years) with acute exacerbation of CB and positive bacterial culture in the sputum, the addition of twice daily 600 mg NAC to standard antibiotic therapy lead to a significantly higher bacterial eradication rate (70 % versus 36 %, p < 0.03). Clinical studies suggest that treatment with NAC has different effects in CB including a reduction of the number and duration of acute exacerbation episodes and possibly influences lung function. The improvement of symptoms and quality of life also has an impact on socio-economic costs. The use of NAC in CB as an antioxidative rather than a mucolytic compound should be considered. However, further placebo controlled studies are undergoing to definitively establish the role of NAC for the treatment of CB and COPD.

Acetylcysteine↗
PubMed2000

Antibiotic therapy in acute exacerbations of chronic bronchitis.

Chronic obstructive pulmonary disease (COPD) comprises a spectrum of conditions including chronic bronchitis, emphysema, asthma, and bronchiectasis. It has a prevalence in the United States of 5.1% to 5.4% in the middle-aged to elderly population, with a lower rate in nonsmoking individuals. Moreover, COPD is complicated by frequent and recurring acute exacerbations of chronic bronchitis (AECB). Overall, COPD represents the fourth leading cause of mortality in the United States and is the second leading cause of work disability. This condition is also associated with high morbidity and health care expenditures. Despite the controversy over the need to prescribe antibiotics for patients with AECB, high-risk patients have been identified who will benefit from this therapy.These include, patients with a history of repeated infections (>4 per year), comorbid illnesses (such as diabetes, asthma, coronary heart disease), or marked airway obstruction. Furthermore, a bacterial cause is shown in approximately 50% of AECB episodes, and primarily includes Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae. Additionally, resistance among community-acquired respiratory pathogens in the United States has risen dramatically, with beta-lactamase production evident in 40% of H. influenzae and greater than 95% of M. catarrhalis isolates, and with approximately 10% of pneumococci highly resistant to penicillin and simultaneously resistant to macrolide antibiotics. The criteria used to make choices for antibiotic use in patients with AECB should include knowledge of the frequencies of pathogen resistance and patients' clinical characteristics. An effective antibiotic, however, must be able to rapidly resolve the acute infection with the least patient morbidity and need for hospitalization. Although there remains controversy as to when to initiate antibiotic therapy in patients with AECB, several guidelines have been published.

Acute Disease↗
PubMed1991

Risk factors for chronic bronchitis and chronic obstructive lung disease.

Among the risk factors for chronic bronchitis and chronic obstructive lung disease, only smoking and alpha 1-antitrypsin deficiency effects have been well demonstrated. Other factors, as air pollution, occupational exposure and childhood lung diseases may have an influence, but on a lower scale. The prevention of chronic bronchitis and chronic obstructive lung disease remains mainly based on antismoking programs.

Air Pollution↗
PubMed1995

Increased airway responsiveness to inhaled methacholine in a rat model of chronic bronchitis.

Chronic exposure of rats to high concentrations of SO2 gas causes pathologic changes in airway similar to those seen in human chronic bronchitis. The purpose of this study was to examine the pulmonary mechanical correlates of these changes and to quantify the extent of mucous hypersecretion by measuring changes in mucous glycoproteins. Female Sprague-Dawley rats were exposed to 250 ppm SO2 gas, 5 h/d, 5 d/wk, for a period of 4 wk. Control rats were exposed to air only. On the day after the last SO2 exposure, rats were anesthetized, instrumented for the measurement of pulmonary resistance (RL) and dynamic compliance (Cdyn), and ventilated. Chronic SO2 exposure caused a small but significant increase in RL and decrease in Cdyn. Airway responsiveness to inhaled aerosolized methacholine was increased in SO2-exposed rats, as indicated by approximately 6.6- and 4.6-fold decreases respectively, in the doses of inhaled methacholine required to double RL or decrease Cdyn to 50% of baseline. SO2 exposure had no effect on the contractile response of the trachea measured in vitro. Tracheae and lungs from SO2-exposed animals exhibited 140 and 535% increases in measured neutral mucous glycoproteins, respectively, and 33 and 37% increases in acid glycoproteins. Our results indicate that this animal model of chronic bronchitis mimics the mucous hypersecretion, airway obstruction, and increased airway responsiveness observed in human bronchitis and may allow us to begin to probe their mechanistic basis.

Animals↗
PubMed2001

Prevalence of chronic bronchitis and chronic respiratory symptoms in adults over the age of 35 years in Isfahan, Iran in 1998.

OBJECTIVE: Chronic obstructive airways disease (COPD) in older patients is reported to be not only common, but also frequently overlooked and untreated by general practitioners. Chronic bronchitis is one of the major components of COPD and can be readily screened. This study investigates the prevalence of chronic bronchitis and related symptoms in Iran with special reference to COPD. METHODOLOGY: A random sample of 4636 participants aged 35 years and over, attended a research clinic for interview and physical examinations. Those reporting classic symptoms of chronic bronchitis were referred to a pulmonary clinic for pulmonary function testing. RESULTS: Two hundred and sixteen patients (4.65%) had chronic bronchitis. Among these, 78 (36.1%) had obstructive airways disease. Decreased forced expiratory volume in 1 s/forced vital capacity to levels of less than 70% were recorded in 45 patients (42.9% of the tested population). Less than 25% of the patients had a previous diagnosis of chronic bronchitis and/or airways disease. CONCLUSION: Obstructive airway diseases are under-diagnosed in developing countries. Physicians practising in such areas of the world should be aware, and try to detect the subclinical illnesses, especially in urban areas.

Adult↗
PubMed1999

[Chronic bronchitis].

Chronic bronchitis (CB) is diagnosed from symptoms. It is important for the diagnosis to distinguish from other diseases accompanying similar symptoms. Recently, some diseases such as diffuse panbronchiolitis (DPB) have been recognized to have some characteristics different from CB, which used to include these diseases. The pathogenesis of CB is mostly smoking and to quit smoking is the basic and most important therapy. Target of medication in CB consists of hypersecretion, airway limitation and infection. A 14-membered ring macrolide such as erythromycin has been found to be effective in some patients with CB.

Anti-Bacterial Agents↗