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Antiviral chemotherapy and prophylaxis of viral respiratory disease.

Respiratory viruses continue to be major causes of morbidity and mortality. Currently available chemotherapy is limited to oral amantadine for uncomplicated influenza A and aerosolized ribavirin for respiratory syncytial virus (RSV) infections. Amantadine is also efficacious for chemoprophylaxis of influenza A virus infections. Rimantadine has similar clinical efficacy and is better tolerated than amantadine. Aerosolized ribavirin may be useful in the treatment of serious respiratory illness caused by viruses other than RSV. Intranasal application of interferon is effective in interrupting the spread of rhinovirus colds in families, but chronic use is limited by nasal toxicity. Several newer agents and approaches for chemoprophylaxis and therapy are at different stages of clinical investigation. Combinations of antiviral agents may offer the best therapeutic advantage but have not been adequately tested in man. As additional drugs become available and uses expand for the currently available agents, rapid viral diagnosis will assume an increasingly important role in their optimal use.

Amantadine↗

Audit in respiratory disease.

Respiratory medical audit is discussed in terms of Structure, Process and Outcome with a description of the audit Feedback Loop of monitoring, assessment, improvement followed by further monitoring and assessment. Methods of monitoring include sentinel case, criterion-based, small group comparison, surveys and peer review. There are professional, social and pragmatic reasons for audit which is the responsibility of the provider professionals and requires adequate resources.

Humans↗

Rehospitalisations for respiratory disease and respiratory syncytial virus infection in preterm infants of 29-36 weeks gestational age.

BACKGROUND: To evaluate rates of rehospitalisation due to respiratory illness in preterm infants of 29-36 weeks gestation without chronic lung disease. PATIENTS AND METHODS: Retrospective single centre cohort study including infants from 1998 to 1999 with follow-up over two respiratory syncytial virus (RSV) seasons. RESULTS: Of 435 infants included 61 infants (14%) experienced 78 rehospitalisations. The overall RSV attack rate was 4.4% over two consecutive RSV seasons for infants below 6 months of age at onset of RSV season (7.7 and 1.1%, respectively, p=0.015), with significant differences between infants of 29-32 and 33-36 weeks gestational age (10.5% vs. 2.3%, p=0.008). None of the infants needed mechanical ventilation or admission to the intensive care unit. Infants with RSV infection were younger of age (mean 4.2 vs. 8.2 months; p=0.015), had longer stays at the hospital (11.5 vs. 7.0 days; p=0.006), and more severe courses of disease (score 3.0 vs. 1.8; p<0.001). Additional risk factors for RSV infection were multiple gestation (OR 5.5; CI 95% 1.439-21.028) and congenital heart disease (OR 4.2; CI 95% 1.005-17.669). CONCLUSION: The total burden of respiratory disease and RSV infection in this population was low. A lower gestational age, multiple gestation, and congenital heart disease were associated with increased risk of RSV infection.

Austria↗

A patient with type 2 Gaucher's disease with respiratory disease.

A 5-month-old boy had respiratory problems and gastroesophageal reflux. Electron microscopy of a tracheal biopsy specimen showed accumulation of lamellar bodies in the columnar cells indicative of lysosomal storage disease. Subsequently, the child had neurologic symptoms and hepatosplenomegaly, and the diagnosis of Gaucher's disease type 2 was made.

Biopsy↗

Criteria for development of animal models of diseases of the respiratory system: the comparative approach in respiratory disease model development.

Advances in the understanding of human respiratory disease can come from careful clinical studies of the diseases as they occur in man, but such studies are naturally limited in terms of experimental manipulation. In the last 2 decades, an increasingly complex plethora of experimental respiratory disease models has been developed and utilized by investigators, but relatively less attention has been paid to the naturally occurring pulmonary diseases of animals as potential models. This paper is aimed at presenting selected examples of spontaneous pulmonary disease in animals that may serve as exploitable models for human chronic bronchitis, bronchiectasis, emphysema, interstitial lung disease, hypersensitivity pneumonitis, hyaline membrane disease, and bronchial asthma. Chronic bronchitis in dogs is characterized by chronic cough, excessive mucus production, and chronic inflammatory changes in bronchial walls. The disease affects mainly smaller-breed dogs of middle age or older. Equine chronic bronchitis tends to be a small airway disease with marked goblet cell proliferation and excessive mucus production, which may be accompanied by alveolar emphysema. Many animals develop bronchiectasis or bronchiolitis obliterans secondary to chronic suppurative bronchopneumonia, but chronic respiratory disease (CRD) of rats may be the most useful model of bronchiectasis. Models for emphysema must include actual alveolar destruction and ideally should be accompanied by appropriate pathophysiologic decrements. Many animals occasionally develop emphysema, but the disease has not been well documented, except possibly in horses. The interstitial lung diseases of man represent a complicated and poorly understood group of entities and near-entities. The same is true for animals, although interstitial lung disease in animals is much less common than bronchopneumonia. Cattle seem prone to develop interstitial lesions. Proliferative interstitial pneumonia of cattle includes many morphologic similarities to the spectrum of human interstitial pneumonitides. Fibrosing alveolitis of cattle is a morphologic end point that may have its origins in different forms of interstitial injury. Hypersensitivity pneumonitis has been best detailed in cattle and in horses and is clinically, etiologically, immunologically, and morphologically similar to the disease in man. Hyaline membrane disease has been poorly documented in animals, with the possible exception of the neonatal respiratory distress syndromes of foals and piglets. Bronchial asthma is similarly not well established as a spontaneous disease in animals, although experimental models exist. Eosinophilic bronchiolitis of cattle may represent a useful asthma model but has been poorly detailed. In order to make them useful as models, more attention should be paid to detailing the clinical, morphologic, and etiologic aspects of these naturally occurring animal pulmonary diseases.

Animals↗

[Gastroesophageal reflux disease and respiratory disease].

The patients treated for oesophageal atresia present a correlation between the clinical sintomatology after recanalization characterized by disfagia, dispnea, recurrent cough, chronic pneumopaties and oesophageal anomalies. Where morphological alterations accounting for the presence of gastro-oesophageal reflux (GOR) were not evident, possible functional alterations of the motility were considered. The incidence of GOR was considerably high and, expression of a congenital alteration of the lower oesophageal sphincter and of oesophageal peristalsis, becomes even more severe due to further stretching of the gastro-esophageal junction. The authors underline that the early demonstration of histological changes, even before recanalization, and the motility disorders of the oesophagus have to be well studied, while the LES is normalized, in order to prevent and treat the possible appearance of the well-known complications of GOR.

Gastroesophageal Reflux↗

An update of rabbit diseases. Part 1: respiratory disease.

The literature relating to respiratory disease in rabbits is reviewed. Pasteurella multocida was identified in the 1920s as the most important and common cause of respiratory disease in rabbits, and today pasteurellosis remains a significant cause of mortality and morbidity in farmed rabbits. Methods of treatment and prevention are reviewed, including recent experimental work in vaccine development.

Journal Article↗

The UCLA population studies of chronic obstructive respiratory disease. IV. Respiratory effect of long-term exposure to photochemical oxidants, nitrogen dioxide, and sulfates on current and never smokers.

Questionnaires, spirometry, and the single-breath nitrogen test were administered to 3,192 participants 25 to 39 yr of age in area exposed to low concentrations of all pollutants (Lancaster, California) and to 2,369 similar participants living in an area exposed to high concentrations of photochemical oxidants, nitrogen dioxide, and sulfates (Glendora, California). The prevalence of symptoms and results in the majority of the tests were worse in the polluted area between current and never smokers and men and women. Those tests associated primarily with small airways (Vmax50, Vmax75, delta N 2(750-1250) showed little or no difference between areas. The difference in the prevalence of participants with a poor FEV1 and/or poor FEV1 and/or poor FVC and in the mean Vmax and closing volume was greater between areas than between smoking categories. These results suggest that long-term exposure to high concentrations of photochemical oxidants, NO2, and sulfates at place of residence may result in measurable impairment in both current smokers and never smokers. Firmer documentation of this effect will require following these populations for changes in lung function that correlate with pollutant exposures.

Adult↗

[Role of the virus of Aujeszky's disease in respiratory diseases of swine].

Studies carried out on pig-breeding farms have established the presence of Aujeszky's disease virus in cases of bronchopneumonia in pigs. On seven out of eight farms with bronchopneumonia the virus wad demonstrated both virologically and serologically, and nearly 50 per cent of the examined diseased pigs on these and other farms had antibodies. The individual serologic studies of pigs having antibodies revealed that the antibodies appeared in the second month of the animals' fattening. This corresponded to the manifestation of the initial symptoms of bronchopneumonia in the respective group.

Age Factors↗