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PubMed1976

The antitussive and expectorant drug Duopect evaluated by the preferential test.

The effect of the preparation Duopect (narcotine hydrochloride + glyceryl guiacolate) on intensity and frequency of cough and expectoration was evaluated by the preferential test in 62 patients with chronic bronchitis. The preparation was compared to narcotine and to a placebo in a double-blind study. Duopect was found to be an effective antitussive and expectorant medicine with only minimal and transient side effects.

Clinical Trials as Topic↗
PubMed1987

Alveolar macrophages from expectorates as indicators of pulmonary irritation in primary aluminum reduction plant workers.

According to a method (the AM-test) previously developed by us, the counting of alveolar macrophages (AM) from expectorates provides an estimation of the potential pulmonary insult from occupational air pollution +/- smoking. In this article we demonstrate a relationship between the number of AM and self-registered pulmonary symptoms and complaints. Employees from different workplaces in a primary aluminum reduction plant gave expectorate samples for the AM-test. A gradient in the number of AM was observed, with increasing AM numbers from the controls to the administration employees to the potroom workers, who had the highest numbers. Pulmonary symptoms and complaints were recorded by means of a questionnaire. A clear covariation between AM numbers and respiratory symptoms and complaints was observed and was most pronounced at the highest pollution levels (in the potrooms). We therefore suggest that the AM-test may serve as an effect indicator as well as a dose indicator.

Adult↗
PubMed2002

Thoracic lymphangiectasis presenting with chyloptysis and bronchial cast expectoration.

A 70-year-old man with recurrent undiagnosed episodes of bronchial cast expectoration and pulmonary infiltrates on chest radiography for 15 years is described. The diagnosis of chyloptysis was established by chemical analysis of the bronchial aspiration. We emphasize the radiological findings of this rare observation. The CT-associated lymphangiography showed mediastinal lymphangiectasis with retrograde opacification of mediastinal and hilar lymph nodes as well as submucosal lymphatic vessels protruding into the lumen of the tracheo-bronchial tree without evidence of thoracic duct obstruction as well as a "crazy-paving appearance." Congenital incompetence of the valves of the lymphatic vessels originating from the thoracic duct is held to be the cause. Chyloptysis and pulmonary lymphatic disorder should be sought in cases of bronchial cast expectoration.

Aged↗
PubMed2004

Fluoride ingestion from toothpaste: fluoride recovered from the toothbrush, the expectorate and the after-brush rinses.

OBJECTIVES: The aim of this study was to determine the effects of rinsing and spitting on fluoride ingestion from toothpaste during normal oral-hygiene procedures of younger children, and hence to make recommendations on rinsing during toothbrushing. METHODS: The brushing habits of 166 Dutch and 185 Irish children between 1.5 and 3.5 years were observed during home visits. The weight of the toothpaste tube was determined before and after use. After brushing, the toothbrush and any associated expectorate and rinses, combined with any toothpaste spilled during the brushing procedures, were collected. The amounts of fluoride retained on the toothbrush and in the associated expectorate and rinses were measured. RESULTS: Over 90% of the Dutch children used a special toddlers' toothpaste with < or =500 ppm F. Eleven per cent of the younger (<2.5 years) Dutch children and 22% of the older children rinsed after brushing. Of the Irish children approximately 52% used a children's toothpaste containing around 500 ppm F. Of the younger Irish children 31% spat without rinsing, while another 31% rinsed during or after brushing. For the older Irish children, these percentages were 14 and 70%, respectively. On average, 22% of the fluoride dispensed on the toothbrush was retained on the brush after brushing irrespective of the rinsing and spitting behaviour of the children. The maximum ingestible amount of fluoride from toothpaste assuming no rinsing or spitting was calculated. CONCLUSIONS: Fluoride ingestion from toothpaste is significantly reduced by rinsing and/or spitting during toothbrushing. Recommendations that younger children use small amounts of toothpaste (< 0.5 g) and that children using toothpaste with > or = 1000 ppm F rinse their mouths after brushing continue to be valid.

Cariostatic Agents↗
PubMed1985

Statistical derivation of a standardised procedure for counting expectorated alveolar macrophages as indicators of occupational air pollution.

A biological test in which counts of expectorated alveolar macrophages are used to evaluate lung irritation attributable to occupational air pollution has been applied to workers exposed to dust and gas pollution. To determine the optimum allocation of resources when performing the test, the sampling and counting procedures have been evaluated statistically. Alveolar macrophages (AM) were recovered from workers at an iron works, an aluminium plant (one large and one small group), and from a small group of non-exposed smokers; the number of subjects was 213. Sampling was repeated with the small group at the aluminium plant (27 subjects) on three consecutive days and the small group of non-exposed smokers on five (3 subjects). AM were counted from smear slides using a light microscope. A standard random effects model was used as the basis for estimating the expectation of the log-transformed overall means (mu) and the variances (var(mu)) of the two categories at the aluminium plant and of the non-exposed smokers. The costs connected with finding mu consist of the financial expenses and the working efforts and time used to perform the test. The precision and reproducibility of the test are closely related to the variability in the results, var (mu). To optimise the costs but still obtain reproducible results, AM should be counted in four drops of expectorate from each of three samples from at least 10 to 20 subjects.

Air Pollutants, Occupational↗
PubMed1996

Acidogenic potential and total salivary carbohydrate content of expectorants following the consumption of some cereal-based foods and fruits.

The acidogenic potential of a group of popular cereal-based foods and fruits and total carbohydrate content of salivary expectorants following their consumption were assessed using an indwelling electrode with telemetry and the anthrone method. Paired t tests indicated that sorbitol did not cause the plaque pH to fall as low as any of the test foods (p <0.05) but there was no significant difference between sucrose and the test foods. Only the fruits produced less acid than sucrose. The breakfast cereals tended to yield the highest levels of total carbohydrate in the salivary expectorants although a greater percentage of original carbohydrate was retained after rice and bread. These results suggest the important effect of carbohydrate retention on plaque pH response.

Acids↗
PubMed1978

Bacteriology of expectorated sputum with quantitative culture and wash technique compared to transtracheal aspirates.

Techniques to improve the reliability of expectorated sputum culture were evaluated in 46 patients using a wash technique, quantitative culture, and a combination of washing and quantification. The wash procedure consisted of a jet of tap water over the specimen contained in a tea strainer. The true lower respiratory tract flora was determined by percutaneous transtracheal aspirates, which served as the basis for evaluating the methods of processing expectorated specimens. Either washing alone or quantification alone decreased the number of specimens with organisms that were not present in companion transtracheal aspirates; however, results that were sufficiently improved to be clearly advantageous for clinical interpretation were achieved only when washing and quantification were combined. Washed sputum specimens yielded oropharyngeal "contaminants" in concentrations exceeding 10(6) bacteria per ml in 12 of 46 specimens (26 per cent). Using this technique, only one specimen contained a misleading potential pathogen, and only one specimen failed to yield a potential pathogen that was recovered with the transtracheal aspirate. The wash procedure decreased the mean concentrations of contaminants approximately 100-fold for all specimens and 1,000-fold for purulent specimens.

Anaerobiosis↗
PubMed2002

The relationship of chronic sputum expectoration to physiologic, radiologic, and health status characteristics in alpha(1)-antitrypsin deficiency (PiZ).

STUDY OBJECTIVES: First, to determine the relationships among chronic sputum expectoration (CSE), exacerbations, airflow obstruction, and emphysema in patients with alpha(1)-antitrypsin deficiency (alpha(1)-ATD) [PiZ]. Second, to use multivariate analysis to determine how these factors influence health status. DESIGN: Cross-sectional, single-center. SETTING: UK center for alpha(1)-ATD, university teaching hospital. PATIENTS: One hundred seventeen nonsmoking patients underwent lung function testing, high-resolution CT (HRCT) scanning with density mask analysis, and health status assessment using the St. George's Respiratory Questionnaire (SGRQ) and short form 36 (SF-36) health survey questionnaire. RESULTS: Patients with CSE (n = 50) had worse postbronchodilator airflow obstruction than those who did not (p = 0.03), with a median FEV(1) of 1.15 L (interquartile range [IQR], 0.76 to 1.82) vs 1.44 L (IQR, 0.99 to 2.93), respectively, and higher HRCT scan voxel index (VI) values indicating more extensive emphysema (patients with CSE: median lower zone VI, 50; IQR, 28 to 61; patients without CSE: median lower zone VI, 41; IQR, 5 to 53; p = 0.04). Patients with CSE also had worse health status, as assessed by the SGRQ (p < 0.01 for all domains) and SF-36 questionnaire (p < 0.05 for seven of nine domains). Exacerbation frequency was greater in those patients with CSE (p < 0.001), with a median of two episodes per year (IQR, 1 to 3) vs 0.66 episodes per year (IQR, 0 to 2) for those without CSE. Stepwise linear regression analysis revealed FEV(1), exacerbation frequency, and lower zone VI to be the most important predictors of health status. CONCLUSIONS: Among patients with alpha(1)-ATD, those with CSE expectoration exhibit greater physiologic impairment and more extensive emphysema than those without. This is reflected in an inferior health status, which is also influenced independently by an increased exacerbation frequency in those with CSE.

Adult↗
PubMed1980

[Expectoration of cerebrospinal fluid: an unusual complication of ventriculoperitoneal shunt].

A child, who had undergone ventriculoperitoneal shunting, presented with repeated episodes of pneumonia and expectoration of CSF. Chest x-ray demonstrated the presence of the shunt catheter in the base of the left lung. In the present case the distal end of the catheter perforated the diaphragm, entering the thoracic cavity through the pleura and penetrating the pulmonary parenchyma. CSF then flowed freely into the alveoli and bronchi and became expectorated during repeated bouts of coughing associated with pneumonia. This respiratory complication disappeared after the removal of the catheter. We theorize that the penetration of the catheter into the thoracic cavity was secondary to its displacement from the iliac fossa to the left infradiaphragmatic space between the spleen and the diaphragm where the intra-abdominal pressure is lowest. The respiratory movements and the hypertension inside the abdomen created a constant friction of the catheter against the diaphragm which was finally perforated, permitting the passage of the peritoneal end of the shunting device into the thoracic cavity and secondary penetration of the lung.

Cerebrospinal Fluid↗
PubMedDate not supplied

Comparison of expectorated sputum after manual chest physical therapy and high-frequency chest compression.

This study is a quantitative comparison of the sputum produced by 12 subjects with cystic fibrosis (CF) who received high-frequency chest compression (HFCC) and standard chest physical therapy (CPT) in randomized order. Six subjects routinely used manual CPT and six routinely used the HFCC. None had acute infections or hospitalization in the six weeks before the study. Two certified respiratory therapists alternated subjects and CPT vs HFCC order during the two weeks of the matched study. For all sessions, the expectorated sputum was collected in preweighed cups, which were reweighed immediately after collection and again after evaporation to dryness. The wet and dry weights of the sputum produced as a result of the two techniques were significantly different, with HFCC having greater weight. Regardless of the mode of therapy, the sputum produced by the subjects who regularly received HFCC had greater water content than did the sputum produced by those subjects who regularly received CPT. No significant difference was found between the two therapists regarding sputum expectorated by the subjects during CPT. These results show that sputum production by subjects with CF who receive CPT by certified respiratory therapists can be as great as the sputum produced by the same subjects who receive HFCC. The results also suggest that unknown factors attributed to the therapists may produce different levels of effort from time to time that may decrease the respiratory therapists' effectiveness, whereas the HFCC therapy may be more consistently effective because it is entirely machine based.

Chest Wall Oscillation↗
PubMed2001

[Plastic bronchitis and mucoid impaction--uncommon disease syndromes with expectoration mucus plugs].

Mucoid impaction and plastic bronchitis are relatively rare disorders caused by the formation of obstructive airway plugs. We observed from February 1999 to June 2000 seven patients with mucoid impaction and one with plastic bronchitis. In the group of mucoid impaction there were 4 patients with bronchial asthma and 3 without history of lung disease. At the admission to hospital all patients suffered from cough, chest pain and effort dyspnea. Two of them expectorated during cough "bronchial casts". The chest X-ray of 5 patients revealed atelectasis of one of the lung's lobes and diffuse opacities in 2 others. In 4 cases during bronchoscopy one bronchus and in another three--numerous bronchi were obstructed with mucoid casts. Removing of the casts caused both the improvement of the patients' condition and withdrawal of atelectasis in 4 cases. In 5 patients the final diagnosis was allergic bronchopulmonary aspergillosis and in two mucoid impaction in the course of asthma without aspergillosis. Plastic bronchitis was observed in 44 years old man, who expectorated white, branching, bronchial casts for three months. On admission he was in respiratory failure. The chest X-ray revealed diffuse alveolar infiltrates and HRCT glass-ground opacities in both lungs and bronchiectasis in the middle lobe. The bronchofiberoscopy disclosed diffuse tracheobronchitis with casts occluding the middle lobe bronchus. Microscopic examination of the removed casts showed aggregates of mucus, macrophages, neutrophils and cells of respiratory epithelium. Precipitins against Aspergillus fumigatus were not found. Staphyloccocus coagulase (-) was cultured from urine and sputum specimens. We administered Vancomycin with Netylmycin, acetylocysteine, oxygen therapy and humid inhalation and the patient recovered. HRCT made six months after admission revelated total withdrawal of glass-ground opacities. The pathogenesis of plastic bronchitis in this case was unclear.

Adult↗
PubMed2001

[Use of expectorated sputum to assess airway inflammation of smoking and its cessation].

To investigate the usefulness of expectorated sputum in the assessment of airway inflammation by smoking. I examined cytokine expression in the sputum of healthy smokers and non-smokers, and compared them before, and at 8,12 and 16 weeks after, cessation of smoking. Four cytokines, interleukin (IL) 8, interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, and IL-10, were assessed by immunohistochemistry. In smokers, the percentage of bronchial epithelial (BE) cells and macrophages with high intracellular contents of the pro-inflammatory cytokines IL-8, IFN-gamma and TNF-alpha, were significantly increased in comparison with non-smokers. In contrast, expression of IL-10 was significantly decreased in smokers. After smoking cessation, expression of IL-8 was significantly decreased by the 16th week, that of IFN-gamma was significantly decreased by the 12th to the 16th week, but that of TNF-alpha was unchanged even at 16 weeks post-cessation, and that of IL-10 was significantly increased at that time. Cytokine expression in BE cells was similar to that in macrophages. From the data, we concluded that expectorated sputum is useful for assessing airway inflammation due to smoking and for following the series of changes that follow smoking cessation.

Adult↗
PubMed1995

The effect of a new expectorant drug on mucus transport in chronic bronchitis.

The expectorant effect of two weeks treatment with cistinexine dihydrochloride (Rec 15/1884/2, Recordati S.p.A, Milano), on mucus transport rate (MTR) was evaluated in a double-blind study on 30 chronic bronchitis patients, 20 treated with active drug (group D), 10 with placebo (group P). After inhalation of nebulized 99mTc labelled human albumin minimicrospheres (HAMM), MTR was determined by external gamma-camera counting over the thorax. To control initial particle deposition a penetration index (PI) was determined as the ratio of activity between peripheral and hilar regions of equal size. Before treatment no differences were found between groups in spirometry, PI, and MTR. After treatment spirometry and PI remained unchanged in both groups. MTR expressed as the half time (T1/2) of the exponential fitting between 0 and 40 minutes showed an interesting behaviour, particularly in group D. Considering the group as a whole, T1/2 did not vary significantly (381 +/- 400 min. before, vs 224 +/- 132 min. after treatment, p = 0.090). However, a statistically significant reduction of the index (815 +/- 396 min. before vs. 258 +/- 120 min. after treatment, p < 0.01) occurred in the seven patients showing at baseline a T1/2 higher than 338 +/- 182 min. (the reference value observed in our laboratory for 8 asymptomatic non smoker subjects). Therefore, the beneficial effect of the drug is seen only in patients with a severe impairment of MTR.

Aged↗
PubMed1988

High-pressure liquid chromatographic assay of dextromethorphan hydrobromide, guaifenesin, and sodium benzoate in an expectorant syrup.

An ion-pair reversed-phase high-pressure liquid chromatographic assay is developed that allows simultaneous quantitation of guaifenesin, dextromethorphan hydrobromide, and sodium benzoate in an expectorant syrup. The method is rapid and accurate. Average recoveries of 99.6, 99.8, and 99.7% with relative standard deviations of 0.5, 0.9, and 0.2% are obtained for guaifenesin, dextromethorphan hydrobromide, and sodium benzoate, respectively, from laboratory prepared samples. Chromatographic conditions are selected to afford a pH that provides adequate separation of guaifenesin, dextromethorphan hydrobromide, sodium benzoate, and sodium saccharin and a detection wavelength that effectively compensates for the great disparity in quantity between guaifenesin and dextromethorphan hydrobromide present in syrups. The relationships between the retention volume of dextromethorphan hydrobromide and the alkyl chain length as well as the concentration of the counterion are studied. The retention profiles for sodium saccharin, guaifenesin, sodium benzoate, and dextromethorphan hydrobromide in the apparent pH range of 2.5 to 6.6 are established.

Benzoates↗
PubMed1994

An expectorant, stepronin, reduces airway secretion in vitro.

Stepronin (SPN) is clinically used as an expectorant, and thenoic acid (TA) is its metabolite. We examined the effects of these drugs on the bioelectric parameters [potential difference (PD), short circuit current (SCC), conductance (G)] of the posterior epithelial membrane of canine trachea and on those of the mucus glycoprotein secretion from feline tracheal isolated glands. PD and SCC were obtained using an Ussing chamber and G was calculated as the ratio SCC/PD. Neither SPN nor TA significantly altered the baseline values of PD and SCC. However, in the mucosal solution, both SPN and TA significantly inhibited PD and SCC evoked by isoproterenol (ISOP), whereas G remained unchanged. Amirolide did not alter the inhibitory action of SPN and TA. Mucus glycoprotein secretion from isolated glands was estimated by measuring trichloride acetic acid-precipitable [3H]-glycoconjugates. SPN and TA significantly reduced mucus glycoprotein secretion. Further, when stimulated by methacholine, these agents significantly inhibited mucus glycoprotein secretion from isolated glands. These findings suggest that SPN inhibits airway secretion in vitro by both decreasing Cl- secretion from epithelial cells and mucus glycoprotein secretion from submucosal glands.

Amiloride↗
PubMedDate not supplied

Neonatal goiter caused by expectorant usage.

A female newborn was admitted with the symptoms of mild respiratory distress, protruding tongue, hypotonicity, cutis marmorata, sclerema, myxedema, abdominal distension, and feeding problems on the first day of life. She had a huge neck mass, a large anterior and posterior fontanel, and hoarse cry. She had no umbilical hernia or jaundice. A history of maternal potassium iodine (expectorant) usage without doctor's advice was obtained; the mother had not attended a clinic throughout the pregnancy. On ultrasonographic examination, the thyroid right lobe was 53 x 31 mm and the left lobe was 34 x 31 mm. The results of thyroid hormone tests on the first day were as follows: T3 20 ng/dl (normal: 32-216 ng/dl), T4 0.9 microg/dl (11.8-22.6 microg/dl), TSH 120 mIU/l (2.5-13.3 mIU/l). This patient is presented to emphasize the role of hypothyroidism in drug-induced neonatal goiter and to discuss the possibility of a life-threatening effect of congenital goiter, i.e. respiratory tract obstruction.

Expectorants↗
PubMed2000

Efficacy and safety of Ascoril expectorant and other cough formula in the treatment of cough management in paediatric and adult patients--a randomised double-blind comparative trial.

The present study was undertaken to study the comparative safety and efficacy of two cough formulas viz, Ascoril expectorant and other cough formula in the management of cough associated with respiratory disorders. Fifty patients having cough associated with various respiratory disorders like bronchitis and upper or lower respiratory tract infections were randomly divided into 2 equal groups and were treated with one of the two cough formulas viz, Ascoril cough formula and other cough formula in double-blind manner over a period of 15 days. The evaluation of improvement was carried out by a rating scale using three clinical parameters--cough, sputum and breathlessness. The physicians were asked to rate the effectiveness of the therapy and patients were asked to rate the acceptability of therapy using pre-defined operational criteria. It was observed that the improvement and symptom relief was almost immediate, quicker and better in the group receiving Ascoril as compared to other group. On effectiveness parameter, 96% of the physicians rated Ascoril as having either 'very high effectiveness or high effectiveness' as opposed to only 34% of the physicians who rated other cough formula as having 'high' or 'very high effectiveness'. While on parameter of acceptability, 96% of the patients rated acceptability of Ascoril as 'high' or 'good' as opposed to only 24% of the patients who rated other cough formula 'high' or 'good'. The findings of this study suggests that Ascoril cough formula has better efficacy as well as better patient acceptability. Thus, Ascoril cough formula is superior to other cough formula in management of cough associated with respiratory disorders.

Adolescent↗