Bronchial Disorders Research Articles

Beraprost, a stable analog of prostacyclin, enhances cough reflex sensitivity to capsaicin in bronchitic patients

ABSTRACTAims: Inflammatory mediators are involved in the pathophysiology of neutrophilic bronchial disorders presenting with chronic productive cough. Accumulating evidence indicates that prostanoids are key elements in the pathophysiology of these disorders. However, little is known about the role of prostacyclin in neutrophilic bronchial inflammation. Methods: The effect of beraprost, a chemically and biologically stable analog of prostacyclin, on cough response to inhaled capsaicin was examined in 14 patients with chronic bronchitis, a neutrophilic bronchial disorder, in a randomized, placebo-controlled crossover study. Capsaicin cough threshold, defined as the lowest concentration of capsaicin eliciting five or more coughs, was measured as an index of the airway cough reflex sensitivity. Results: After a 2-week treatment with beraprost (80 μg twice a day orally), the cough threshold was significantly (P < .05) decreased as compared with placebo [12.2 (geometric standard error of the mean [GSEM] 1.5) μM vs. 24.4 (GSEM 1.3)]. Conclusions: These findings indicate that prostacyclin is involved in the pathophysiology of cough reflex sensitivity in patients with chronic bronchitis, a frequently encountered neutrophilic bronchial disorder presenting with chronic productive cough.

Frequency of coprescription and potential risk of bronchospasm in Colombian patients users of topical antiglaucomatous betablockers and bronchodilators

Background: Cardiovascular and respiratory effects of adrenergic agonists used in diseases like chronic obstructive pulmonary disease (COPD), and β-blockers used in glaucoma generate competitive antagonism on the same adrenergic receptor when used simultaneously with the aggravation that the β-blockers can precipitate bronchospasm. Objective: Determine de frequency of coprescription and potential risk of interaction between bronchodilators and topical antiglaucomatous β-blockers for glaucoma in a database of Colombian patients. Methods: Cross-sectional study in patients older than 40 years treated for bronchial disorders and glaucoma between January 1 and October 31, 2012. We used information about 6.2 million population database of individuals enrolled in Health System of Colombia. In the database it was assessed all prescription records of topical β-blockers and any bronchodilators and the frequency of potential risk of developing drug-induced bronchospasm. The identified patients were informed to the physician responsible to the health attention. Results: We found 1756 patients were receiving topical β-blockers and bronchodilators. Most were women (63.2 %), mean age 73.3 ± 11.1 years, in 61 cities. The antiglaucoma drugs more employees were: timolol (67.5 % of patients), timolol/dorzolamide (18.8 % of patients) and bronchodilators: salbutamol (43.8 % of patients) and ipratropium (41.8 % of patients). The more frequent risk associations of bronchospasm were: salbutamol + timolol (n = 890, 50.6 % of patients), ipratropium bromide + timolol (n = 827, 47.1 %) salbutamol + timolol + dorzolamide (n = 258, 14.6 % of patients) and ipratropium bromide + timolol + dorzolamide (n = 255, 14.5 % of patients). Conclusions: The database research of Negative Outcomes Associated with Medication is useful to know problems in prescription of many therapies. There are potential interactions between antiglaucoma drugs and bronchodilators that increase the risk of precipitating bronchospasm in patients who present asthma, COPD and glaucoma in Colombia. Implementing strategies that link drug dispensers and medical insurers can reduce risks associated with the medication.

Eosinophilic Bronchial Disorders Presenting Chronic Cough; Atopic Cough, Cough Variant Asthma and Non-Asthmatic Eosinophilic Bronchitis

Chronic persistent non-productive cough is troublesome, whereas productive cough is physiologic and acts to remove abnormal secretions and foreign bodies from the lower respiratory tract. Atopic cough is a new clinical entity for bronchodilator-resistant non-productive cough associated with generalized atopy. Pathological characteristics of atopic cough included trachea bronchitis without Broncho Alveolar Lavage (BAL) eosinophilia, and the physiological characteristics included hypersensitivity of the cough reflex without bronchial hyper reactivity. Patients with atopic cough have eosinophilia of the nebulized hypertonic saline-induced sputum but normal spirometry findings and no variability of Peak Expiratory Flow (PEF). These features of atopic cough are distinct from those of cough variant asthma, since these patients have mild bronchial hyper reactivity and eosinophilic inflammation of the central and peripheral airways and their cough is responsive to bronchodilator treatment. Moreover cough-variant asthma is a precursor of typical asthma, while atopic cough is not, because nearly 30% of patients with cough-variant asthma eventually develop typical asthma but patients with atopic cough do not. Although nearly 60% of patients with atopic cough can be successfully treated with histamine H1-receptor antagonists, but other still require additional corticosteroid therapy because bronchoscopic study indicate that bronchial eosinophilic inflammation is more severe in the H1-receptor antagonist-resistant group. Further investigations are required for the clinical entity of eosinophilic bronchitis without asthma, since it seems to resemble to atopic cough and there seems to be considerable overlap of these two clinical entities.

β-sitosteryl-3-O-β-glucopyranoside isolated from the bark of Sorbus commixta ameliorates pro-inflammatory mediators in RAW 264.7 macrophages

The bark of Sorbus commixta has been used in Asian traditional medicine for treatment of cough, asthma, bronchial disorders, gastritis and dropsy. However, the anti-inflammatory effect of β-sitosteryl-3- O -β-glucopyranoside, a major compound of the bark of S. commixta, is poorly understood. In this study, we investigated the anti-inflammatory effect and the underlying molecular mechanisms of β-sitosteryl-3-O-β-glucopyranoside in lipopolysaccharide (LPS)-induced RAW 264.7 cells. Prostaglandin E2 (PGE2) and cytokines released from cells were measured using EIA assay kit. The expression of inducible NO synthase (iNOS) and cyclooxygenase (COX)-2, Tumor necrosis factor-alpha (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6) was measured by real-time polymerase chain reaction (RT-PCR) and/or Western blot analysis. β-sitosteryl-3-O-β-glucopyranoside inhibited the production of nitric oxide (NO) and PGE2 along with the expression of iNOS and COX-2 in LPS-stimulated RAW264.7 cells. In addition, β-sitosteryl-3-O-β-glucopyranoside reduced the release of pro-inflammatory cytokines, such as TNF-α, IL-1β and IL-6. Moreover, β-sitosteryl-3-O-β-glucopyranoside inhibited the NF-κB activation induced by LPS, which was associated with the abrogation of IκBα degradation and subsequent decreases in nuclear p65 levels. The result suggested that the β-sitosteryl-3-O-β-glucopyranoside inhibited NO and pro-inflammatory productions by down-regulating the gene expression of pro-inflammatory mediators via the negative regulation of the NF-кB pathway in LPS-stimulated RAW 264.7 cells.

Chemopreventive Effect of Lagenaria siceraria in Two Stages DMBA Plus Croton Oil Induced Skin Papillomagenesis

Cancer chemoprevention is a dietary or therapeutic strategy to prevent, suppress, or delay carcinogenesis either at initiation or progression level with nontoxic agents. Use of natural dietary compounds has been a major chemopreventive approach to modulate tumorigenic pathways. In the present study, we have evaluated Lagenaria siceraria (bottle gourd), a common vegetable of Indian household for its chemomodulatory potential. The fruit has been used in traditional medicine for a very long time for health benefits and to cure pain, ulcers, fever, cough, asthma, and other bronchial disorders. However, despite its reported beneficial effect the chemo modulatory potential of this plant has not been reported. Therefore chemopreventive effect of bottle gourd juice (BGJ) was studied against 7,12-dimethylbenz(a)anthracene (DMBA) plus croton oil induced skin papillomagenesis in Swiss albino mice. The effect was studied both at antiinitiation and antiinitiation/promotion level followed by histopathological study. A dose of 2.5% and 5% given in drinking water showed significant decrease in papilloma number, papilloma incidence, papilloma multiplicity, papilloma latency, papilloma volume, and papilloma size in different size range. Histopathological study showed chemopreventive effect by minimizing loss of stratification, a decrease in number of epithelial layers, reducing dermal infiltration and protection for various cytoplasmic changes. Higher dose of BGJ was found to be more effective than lower dose and the chemopreventive effect was maximum for antiinitiation/promotion treatment. Altogether, this study reports the chemopreventive effect of Lagenaria siceraria on skin papillomagenesis for the first time and suggests that its consumption may help in suppression of skin cancer.

Bronchiolite et prise alimentaire des dernières 24 h : un outil de dépistage de l’hypoxie

BackgroundHypoxia associated with bronchiolitis is not always easy to assess on clinical grounds alone. The aim of this study was to determine the value of food intake during the previous 24h (bottle and spoon feeding), as a percentage of usual intake (24h FI), as a marker of hypoxia, and to compare its diagnostic value with that of usual clinical signs. MethodsIn this observational, prospective, multicenter study, 18 community pediatricians, enrolled 171 infants, aged from 0 to 6months, with bronchiolitis (rhinorrhea+dyspnea+cough+expiratory sounds). Infants with risk factors (history of prematurity, chronic heart or lung disorders), breast-fed infants, and infants having previously been treated for bronchial disorders were excluded. The 24h FI, subcostal, intercostal, supracostal retractions, nasal flaring, respiratory rate, pauses, cyanosis, rectal temperature and respiratory syncytial virus test results were noted. The highest stable value of transcutaneous oxygen saturation (SpO2) was recorded. Hypoxia was noted if SpO2 was below 95% and verified. Results24h FI greater or equal to 50% was associated with a 96% likelihood of SpO2 greater or equal to 95% [95% CI, 91–99%]. In univariate analysis, 24h FI less than 50% had the highest odds ratio (13.8) for SpO2 less than 95%, compared to other 24h FI values and other clinical signs, as well as providing one of the best compromises between specificity (90%) and sensitivity (60%) for identifying infants with hypoxia. In multivariate analysis with adjustment for age, SpO2 less than 95% was related to the presence of intercostal retractions (OR=9.1 [95% CI, 2.4–33.8%]) and 24h FI less than 50% (OR=10.9 [95% CI, 3.0–39.1%]). Hospitalization (17 infants) was strongly related to younger age, 24h FI and intercostal retractions. ConclusionIn practice, the measure of 24h FI may be useful in identifying hypoxia and deserves further study.

Food intake during the previous 24 h as a percentage of usual intake: a marker of hypoxia in infants with bronchiolitis: an observational, prospective, multicenter study

BackgroundHypoxia associated with bronchiolitis is not always easy to assess on clinical grounds alone. The aim of this study was to determine the value of food intake during the previous 24 hours (bottle and spoon feeding), as a percentage of usual intake (24h FI), as a marker of hypoxia, and to compare its diagnostic value with that of usual clinical signs.MethodsIn this observational, prospective, multicenter study, 18 community pediatricians, enrolled 171 infants, aged from 0 to 6 months, with bronchiolitis (rhinorrhea + dyspnea + cough + expiratory sounds). Infants with risk factors (history of prematurity, chronic heart or lung disorders), breast-fed infants, and infants having previously been treated for bronchial disorders were excluded.The 24h FI, subcostal, intercostal, supracostal retractions, nasal flaring, respiratory rate, pauses, cyanosis, rectal temperature and respiratory syncytial virus test results were noted. The highest stable value of transcutaneous oxygen saturation (SpO2) was recorded. Hypoxia was noted if SpO2 was below 95% and verified.Results24h FI ≥ 50% was associated with a 96% likelihood of SpO2 ≥ 95% [95% CI, 91–99]. In univariate analysis, 24h FI < 50% had the highest odds ratio (13.8) for SpO2 < 95%, compared to other 24h FI values and other clinical signs, as well as providing one of the best compromises between specificity (90%) and sensitivity (60%) for identifying infants with hypoxia. In multivariate analysis with adjustment for age, SpO2 < 95% was related to the presence of intercostal retractions (OR = 9.1 [95% CI, 2.4-33.8%]) and 24h FI < 50% (OR = 10.9 [95% CI, 3.0-39.1%]). Hospitalization (17 infants) was strongly related to younger age, 24h FI and intercostal retractions.ConclusionIn practice, the measure of 24 h FI may be useful in identifying hypoxia and deserves further study.

The diagnosis of asthma, a clinical syndrome

Clinical experience and now genetic data indicate that asthma is a heterogeneous clinical syndrome—clinical cases emerge, proceed and respond to treatments in different ways. Currently the diagnosis of asthma (as...

Bronchiolitis and bronchial disorders in interstitial lung disease

Bronchial and bronchiolar abnormalities in interstitial lung diseases (ILDs) are an issue often underestimated. However, new interstitial patterns with bronchiolar involvement are being described and the concept is still evolving. The scope of this review is to introduce a comprehensive approach to airway disorders in the context of ILDs, mainly from a pathologic perspective. Recent studies have revealed significant inflammatory and structural alterations at the level of small airways in idiopathic interstitial pneumonias, which may participate in the lung-remodeling pathogenetic process. A suggested pathogenetic role of cigarette smoking for lung-remodeling in smoking-related ILDs is further investigated, and unclassified fibrosis as a prominent feature in lung biopsy specimens of smokers has been established. New targeted therapies for lymphangioleiomyomatosis based on molecular and biologic properties of the disease are currently undergoing clinical trials. Combined pharmaceutical and interventional therapeutic regimens are of growing concern for refractory airway lesions in sarcoidosis. The application of volumetric high-resolution computed tomography (HRCT) chest scanning with acquisition of expiratory images provides valuable information about the involvement of small airways in ILDs. The imaging and pathologic focus on airway abnormalities in ILDs make them an integral part of their pathology with a significant pathogenetic role in interstitial processes and variable contribution to the functional status of patients.

케타스 캡슐 10밀리그램(이부딜라스트 10 밀리그램)에 대한 피나토스 캡슐 10밀리그램의 생물학적동등성

Ibudilast, 3-isobutyryl-2-isopropyrazolo[1,5-a]pyridine, is a nonselective inhibitor of cyclic nucleotide phosphodiesterase (PDE). It preferentially inhibits PDE 3A, PDE4, PDE10 and PDE11 as well as a number of the other PDE families, albeit to a lesser extent. Ibudilast is used clinically to treat bronchial asthma and cerebrovascular disorders. Thes e clinical uses are based on the ability of ibudilast to inhibit platelet aggregation, improve cerebral blood flow and attenuate allergic reactions. The purpose of the present study was to evaluate the bioequivalence of two ibudilast capsules, Ketas capsule (Handok Pharmaceuticals Co., Ltd.) and Pinatos capsule (Sam Chun Dang Pharm. Co., Ltd.), according to the guidelines of the Korea Food and Drug Administration (KFDA). The in vitro release of ibudilast from the two ibudilast formulations was tested using KP Apparatus method with various dissolution media. Twenty six healthy male subjects, 23.311.09 years in age and 70.458.51 kg in body weight, were divided into two groups and a randomized cross-over study was employed. After a single capsule containing 10 mg as ibudilast was orally administered, blood samples were taken at predetermined time intervals and the concentrations of ibudilast in serum were determined using HPLC/UV detector. The dissolution profiles of two formulations were similar in all tested dissolution media. The pharmacokinetic parameters such as , and were calculated, and computer programs (Equiv Test and K-BE Test 2002) were utilized for the statistical analysis of the parameters using logarithmically transformed , and untransformed . The results showed that the differences between two formulations based on the reference drug, Ketas, were 6.99%, -2.48% and 9.93% for , and , respectively. There were no sequence effects between two formulations in these parameters. The 90% confidence intervals using logarithmically transformed data were within the acceptance range of log 0.8 to log 1.25 (e.g., log 0.8791~log 1.1861 and log 0.8347~log 1.1199 for and , respectively). Thus, the criteria of the KFDA bioequivalence guideline were satisfied, indicating Pinatos capsule was bioequivalent to Ketas capsule.

A Chalcone Glycoside from the Fruits of Sorbus commixta Hedl.

Sorbus commixta Hedl. (Rosaceae) has been traditionally used in oriental countries for the treatment of asthma and other bronchial disorders. In this study, a chalcone glycoside was isolated from the ethyl acetate extract of the fruits of this plant. The compound was identified as neosakuranin based on the spectroscopic analysis and comparion with literature data. This is the first report of isolation of neosakuranin from Sorbus commixta.

17,18-Epoxyeicosatetraenoic Acid Targets PPARγ and p38 Mitogen–Activated Protein Kinase to Mediate Its Anti-inflammatory Effects in the Lung

This study sought to assess putative pathways involved in the anti-inflammatory effects of 17,18-epoxyeicosatetraenoic acid (17,18-EpETE), as measured by a decrease in the contractile reactivity and Ca(2+) sensitivity of TNF-α-pretreated human bronchi. Tension measurements performed in the presence of 12-(3-adamantan-1-yl-ureido)-dodecanoic acid (AUDA), a soluble epoxide hydrolase (sEH)-specific inhibitor, demonstrated that 17,18-EpETE reduced the reactivity of TNF-α-pretreated tissues. The overexpression of sEH detected in patients with asthma and TNF-α-treated bronchi contributed to the maintenance of hyperresponsiveness in our models, which involved intracellular proinflammatory cascades. The inhibition of peroxisome proliferator-activated receptor (PPAR)γ by GW9662 abolished 17,18-EpETE + AUDA-mediated anti-inflammatory effects by inducing IκBα degradation and cytokine synthesis, indicating that PPARγ is a molecular target of epoxy-eicosanoids. Western blot analysis revealed that 17,18-EpETE pretreatment reversed the phosphorylation of p38 mitogen-activated protein kinase (p38-MAPK) induced by TNF-α in human bronchi. The Ca(2+) sensitivity of human bronchial explants was also quantified on β-escin permeabilized preparations. The presence of SB203580, a p38-MAPK inhibitor, reversed the effect induced by epoxy-eicosanoid in the presence of AUDA on TNF-α-triggered Ca(2+) hypersensitivity by increasing the phosphorylation level of PKC Potentiated Inhibitor Protein-17 (CPI-17) regulatory protein. Moreover, PPARγ ligands, such as rosiglitazone and 17,18-EpETE, decreased the expression of CPI-17, both at the mRNA and protein levels, whereas this effect was countered by GW9662 treatment in TNF-α-treated bronchi. These results demonstrate that 17,18-EpETE is a potent regulator of human lung inflammation and concomitant hyperresponsiveness, and may represent a valuable asset against critical inflammatory bronchial disorder.

Pulmonary Changes in Preterm Neonates with Hyaline Membrane Disease (a Clinicomorphological Study)

Objective: to reveal lung morphological changes in preterm neonatal infants with hyaline membrane disease (HMD) in the use of exogenous surfactants and artificial ventilation. Materials and methods. Case histories and autopsy protocols were analyzed in 90 preterm neonates who had died from severe respiratory failure. All the neonates were divided into 4 groups: 1) 20 (22.2%) infants who had received the exogenous surfactant Curosurf in the combined therapy of HMD; 2) 19 (21.1%) babies with HMD who had taken Surfactant BL; 3) 25 (27.8%) surfactant-untreated infants who had died from HMD; 4) 26 (28.9%) very preterm neonates with extremely low birth weight who had died within the first hour of life. The lungs were histologically and morphometrically examined. Results. The study demonstrated the specific course of HMD when exogenous surfactants and artificial ventilation were used. The contributors to the development of the disease are intranatal amniotic fluid aspiration and intranatal fetal hypoxia. Conclusion. Artificial ventilation and the use of exogenous surfactants do not block the generation of hyaline membranes. The latter differ in formation time, form, and location. The differences in a cell response to hyaline membranes were found in the neonatal infants receiving exogenous surfactants. The characteristic morphological signs of the disease for all the neonates enrolled in the study are alveolar and bronchial epithelial damages and microcirculatory disorders. Key words: preterm neonatal infants, hyaline membrane disease, exogenous surfactants, artificial ventilation, histology, morphometry.

Affan Hamakhan Jafar: treating trauma in northern Iraq

Affan Hamakhan Jafar: treating trauma in northern Iraq

Comparison of anti-inflammatory activity of Peucedanum praeruptorum Dunn, Angelica decursiva Franchet et Savatier and Anthriscus sylvestris Hoff

Peucedanum praeruptorum Dunn (PP), Angelica decursiva Franchet et Savatier (AD) and Anthriscus sylvestris Hoff (AS) belong to the family Umbelliferae and are widely distributed in Korea, Japan, and China. The roots of PP and AD is known as a famous traditional Korean medicine (Jeonho) can be used to cure some diseases such as cough due to pathogenic wind-heat, accumulation of phlegm, heat in the lung, bronchial disorders and bronchitis. The roots of AS which has different effect compared to PP and AD but is also used together with PP and AD in Korea. However, their efficacy on inflammation is not clear. In this study, we estimated their anti-inflammatory effect and we compared their constituent by high performance liquid chromatography (HPLC). For the determination of anti-inflammatory effects, we investigated Nitrite oxide (NO) and prostaglandin E2 (PGE2) production by ELISA. The expressions of inducible nitrite oxide (iNOS) and cyclooxygenase-2 (COX-2) were determined by western blotting in lipopolysaccharide (LPS) – induced RAW 264.7 macrophage cells. Methanol extracts of PP and AD (25µg/ml) decreased NO and PGE2 production. The expressions of iNOS and COX-2 protein were also decreased in methanol extracts of PP and AD (25µg/ml). AD found to be more potent than the other extracts. The above study therefore indicates that AD might represent new therapeutic options for treatment of inflammatory diseases.

Manifestations respiratoires au cours du syndrome de Gougerot-Sjögren

Sjogren's syndrome is a common auto-immune disease. Clinically significant pulmonary involvement affects approximately 10% of patients and may be the first manifestation of the disease, putting the respiratory physician in a position to suspect and confirm the diagnosis. Besides interstitial lung disease and bronchial disorders, cough is a common symptom of the disease and particularly difficult to treat. Lung cysts and amyloid deposits, sometimes associated with lymphoma, have recently been described. The development of a primary pulmonary lymphoma, usually from MALT, is a major complication of the disease. Characterisation of the pathophysiology of pulmonary involvement in Sjogren's syndrome and the institution of specific treatment merits the interest of the respiratory physician. The respiratory physician should consider the diagnosis of Sjogren's syndrome in many different clinico-pathological situations.

Duration of tracheal sound recorded during forced expiration: From a model to establishing standards

Analysis of the duration of tracheal sound recorded during forced expiration (TSFE) was performed to detect bronchial conductance disorders and to develop a method for establishing individually tailored standards. A standard individual duration of the TSFE served as an estimate of the relevant expiratory resistance of the bronchial tree in healthy subjects and showed the extent to which sound duration exceeded that predicted from the normal individual resistance in flow-limited subjects.

Nephropathy, polyneuropathy, and gastroenteritis in a child with Churg–Strauss syndrome

Churg-Strauss syndrome (CSS) is a serious but rare pauci-immune vasculitis of small- and medium-sized blood vessels. It is commonly seen in association with bronchial asthma and/or allergic disorders. The syndrome is characterized by the presence of asthma, hypereosinophilia, and vasculitis in any part of the body. Vasculitis is often associated with significant distortion of normal functions. A rather severe case of CSS in an 8-year-old Nigerian girl with asthma and allergic rhinoconjunctivitis is reported. She presented with multiple morbidities, namely, vasculitic polyneuropathy and also nephritic-nephrotic syndrome that eventuated in acute renal failure after an onset of vasculitic gastroenteritis. Routine screening of all asthmatic patients for CSS is advocated.

A 10‐year follow‐up study of pulmonary function in symptomatic elite cross‐country skiers – athletes and bronchial dysfunctions

A high prevalence of asthma-like symptoms and abnormal bronchial reactivity to various stimuli has been reported among endurance athletes. This report presents the cases of three cross-country skiers who have shown a progressive development of airway obstruction during their sport careers. The observed decline in FEV1, FEV1/FVC and/or FVC (FEV, forced expiratory volume; FVC, forced expiratory vital capacity) was greater than expected from longitudinal regression equations describing the ageing effect on pulmonary function. The three subjects encountered abnormal respiratory discomfort during their sport activity which was not systematically associated with abnormal bronchial reactivity (either to methacholine or exercise hyperventilation). At the end of the follow-up periods (9-12 years), all three skiers presented objective signs of airflow limitations during intense exercise. This report suggests that repeated chronic hyperventilation of cold dry air in cross-country skiers for several years can induce permanent bronchial disorders which may include remodeling processes and induce ventilatory limitations during intense exercise.

Significance of Spectral and Time Parameters of Forced Expiratory Sound in Evaluating Bronchial Patency

Spectral and time characteristics of forced expiratory sound, recorded in the trachea, were analyzed in 96 subjects. Sick and healthy subjects and the risk group demonstrated substantial differences in the acoustic parameters (total sound duration, “vortex stoppage” duration, and emergence of spectral components with high frequency and narrow band at the end of an expiration). The authors suggest and substantiate acoustic criteria of the bronchial patency disorder, assuming on this basis that such disorders are more common in patients with chronic nonobstructive bronchitis (70.8%) and subjects at risk for chronic obstructive pulmonary diseases (45.4%) than is demonstrated by conventional functional methods.