Bronchitis Patients Research Articles

Acute respiratory illness as a trigger for detecting chronic bronchitis in adults at risk of COPD: a primary care survey

To evaluate the impact of chronic bronchitis in patients identified among subjects at risk of chronic obstructive pulmonary disease (COPD) but currently free from any known chronic respiratory disorder, visiting a general practitioner for an acute respiratory episode. A multicentre, cross-sectional survey carried out in primary care. Primary care practitioners (n = 772) examined 14,030 patients with acute cough (male: 56.9%, age 50.6 ± 16.5 years). Of these, 3,615 were at risk of COPD (> 40 years and tobacco use > 10 pack-years) and constituted the study population: 79.8% reported current symptoms of chronic bronchitis. Compared to patients without chronic bronchitis, they were older, more frequently exposed to occupational pollutants or to passive smoking, had more tobacco use (p < 0.001), reported dyspnoea > Grade 2 more frequently, and had poorer quality of life as assessed by the EuroQOL-5D questionnaire. In this survey, previously unrecognised chronic bronchitis was diagnosed in a high proportion of at-risk patients with acute respiratory episodes. Chronic bronchitis was associated with significantly poorer health status. Acute respiratory illness could be an appropriate opportunity for screening those patients at risk of COPD with lung function testing.

Pseudomonas aeruginosa: Host defence in lung diseases

Lung infections caused by the opportunistic pathogen Pseudomonas aeruginosa can present as a spectrum of clinical entities from a rapidly fatal pneumonia in a neutropenic patient to a multi-decade bronchitis in patients with cystic fibrosis. P. aeruginosa is ubiquitous in our environment, and one of the most versatile pathogens studied, capable of infecting a number of diverse life forms and surviving harsh environmental factors. It is also able to quickly adapt to new environments, including the lung, where it orchestrates virulence factors to acquire necessary nutrients, and if necessary, turn them off to prevent immune recognition. Despite these capabilities, P. aeruginosa rarely infects healthy human lungs. This is secondary to a highly evolved host defence mechanism that efficiently removes inhaled or aspirated pseudomonads. Many arms of the respiratory host defence have been elucidated using P. aeruginosa as a model pathogen. Human infections with P. aeruginosa have demonstrated the importance of the mechanical barrier functions including mucus clearance, and the innate immune system, including the critical role of the neutrophilic response. As more models of persistent or biofilm P. aeruginosa infections are developed, the role of the adaptive immune response will likely become more evident. Understanding the pathogenesis of P. aeruginosa, and the respiratory host defence response to it has, and will continue to, lead to novel therapeutic strategies to help patients.

Respiratory infections caused by Branhamella catarrhalis in 5 different hospitals

During 9 months (from January 1988 to September 1988), we experienced 82 patients (94 episodes) of respiratory infections with Branhamella catarrhalis in 5 different hospitals. There were 11 patients of acute bronchitis, 8 patients of pneumonia, 56 patients of chronic bronchitis (68 episodes), 3 patients of bronchiectasis, 3 patients of bronchial asthma with infection and chronic pulmonary emphysema in one patient. Ten cases of acute bronchitis and 3 cases of pneumonia had a recent history of common cold, with no underlying disease. There were 68 episodes of acute exacerbation of chronic bronchitis, the highest among 94 episodes of all respiratory infection. In chronic bronchitis the single pathogen B. catarrhalis was more than B. catarrhalis associated with other pathogens. H. influenza was associated with B. catarrhalis in in most cases of polymicrobial infection. beta-lactamase producing B. catarrhalis was 71% and oral penicillin was not effective in 8 cases of infection by beta-lactamase producing strains. These results show that B. catarrhalis is very important as a common pathogen of respiratory infection.

PGE 2 May Decrease Airway Inflammation and Muscular Hyperplasia in Eosinophilic Bronchitis Patients through Prostanoid Receptors EP2 and EP4

RATIONALE: Eosinophilic bronchitis (EB) is characterized by chronic cough and sputum eosinophilia without bronchial hyperresponsiveness. Patients with EB show increased levels of prostaglandin E2 (PGE2) in sputum supernatant compared with asthmatic subjects. PGE2 could play a protective role in this disorder.

Bronchial Casts and Pandemic (H1N1) 2009 Virus Infection

Bronchial Casts and Pandemic (H1N1) 2009 Virus Infection

Antibiotic Prescription Pattern for Viral Respiratory Illness in Emergency Room and Ambulatory Care Settings

To evaluate the current practice pattern of antibiotic prescription rate in viral respiratory tract infection diagnosed children among different specialty health care providers. The study was a retrospective case review study where a random sample of 1200 child care visits coded as viral respiratory infections in primary care provider's office, convenient care clinic, or emergency room in 2006 were analyzed. Overall, the antibiotic prescription rate was 30%. The prescription rate was 3.7 times (95% confidence interval [CI] = 1.90-7.31) higher for bronchitis patients and 2.5 times (95% CI = 1.46-4.30) higher for viral pharyngitis patients than for common cold patients. Antibiotics were written more by emergency physicians (odds ratio [OR] = 11.04; 95% CI = 5.78-21.10) and family practitioners (OR = 5.22; 95% CI = 2.99-9.10) than by pediatricians. Although not recommended, children seen in the emergency room and family practitioner's office are more likely to receive antibiotic prescriptions than those seen in the pediatrician's office.

SP-D counteracts GM-CSF-mediated increase of granuloma formation by alveolar macrophages in lysinuric protein intolerance

BackgroundPulmonary alveolar proteinosis (PAP) is a syndrome with multiple etiologies and is often deadly in lysinuric protein intolerance (LPI). At present, PAP is treated by whole lung lavage or with granulocyte/monocyte colony stimulating factor (GM-CSF); however, the effectiveness of GM-CSF in treating LPI associated PAP is uncertain. We hypothesized that GM-CSF and surfactant protein D (SP-D) would enhance the clearance of proteins and dying cells that are typically present in the airways of PAP lungs.MethodsCells and cell-free supernatant of therapeutic bronchoalveolar lavage fluid (BALF) of a two-year-old patient with LPI were isolated on multiple occasions. Diagnostic BALF samples from an age-matched patient with bronchitis or adult PAP patients were used as controls. SP-D and total protein content of the supernatants were determined by BCA assays and Western blots, respectively. Cholesterol content was determined by a calorimetic assay or Oil Red O staining of cytospin preparations. The cells and surfactant lipids were also analyzed by transmission electron microscopy. Uptake of Alexa-647 conjugated BSA and DiI-labelled apoptotic Jurkat T-cells by BAL cells were studied separately in the presence or absence of SP-D (1 μg/ml) and/or GM-CSF (10 ng/ml), ex vivo. Specimens were analyzed by light and fluorescence microscopy.ResultsHere we show that large amounts of cholesterol, and large numbers of cholesterol crystals, dying cells, and lipid-laden foamy alveolar macrophages were present in the airways of the LPI patient. Although SP-D is present, its bioavailability is low in the airways. SP-D was partially degraded and entrapped in the unusual surfactant lipid tubules with circular lattice, in vivo. We also show that supplementing SP-D and GM-CSF increases the uptake of protein and dying cells by healthy LPI alveolar macrophages, ex vivo. Serendipitously, we found that these cells spontaneously generated granulomas, ex vivo, and GM-CSF treatment drastically increased the number of granulomas whereas SP-D treatment counteracted the adverse effect of GM-CSF.ConclusionsWe propose that increased GM-CSF and decreased bioavailability of SP-D may promote granuloma formation in LPI, and GM-CSF may not be suitable for treating PAP in LPI. To improve the lung condition of LPI patients with PAP, it would be useful to explore alternative therapies for increasing dead cell clearance while decreasing cholesterol content in the airways.

Responsiveness of the cough and sputum assessment questionnaire in exacerbations of COPD and chronic bronchitis

To assess the responsiveness of the Cough and Sputum Assessment Questionnaire (CASA-Q) in COPD and chronic bronchitis patients recovering from an acute exacerbation. The 20-item questionnaire with a 7-day recall assesses the frequency and severity of cough and sputum and their impact on everyday life in clinical (trial) settings. The four domains (cough/sputum symptom and impact) use scales from 0 to 100, with lower scores indicating higher symptom/impact levels. Outpatients were enrolled within 48h of symptom onset of their exacerbation. Treatment was initiated at the discretion of the investigator, and patients observed for 6 weeks. During study visits, 59 eligible patients completed the CASA-Q at enrolment, week 1, 2 and 6. Responsiveness was assessed by calculating standardized effect sizes. Of the 19 male and 40 female patients with a mean (standard deviation, SD) age of 61.1 (10.5) years, all were classified by their physician to have improved or recovered after six weeks. The mean (SD) CASA-Q sores for the cough symptom, cough impact, sputum symptom and sputum impact domains increased from 32.6 (21.0), 40.7 (22.4), 37.4 (20.1), 47.1 (24.2) at enrolment to 54.0 (19.8), 63.7 (21.3), 55.1 (19.0), 65.5 (20.5) at week 6, respectively. Standardized effect sizes for patients improved or recovered from their exacerbation at week 6 were above 1.0 for the cough domains and at least 0.77 for the sputum domains. The CASA-Q was responsive to symptom changes in patients recovering from an exacerbation.

The handling of inhalers by bronchitis patients

A high percentage of patients are admitted to the Internal Medicine Unit with respiratory pathology, principally chronic obstructive pulmonary disease. The basis of treatment of the patient with chronic obstruction of the airways are the bronchodilators and corticoids administered by inhalation. There is a close relation between the correct use of the inhaler and its therapeutic efficiency. As chronic obstructive pulmonary disease is chronic, the patient is obliged to utilise inhaler treatment both in the hospital and at home. With the aim of determining what they know about inhalers, and how they use them, as well as to obtain information about the follow up practised with these patients, a study was designed that was carried out for one month in the Internal Medicine Unit of the "Virgen del Camino" Hospital of Pamplona. Data was gathered using a questionnaire with nine questions that were put to a sample of 23 patients admitted to this unit and who used inhalers during their hospital stay. It was verified that 57% of the patients did not use the inhalers correctly, 61% did not know when the container had run out and 70% did not even know the name of the medicine they were using. The study showed that the patients did not correctly administer the inhalatory medicines, which annulled or diminished the effectiveness of the treatment, given that there is a close relation between the correct use of the inhaler and its therapeutic efficiency.

The Usefulness of Induced Sputum Examination in the Diagnostic Evaluation of Selected Chronic Inflammatory Diseases of the Respiratory Tract

Usefulness of the cytological analysis in diagnostics some of chronic inflammatory diseases of the respiratory system was assessed on the basis of the normal values for the composition of sputum inflammatory cells among healthy inhabitants of Silesia. Examined: 96 healthy subjects (control group), 42 patients with bronchial asthma, 49 patients with chronic obstructive pulmonary disease (COPD) and 30 patients with chronic bronchitis (CB). Spirometry, before and 15 minutes after 200 micrograms of salbutamol, and sputum examination were performed in all participants. Airway responsiveness on metacholine was performed in people with no contraindication. In comparison to the control group, the percentage of eosinophils was significantly higher in all patients (p<0.00001). Median values were following: asthma patients--10.3%, COPD patients--1.5%, CB patients--1.6% and control subjects--0.3%. Important statistic differences (p<0.05%) have been observed in the average percentage of the neutrophils in induced sputum between healthy subjects and patients with asthma, COPD and CB. Respective median values were: 45.75%, 38.1%, 77.5% and 58.1%. The percentage of patients whose sputum eosinophils results were above the normal values (>2.8%) was as follows: 85% of the number of patients with bronchial asthma, 38% of patients with COPD, 20% of patients with CB and 6% of healthy subjects. These results suggest that cytological examination of induced sputum is a good adjunctive test in diagnostics of the chronic inflammatory diseases of the respiratory system. The percentage of eosinophils in induced sputum above 2.8% most probably confirms bronchial asthma diagnosis.

Occupational diseases. Epidemiological trends of the occupational dust diseases, prevention and early diagnosis

The aim of the study was to present the main groups of occupational diseases In Bulgaria, as well as the epidemiological trends and the prognosis of the benign and malignant occupational dust diseases in workers exposed to non-organic dust up to 1985y, and during 1985 - 2003 periods, as well as to propose ideas for adequate medical check-up. Materials and methods. We investigated the all number of patients with benign and malignant occupational dust diseases in Bulgaria during the period 1985 - 2000y was investigated. The information was obtained by the last regional departments for medical service of pneumoconiosis in Bulgaria. Addition- ally, we investigated dust diseases in 116 miners from brown coal mining in Bobov dol mine, 113p. - from black coal mining in Balkan mine, 53p. - from anthracite coal mining in Antra, 198 - from lead-zinc ore mining in Lucky, Gorubso, and 120 asbestos exposed workers, who have worked since 1985 to 2003y, and 121 non-exposed workers have used as a control group. A clinical (anamnesis, physical examination), radiological (chest ex-ray, accounted by ILO'80) and spirometry was done of dust exposed workers and non-exposed screened individuals were performed. A non-parametric statistical analysis with significance calculation (P) by us age SPSS software was done. Additionally, the all number and the incidence of malignant mesothelioma per 100000 person's population were investigated. Results and discussion. The dust diseases in exposed workers up to 1985y decrease. We detected new diagnosed pneumoconiosis and occupational dust bronchitis in patients with 10+years exposure to quartz and asbestos, who have been worked up to 1985y. It has been accounted an increase of the incidence of malignant mesothelioma during the period 1990 - 2000y. Conclusions. We prognosticate a rise in the incidence of silicosis, asbestosis, and mesothelioma in the future 10-20 y. due to low quality of the preventive measures in the basic dust industries in Bulgaria during the last two decades. We consider it is necessary to perform wide studies in dust exposed workers, and to create a register of the dust, as well as of the exposed workers, and of the dust diseases in Bulgaria. Scripta Scientifica Medica 2009; 41(1): 103-106.

Pranayama: The power of breath

Pranayama, the regulation of inhalation and exhala tion, is accomplished by eliminating the pause betw een inhalation and exhalation or expending it by retention. Pranayama regulates the motion of the lungs, resulting into c ontrol of heart and vagus nerve. The science of pranayama is thus intimately connect ed with the autonomic nervous system and brings its functions under conscious control via breathing patterns and movements of the diaphragm and lungs. The nasal tissue is erectile similar to sex organs in men and women, which is very sensitive to breath. Contr ol of breath constitutes an obvious starting point toward attainment of control of autonomic nervous system, which appears to have beneficial effects on the functions of omental adipocy tes, brain, heart, lungs, liver, and kidney functions. The left nostril, diaphragm, and stomach are supplied by the vagus nerve, which may influence pituitary function, hypothalamus, pineal gland and suprachias matic nucleus. Studies conducted in Italy have show n that verbalization of mantras (i.e., om-mani-padme-om ) can decrease the breathing rate, due to increased vagal activity, resulting into increased nitric oxide release when the breathing rate is brought do wn to less than six breaths per minute. We have obs erved in 101 patients of chronic bronchitis or asthma, the role of breathing patterns in their treatment. Common methods for pr anayama are discussed. Further studies are necessary to establish the role of pran ayama in the management of diseases.

Exhaled Nitric Oxide Measurement Is Useful for the Exclusion of Nonasthmatic Eosinophilic Bronchitis in Patients With Chronic Cough

Nonasthmatic eosinophilic bronchitis (NAEB) is an important cause of chronic cough, and it can be diagnosed by an induced-sputum (IS) examination. However, an IS examination is a complex and time-consuming procedure, and it has limited clinical application. This study aimed to evaluate the role of exhaled nitric oxide (NO) for the investigation of chronic cough, especially of NAEB. Two hundred eleven nonsmoking patients with a cough lasting > 3 weeks were enrolled in the study. The patients were examined and investigated with conventional diagnostic tools, including an IS examination. Exhaled NO was measured by a chemoluminescent analyzer. One hundred seventeen patients with adequate IS results were analyzed: asthma, n = 14; NAEB, n = 21; and "others," n = 82. Exhaled NO and IS eosinophils were significantly higher in the asthma group and NAEB group than in the others group. Exhaled NO and IS eosinophils were significantly correlated in the asthma and NAEB groups. In the nonasthmatic group, the sensitivity and specificity of exhaled NO for detecting NAEB, using 31.7 parts per billion as the exhaled NO cutoff point, were 86% and 76%, respectively. Positive and negative predictive values were 47% and 95%, respectively, and positive and negative likelihood ratios were 3.51 and 0.19, respectively. We concluded that exhaled NO measurement may be useful as part of the initial evaluation for chronic cough, especially for the exclusion of NAEB. A low level of exhaled NO suggested little likelihood of NAEB for the nonasthmatic patients with chronic cough.

Systems for the management of respiratory disease in primary care — an international series: Pakistan

Pakistan has a population exceeding 160 million. Communicable diseases remain the most important health problem in Pakistan, with non-communicable diseases and injuries comprising a quarter of all deaths. The government provides a multi-tiered healthcare system, from the Basic Health Unit at the village level, ranging up to the tertiary care teaching hospitals in the larger cities. These facilities are accessible to all, and are usually free or highly subsidised. Patients have the choice to see a private or government GP, a specialist, or an alternative medicine healer. The current National Health Policy focusses mainly on prevention of communicable diseases, as well as improving primary and secondary health care services. Only 6% of 13 to 14 year olds are medically diagnosed as having asthma, and more than half report symptoms of rhinitis. The prevalence of chronic bronchitis in patients over 65 is 14% and 6% in rural females and males, respectively, and 9% (with no sex difference) in urban areas. The higher rates of chronic bronchitis observed in females in rural areas may be attributed to high levels of indoor air pollution due to cooking over smoking fires. It is estimated that 36% of adult males, and 9% of females, smoke, and the cigarette consumption per person per year in Pakistan is among the highest in South Asia. Pakistan is ranked 7th among the 22 highest tuberculosis disease burden countries in the world. In 2006 the number of all TB cases was 76,668 compared to 97,245 in 2004. It is estimated that 70-80,000 people are infected with HIV, but only 3,000 AIDS cases have been reported so far. The incidence of acute respiratory infections in children varies, and is a common cause of morbidity. In adults, it is estimated that pneumonia may affect as many as 2.8 million Pakistanis. Patients usually can access their local GPs or alternative medical practitioners with relative ease. In villages in remote areas, access to government-run health care facilities can sometimes be quite difficult. Respiratory illnesses like asthma, allergy and COPD, are still a relatively low priority area, and even simple equipment--e.g. a peak flow meter--is not commonly available. Specialised equipment like spirometers and allergy testing facilities are only available in a few larger cities and hospitals. The WHO's Global Alliance against Chronic Respiratory Diseases (GARD) is expected to be launched in 2008. This will be a platform for strengthening primary care respiratory activities with the involvement of the International Primary Care Respiratory Group (IPCRG). Various non-governmental organisations have plans to promote awareness regarding all aspects of allergy, asthma, COPD, and other chronic respiratory diseases, in the future.

Moxifloxacin: a respiratory fluoroquinolone

Background: Respiratory quinolones are a class of antimicrobials with a high activity against most respiratory pathogens. Moxifloxacin is a fourth-generation fluoroquinolone that has been shown to be effective against Gram-positive, Gram-negative, and atypical strains, as well as multi-drug resistant Streptococcus pneumoniae. Objective: To review and update the clinical efficacy of moxifloxacin in the treatment of respiratory infections. Method: To perform a systematic review of publications on the clinical efficacy of moxifloxacin in respiratory infections. Results: The clinical efficacy of moxifloxacin has been shown in controlled studies of community-acquired pneumonia, exacerbations of chronic bronchitis and acute bacterial rhinosinusitis. Moxifloxacin has demonstrated a faster resolution of symptoms in community-acquired pneumonia and exacerbations of chronic bronchitis patients compared with first-line therapy together with excellent eradication rates. Conclusions: The use of moxifloxacin as first-line therapy for moderate to severe respiratory infections in the community and the hospital has been recognized in international guidelines.

Haemoptysis associated with gatifloxacin in a 27 year old male asthmatic – a case report

Gatifloxacin is a 8-methoxyfluoroquinolone antimicrobial with an extended spectrum of antimicrobial activity. It was approved for use in the United States in 1999 and was introduced in India in October 2001. The drug is approved for use in the treatment of various respiratory infections including bronchitis, urinary tract infections and gonorrhoea [1]. We report a case of haemoptysis associated with gatifloxacin. A 27 year old male patient, known to have bronchial asthma which was well controlled, attended the Respiratory and Chest Diseases outpatient department with the complaint of frank blood in the sputum. He had had a cough and mucopurulent sputum for the last 10 days. On the fourth day of cough he took gatifloxacin 400 mg (Gatikind, Mankind India) once daily (self medication being a doctor) for 5 days. The symptoms of cough and sputum improved but he had a bout of frank haemoptysis on the fifth day of the treatment for which he presented to the physician. The drug was stopped and thereafter, no episode of haemoptyis occurred. There was no history of violent coughing or any concomitant medication. On examination bilateral breath sounds were present and no added sounds were heard. Spirometry was performed and FEV1 was found to be more than 80% of the predicted value. The chest X-ray showed no significant finding. Bleeding and clotting times were in the normal range. Complete blood count was not available. The diagnosis of bronchitis was made as the patient had symptoms consistent with upper respiratory tract infection and normal chest radiograph [2]. There was no history of gatifloxacin intake in the past. The patient provided written informed consent for publication of this report. The case was reported to the zonal centre under the national pharmacovigilance programme. Although bronchitis is a common cause of haemoptysis [2], in this case the event surfaced when the symptoms of bronchitis were improving. The temporal relationship between the administration of gatifloxacin with the occurrence of the event, and no further episode of haemoptysis on stopping the drug, also supports that the event could be due to gatifloxacin. There are reports suggesting occurrence of haemorrhage with gatifloxacin [3] and increased risk of bleeding with the concomitant use of warfarin and gatifloxacin [4, 5]. The strength of association was examined using the Naranjo's Adverse Drug Reaction Probability Scale, in which a score of +4 was obtained suggesting a ‘possible’ link. The Naranjo's algorithm defines adverse reactions as definite (score > 9), probable (score between 5 and 8), possible (1–4) and doubtful (<1) [6]. There could be several possible explanations for gatifloxacin associated haemoptysis. Infection in bronchitis causes superficial mucosal inflammation and oedema which can lead to the rupture of the superficial blood vessels. Gatifloxacin is widely distributed throughout the body into many body tissues and fluids. Rapid distribution of gatifloxacin into tissues also results in high concentrations of gatifloxacin in the respiratory system including the bronchial mucosa [3]. This could probably increase the inflammation of the mucosal cells. This effect coupled with the drug's characteristic to interfere with the coagulation cascade [4, 5] may explain haemoptysis associated with gatifloxacin in patients of bronchitis. This hypothesis needs to be further tested. In conclusion, gatifloxacin has been approved for use in bronchitis because of its enhanced activity against the respiratory pathogens and high concentration in the respiratory tract [3, 7]. However, in the view of this patient (a doctor) and in the light of previously reported cases of haemorrhage, its use in bronchitis needs to be monitored carefully.

Genotyping analysis of Mycoplasma pneumoniae clinical strains in Japan between 1995 and 2005: type shift phenomenon of M. pneumoniae clinical strains

Mycoplasma pneumoniae clinical isolates obtained between 1995 and 2005 were examined to determine the prevalent genotype. One hundred and twenty-seven strains isolated from bronchitis and pneumonia patients were genotyped by a PCR-RFLP method based on nucleotide sequence polymorphisms of the p1 gene, which encodes the major adhesin protein. The typing results established that 66 of the isolates were group I strains, 45 were group II strains and 16 were group II variants. Analysis of the annual occurrence of these isolates showed a predominance of group II strains between 1995 and 2001 (n=37). No group I strain was found during this period. However, group I strains appeared in the isolates from 2002 (2/5 isolates, 40 %) and increased in specimens taken after 2003, thereby constituting a large proportion of the isolates. In 2004 and 2005, no group II strains were found among the isolates (n=49), although there were nine group II variants. Throat swabs and sputum samples obtained from patients with respiratory infections between 1997 and 2005 were also analysed by PCR-RFLP or a new nested PCR to detect the p1 gene DNA. Typing analysis of these p1 gene DNAs also showed that the group I p1 gene was not present in specimens taken before 2000, but was present and dominant in specimens taken after 2001. These results indicate that, in Japan, the prevalent type of M. pneumoniae changed from a group II strain to a group I strain around 2002.

SERUM LACTATE DEHYDROGENASE ISOENZYMES AS MARKER FOR LUNG TISSUE DAMAGE IN ACUTE BRONCHITIS PATIENTS

BACKGROUND/OBJECTIVES: Total serum lactate dehydrogenase (LDH) and LDH isoenzymes are found increased in tissue damaging diseases. Literature reveals that LDH and its isoenzymes specifically LDH-3 increase in blood due to damage of lung tissue. Acute bronchitis is diagnosed only on clinical grounds and no laboratory tests had been established to confirm diagnosis. This study was conducted to establish a guiding factor that can be helpful in assessment of lung tissue damage and this finding will be having prognostic importance including drug effectiveness in acute bronchitis patients which can be helpful in prevention of developing the chronic course of illness. METHODS: Patients were collected from Out Patients Department of Liaquat University Hospital Jamshoro / Hyderabad, Sindh - Pakistan. Total serum LDH was estimated by spectrophotometer and LDH isoenzymes were measured by electrophoresis on cellulose acetate membrane. RESULTS: Total serum LDH (260.84±7.08mu/ml p<0.001) and LDH-3 (65.60±1.92mu/ml p<0.001) were found statistically significant as compared to control subjects. CONCLUSION: Increased serum LDH and LDH-3 are marker for extent of lung tissue damage. Monitoring of these parameters can be a better guide for the prognosis and treatment including drug effectiveness in patients of acute bronchitis.

Increased prostaglandin E2 levels in the airway of patients with eosinophilic bronchitis

Eosinophilic bronchitis is a common cause of chronic cough, which like asthma is characterized by sputum eosinophilia, but unlike asthma there is no variable airflow obstruction or airway hyperresponsiveness. We tested the hypothesis that the different airway function in patients with eosinophilic bronchitis and asthma could be caused by an imbalance in the production of bronchoconstrictor (LTC(4)) and bronchoprotective (prostaglandin E(2); PGE(2)) lipid mediators. We measured cytokines levels, proinflammatory mediators and eicosanoids concentration in sputum from 13 subjects with nonasthmatic eosinophilic bronchitis, 13 subjects with asthma, and 11 healthy control subjects. Cytokines mRNA levels were measured by real time PCR, proinflammatory mediators, PGE(2), and LTC(4) were measured by enzyme immunoassays. The median sputum eosinophil count was not statistically different in patients with asthma (7.95%) and eosinophilic bronchitis (15.29%). The levels of mRNA specific to interleukin-5 (IL-5), IL-4, IL-10, IL-13, interferon gamma (IFN-gamma), IL-2, vascular endothelial growth factor and transforming growth factor beta were similar in both conditions. In addition, no differences were found between asthma and eosinophilic bronchitis in proinflammatory cytokines, such as IL-8, IFN-gamma and tumor necrosis factor alpha (TNF-alpha) levels. Sputum cysteinyl-leukotrienes concentration was raised both in eosinophilic bronchitis and asthma patients. We found that induced sputum PGE(2) concentrations were significantly increased in subjects with eosinophilic bronchitis (838.3 +/- 612 pg/ml) when compared with asthmatic (7.54 +/- 2.14 pg/ml) and healthy subjects (4 +/- 1.3 pg/ml). This data suggest that the difference in airway function observed in subjects with eosinophilic bronchitis and asthma could be due to differences in PGE(2) production in the airways.

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