Chronic Bronchial Infection Research Articles

Examination of bacteria in chronic bronchial infections. Importance of tetracycline-resistance of pneumococcus

Es wurden die Krankengeschichten von 116 chronischen Bronchitikern, die in den Jahren 1971–1972 aus sieben Abteilungen des Koranyi-Landesinstituts fur Tuberkulose und Pulmonologie entlassen wurden, bearbeitet. Unseren Daten gemas war die erste antibakterielle Behandlung in 82% der Falle ohne vorherige bakteriologische Untersuchung erfolgreich und nach Medikamentenwechsel war die Therapie nur in 4,3% erfolglos.

Serum and Secretory Antibodies in Patients With Chronic Bronchitis

Serum and secretory immunoglobulins were studied in patients with chronic bronchitis. Serum immunoglobulin levels of 26 patients with chronic bronchitis were not markedly higher than those of 23 controls. The same patients also had serum antibodies to Haemophilus influenzae but not markedly more than the control group. Serum antibodies were principally IgG and, to a lesser extent, IgM and IgA. Immunoglobulins G and A were found in saliva and sputum by immunodiffusion, and all three immunoglobulins were found by immunofluorescence. Sputum concentrations of IgG and IgA were approximately equal and were found in concentrations three to four times higher than that in saliva. Specific H influenzae and pneumococcal antibodies generally were present in sputum. From these studies, no immunological effect could be demonstrated in these patients to explain their chronic bronchial infection.

Amoxycillin in the treatment of chronic non-tuberculous bronchial infections

A preliminary study of the effect of amoxycillin on advanced chronic bronchial infections, mostly caused by H. influenzae , suggests that this drug has a therapeutic value substantially greater than that of its close relative, ampicillin. Amoxycillin is absorbed approximately twice as efficiently as ampicillin from the bowel, and therefore a dosage regimen of 500 mg amoxycillin 6-hourly was chosen to compare with i g ampicillin 6-hourly. Of 11 patients whose sputum purulence was unchanged by ampicillin, 6 showed loss of pus from the sputum, or almost total disappearance of sputum, when given amoxycillin. There is some evidence that amoxycillin may penetrate the bronchial mucous membrane more easily than ampicillin, and, if this is confirmed, amoxycillin seems likely to prove significantly more effective than ampicillin in bactericidal therapy of chronic respiratory infections.

Amoxycillin in the treatment of chronic non-tuberculous bronchial infections

A preliminary study of the effect of amoxycillin on advanced chronic bronchial infections, mostly caused by H. influenzae, suggests that this drug has a therapeutic value substantially greater than that of its close relative, ampicillin. Amoxycillin is absorbed approximately twice as efficiently as ampicillin from the bowel, and therefore a dosage regimen of 500 mg amoxycillin 6-hourly was chosen to compare with i g ampicillin 6-hourly. Of 11 patients whose sputum purulence was unchanged by ampicillin, 6 showed loss of pus from the sputum, or almost total disappearance of sputum, when given amoxycillin. There is some evidence that amoxycillin may penetrate the bronchial mucous membrane more easily than ampicillin, and, if this is confirmed, amoxycillin seems likely to prove significantly more effective than ampicillin in bactericidal therapy of chronic respiratory infections.

A Perspective on the Role of Cromolyn Sodium as an Antiasthmatic Agent

The effectiveness of cromolyn sodium versus placebo for the prophylaxis of asthmatic symptoms was studied by using a double-blind-crossover clinical trial in 20 patients with symptomatic asthma. Eleven patients showed significant improvement in maximum voluntary ventilation, dyspnea index, and maximum mid-expiratory flow rate. Asthma uncomplicated by chronic bronchial infection predominated in this group. The average age was 32 years and the mean residual volume/total lung capacity ratio was 32 percent (SD ± 10 percent). Nine patients failed to show significant improvement in the above noted variables and chronic bronchial infection was an important factor in the asthma of all these patients; the average age was 50 years and the mean residual volume/total lung capacity ratio was 54 percent (SD ± 11 percent). Good agreement between subjective assessment and objective pulmonary function measurements was noted in 18 out of 20 cases. Cromolyn sodium appears to be more effective in young asthmatics with a low incidence of bronchial infection and with only mild pulmonary hyperinflation.

Endobronchial Polymyxin B: Experimental Observations in Chronic Bronchitis

Observations in three patients have shown that endobronchial administration of polymyxin B in 10 ml of saline through a transtracheal catheter achieves a wide bronchopulmonary distribution. The antibiotic was well tolerated when administered three times daily in doses of 300 μg to 1.0 mg. Concentrations of the antimicrobial reaching levels of 1.8 to 3.1 μg ml of expectorated sputum were achieved without adverse effects in a patient continuously for seven weeks with 1 mg of polymyxin B. Therapeutic concentrations of the drug in the sputum were maintained as long as 12 hours after endobronchial administration. The effectiveness of this technique in suppressing a chronic life-threatening bronchial infection with Pseudomonas aeruginosa is documented. The endobronchial approach in the treatment of chronic bronchitis is discussed.

Suppressive therapy of chronic bronchial infections.

The studies of long‐term antibiotic therapy reported in the literature are reviewed. The best clinical and bacteriologic results were obtained with 1 to 2 Gm. of tetracycline administered each day. Lesser degrees of improvement were reported when smaller doses were given, when the antibiotic was administered twice a week, or when therapy was given for a portion of the year only. Penicillin therapy was considerably less effective, erythromycin therapy appeared totally ineffective, and oleandomycin‐penicillin therapy was more effective than penicillin but less so than tetracycline.Untoward reactions occurred in all regimens but, prOvided patients reported them promptly, were not serious. Tetracycline‐resistant staphylococci appeared in the sputum of an occasional patient during therapy with that antibiotic but did not cause any complications, except possibly the development of pneumonia in 1 patient.

Anti-antibody in pulmonary tuberculosis and other respiratory diseases

Summary A high incidence (14·1%) of positive anti-antibody titres was found in patients with pulmonary tuberculosis. However, a comparable incidence (14·7%) of positive titres was found in patients with non-tuberculous chronic bronchial infection. It is considered that the test is unlikely to be of value in the differential diagnosis of respiratory disease.

Chronic Bronchial Infection

Chronic Bronchial Infection

Tracheal Diverticulosis

Tracheal diverticula are rarely diagnosed clinically and are usually only discovered at autopsy. Rokitansky¹was one of the first to describe these lesions accurately, and it was his belief that they developed as a result of chronic pulmonary and bronchial infection. He stated that they occurred in the upper part of the right posterior tracheal wall, and that they originated from mucous glands. Chiari,²however, contended that some diverticula were rudimentary bronchi, occurring on the right side of the trachea at the site of tripartition of the bronchial tree. In 1889 he described six autopsies in which tracheal diverticula were present on the lower end of the trachea on the right between the 17th and 22nd tracheal rings. This type of growth always extends obliquely down and outward, the shape being that of a short, cylindrical tube. Ziegler and Kahlden, in 1897,³and Mackenzie, in 1911,⁴

Paradox of bronchiectasis.

Septic bronchiectasis in its commonest development is another penalty imposed on modern man for his evolutionary assumption of an erect posture. The normal bronchus prevents the accumulation of secretions by ciliary action and peristalsis. Loss of these excretory actions in dependent bronchi results in the collection and concentration of secretions, thus providing a perfect environment for the culture of bacilli. Such a mechanical factor can explain a seeming paradox of bronchiectasis: widespread ectasia of bronchi ascendant from the hilum may produce few symptoms, whereas, in a different patient, involvement of a small dependent subsegment may produce such symptoms as toxicity, hemoptysis, harassing cough, and production of purulent sputum. ETIOLOGY There is little proved knowledge of the pathogenesis of bronchiectasis. Mallory1lists five potential etiological factors: chronic bronchial infection; congenital abnormalities of the bronchial tree; bronchostenosis; pneumonitis, or its sequel, pulmonary fibrosis; and pulmonary atelectasis. Anspach2has presented convincing

Treatment of Chronic Bronchial Infections with Antibiotics

Treatment of Chronic Bronchial Infections with Antibiotics

Antibiotic therapy in infections of the respiratory tract.

THE INTENTION of this paper is to appraise the value of antibiotic treatment in chronic bronchial infections. Patients with bronchial asthma and pulmonary emphysema frequently suffer from associated chronic bronchitis. In other cases of chronic bronchitis bronchospasm of slight to moderate extent is often present. Similarly, patients with bronchiectasis at times manifest bronchospasm and variable degrees of pulmonary emphysema. The results of treatment of these clinical entities with penicillin, especially by inhalation, and with aureomycin, terramycin, and chloramphenicol (chloromycetin®) will be presented, as well as a preliminary statement of the use of the diethylaminoethyl ester of penicillin. The use of antibiotic drugs in bronchiectasis has been restricted in some clinics to the treatment of febrile episodes and the preparation of these patients for surgery.1Although the management of chronic infection in bronchopulmonary disease poses complex problems, the use of the antibiotic agents and procedures which are now available results in

Pulmonary Fibrosis: Clinical Aspects

MY CONTRIBUTION to this symposium on pulmonary fibrosis will be short, since my only object is to try to correlate the x-ray, pathological, and clinical findings. I believe that Dr. Mallory2 has made a distinct contribution to our knowledge of pulmonary fibrosis and when we accept his group of cases it changes our previous ideas of classification. From the clinician's standpoint there are now four groups of cases in which varying degrees of pulmonary fibrosis play an important part: first, those with known etiology (tuberculosis, silicosis, and radiation therapy); second, the group with either asthma or emphysema, where the fibrosis seems to be the result of organizing pneumonia; third, Dr. Mallory's cases of fibrosing granulomata; and fourth, a miscellaneous group of unusual conditions. From the standpoint of the practitioner of internal medicine, the group with “senile emphysema” is probably the largest and most important. The age of onset is usually in the fifty's. Acute respiratory infection is often the apparent inciting factor. Dyspnea with exertion is the outstanding symptom, and there are varying degrees of chronic bronchial infection and bronchial spasm. In many of these cases of emphysema, as well as in a large proportion of those with extensive fibrosis, cor pulmonale (right-sided heart failure) plays a definite part, but the severity of symptoms is often independent of the degree of pulmonary fibrosis, and cor pulmonale of alarming proportions may occur in cases with very little scar tissue. Many cases of asthma also fall into this group One of our favorite cases of clinical “idiopathic pulmonary fibrosis” was that of a woman who had had asthma since childhood; from the postmortem standpoint, this was classified as asthma with very extensive organized pneumonia. In reviewing the slides recently Dr. Mallory did not admit it to the group of fibrosing granulomata. In practically all of these cases of asthma and emphysema, such fibrosis as develops seems to be the result of organized pneumonia. The third group is one which in the past we have called “idiopathic pulmonary fibrosis,” but Dr. Mallory has shown that the majority of these cases can be placed in a group of granulomata of the lung which histologically resemble sarcoid disease. For the time being I believe that many cases in which we can safely rule out organized pneumonia should be considered as fibrosing granulomata. This leaves for the fourth group a few miscellaneous unusual cases. We have, for example, cases resembling “fibrosis,” which have proved to be bronchiolectasis, where there is a marked dilatation of the smaller bronchioles with very little dilatation or infection in the larger bronchi. Now let us go back to Dr. Mallory's approach to the problem of “idiopathic pulmonary fibrosis” and his 6 cases of a granulomatous process, histologically similar to sarcoid disease, which have gone on to pulmonary fibrosis with resulting death.

Inhalation Therapy in Chronic Bronchial Infections

SUMMARY 1.A study has been made to determine the efficacy of inhalation therapy in bronchial infection. To rule out spontaneous remission, improvement by medical treatment, and the production of the effect by a blood level of penicillin the following criteria were used in selection of cases: a.There must be definite bronchographic evidence of bronchiectasis. b.There must be a history which is definitely of this type of infection for a long period of time. c.All of the patients should have been previously treated by all other methods of medical treatment including bed rest, postural drainage, sulfonamides by mouth and penicillin by injection. 2.Forty-two patients satisfying these criteria were treated over a period of two years. All of the patients have been followed for at least 1 year. 3.Of the 42 patients there were 19 cases of complete disappearance of symptoms; 14 cases of marked improvement in symptoms and general condition, although some symptoms remained; and 8 cases in which no clinical improvement could be found. Recurrence of symptoms with an entirely new bacterial flora as indication of new infection was the rule rather than the exception. 4.The concentration of penicillin per c.c. in the nebulized solution did not appear to be an important factor per se. The sensitivity of the organism to penicillin was the most important factor in the determination of the result. 5.Inhalation therapy appears to be a definite method of treatment with a definite effect upon bronchial disease. Its efficacy is limited by the effectiveness of the chemotherapeutic agent used. 6.Continued medical supervision and customary means of treatment including postural drainage remains an essential element in the treatment of chronic bronchial infections.

Survey of bronchial asthma in soldiers: Bronchoscopic findings and incidence of respiratory infection

1. 1. A survey of 250 cases of perennial bronchial asthma in soldiers, in whom routine diagnostic studies were supplemented by bronchoscopy, has been presented. 2. 2. Of those cases, 81.4 per cent were medical casualties evacuated from overseas, 84 per cent were under 35 years of age, and 43.8 per cent had asthma of less than five years' duration. 3. 3. Fifty per cent of the patients had chronic suppurative sinusitis. 4. 4. Bronchoscopy revealed bronchial abnormalities in 89.6 per cent of the series. These were differentiated as (1) chronic suppurative bronchitis in 49.2 per cent; (2) chronic nonsuppurative bronchitis in 38.8 per cent; and (3) allergic bronchitis in 1.6 per cent. 5. 5. Chronic bronchial infection was noted in a significant number of young individuals with asthma of relatively short duration. 6. 6. In this series, chronic suppurative infection of the respiratory tract was found in 73.2 per cent of all patients. 7. 7. The significance of this observed incidence of chronic respiratory infection in asthma has been briefly discussed.

ETIOLOGY OF BRONCHIECTASIS

Cases of chronic disease of the lower respiratory tract attended by purulent sputum in large amounts show an overwhelming incidence of chronic sinus infection. In cases of bronchiectasis, both the incidence and the degree of sinus involvement are higher than in any other group of cases. Of the patients with bronchiectasis studied by Kern and me, 1 well over 90 per cent showed roentgen indications and 80 per cent showed clinical evidence of active sinus disease. The average number of sinuses involved per patient is very high, and in most instances there is pansinusitis. Whether the disease is primary or secondary in patients with bronchiectasis usually cannot be determined. While chronic purulent sinusitis may initiate chronic bronchial infection and bronchiectasis, it is equally possible that the constant spraying of the pharyngeal structures by coughed-up sputum carries infection to the nasal chambers. Thus, purulent pansinusitis has been observed to develop in patients

ASTHMA IN CHILDREN TREATED WITH AUTOGENOUS (BRONCHOSCOPIC) VACCINE

Chronic bronchial infection plays an important role in nearly every case of asthma in which involvement is severe enough and has lasted long enough. There is abundant clinical experience that vaccine therapy, whether by a specific or by a nonspecific mechanism, is useful in such cases. An autogenous vaccine has at least some claim to a specific factor, and such specificity is most certain if the culture is obtained directly from the bronchial tree through the bronchoscope. The purpose of this paper is to report the result of therapy in 112 cases in which asthma in children was treated with an autogenous vaccine prepared from material removed through the bronchoscope. The data presented here are the results of a study in which information was sought on the actual conditions in the tracheobronchial tree in asthmatic children. While a number of reports on bronchoscopic findings for adults have appeared, there have