Chronic Productive Cough Research Articles

No change in prevalence of symptoms of COPD between 1996 and 2006 in Finnish adults – a report from the FinEsS Helsinki Study

BackgroundThe age-dependent increase of chronic obstructive pulmonary disease (COPD) prevalence caused by smoking and other inhalational exposures in the general population is well-known worldwide. However, time trends are poorly known, due to lower number of high-quality studies especially following nationwide efforts on diminishing exposure levels. This study aimed to compare the prevalence of COPD symptoms and their major determinants in Finnish adults in 1996 and 2006.MethodsTwo identical postal surveys were conducted among two random population samples from Helsinki using identical methodologies in 1996 and 2006, with 6,062 (76%) and 2,449 (62%) participants, respectively.ResultsThe physician-diagnoses of COPD remained at 3.7%, whereas physician-diagnoses of asthma and use of asthma medicines increased in both genders. Current smoking reduced from 33.4 to 27.3% (p<0.001), and the amount of cigarettes smoked also reduced significantly. The crude prevalence of chronic productive cough was 12.1 and 11.1%, wheezing with dyspnoea without a cold (wheezing triad) 7.3 and 7.7%, and dyspnoea grade II 13.8 and 13.6%, in 1996 and 2006, respectively. Among subjects with physician-diagnosed COPD, the prevalences of chronic productive cough and recurrent wheeze reduced significantly, from 60.6 to 40.7% and 53.5 to 38.5%, respectively.ConclusionFrom 1996 to 2006, the prevalence of obstructive airway symptoms common in different phenotypes of COPD did not increase in Finnish adults. This suggests that the upward trend of COPD prevalence might have reached a plateau. Current smoking and the quantities smoked diminished suggesting a wider impact of stronger legislation and smoking-cessation efforts during the Finnish National Programme for COPD.

Endobronchial Lipoma in a Never-Smoker

Endobronchial lipomas, usually found in the obese and in smokers, can cause patients significant distress with chronic cough, chest pain, dyspnea, and increased infection risk. Here we present a case of a 61 year-old obese, never-smoker gentleman who initially presented with chronic productive cough, hemoptysis, chills and night sweats; and was later found to have a right upper lobe lung parenchymal lesion. Biopsy demonstrated a picture consistent with obstructive endobronchial lipoma.

Prevalence of airflow obstruction according GOLD, ATS and ERS criteria in symptomatic ever-smokers referring to a Pulmonary Rehabilitation Department

To evaluate in a Pulmonary Rehabilitation (PR) setting the prevalence of airflow obstruction (AO) in either current or former smokers > or = 45 years old both with dyspnoea and with chronic productive cough, using European Respiratory society (ERS) statement (FEV1/SVC < 88 and < 89% predicted in men and women, respectively), American Thoracic Society (ATS) statement (FEV1/FVC < 75%), and Global Initiative for Chronic Obstructive Lung Disease (GOLD) statement (FEV1/FVC < 70%). Lung function tests were performed in each patient who was referred to our PR department due to respiratory diagnosis or symptoms. For analysis, in patients showing AO we used post-bronchodilator lung function values. In 184 ever-smoker patients with symptoms of chronic obstructive pulmonary disease (COPD), the prevalence rates of AO were as follows: ERS = 89.7%, ATS = 76.6%, and GOLD = 63.6%. Patients with AO according ERS criteria showing moderate to severe (M/S) obstruction (i.e., FEV1 < 70% predicted) were 119. Patients with ERS M/S AO but without AO using either ATS or GOLD criteria were 8.4% and 19.3%, respectively. Prevalence of AO is highly dependent on which guidelines it is based. ATS and particularly GOLD statement can cause a large under-diagnosis even of moderate to severe COPD. Diagnosis of COPD may be overlooked if SVC is not performed.

Protracted bacterial bronchitis: The last decade and the road ahead.

SummaryCough is the single most common reason for primary care physician visits and, when chronic, a frequent indication for specialist referrals. In children, a chronic cough (>4 weeks) is associated with increased morbidity and reduced quality of life. One common cause of childhood chronic cough is protracted bacterial bronchitis (PBB), especially in children aged <6 years. PBB is characterized by a chronic wet or productive cough without signs of an alternative cause and responds to 2 weeks of appropriate antibiotics, such as amoxicillin‐clavulanate. Most children with PBB are unable to expectorate sputum. If bronchoscopy and bronchoalveolar lavage are performed, evidence of bronchitis and purulent endobronchial secretions are seen. Bronchoalveolar lavage specimens typically reveal marked neutrophil infiltration and culture large numbers of respiratory bacterial pathogens, especially Haemophilus influenzae. Although regarded as having a good prognosis, recurrences are common and if these are frequent or do not respond to antibiotic treatments of up to 4‐weeks duration, the child should be investigated for other causes of chronic wet cough, such as bronchiectasis. The contribution of airway malacia and pathobiologic mechanisms of PBB remain uncertain and, other than reduced alveolar phagocytosis, evidence of systemic, or local immune deficiency is lacking. Instead, pulmonary defenses show activated innate immunity and increased gene expression of the interleukin‐1β signalling pathway. Whether these changes in local inflammatory responses are cause or effect remains to be determined. It is likely that PBB and bronchiectasis are at the opposite ends of the same disease spectrum, so children with chronic wet cough require close monitoring. Pediatr Pulmonol. 2016;51:225–242. © 2015 Wiley Periodicals, Inc.

Self-reported symptoms of chronic cough and breathlessness in working-age men in the city of Izhevsk, Russia: associations with cardiovascular disease risk factors and comorbidities

IntroductionVery little is known about the prevalence of respiratory symptoms or their associations with other health conditions in Russia.MethodsBetween 2008 and 2010, a sample of 983 men resident in Izhevsk,...

Children with chronic wet or productive cough – treatment and investigations

Children with chronic wet or productive cough – treatment and investigations

Effects of different antibiotic classes on airway bacteria in stable COPD using culture and molecular techniques: a randomised controlled trial

BackgroundLong-term antibiotic therapy is used to prevent exacerbations of COPD but there is uncertainty over whether this reduces airway bacteria. The optimum antibiotic choice remains unknown. We conducted an exploratory...

Interventions for bronchiectasis: an overview of Cochrane systematic reviews.

Interventions for bronchiectasis: an overview of Cochrane systematic reviews.

Toxicidad pulmonar crónica por nitrofurantoína

Nitrofurantoin is an antibacterial agent used in the management of urinary tract infections. It can rarely induce acute or chronic pulmonary toxicity and generate an interstitial pneumonitis which can turn into fibrosis, besides originating hepatic toxicity and other conditions.Chronic toxicity has a variable clinical expression, and its radiologic presentation forces to carry out a comprehensive differential diagnosis of interstitial lung conditions. The first measure would be the drug withdrawal, which usually ensures favourable evolution without supporting therapeutic measures.We present the case of a 69 year-old woman who consulted for chronic productive cough and lung sounds, with a history of recurrent cystitis treated with nitrofurantoin. The CT scan showed localized infiltrates together with interstitial lung disease with septal thickening and traction bronchiectasis. Hepatic toxicity data were also found.After drug withdrawal patient evolved favourably without the need for steroid treatment.

Airway clearance strategies in cystic fibrosis and non-cystic fibrosis bronchiectasis.

Many patients with cystic fibrosis (CF) and non-CF bronchiectasis present with common symptoms in clinical domains that appear to benefit from airway clearance strategies. These symptoms include chronic productive cough, retention of excessive, purulent mucus in dilated airways, impairment of normal mucociliary clearance (MCC), atelectasis, breathlessness, fatigue, respiratory inflammation, fever, infection, and airflow obstruction. Airway clearance strategies may involve singular and focused interventions for the purpose of removing secretions and improving lung recruitment and gas exchange in patients with atelectasis. Strategies may also involve indirect or adjunctive interventions that facilitate or enhance effective airway clearance at different ages or stages of the disease process, for example, inhalation therapy, exercise, oxygen therapy, or noninvasive ventilation. The aim is to optimize care by selecting any one or combination of these in responding intelligently and sensitively to individual and changing patient requirements during their lifetime. Currently, a solid evidence base does not exist for airway clearance strategies in CF and non-CF bronchiectasis, and much of airway clearance clinical practice remains in the domain of clinical expertise. The paucity of evidence is partly explained by the relatively immature research machinery in allied health care internationally but is also partly to do with inadequate or inappropriate research designs. This article aims to provide an overview of the nature of, and physiological basis for, the direct and indirect airway clearance strategies in CF and non-CF bronchiectasis with reference to the best available evidence.

A Case of Significant Endobronchial Injury due to Recurrent Iron Pill Aspiration.

Gastric mucosal damage by iron pills is often reported. However, iron pill aspiration is uncommon. Oxidation of the impacted iron pill causes bronchial mucosal damage that progresses to chronic bronchial inflammation, necrosis, endobronchial stenosis and rarely, perforation. We reported a case of a 92-year-old woman with chronic productive cough and significant left-sided atelectasis. Bronchoscopy revealed substantial luminal narrowing with exudative inflammation of the left main bronchus. Bronchial washing cytology showed necroinflammatory exudate and a small amount of brown material. Mucosal biopsy showed diffuse brown pigments indicative of ferrous pigments, crystal deposition, and marked tissue degeneration. After vigorous coughing, she expectorated dark sediments and her symptoms and radiological abnormalities improved. There are a few such reports worldwide; however, this was the first case reported in Korea. Careful observation of aspiration-prone patients and early detection of iron pill aspiration may prevent iron pill-induced bronchial injury.

Serious Complications after Self-expandable Metallic Stent Insertion in a Patient with Malignant Lymphoma.

An 18-year-old woman was evaluated for a chronic productive cough and dyspnea. She was subsequently diagnosed with mediastinal non-Hodgkin lymphoma (NHL). A covered self-expandable metallic stent (SEMS) was implanted to relieve narrowing in for both main bronchi. The NHL went into complete remission after six chemotherapy cycles, but atelectasis developed in the left lower lobe 18 months after SEMS insertion. The left main bronchus was completely occluded by granulation tissue. However, the right main bronchus and intermedius bronchus were patent. Granulation tissue was observed adjacent to the SEMS. The granulation tissue and the SEMS were excised, and a silicone stent was successfully implanted using a rigid bronchoscope. SEMS is advantageous owing to its easy implantation, but there are considerable potential complications such as severe reactive granulation, stent rupture, and ventilation failure in serious cases. Therefore, SEMS should be avoided whenever possible in patients with benign airway disease. This case highlights that SEMS implantation should be avoided even in malignant airway obstruction cases if the underlying malignancy is curable.

Double Aortic Arch in Adolescence: A Case Report

Introduction: Double aortic arch (DAA) is the most frequently encountered vascular ring malformation characterized by a complete encirclement of the trachea and esophagus by the aortic arch with a wide clinical spectrum. Objective: The aim of this study is to describe a case of DAA in adolesecents. Case Presentation: An 11-year-old boy was admitted for chronic productive cough which initially was diagnosed with pulmonary arterial hypertension. The final diagnosis was DAA which was established after chest computed tomography (CT) scan. Conclusion: Establishing a diagnosis of DAA in adolescents requires thorough understanding and clinical skills in performing diagnostic steps. The management of heart failure symptoms and other comorbidities is essential while preparing for its definite therapy.

Tuberculin skin test positivity without tuberculosis contact: A major challenge in childhood.

Worldwide, tuberculin skin tests (TSTs) commonly give false positive results for those who had been given the Bacillus-Calmette-Guerin vaccine such as is routinely administered in Turkey. This study aimed to evaluate the patients referred to us who had positive TSTs despite lack of tuberculosis (TB) disease contacts. Between September 2011 and September 2012, 183 patients were prospectively evaluated for differential diagnosis of TST positivity despite lack of TB disease contact. They were then followed up by us to determine an accurate diagnosis. Among our patients' most common symptoms indicating a need for TST were chronic cough, productive cough or sputum expectoration, and recurrent or persistent wheezing. Chest x-rays were taken of all patients, and the findings were noted. Interferon gamma release assays were performed on 75% of the patients, of which 96% were negative for TB. The most common final diagnoses were asthma (44%), allergic rhinitis (13%), bronchopneumonia (11%) and reactive lymphadenitis (6.5%). Further evaluations for TB were required of 36 patients, and TB disease was established in 12 of them (6.5%). In patients who had had no known TB contact, the most common symptom indicating need for TST was chronic cough; the most common diagnoses were asthma and allergic rhinitis. Cavitary lesions, haemoptysis, persistent infiltration, pleural effusion and thoracic lymphadenopathy despite antibiotherapy should alert physicians to the possibility of TB.

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.

Evaluation of Spirometric Testing as a Routine Preoperative Assessment in Patients Undergoing Bariatric Surgery

The value of spirometry as a routine preoperative test for bariatric surgery is debatable. The aim of this study was to assess the relationship between spirometry results and the frequency of postoperative pulmonary complications in 602 obese patients. Clinical files of patients undergoing bariatric surgery between 2004 and 2013 were reviewed. Demography, risk factors, respiratory symptoms, and spirometry results (forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), FEV1/FVC) were recorded, and their relationship with postoperative pulmonary complications was evaluated. There were 256 males and 346 females with a mean age of 40.2 ± 11.6 years and a mean BMI of 42.1 ± 6.4 kg/m2. History of smoking was found in 408 patients (68 %). Preoperative respiratory symptoms were present in 328 (54.5 %). Most frequent symptoms were snoring (288), dyspnea (119), bronchospasm [6], and chronic productive cough [6]. In 153 patients, history of respiratory disease was documented. The obstructive sleep apnea syndrome (OSAS) was present in 124, 20 requiring continuous positive airway pressure (CPAP). Asthma was present in 27 and chronic obstructive pulmonary disease (COPD) in 2. Variables associated to a higher risk of pulmonary complications were OSAS (OR 2.3), an abnormal spirometry (OR 2.6), male gender (OR 1.9), and preoperative respiratory symptoms (OR 1.9). Using multivariate logistic regression, an abnormal spirometry was a significant predictor of postoperative pulmonary complications in patients with respiratory symptoms and/or OSAS. However, it lost prognostic significance when both conditions were subtracted. In obese patients undergoing bariatric surgery, abnormal preoperative spirometry predicts postoperative respiratory complications only in patients with OSAS.

Children with chronic suppurative lung disease have a reduced capacity to synthesize interferon-gamma in vitro in response to non-typeable Haemophilus influenzae.

Chronic suppurative lung disease (CSLD) is characterized by the presence of a chronic wet or productive cough and recurrent lower respiratory infections. The aim of this study was to identify features of innate, cell-mediated and humoral immunity that may increase susceptibility to respiratory infections in children with CSLD. Because non-typeable Haemophilus influenzae (NTHi) is commonly isolated from the airways in CSLD, we examined immune responses to this organism in 80 age-stratified children with CSLD and compared their responses with 51 healthy control children. Cytokines involved in the generation and control of inflammation (IFN-γ, IL-13, IL-5, IL-10 at 72 hours and TNFα, IL-6, IL-10 at 24 hours) were measured in peripheral blood mononuclear cells challenged in vitro with live NTHi. We also measured circulating IgG subclass antibodies (IgG1 and IgG4) to two H. influenzae outer membrane proteins, P4 and P6. The most notable finding was that PBMC from children with CSLD produced significantly less IFN-γ in response to NTHi than healthy control children whereas mitogen-induced IFN-γ production was similar in both groups. Overall there were minor differences in innate and humoral immune responses between CSLD and control children. This study demonstrates that children with chronic suppurative lung disease have an altered systemic cell-mediated immune response to NTHi in vitro. This deficient IFN-γ response may contribute to increased susceptibility to NTHi infections and the pathogenesis of CSLD in children.

A case of chronic necrotizing bronchopulmonary aspergillosis presenting with hemoptysis and a pulmonary mass mimicking lung cancer

Chronic necrotizing pulmonary aspergillosis usually affects the immunocompromised patients with abnormal pulmonary defense mechanisms. Herein, we report a 62-year-old man admitted to our clinic with the complaint of chronic productive cough, hemoptysis and history of recurrent lower respiratory tract infections in last one year. Computed tomographic scan revealed an irregularly shaped mass in the right middle lobe. Fiberoptic bronhoscopy demonstrated the hemorrhage and stenosis in the middle lobe bronchus. Cytologic examinations of bronchoscopic samples demonstrated the hyphae of Aspergillus. An urgent thoracotomy, right middle lobectomy and sleeve resection of posterior segment of upper lobe were performed due to massive hemoptysis and the final diagnosis was local invasive and necrotizing aspergillosis. Keywords: Bronchopulmonary; Aspergillosis; Hemoptysis

Incidence of chronic bronchitis: a prospective study in a large general population.

A county in western Sweden. To prospectively investigate the incidence rate of chronic bronchitis (CB) in relation to smoking, age, sex, atopy and asthma in a large sample of the general population. Subjects from a county in western Sweden born between 1943 and 1973, who had participated in our previous study in 1993, were mailed a new questionnaire in 2003. Altogether 11 463 (72%) answered the questionnaire, which comprised items about smoking, atopy, respiratory symptoms and age at onset of CB symptoms. CB was defined as chronic productive cough for at least 3 months per year for 2 consecutive years. There were 98 new cases of CB during 1993-2003 in the study population aged 30-60 years at follow-up. The incidence rate was 0.9/1000 person-years (py); there was no significant difference between women and men or different age groups. However, CB incidence was higher in women in relation to smoking (incidence rate ratio 3.6, 95%CI 1.9-7.3) and in those with ever asthma (hazard ratio 5.6, 95%CI 3.5-9.0). This prospective general population-based study shows an incidence rate of CB of 0.9/1000 py. Smoking and asthma were both associated with an increased risk of CB.

Toxicity of inorganic vanadium compounds

Vanadium causes a variety of toxic effects such as hematological and biochemical changes, e.g., hemolysis and decrease in erythrocyte count/hemoglobin level/hematocrit index, neurobehavioral injury, i.e. general activity and learning, and abnormalities in development and reproduction, e.g., ,embryotoxicity, teratogenicity, or morphological and functional lesions in liver, kidneys, bones, spleen and leukocytes. Inhalation of vanadium may cause rhinitis, pharyngitis, chronic productive cough, tracheobronchitis, and bronchopneumonia. Moreover, the most often observed side effects include loss of appetite and significant reduction of body weight, often leading to anorexia, weakness, and nose bleeding, vomiting, diarrhoea, dehydration, pulmonary hemorrhage, or death.