Severe Chronic Bronchitis Research Articles

Low incidence of bronchus-associated lymphoid tissue (BALT) in chronically inflamed human lungs.

The relevance of bronchus-associated lymphoid tissue (BALT) in man is still under discussion. Animal experiments indicate that the development of BALT is dependent on microbial stimulation. Therefore, the incidence of BALT was investigated retrospectively in specimens removed during surgical procedures on patients with chronic pulmonary inflammation. All these patients had severe chronic bronchitis and bronchiectasis, but BALT was found in only 8%. In patients with BALT and a malignant tumor, occlusion of a bronchus with poststenotic pneumonia was always present and BALT was observed exclusively in areas peripheral to the occlusion. In man other compartments of the lung must be responsible for the immune function of BALT found in animals.

Isolation and characterization of a macrophage-derived high molecular weight protein involved in the regulation of mucus-like glycoconjugate secretion

Pulmonary macrophages release a variety of mediators that are involved in inflammatory processes and probably are involved in respiratory mucus secretion. Conditioned media obtained from activated pulmonary macrophages were found to contain a protein that functioned as a secretagogue for mucus-like glycoconjugate (MLGC) in an in vitro bioassay. A human macrophage-derived hybridoma cell line, HB-63, exhibited the same properties and was very useful in obtaining large amounts of the protein for purification and characterization. With ultrafiltration membranes and gel electrophoresis, the protein isolated from the conditioned media of zymosan- or lipopolysaccharide-treated cells was found to have a molecular weight of approximately 68 kd. The purified protein obtained from hybridoma cells and from pulmonary macrophages exhibited strong biologic activity when it was used to stimulate MLGC secretion, both in human airway explants and in an in vitro human secretory epithelial cancer cell line. The proteins from both sources were found to have similar amino acid compositions. Preliminary results indicate the presence of the 68 kd protein in the bronchoalveolar lavage fluid of a patient with severe chronic bronchitis and mucus hypersecretion. The role of this novel protein in the lungs is, so far, speculative. The 68 kd protein may be a useful tool for studying the biosynthesis and regulation of MLGC secretion and hypersecretion.

Treatment of severe chronic bronchitis with ceftazidime

The aim of this study was to determine whether ceftazidime is more effective than other antibiotics in the treatment of severe acute exacerbation of chronic bronchitis, particularly when other antibiotics have previously failed. Our investigations showed that ceftazidime is effective and well tolerated in patients with severe chronic bronchitis and purulent sputum. The effectiveness of ceftazidime was seen in a reduction of the volume of sputum produced daily and in a colour change from yellow-green to clear-white. The absence of an effect on parameters of lung function was not unexpected since our patients had long-lasting chronic bronchitis.

Prediction of Pulmonary Arterial Pressure in Chronic Obstructive Pulmonary Disease by Radionuclide Ventriculography

Pulmonary arterial hypertension represents an important parameter for the assessment of the severity of chronic bronchitis. The measurement of the pulmonary arterial pressure, however, requires invasive techniques of limited routine use because of costs and associated risks. The aim of this study is to evaluate whether the 81mKr right ventricular ejection fraction and parameters derived from equilibrium 99mTc red blood cells' right ventricular curve allow a better estimation of PAP than the 99mTc RVEF. In 41 patients with severe chronic bronchitis, the linear correlation between PAP and 99mTc RVEF was -0.61 (p less than 0.001). None of the parameters derived from the right ventricular curve was better correlated to PAP than the 99mTc RVEF. In 16 other chronic bronchitis patients, the 81mKr RVEF correlated moderately to PAP. In conclusion, the alternative isotopic methods proposed in this work do not provide a reliable estimation of pulmonary arterial pressure in patients with chronic bronchitis.

Increased bronchial chloride concentration in cystic fibrosis

Ten patients with cystic fibrosis (CF) and 10 patients with severe chronic bronchitis were analysed for bronchial electrolyte composition. Samples aspirated from the left main bronchus by a fibre-optic bronchoscope were dissolved in an iso-osmolar solution of N-acetylcysteine, and separated from cells and bacteria by gentle centrifugation. The concentrations of potassium and calcium were measured by flame emission and atomic absorption spectrometry, and found to be similar in both groups of patients. The mean concentration of chloride, measured by coulometric titration, was significantly higher in patients with CF than in patients with chronic bronchitis (170 vs. 85 mmol l-1, p less than 0.01). The findings are consistent with a functional abnormality of the chloride channels of the airway epithelium in patients with CF.

Multibloc laryngotrachéal pour biopsie de la base de langue et des sinus piriformes lors d'une laryngoscopie

Most laryngoscopies with diagnostic biopsies are usually carried out under general anaesthesia. Multiple laryngotracheal blocks were used in the patient reported ; this 55 year old man presented with cachexia and a history of severe angina, myocardial infarction, arterial hypertension and chronic bronchitis. The different nerve blocks were carried out with a total of 2 mg · kg−1 lignocaine : the superior laryngeal nerve trunk, the internal laryngeal nerve, the trachea (by an intratracheal injection) and the tongue (using a lignocaine gel). The whole procedure was well tolerated by the patient. The advantages and disadvantages of this technique are discussed.

Decreased Theophylline Clearance in a Patient with Severe Hypothyroidism

The effect of thyroid function on the liver's ability to metabolize various therapeutic agents is well documented, but evidence that changes in thyroid function affect the rate at which theophylline is metabolized is limited. We report a case of a 55-year-old woman with severe hypothyroidism and chronic bronchitis whose theophylline clearance doubled from 0.50 to 1.02 ml/min/kg with aggressive inpatient intravenous levothyroxine treatment. Chronic outpatient data showed that theophylline clearance remained relatively constant as thyroid function stabilized. This case is further evidence that thyroid function indeed has an effect on theophylline metabolism.

Efficacy of imipenem/cilastatin in patients with severe bacterial infections

In this study imipenem/cilastatin was used successfully to treat 21 patients with a variety of severe infections caused by Gram-positive and Gram-negative aerobic bacteria. Overall clinical cure was achieved in 18 of 21 patients. Fourteen of 16 infecting organisms were eradicated by imipenem. In spite of in-vitro susceptibility to imipenem before therapy two species of Pseudomonas (Pseudomonas aeruginosa and Ps. fluorescens) could not be eliminated in two patients. Resistance developed in the strain of Ps. aeruginosa during treatment of a patient with pneumonia for eight days. The pneumonia was considered to be clinically cured. The strain of Ps. fluorescens became resistant during therapy in a patient suffering from an acute exacerbation of severe chronic bronchitis in whom the antibiotic treatment had failed. Imipenem/cilastatin proved to be highly effective and well tolerated in this group of patients.

Carotid blood flow measured by an ultrasonic volume flowmeter in carotid stenosis and patients with dementia.

The volume flowmeter is a simple, noninvasive Doppler ultrasound technique that provides accurate measurement of carotid artery diameter and flow. The device provides a useful laboratory test that can aid significantly in diagnosis of carotid stenosis and dementia.

Nocturnal cough in patients with chronic bronchitis and emphysema.

Patients with respiratory disease commonly report that their sleep is disrupted by nocturnal cough. We have recorded cough during the night in 10 patients with severe chronic bronchitis and emphysema (forced expiratory volume in one second, 1.0 +/- SEM 0.1/L) who complained of nocturnal cough and correlated cough with electroencephalographic sleep stage and arterial oxygenation. Cough was recorded using a directional microphone and an auto-editing tape recorder system. Each cough was subsequently verified by a listener. There was a mean of 14.6 +/- 4.5 bouts of coughing per patient per night, each bout lasting on average 3.9 +/- 0.2 s. Eighty-five percent of coughing bouts occurred during electroencephalographically confirmed wakefulness (p less than 0.02 versus sleep), and coughs during true sleep were rare, with only 1 patient coughing during rapid eye movement sleep and none during Stages 3 and 4 sleep. Cough was only once followed by arousal. There was no correlation between cough and either apneas or hypoxemia during sleep. We conclude that spontaneous cough is suppressed during sleep and only rarely awakens patients.

Cor pulmonale in asthma

The development of right ventricular failure due to pulmonary hypertension is a common complication of severe chronic bronchitis and emphysema (Renzetti et al. 1976) but is rare in bronchial asthma (Clark 1977). We report a 20-year-old extrinsic asthmatic with persistent hypoxaemia and carbon dioxide retention, secondary polycythaemia and cor pulmonale and describe his further investigation.

Cor pulmonale in asthma

The development of right ventricular failure due to pulmonary hypertension is a common complication of severe chronic bronchitis and emphysema (Renzetti et al. 1976) but is rare in bronchial asthma (Clark 1977). We report a 20-year-old extrinsic asthmatic with persistent hypoxaemia and carbon dioxide retention, secondary polycythaemia and cor pulmonale and describe his further investigation.

Night Sleep of Patients with Chronic Ventilatory Failure and Age Matched Controls: Number and Duration of the EEG Episodes of Intervening Wakefulness and Drowsiness

Characteristics of the episodes of wakefulness and drowsiness (stage 0 + 1) intervening in a night of electrophysiologically monitored sleep were compared in a homogeneous group of 13 patients (mean age 57 years) with severe hypoxic chronic bronchitis and emphysema (blue and bloated variety) and 8 age matched control subjects. The total amounts of stage 0 + 1 accumulated over one night (preceded by one night of adaptation) were high in both groups (28% in the patients, 22% in the control subjects). A significant difference was found in the number of brief arousals (episodes of stage 0 + 1 lasting for less than 1 min), which averaged 10/h of sleep in the patients, and 6/h of sleep in the control subjects (p less than 0.05, two tailed). The numbers of longer episodes of stage 0 + 1 were not significantly different and varied independently from the numbers of brief arousals in the individuals. Only a small proportion (8 %) of brief arousals was linked to episodes of hypopnea or apnea in the bronchitic patients. Large numbers of brief arousals/h of non rapid eye movement sleep inthe bronchitic patients correlated significantly with small percentages of stage 3 + 4 sleep (p less than 0.05), and were associated with smell numbers of hypoxemic episodes occurring predominantly in rapid eye movement sleep. The findings indicate a more fractionated sleep in the patients with chronic hypoxic bronchitis, and suggest that the brief arousals represent a limiting factor rather than a result of the nocturnal hypoxemic episodes occurring in these patients.

The renal glomerulus in hypoxic cor pulmonale.

We measured the mean capillary tuft area by a custom-built semi-automatic technique in postmortem sections from the kidneys of 16 patients with "blue and bloated" chronic bronchitis and emphysema and in seven patients of similar age who were free of respiratory and renal disease at death. Nine bronchitic patients had received domiciliary oxygen treatment while seven had not. The mean glomerular tuft area in these treated bronchitic patients (14 200 microns2) was not significantly different from that of the untreated patients (16 900 microns2) but the tuft area in the bronchitic subjects was significantly larger than that of the non-bronchitic controls (12 100 microns2, p less than 0 . 02). There was no reduction in glomerular cellularity to suggest passive venous distension, and glomerular size was not correlated with clinical or pathological indices of cor pulmonale (including red cell mass). The arterial oxygen tension (Po2), however, was correlated with glomerular size (r = 0 . 68, p less than 0 . 01) if allowance was made for the higher Po2 of the patients receiving oxygen. The percentage of glomeruli with an identifiable juxtaglomerular apparatus also increased with increasing glomerular size. These structural changes in the kidneys of patients with severe chronic bronchitis and emphysema may reflect changes in renal salt and water handling that are potentially reversible by oxygen treatment.

The influence of theophylline on maximal response to salbutamol in severe chronic obstructive pulmonary disease.

We have previously shown that inhaled salbutamol further increases the bronchodilator response after the maximum effect of theophylline has been obtained in patients with severe chronic bronchitis. We now report the results of adding maximally effective doses of theophylline to the maximum response obtainable from salbutamol in ten of these patients. We constructed dose response curves to ensure maximum possible effect from salbutamol. Response plateaus (in nine out of ten patients) were achieved with cumulative doses of between 200 micrograms and 3,000 micrograms salbutamol and there was a significant response (p less than 0.05) in every subject: the mean FVC response was 1.11 (ranging from 0.5 to 1.81) and the mean FEV1 response was 0.41 (ranging from 0.1 to 0.81). Theophylline, in their previously determined maximally effective doses, produced statistically significant (p less than 0.05) small further increases in both FVC (0.2 to 0.61) and FEV (0.1 to 0.61) in four patients only. The other six did not respond. In patients classified as chronic bronchitics there is clearly a wide variation in response to bronchodilators and a surprising degree of reversibility can be achieved. But because of this variation in response, conventional drug doses may be too small in some cases. Ideally, each bronchodilator should be prescribed after some form of individual dose response studies. Although this acute study shows little or no benefit in the height of the bronchodilator response the usefulness of this combination can only really be decided after similar studies including the duration of effect in long term administration.

Carbon monoxide and exercise tolerance in chronic bronchitis and emphysema.

The effects of carbon monoxide on exercise tolerance as assessed by the distance walked in 12 minutes were studied in 15 patients with severe chronic bronchitis and emphysema (mean forced expiratory volume in one second 0.56 1, mean forced vital capacity 1.54 1). Each subject walked breathing air and oxygen before and after exposure to sufficient carbon monoxide to raise their venous carboxyhaemoglobin concentration by 9%. There was a significant reduction in the walking distance when the patients breathed air after exposure to carbon monoxide (p less than 0.01), and the significant increase in walking distance seen after exercise when breathing oxygen at 2 1/minute via nasal cannulae was abolished if carbon monoxide has previously been administered. Thus concentrations of carboxyhaemoglobin frequently found in bronchitic patients who smoke may reduce their tolerance of everyday exercise, possibly by interfering with the transport of oxygen to exercising muscles.

Low frequency breathing at rest and during exercise in severe chronic obstructive bronchitis.

The effect of low frequency breathing compared with spontaneous breathing was examined at rest and during exercise (40 watts) in 12 patients suffering from severe chronic obstructive bronchitis. At rest low frequency breathing improved significantly the alveolar ventilation and the tensions of oxygen and carbon dioxide in the arterial blood. There was no significant change in ventilation minute volume. During exercise low frequency breathing significantly decreased ventilation minute volume, and there was no significant improvement in gas exchange. The decrease in ventilation during low frequency breathing at 40 watts compared with spontaneous breathing at the same lung volume was due to expiratory flow limitation. The findings suggest that this technique may impair exercise tolerance in patients with severe chronic obstructive bronchitis.

A new permanent tracheostomy tube – speech valve system

A permanent tracheostoma is often necessary in patients with respiratory diseases such as severe bronchial asthma or chronic bronchitis in order to reduce dead space. Another group of patients who require a permanent tracheostoma are those with laryngeal stenosis or bilateral vocal cord pareses whose general condition makes them unsuitable candidates for more advanced surgical procedures. This has usually been achieved by a conventional tracheostomy tube which, however, carries many problems; the ability to cough is greatly reduced when a sufficient intra-abdominal pressure cannot be acquired, speech is impaired, the tube has to be changed regularly, it must be fixed by bands around the neck, etc. These problems can be significantly reduced by using a short, straight tube placed in the stoma and kept securely in position by an outer flange and four flaps on the tracheal side. To this tube is attached a special two-way valve adjustable for either inspiration and expiration or for inspiration only in which case it also serves as a speech valve. Up to now this construction has been used in 16 patients with excellent results, one patient has had this device continuously since 1970 without any complications.

Bronchodilatation and the site of airway resistance in severe chronic bronchitis.

Twenty-one patients with severe chronic bronchitis and emphysema (FEV1 less than 1 1) inhaled 80 microgram of the atropine-like agent ipratropium or placebo in a double-blind study and three hours later inhaled 200 microgram salbutamol. After 80 microgram ipratropium, mean FEV1 was significantly greater than after 200 microgram salbutamol (P less than 0.025), but the difference was only 40 ml and the clinical significance of this difference is unproved. There was no correlation between the patient's response to ipratropium and the response to salbutamol. When salbutamol was administered three hours after ipratropium, the FEV1 rose to higher levels than after either agent alone (P less than 0.01). Studies breathing 80% helium/20% oxygen suggest that ipratropium dilates both large and small airways. There was no correlation between the response to helium/oxygen and the response to either bronchodilator. The results suggest that in severe chronic bronchitis and emphysema ipratropium is at least as effective as salbutamol, and that such patients should have reversibility studies with salbutamol alone, ipratropium alone, and after both agents together. The combination of ipratropium and salbutamol may be clinically useful.

Pulmonary blood volume in chronic bronchitis.

1. Pulmonary blood volume was measured in 39 patients with severe chronic bronchitis, of whom 29 had recently recovered from an acute exacerbation. Pa,o2 was below 10·3 kPa in all but five patients, Pa,co2 was above 5·6 kPa in 26 cases, and pulmonary artery mean pressure was above 20 mmHg in 29 cases. Pulmonary blood volume was measured with the double-injection—single-sampling technique using Indocyanine Green and pulmonary wedge injection. 2. Pulmonary blood volume in the 39 patients was significantly lower (343 ± 95 ml) than in a group of 16 normal subjects (469 ± 117 ml) studied previously by the same method. There was no correlation between pulmonary blood volume and driving pressure across the pulmonary circulation, or between pulmonary blood volume and Pa,o2. 3. Breathing 26–29% oxygen in 19 patients caused no significant changes in either pulmonary blood volume or pulmonary vascular resistance. Therefore the reduced pulmonary blood volume could not be attributed to hypoxic pulmonary vasoconstriction. 4. The finding of a diminished pulmonary blood volume in chronic bronchitis is best explained by a loss of pulmonary vessels. Pulmonary blood volume was not correlated with total lung capacity nor with the residual volume/total lung capacity ratio, nor was it significantly higher in the 16 patients with normal total lung capacity (352 ± 73 ml) than in the 23 patients with a total lung capacity greater than 110% of normal (331 ± 110 ml). There was therefore no correlation between the amount of emphysema and the reduction in pulmonary blood volume.