Severe Chronic Bronchitis Research Articles

Distribution of plasma cells and other cells containing immunoglobulin in the respiratory tract in chronic bronchitis.

<b>Soutar, C. A. (1977).</b><i>Thorax</i>, <b>32,</b> 387-396. <b>Distribution of plasma cells and other cells containing immunoglobulin in the respiratory tract in chronic bronchitis</b> A study of the distribution of cells containing immunoglobulin in the respiratory tract in chronic bronchitis has been carried out on necropsy tissues from six subjects who died from complications of severe chronic obstructive bronchitis and five subjects with `incidental9 chronic bronchitis who died from unrelated disease. The results have been compared with previous reported findings in normal subjects. There was a deficiency of IgA cells in all six subjects with fatal chronic bronchitis when compared with normal subjects. The IgA cell counts in the subjects with `incidental9 chronic bronchitis corresponded to normal values for healthy non-smokers and did not share the increased cell counts in lower lobe bronchus occurring in healthy smokers. This work suggests that subjects who die from chronic obstructive bronchitis are deficient in plasma and other cells containing IgA in the respiratory tract, and that subjects with `incidental9 chronic bronchitis are normal in this respect. A preliminary study in which local bronchial secretion of IgA was estimated in the sputum of patients with severe chronic obstructive bronchitis showed that bronchial IgA secretion appeared to be low during acute infections in five out of 14 patients. This finding is consistent with the hypothesis that bronchial IgA secretion is impaired in a proportion of patients with severe chronic bronchitis.

Long-term domiciliary oxygen therapy in cor pulmonale complicating chronic bronchitis and emphysema.

Ten patients with cor pulmonale complicating severe chronic bronchitis and emphysema have been treated with 2 litres/min of oxygen for prolonged periods in the day, at home, over 12 to 62 months. Two patients died after 12 and 36 months of treatment. Pulmonary arterial pressure was reduced in seven patients, and red cell mass in eight, when the oxygen was given for over 15 hours in the day. Hospital inpatient treatment was greatly reduced following the start of long-term oxygen treatment in all patients. This treatment is expensive, and a controlled trial is necessary to establish its definitive place and cost-effectiveness, but the results of such a current Medical Research Council trial will not be available for a further two years.

Response to a respiratory stimulant (doxapram) in severe respiratory failure

Four patients with exacerbations of severe chronic bronchitis developed severe carbon dioxide retention and coma after oxygen administration. Intravenous doxapram initially produced rapid improvement in arterial blood gas tensions and alertness. The sequence of events suggested that doxapram was acting more as a respiratory stimulant than as an analeptic. Three of the 4 patients subsequently relapsed and died, 2 having failed to respond to further treatment with doxapram.

Response to a respiratory stimulant (doxapram) in severe respiratory failure

Four patients with exacerbations of severe chronic bronchitis developed severe carbon dioxide retention and coma after oxygen administration. Intravenous doxapram initially produced rapid improvement in arterial blood gas tensions and alertness. The sequence of events suggested that doxapram was acting more as a respiratory stimulant than as an analeptic. Three of the 4 patients subsequently relapsed and died, 2 having failed to respond to further treatment with doxapram.

Immunosuppressive therapy of asthma

Eleven asthmatic men were treated with the antimetabolites thioguanosine or 6-mercaptopurine. Eight completed 12 weeks of treatment. Reversible drug toxicity occurred in 2 patients. Four patients with severe chronic asthma, chronic bronchitis, and continuous wheezing were not improved. Five patients with intermittent asthma of recent onset improved and had no severe attacks during therapy. Two of them showed consistently improved air flow rates and blood oxygenation, though some obstruction to air flow persisted. The cytology and types of mucus in stained sections of sputum helped to classify patients. Immunosuppressive therapy may prove to be useful in selected patients who have asthma but do not have chronic bronchitis.

Atypical Reaction to Isoproterenol

To The Editor:— Isoproterenol hydrochloride has been in use for approximately eight years as a bronchodilator. It is most commonly administered as an aerosol spray from hand nebulizers. While paradoxical reactions have been noted with isoproterenol hydrochloride, 1 to the best of our knowledge no cases of allergy to this drug have been reported. Recently, we had the opportunity to study a case which may represent such allergy. This was the tenth Albany (NY) Veterans Administration Hospital admission for a 48-year-old white man known to have severe emphysema and chronic bronchitis. The patient was told he had "asthma" as a child. Eight years prior to the present admission, he was said to have emphysema. Positive skin reactions to dust and wool had been noted. The present admission was precipitated by a bout of shortness of breath and increased cough of three days' duration. A therapeutic regimen was instituted including intravenously

Experimental carcinogenesis. Bronchial intramural adenocarcinomas in rats from x-ray irradiation of the chest.

One hundred eighty-six rats and 202 hamsters, that survived the respective time periods when the first lung cancer was diagnosed in each species, had been given an exposure of 3000 R or 4000 R of x-irradiation applied externally to the chest. About 43% of the rats, but only 2% of the hamsters, developed lung cancer. To enhance the prevalence of lung cancer, some of the irradiated animals were injected intratracheally with 9, 10-dimethyl-1, 2-benzanthracene (DMBA). Lung cancer prevalence in irradiated animals injected with DMBA was no higher than that in irradiated animals not so injected. Intratracheal injections of DMBA in nonirradiated rats did not result in tumor production but, in nonirradiated hamsters, DMBA caused a 6% prevalence of lung cancer. The mortality rate of both animal species showed a more than additive effect in animals given the higher x-ray dosage plus intratracheal injections of either DMBA or iron oxide alone. The lung cancers in the irradiated rats predominantly affected bronchi (86%) and were mostly adenocarcinomas (88%). The cancers were generally intramural and were covered by an intact and normal surface epithelium. Their origin appeared to be from aberrant intramural glands. These glands are not found in the bronchi of germ-free rats but do occur in bronchi thickened by severe endemic chronic bronchitis.

Continuous Suppressive Antimicrobial Treatment in Chronic Infected Bronchitis During the Winter Months

Sixty-three patients with moderately severe chronic bronchitis took part in a double-blind investigation into the effect of tetracycline (twice 0.5 gm daily) and sulfaphenazole (twice 0.5 gm daily) taken during the winter-months. Tetracycline suppressed both D. pneumoniae and H. influenzae in the sputum. Bacteriologic findings in the sulfaphenazole-group did not differ from those in the placebo-group. As regards the clinical results, there were no significant differences between the groups. There were no indications of any marked influence of viral infections of the types studied present during this investigation or of a less virulent bacterial flora (producing less severe infections) having interfered with a proper clinical evaluation of the effects of tetracycline therapy.

The Bronchospastic Component in Patients With Chronic Bronchitis and Emphysema

The bronchospastic component in 100 patients with moderate to severe chronic bronchitis and emphysema was investigated by determination of serial, timed vital capacity (FEV₁) before and after isoproterenol hydrochloride inhalation. Four hundred twenty-five studies over a one- to five-year period showed that the FEV₁decreases with progression of disease; however, the degree of bronchospasm did not change significantly, indicating a tendency for bronchospasm to persist in many patients in spite of the use of bronchodilators (95 patients), daily intermittent positive pressure breathing (51 patients), and steroids (21 patients). A paradoxical response to isoproterenol was encountered in nine patients. Eighty-four patients showed definite improvement in FEV₁in one or more tests after isoproterenol administration. It is concluded that a bronchospastic component exists in most patients with chronic bronchitis and emphysema, whether or not a history of asthma is elicited.

Prophylactic chemotherapy in chronic bronchitis

Summary Ninety-eight cases of moderate or severe chronic bronchitis were included in a trial designed to compare three other chemotherapeutic regimes with continuous daily tetracycline during four months of the 1957/1958 winter. The results obtained in 93 patients divided into four treatment groups are described. Clinical improvement was noted in 15 of 25 patients who received 750 mg. of tetracycline daily during the trial. Similar benefit was obtained in 10 of 21 patients who were given short courses of tetracycline, 1 g. daily for five days, taken on their own initiative at the onset of exacerbations. With both methods there was a considerable reduction in the time lost from work compared with the previous winter. Although continuous daily tetracycline therapy may be preferable in certain advanced cases, intermittent treatment, as here described, offers a reasonable and less costly alternative with a wider field of application amongst sufferes from this disease. Forty-seven patients, divided into two groups, were given short courses of erythromycin either for the prompt treatment of exacerbations or at monthly intervals. It would appear from the results that this antibiotic has no place in the routine management of chronic bronchitis. A tetracycline-resistant, Staph. pyogenes —sensitive to erythromycin—was isolated in two cases. In one it emerged after three months of daily tetracycline administration; in the other it was found in the pre-treatment sputum and persisted in subsequent specimens. No resistant strains of Haem. influenzae or Strep. pneumoniae appeared.

The treatment of patients with severe asthma and chronic bronchitis

IT is considered that asthmatics are peculiarly liable to develop chronic bronchitis, and the experience of a recent community survey in Newcastle (1957) gave very strong confirmatory evidence of this. O f 464 confirmed bronchifics, 43 were found to be asthmatical, whereas of 485 confirmed non-bronchitics selected by a random method, only 5 were asthmatics. The use of such a term as asthmatic bronchitis has, however, been avoided as inaccurate and likely to prove misleading. All the patients were severely disabled, losing at least three months' work each year, and in fact many had not worked for a number of years because of their disability. A number who were working for a considerable part of the year were able to do so only because they had managed to obtain very light work where they could take their own time. All were admitted in a deliberate at tempt to improve their health. Emergency cases, such as status asthmaticus and acute infective episodes, were excluded. The series is otherwise unselected and consecutive. Diagnosis depended upon the clinical signs and upon the history. The clinical signs insisted on were poor air entry and expiratory obstruction, associated with an obvious bronchial stridor (though other signs were often present). The history has not necessarily been uniform and the cases have, in fact, fallen into three groups. In the first of these groups, a characteristic story of intermittent asthma from childhood became complicated at some point by persistent cough with sputum. Coincidentally continuous wheezing with breathlessness replaced the earlier intermittent asthmatic attacks. Recurrent winter colds on the chest became a further regular complication. In the second group continuous asthma and chronic bronchitis commenced almost simultaneously, although acute asthmatic attacks occurred in addition in some cases. The third group was much the smallest. In these cases, chronic bronchitis had been present for some years before becoming complicated by asthma, continuous with or without acute attacks. In both the second and third groups persistent nasal catarrh was an extremely common associated symptom.

Surgery of extensive malignant neoplasms of the upper digestive and respiratory systems.

Introduction In this paper there are presented the detailed histories of two cases in each of which an operation had to be planned to deal with an extensive malignant neoplasm of the upper parts of the digestive and respiratory systems. These are then discussed in the light of a brief review of the literature and experience of other cases. While such operations have to be varied in detail to suit the particular case, emphasis is placed here on the underlying general principles observance of which may mitigate failure. It is hoped that the conclusions reached may prove of use to others. Report of Cases Case1.—A 64-year-old man, with a severe chronic bronchitis, addicted to drinking much beer and to smoking, presented with a history of mouth discomfort for one week. He had a large carcinoma inside the left cheek involving the mandible at the junction of the body with