Surface-enhanced raman spectroscopy: A non invasive alternative procedure for early detection in childhood asthma biomarkers in saliva.

The early detection of bronchial inflammation in asthma, through a non-invasive, simple method and under a subclinical state, could lead to a more effective control of this condition. The aim of this study was to identify biomarkers of bronchial inflammation in the saliva of children with asthma through immunoassay and Surface Enhanced Raman Spectroscopy (SERS). We conducted an analytical cross-sectional study in 44 children ages 6-12; the diagnosis of asthma was made according to Global Initiative for Asthma (GINA) standards. The children's saliva was analyzed by immunoassay for the quantification of 37 cytokines, as well as SERS analysis in a confocal Raman microscope at 785 nm. We found a significant association between bronchial obstruction and IL-8 (p = 0.004), IL-10 (p = 0.008) and sCD163 (p = 0.003). The Raman spectra showed significant amplification in the region of 760 to 1750 cm-1. The Principal Component Analysis and Linear Discriminant Analysis (PCA-LDA) method has a sensitivity of 85%, specificity of 82% and an accuracy of 84% for the diagnosis of asthma. These results demonstrate the presence of a subclinical inflammatory state, suggestive of bronchial remodeling in the population studied. The SERS method is a potential tool for identifying bronchial inflammation and its endotype, allowing for a highly sensitive and specific diagnosis.

Bronquitis plástica idiopática como causa infrecuente de atelectasia pulmonar masiva recurrente / Idiopathic Plastic Bronchitis as an Uncommon Cause of Massive Pulmonary Atelectasis

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Phenotyping airways disease: an A to E approach.

The airway diseases asthma and chronic obstructive pulmonary disease (COPD) are heterogeneous conditions with overlapping pathophysiological and clinical features. It has previously been proposed that this heterogeneity may be characterized in terms of five relatively independent domains labelled from A to E, namely airway hyperresponsiveness (AHR), bronchitis, cough reflex hypersensitivity, damage to the airways and surrounding lung parenchyma, and extrapulmonary factors. Airway hyperresponsiveness occurs in both asthma and COPD, accounting for variable day to day symptoms, although the mechanisms most likely differ between the two conditions. Bronchitis, or airway inflammation, may be predominantly eosinophilic or neutrophilic, with different treatments required for each. Cough reflex hypersensitivity is thought to underlie the chronic dry cough out of proportion to other symptoms that can occur in association with airways disease. Structural changes associated with airway disease (damage) include bronchial wall thickening, airway smooth muscle hypertrophy, bronchiectasis and emphysema. Finally, a variety of extrapulmonary factors may impact upon airway disease, including rhinosinusitis, gastroesophageal reflux disease, obesity and dysfunctional breathing. This article discusses the A to E concept in detail and describes how this framework may be used to assess and treat patients with airway diseases in the clinic.

Heterogeneity of bronchitis in airway diseases in tertiary care clinical practice.

BACKGROUND: Sputum cell counts have identified inflammatory subtypes of bronchitis in relatively small numbers of subjects with asthma, chronic obstructive pulmonary disease (COPD) and chronic cough in research studies. The prevalence of different subtypes of bronchitis in routine clinical practice, however, has not been reported. OBJECTIVE: To examine the heterogeneity of bronchitis and its relationship to the severity of airflow obstruction. METHODS: A retrospective cross-sectional survey based on a computerized database of spontaneous or induced sputum cell counts examined in a large university tertiary respiratory outpatient clinic. RESULTS: The database contained 4232 consecutive sputum records from 2443 patients with chronic cough (39%), asthma (37%), asthma with COPD (9%), COPD (13%) and bronchiectasis (3%). Total and differential cell counts were obtained from 86% of successful sputum samples. Induced sputum provided more viable samples than spontaneous expectorate. Approximately one-third of patients with asthma and one-fifth of patients with COPD experience eosinophilic bronchitis. Asthmatic patients with moderate to severe airflow obstruction had a greater number of sputum eosinophils. There was a significantly higher number of total cell counts and percentage of neutrophils in the sputum of COPD patients with moderate and severe airflow obstruction than in those with mild airflow obstruction. CONCLUSION: There is heterogeneity in the cellularity of sputum in various airway diseases. Patients with clinically stable airway diseases may have high sputum cell counts. During exacerbations, more patients may experience neutrophilic bronchitis. Severity of airflow obstruction is associated with eosinophilic bronchitis in patients with asthma, and neutrophilic bronchitis in patients with nonasthmatic COPD.

The A to E of airway disease.

The terms asthma and chronic obstructive pulmonary disease have evolved from their original very specific physiology-based definition to describe additional disease entities such as symptoms, airway inflammation and airway structure. We argue that as a result there is widespread confusion about what the terms mean. This has become a significant hurdle to optimal disease management and drug development. We propose that these disease labels should be replaced with a new alphabetical assessment tool for characterizing airway disease, which provides a checklist of five relatively independent factors potentially responsible for morbidity in patients with airway disease: Airway hyperresponsiveness, Bronchitis, Cough reflex hypersensitivity, Damage to the airway and surrounding lung and Extrapulmonary factors. We speculate that the use of this system to characterize airway disease will improve outcomes by promoting better targeting of new and existing treatments.

[Sinobronchitis--historical aspect]. / Zespól zatokowo-oskrzelowy w aspekcie historycznym.

There is evidence that a link exists between the upper and lower respiratory tracts. During the last fifty years many clinical observations has lead to a new pathogenic view of rhinosinusitis and asthma defined as Sinobronchial Syndrome. The inflammatory process in the nose and bronchi explains some of the complex interactions among different clinical diseases, such as rhinosinusitis, asthma, bronchial hyperresponsiveness and viral infections.

Aerosolized antibiotics and ventilator-associated tracheobronchitis in the intensive care unit.

CONTEXT: In critically ill intubated patients, signs of respiratory infection often persist despite treatment with potent systemic antibiotics. OBJECTIVE: The purpose of this study was to determine whether aerosolized antibiotics, which achieve high drug concentrations in the target organ, would more effectively treat respiratory infection and decrease the need for systemic antibiotics. DESIGN: Double-blind, randomized, placebo-controlled study performed from 2003 through 2004. SETTING: The medical and surgical intensive care units of a university hospital. PATIENTS: Critically ill intubated patients were randomized if: 1) > or = 18 yrs of age, intubated for a minimum of 3 days, and expected to survive at least 14 days; and 2) had ventilator-associated tracheobronchitis defined as the production of purulent secretions (> or = 2 mL during 4 hrs) with organism(s) on Gram stain. Of 104 patients monitored, 43 consented for treatment and completed the study. No patients were withdrawn from the study for adverse events. INTERVENTION: Aerosol antibiotic (AA) or aerosol saline placebo was given for 14 days or until extubation. The responsible clinician determined the administration of systemic antibiotics (SA). Patients were followed for 28 days. MAIN OUTCOME MEASURES: Primary: Centers for Disease Control National Nosocomial Infection Survey diagnostic criteria for ventilator-associated pneumonia (VAP) and clinical pulmonary infection score. Secondary: white blood cell count, SA use, acquired antibiotic resistance, and weaning from mechanical ventilation. RESULTS: Most patients had VAP at randomization. With treatment, the AA group had reduced signs of respiratory infection: reduced Centers for Disease Control National Nosocomial Infection Survey VAP (14/19; 73.6%) to (5/14; 35.7%) vs. placebo (18/24; 75%) to (11/14; 78.6%), reduction in clinical pulmonary infection score, lower white blood cell count at day 14, reduced bacterial resistance, reduced use of SA, and increased weaning (all p < or = .05). CONCLUSIONS: In critically ill patients with ventilator-associated tracheobronchitis, AA decrease VAP and other signs and symptoms of respiratory infection, facilitate weaning, and reduce bacterial resistance and use of systemic antibiotics.

Plastic bronchitis: new insights and a classification scheme.

Plastic bronchitis is a rare disease in which there is the formation of large gelatinous or rigid branching airway casts. The history of the disease is reviewed and a classification system is proposed based on our current understanding. This system classifies plastic bronchitis by clinical disease association and cast histology. A summary of the medical literature is included together with guidelines for treatment. The evidence for these treatment decisions is reviewed.

Bronquitis plástica asociada a miocardiopatía restrictiva / Plastic bronchitis associated to restrictive miocardiopathy

La bronquitis plástica se caracteriza por la formación de moldes bronquiales con ramificaciones que remedan la anatomía del árbol respiratorio. Se asocia con una enfermedad pulmonar subyacente y con cardiopatías congénitas cianóticas, especialmente luego de la cirugía correctiva. Se desconoce el mecanismo de producción de los moldes. Se propuso como posible mecanismo la existencia de anormalidades de los linfáticos pulmonares asociadas a alteraciones del drenaje, lo que se conoce como "goteo linfático endobronquial". Los síntomas incluyen tos productiva, disnea, fiebre y sibilancias. El diagnóstico se basa en el interrogatorio, radiografías y tomografías computadas de función pulmonar y se confirma por la expectoración espontánea de moldes o su visualización mediante fibrobroncoscopia. Las terapias aún son limitadas y deben estar dirigidas al tratamiento de la enfermedad de base, incluidala remoción de los moldes bronquiales. Los pacientes con cardiopatía poseen índices de mortalidad más elevados que los niños con bronquitis plástica asociada a otras patologías. Presentamos a un niño de 4 años, con bronquitis plástica asociada a miocardiopatía restrictiva.(AU)

Bronquitis plástica asociada a miocardiopatía restrictiva / Plastic bronchitis associated to restrictive miocardiopathy

La bronquitis plástica se caracteriza por la formación de moldes bronquiales con ramificaciones que remedan la anatomía del árbol respiratorio. Se asocia con una enfermedad pulmonar subyacente y con cardiopatías congénitas cianóticas, especialmente luego de la cirugía correctiva. Se desconoce el mecanismo de producción de los moldes. Se propuso como posible mecanismo la existencia de anormalidades de los linfáticos pulmonares asociadas a alteraciones del drenaje, lo que se conoce como "goteo linfático endobronquial". Los síntomas incluyen tos productiva, disnea, fiebre y sibilancias. El diagnóstico se basa en el interrogatorio, radiografías y tomografías computadas de función pulmonar y se confirma por la expectoración espontánea de moldes o su visualización mediante fibrobroncoscopia. Las terapias aún son limitadas y deben estar dirigidas al tratamiento de la enfermedad de base, incluidala remoción de los moldes bronquiales. Los pacientes con cardiopatía poseen índices de mortalidad más elevados que los niños con bronquitis plástica asociada a otras patologías. Presentamos a un niño de 4 años, con bronquitis plástica asociada a miocardiopatía restrictiva.

Plastic bronchitis in children: a case series and review of the medical literature.

Plastic bronchitis is characterized by marked obstruction of the large airways by bronchial casts. We reviewed our experience and the literature to determine whether mortality rates are determined by underlying disease or cast type. We present 3 children with obstructive bronchial casts. One 3-year-old patient with Noonan's syndrome developed respiratory failure following surgery for tetralogy of Fallot requiring support with extracorporeal membrane oxygenation (ECMO) the first such case. There were 42 cases in the literature of children with plastic bronchitis. Casts may be divided into two types. Type I casts are inflammatory, consisting mainly of fibrin with cellular infiltrates, and occur in inflammatory diseases of the lung. Type II, or acellular casts, consist mainly of mucin with a few cells, and usually occur following surgery for congenital cardiac defects. Patients categorized by underlying disease included 31% with asthma or allergic disease, 40% with underlying cardiac defects, and 29% with other diseases. Mortality was 16%, but increased to 29% in patients with cardiac defects. Deaths occurred as long as 1 year after surgical repair for underlying defects. There were no deaths in patients with asthma. Life-threatening events were statistically higher in patients with cardiac defects (41%) than in those with asthma (0%, P = 0.02). Higher mortality in patients with type II casts compared to type I casts did not reach statistical significance (28% vs. 6%; P = 0.06). In conclusion, patients presenting with plastic bronchitis are at high risk for serious complications, especially with underlying cardiac disease.

Functional insufficiency of the system responsible for reactive oxygen species generation by blood neutrophils.

We studied functional activity of the system responsible for generation of reactive oxygen species by blood neutrophils and involved in pathophysiological mechanisms of bronchopulmonary diseases. Insufficiency of this system can be classified as relative, latent (type I and II), and severe.

Different patterns of chronic tissue wasting among patients with chronic obstructive pulmonary disease.

BACKGROUND & AIMS: Nutritional depletion is frequently present in patients with chronic obstructive pulmonary disease, but it is unknown whether a difference exists between the two subtypes. The aim of this study was to determine whether patterns of tissue depletion were different between emphysema and chronic bronchitis patients and whether these were related to pulmonary function. METHODS: In 99 severe COPD patients and 28 healthy volunteers, body weight and composition were assessed by dual-energy X-ray absorptiometry. Patients were stratified into chronic bronchitis (n=50) and emphysema (n=49) by high-resolution computed tomography. RESULTS: Lean mass depletion was found in 37% of the emphysema patients and in 12% of the chronic bronchitis patients. The emphysema patients had lower values for body mass index than the other groups (P< 0.01), mainly due to a lower lean mass (P< 0.01) and bone mineral content (P< 0.01). Fat mass was also lower in the emphysema group compared to the chronic bronchitis group (P< 0.001). The chronic bronchitis patients had a higher fat mass (P< 0.05) and a lower bone mineral content (P< 0.01) than the healthy volunteers. CONCLUSIONS: Substantial differences in body composition were found not only between chronic obstructive pulmonary disease patients and healthy volunteers, but also between chronic bronchitis and emphysema patients.

[Reflections on the new occupational disease No. 4111: without reasonable doubt Mr. X. in his 70th year suffers from chronic obstructive bronchitis and Mr. Y. from pulmonary emphysema]. / Uberlegungen zur neuen Berufskrankheit Nr. 4111. Ohne jeden vernünftigen Zweifel leidet Herr X. seit Mitte der 70er Jahre an einer chronischen obstruktiven Bronchitis und Herr Y. an einem Lungenemphysem.

Without reasonable doubt Mr. X. suffers from a chronic obstructive bronchitis and Mr. Y. from pulmonary emphysema. With relation to the new occupational disease no. 4111 the safe diagnosis of chronic obstructive bronchitis and of pulmonary emphysema is very difficult. The various aspects are described here.

Economic evaluation of ciprofloxacin compared with usual antibacterial care for the treatment of acute exacerbations of chronic bronchitis in patients followed for 1 year.

OBJECTIVE: To undertake a 1-year prospective economic evaluation of ciprofloxacin compared with usual antibacterial care (any antibacterial other than a quinolone) for the treatment of acute exacerbations of chronic bronchitis (AECB) in adults presenting with a type I or type II AECB. DESIGN: Patients entered the study with an initial AECB and were randomised to the ciprofloxacin group or the usual care group. The following measurements were taken at the end of each AECB and every 3 months: resource utilisation, St. George's Respiratory Questionnaire, Nottingham Health Profile and Health Utilities Index (HUI). The following additional measurements were taken after each AECB: AECB-symptom days and willingness to pay to avoid the AECB. Economic evaluations were performed from the societal viewpoint and the viewpoint of a major third-party payer. Cost-effectiveness analysis was based on cost per AECB-symptom day averted; cost-utility analysis (CUA) was based on cost per quality-adjusted life-year (QALY) gained using the HUI as the basis for calculating QALYs. Cost-benefit analysis was based on the willingness-to-pay (WTP) data. SETTING: This was a study of outpatients enrolled from 46 family physicians and 2 respirologists in Ontario (29 sites) and Québec (19 sites), Canada, between November 1993 and June 1994. PATIENTS AND PARTICIPANTS: 240 adult male and female patients aged > or = 18 years with chronic bronchitis. MAIN OUTCOME MEASURES AND RESULTS: WTP data did not pass scope tests for reasonableness. Ciprofloxacin was more costly and provided better outcomes compared with usual antibacterial care. The base-case results are as follows (1994/1995 values): the incremental annual cost was 578 Canadian dollars ($Can) from the societal viewpoint and $Can840 for the third-party payer; the cost-effectiveness ratio per AECB-symptom day averted was $Can209 from the societal viewpoint and $Can304 for the third-party payer; the cost-utility ratio per QALY gained was $Can18,600 from the societal viewpoint and $Can27,000 for the third-party payer. According to Laupacis criteria, these CUA results are strong evidence in favour of adoption from the societal viewpoint and moderate evidence in favour from the viewpoint of the third-party payer. A subgroup analysis suggests that ciprofloxacin may be particularly cost effective, even 'win-win', in patients with more severe disease. CONCLUSIONS: The sensitivity analyses indicate that the results are relatively robust. Nevertheless, the statistical uncertainty in the results is sufficient that the findings cannot be accepted unequivocally. A further study with a larger sample size would be useful to confirm (or deny) the findings of this study.