Objective To determine the airway wall thickness at the segmental and subsegmental levels in patients with bronchial asthma and eosinophilic bronchitis ( EB) by high resolution CT scanning,and evaluate its relationship with airway hyperresponsiveness. Methods High resolution CT scanning was performed in 14 subjects with asthma,15 subjects with EB, 15 subjects with cough variant asthma ( CVA) ,and 14 healthy volunteers. Total airway and lumen diameter, total airway cross sectional area and lumen area which corrected by body surface area ( BSA) were measured. The percentage of airway wall area to total airway cross sectional area ( WA% ) and wall thickness to airway diameter ratio ( T/D) were calculated for the right upper lobe apical segmental bronchus ( RB1) and all airways clearly visualized with a transverse diameter of 1-6 mm. Results T/D/BSA and WA% in the asthma patients were all significantly higher than those in the subjects with EB, CVA and healthy volunteers. T/D/BSA and WA% in the EB patients were significantly higher than the healthy volunteers, and similar with the CVA patients. Al /BSA in the patientswith asthma and CVA was less than the subjects with EB and the healthy volunteers. However, Al /BSA in the EB patients was similar with the healthy volunteers. Conclusions The airway wall thickness and remodeling can be measured and assessed by high resolution CT. Airway wall thickness and remodeling inEB patients are milder than asthma patients, which may be associated with airway hyperresponsiveness that presents in asthma but not in EB.
Objective To summarize the clinical features, diagnosis and treatment of postinfection bronchiolitis obliterans. Methods Clinical manifestation, chest X-ray, characteristics of lung function,computed tomography ( CT) of 6 patients with postinfection bronchiolitis obliterans from August 2009 to June2012 were analyzed retrospectively.Results All 6 cases were diagnosed as bronchiolitis obliterans after pneumonia. One patient had severe pneumonia complicated with congenital atrial septal defect and heart failure. 3 cases were complicated with varying degrees of cardiac insufficiency. Adenovirus in sputumsample were found in2 cases, smear positive for parainfluenza virus was found in1 case, mycoplasma were found in 2 cases, and no specific pathogen was found in the last one. All 6 cases were suffered frompersistent cough,wheezing and shortness of breath with three depression sign in 4 cases. The symptoms lasted for at least 6 weeks. Crackles and wheezing were present in all 6 cases. Small airway lesion was presented by pulmonary CT. Bronchiectasis was showed in 2 cases, atelectasis in 1 case, and consolidation in 1 case. Pulmonary function tests showed mixed ventilatory dysfunction. Bronchofiberscope examination was operated in5 cases,only endotracheitis was found. Prednisone and azithromycin were given orally in all the cases, but the clinical symptoms were persistent in the course of treatment and no death occured. Conclusions Clinical symptoms of bronchiolitis obliterans are characterized by persistent cough and wheezing. Small airway lesions were present in pulmonary CT. Repeated lower respiratory infection is common. Prednisone is widely used in treatment of bronchiolitis obliterans, but the therapeutic effect is uncertain.
Objective To investigate the effects of methylprednisolone on airway inflammation of chronic bronchitis in rats, and to explore its possible mechanism. Methods Forty SD rats were randomly divided into five groups, ie. a blank control group, amethylprednisolone control group, a model group, and two methylprednisolone intervention groups. Chronic bronchitis model was established by cigarette inhalation in the model group and two intervention groups. Methylprednisolone was injected intraperitoneally in the two intervention groups before exposing to cigarette smog ( at the dose of 1 mg/ kg and 10 mg/ kg, qd,respectively) . The protein expression of phosphodiesterase 4D ( PDE4D ) in trachea and lung samples was determined by immunohistochemical staining. The average optical density of positive staining of PDE4D was determined by image analysis technique and gray scale scanning. Bronchoalveolar lavage fluid ( BALF) was collected for total and differential cell counts, and the concentrations of TNF-αand interleukin-8 ( IL-8) in BALF were detected by ELISA. Results Cigarette smoking induced obvious airway inflammation in themodel group, and the inflammation was alleviated in the two methylprednisolone intervention groups.Compared with the two control groups, the expression of PDE4D was obviously elevated in tracheal and lungs in the model group( P lt; 0. 05) . Moreover, the increased expression of PDE4D was positively related with theincreased release of TNF-αand IL-8 in BALF. The expression of PDE4D and the release of TNF-αand IL-8 in BALF were decreased after the treatment with methylprednisolone in a dose-dependent manner ( P lt;0. 05) . Compare with the low dose intervention group, there was no markedly difference related to PMNnumber and TNF-α release in the high dose intervention group ( P gt; 0.05) . Conclusions Methylprednisolone may alleviate airway inflammation of chronic bronchitis by inhibiting the expression of PDE4D in rats. Inhibition of PDE4D may down-regulate TNF-αactivity, which may further reduce IL-8 release and alleviate airway inflammation.
Chinese medicine (CM) has significant clinical effects in the treatment of tracheal-bronchitis. It is of important clinical significance to formulate guidelines for the diagnosis and treatment of tracheal-bronchitis based on the characteristics of TCM syndrome differentiation. The Respiratory Disease Branch of China Association of Chinese Medicine and Respiratory Disease Branch of China Medical Association of Minorities organized and established a multi-disciplinary background working group, based on the World Health Organization Handbook for Guideline Development and the Guideline Development Handbook for Diagnosis and Therapy of Integrative Medicine to develop this guideline. It was developed through technical links such as clinical problem investigation, evidence collection and evaluation, Delphi consultation, and expert consensus meetings. Based on the current best evidence, CM intervention costs and expert experience, 25 recommendations were established to standardize the etiology and pathogenesis of tracheal-bronchitis, syndrome differentiation and treatment, prevention, and care, etc., which can be used by physicians at different levels of medical institutions.
Objective To evaluate the therapeutic effect, safty and tolerance of Gankeshuangqing Capsule in the treatment of patients suffering from wind-heat syndrome (acute upper respiratory infection or acute bronchitis). Methods The clinical trials were designed multicentered, double blind, double dummy, randomized and parallel positive drug controlled. A total of 289 patients participated in the trials. Those who suffered from acute upper respiratory infection were given throat virus-detection to make a definite diagnosis of the origins of disease. Results Among the 40 patients who were diagnosed with virus infection, 81.82% in Gankeshuangqing group were healed, but only 50.00% in control group, and significant differences were observed between the two groups (Plt;0.05). At the end of the third day of treatment, the rates of cure and excellence in patients suffering from acute upper respiratory infection were 80.00% in Gankeshuangqing group, and 68.57% in control group, and both groups showed good therapeutic effect，but there was no significant difference between the two groups (Pgt;0.05). At the end of the seventh day of treatment, the rates of cure and excellence in patients suffering from acute bronchitis were 82.35% in Gankeshuangqing group, and 63.77% in control group, and both groups showed good therapeutic effect, and there were significant differences between the two groups (Plt;0.05)；only one patient in Gankeshuangqing group had constipation during the treatment, but there was no evidence showing that it is caused by Gankeshuangqing. Conclusion The results show that Gankeshuangqing Capsule has a definite effect on wind-heat syndrome (acute upper respiratory infection or acute bronchitis) with good safety.
Objective To explore the clinical characteristics, diagnose and treatment of bronchiolitis obliterans (BO) associated with lymphoma and paraneoplastic pemphigus (PNP). Methods One patient with BO associated with lymphoma and paraneoplastic pemphigus was presented and literatures which searched through Wanfang Med online and PubMed on this subject were reviewed. Results A 44-year-old woman was admitted to this hospital because of oral ulcer for two years, and persistent dyspnea for fourteen months. She had been diagnosed with PNP one year earlier. Pulmonary function displayed severe obstructive ventilator dysfunction, negative response to the bronchodilator. Chest CT showed bronchiolectasis. The ratio of neutrophils increased in bronchoalveolar lavage fluid. The pathology of ultrasound-guided neck and inguinal lymph node biopsy showed non-Hodgkin’s lymphoma. Based on the clinical presentation, the image and pathology of this patient, the diagnosis of having PNP with BO secondary to the lymphoma was made. After 10 cycles of CHOP chemotherapy, lymphoma and PNP went into remission, but the patient died from respiratory failure. The literatures were reviewed and 15 patients were found, out of them 60% (9/15) were female, 47% (7/15) follicular lymphoma and 47% (7/15) diagnosis of clinical BO which did not be supported by pathology. Lymphoma-PNP-BO was a clinical syndrome and 67% of the initial presentations were PNP. Patients died within 7 to 60 months. Conclusions BO associated with lymphoma and PNP is rare and the most common initial presentation is PNP. BO is the major cause of death. Treatments included chemotherapy, corticosteroid and immunosuppressor, lymphoma and PNP can be alleviated, but BO is aggravating.
Objective To investigate the effects of montelukast ( MK) on the airway inflammation and the risk of the recurrence of wheezing in the treatment of infants with RSV bronchiolitis.Methods 60 infants ( aged 6-24 months) with RSV bronchiolitis admitted between December 2010 and December 2011 were recruited in the study. They were randomly assigned into a conventional group and a MK group ( n =30 in each group) . All patients received conventional treatments including inhalation of budsonide and so on.The subjects in the MK group received oral montelukast ( 4 mg qn for 12 weeks) additionally. The levels of serum cysteinyl leukotrienes ( CysLTs ) , total immunoglobuline E ( T-IgE) , eosinophil cationic protein ( ECP) and fractional exhaled nitric oxide ( FeNO) were assayed before and after the treatments. Thenumber of recurrence of wheezing was recorded through outpatient and telephone follow-up for 12 months. 30 healthy infants participating the health examination in outpatient were selected as control, and those who got atopic disease or respiratory tract infections recently were excluded. Results The levels of CysLTs, ECP and FeNO of the patients with RSV bronchiolitis before treatment were significantly higher than those in the normal control group, and the levels of CysLTs and FeNO were significantly decreased after treatment ( P lt;0. 05) . The levels of CysLTs and FeNO after treatment in the MK group was significantly lower than those in the conventional group. The level of ECP was significantly decreased after treatment in the MK group ( P lt;0. 05) ,·186· Chin J Respir Crit Care Med, March 2013 , Vol. 12 , No. 2 http: / /www. cjrccm. com which was not significantly changed in the conventional group( P gt; 0. 05) . The number of recurrence of wheezing in the MK group was more less that that in the conventional group ( P lt; 0. 05) . Conclusion Maintenance treatment with montelukast after the treatment of the acute phase of bronchiolitis can prevent recurrence of wheezing by suppressing airway inflammation in infants with RSV bronchiolitis.
Objective To investigate the causal relationship between 91 circulating inflammatory proteins and respiratory tract infection by bidirectional Mendelian randomization. Methods single nucleotide polymorphisms (SNPs) for 91 inflammatory circulating proteins were derived from GWAS data from a genome-wide association study of 14 824 subjects of European ancestry on the Olink Target platform, and SNPs for acute bronchitis, acute bronchiolitis, and acute laryngitis and tracheitis were derived from GWAS pooled data in the FinnGen database. Inverse variance weighting method was used as the main research method to conduct bidirectional Mendelian randomization analysis, and Cochran’ IVW Q test, MR-Egger regression method and one by one elimination method were used to conduct sensitivity tests to evaluate heterogeneity and horizontal pleiotropy. In order to reduce the incidence of Class I errors and improve the feasibility of the study, Bonferroni correction was performed.ResultsLevels of C hemokine C-X-C motif ligand 6 (CXCL6), matrix metalloproteinase-1 (MMP-1), hepatocyte growth factor (HGF), interleukin-10 (IL-10), chemokine C-X3-C motif ligand 1 (CX3CL1), and TNF-related activation-induced cytokine (TRANCE) were causally associated with acute bronchitis. MMP-1 level [OR: 1.239 0, 95%CI: 1.111 6-1.382 2, P<0.000 5] had a significant causal relationship with acute bronchitiss and played a promoting role. Levels of macrophage inflammatory protein-1α (MIP-1α), signaling lymphocyte activating molecules, and FMS-associated tyrosine kinase 3 ligand (FIt3L) were potentially causally associated with acute bronchiolitis. There was a potential causal relationship between C-X-C motif chemokine 5 (CXCL5), T cell surface glycoprotein CD6 subtype (CD6), fibroblast growth factor 19 (FGF-19), C-C motif chemokine 23 (CCL23), monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor ligand superfamily member 12 (TNFSF12) levels and acute laryngitis and tracheitis. In reverse Mendelian randomization analysis, there were no positive results between acute bronchitis, acute bronchiolitis and 91 inflammatory factors. Acute laryngitis and tracheitis [OR: 1.076 3,95%CI: 1.012 9-1.143 7, P=0.017 6] were potentially causally associated with FGF-19 levels. Conclusions MMP-1 level have a significant causal relationship with acute bronchitis. The levels of other inflammatory factors such as CXCL6, HGF, MIP-1 alpha, FIt3L, CXCL5, FGF-19 are potentially causally associated with respiratory tract infections. MMP-1 may be an important target for the prediction or treatment of acute bronchitis.
Objective To evaluate and select essential medicine for acute bronchitis using evidence-based methods based on the burden of disease. Methods By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence. Results (1) Eight guidelines were included (seven foreign guidelines, one domestic guideline; five based on evidence, three based on expert consensus). (2) A result of six RCTs (n=816, low quality) indicated that pentoxyverine had efficiencies of 53% to 82% for cough relief. Among the six RCTs, a result of three RCTs (n=283) indicated that pentoxyverine was slightly less efficient than procaterol (RR=0.86, 95%CI 0.78 to 0.94, P=0.001); a result of two RCTs (n=233) indicated that pentoxyverine was slightly less efficient than Chinese medicinals decoction (RR=0.82, 95%CI 0.74 to 0.91, Plt;0.001). Adverse reaction of pentoxyverine (incidence: 0% to 2.4%) mainly covered nausea, palpitation, etc. Pentoxyverine cost 0.20 yuan (for adult) or 0.08 yuan (for child) daily, which was orally taken and applicable to the target population. (3) A result of six RCTs (n=403, low quality) indicated that the efficiencies of dextromethorphan for cough relief was 47.0% to 95.3%. Among the six RCTs, a result of one RCT (n=283) indicated that dextromethorphan hydrobromide (nasal drop) was more efficient than blank intervention (RR=3.71, 95%CI 1.91 to 7.21); a result of one RCT (n=43) indicated that dextromethorphan (for oral use) was more efficient than placebo (RR=1.74, 95%CI 1.13 to 2.66); a result of one RCT (n=300, moderate quality) indicated that dextromethorphan was more efficient than pentoxyverine (RR=1.16, 95%CI 1.07 to 1.26); a result of one observational study (n=121, low quality) indicated that dextromethorphan given for 5 days had an efficiency of 66.5%. Adverse reaction of dextromethorphan (incidence: 2% to 30%) mainly covered mouth dryness, dizziness, nausea, etc. Conclusion (1) We offer a b recommendation for dextromethorphan used in relieving dry cough due to acute bronchitis. (2) We offer a weak recommendation for pentoxyverine as symptomatic treatment for cough relief. (3) We make a recommendation against antibiotics, β2-agonist bronchodilators and mucolytic agents as routine use. (4) More large-scale, multi-center, double-blinded RCTs are needed in clinical and pharmacoeconomic studies of acute bronchitis in hopes of producing high-quality local evidence.
Objective To evaluate systematically the effect of antibiotic treatment on ventilator-associated tracheobronchitis (VAT). Methods Pubmed,Web of Science,OVID SP (ACP Journal Club,Cochrane Central Register of Contralled Trials,Embase,Medline),as well as China National Knowledge Infrastructure,China Science and Technology Journal Database,and Wanfang Data were searched for literatures about antibiotic treatment on VAT.The search deadline was March 2016.Meta-analysis was conducted with RevMan 5.3 software. Results A total of 6 studies with 769 patients were included.Among 769 patients,432 patients were treated by antibiotics,and 337 patients in control group were treated without antibiotics.Meta-analysis showed antibiotics treatment significantly reduced incidence of ventilator-associated pneumonia compared with control group [OR=0.27,95%CI (0.17,0.43),P<0.05],and shortened length of ICU stay [MD -1.51,95%CI(-2.04,-0.98),P<0.00001] .There were no significant difference in duration of mechanical ventilation [MD -2.52,95%CI (-6.85,1.81),P=0.25],mortality [OR=0.41,95%CI(0.15,1.14),P=0.09],or drug-resistant bacteria production [OR=0.62,95%CI(0.17,2.19),P>0.05]. Conclusions Antibiotic treatment can reduce incidence of ventilator-associated pneumonia in patients with VAT.Further more high quality randomized controlled trials are needed to assess the effect of antibiotic treatment on VAT.