Chronic Bronchitis

The aim of this study was to investigate whether it is possible to detect high-resolution computed tomography (HRCT) findings in aluminium powder workers, which are consistent with early stages of aluminosis. 62 male workers from 8 departments of two plants producing aluminium (Al) powder were investigated using a standardized questionnaire, physical examination, lung function analysis, biological monitoring of Al in plasma and urine, chest X-ray, HRCT and immunological tests. Chronic bronchitis was observed in 15 (24.2%) of the workers, and four workers (6.5%) reported shortness of breath during exercise. HRCT findings in 15 workers (24.2%) were characterized by ill-defined centrilobular nodular opacities. Workers with ill-defined centrilobular nodular opacities had a lower vital capacity than workers who had no such HRCT-findings (90.9 % pred. vs. 101.8 % pred., p = 0.01). Biological monitoring in plasma and urine revealed higher internal exposure to Al in affected workers (33.5 μ...

Objective: To study the self-reported prevalence of respiratory symptoms and diseases among construction painters and estimate the potential risk for this group compared with a representative group of carpenters sharing the construction work environment but without significant exposure to paint. Methods: A questionnaire study was conducted on 1,000 male Finnish construction painters and 1,000 carpenters (mean response rate 60.5%). Symptoms and diseases of the respiratory tract were studied, by logistic regression modelling, in relation to occupation and duration of painting experience. Age, atopy and smoking habits were taken into account. Results: The painters reported more asthma-like, rhinitis, laryngeal and eye symptoms than the carpenters [odds ratio (OR) 1.4-1.8]. The difference in the prevalence of asthma between the occupations was not statistically significant, but the painters with 1-10 years of painting experience had a threefold risk of asthma compared with the carpenters. Chronic bronchitis was linked to painting occupation [OR 1.9, 95% confidence interval (CI) 1.2-3.0] and to the duration of exposure; OR (CI) for over 30 years of painting was 2.2 (1.2-4.0). Occupation was not associated with allergic rhinitis or conjunctivitis. Conclusions: The results indicate a higher risk for respiratory symptoms and chronic bronchitis among construction painters than among carpenters.

During the last decade, a growing interest in recycling of domestic waste has emerged, and action plans to increase the recycling of domestic waste have been agreed by many governments. A common feature of these plans is the implementation of new systems and equipment for the collection of domestic waste which has been separated at source. However, only limited information exists on possible occupational health problems related to such new systems. Occupational accidents are very frequent among waste collectors. Based on current knowledge, it appears that the risk factors should be considered as an integrated entity, i.e. technical factors (poor accessibility to the waste, design of equipment) may act in concert with high working rate, visual fatigue due to poor illumination and perhaps muscle fatigue due to high work load. Musculoskeletal problems are also common among waste collectors. A good deal of knowledge has accumulated on mechanical load on the spine and energetic load on the cardio-pulmonary system in relation to the handling of waste bags, bins, domestic containers and large containers. However, epidemiologic studies with exposure classification based on field measurement are needed, both to further identify high risk work conditions and to provide a detailed basis for the establishment of occupational exposure limits for mechanical and energetic load particularly in relation to pulling, pushing and tilting of containers. In 1975, an excess risk for chronic bronchitis was reported for waste collectors in Geneva and data from the Danish Registry of Occupational Accidents and Diseases also indicate an excess risk for pulmonary problems among waste collectors compared with the total work force. Surprisingly few measurements of potentially hazardous airborne exposures have been performed, and the causality of work-related pulmonary problems among waste collectors is unknown. Recent studies have indicated that implementation of some new waste collection systems may result in an increased risk of occupational health problems. High incidence rates of gastrointestinal problems, * Corresponding author.

Natural molecules have been a boon in the field of medical science and therapeutics. With the progress of latest technology and advancement in synthetic chemistry and computational biology, it has now become possible to precisely decide the best possible fit inhibitor molecule
for the pathologically important target molecules in the human body. In recent history, many naturally occurring molecules have been derivatized to improve the inhibitory potential. Bromhexine is one such molecule that has been derivatized from the naturally occurring molecule vasicine. Vasicine is obtained from Adhatodavasica, a very well known herb for
respiratory and other inflammatory diseases. The present review describes the importance and uses of bromhexine in the area of therapeutics with a light on its mechanism of action and
its use in several diseases such as asthma and chronic bronchitis.

Chronic obstructive pulmonary disease (COPD) is an increasing health problem and one of the leading causes of morbidity and mortality worldwide, but knowledge about its pathogenesis has increased substantially in recent years. The disease results from interaction between individual risk factors (like enzymatic deficiencies) and environmental exposures to noxious agents, like cigarette smoking, occupational dusts, air pollution and infections in childhood. The main mechanisms that may contribute to airflow limitation in COPD are fixed narrowing of small airways, emphysema and luminal obstruction with mucus secretions. COPD is characterised by a chronic inflammatory process in the pulmonary tissue, with a pattern different from bronchial asthma, associated with extrapulmonary effects and is considered now a complex, systemic disease. Optimal therapeutic targeting of COPD depends on a clear understanding of the precise mechanisms of these complex processes and on early and correct evaluation of disease severity. A combination of pharmacological and non-pharmacological approaches is used to treat COPD. Bronchodilators are the mainstay of COPD treatment and can be combined with inhaled corticosteroids for greater efficacy and fewer side effects. The use of LTOT for hypoxemic patients has resulted in increased survival, and expanded drug therapy options have effectively improved dyspnoea and quality of life. Recent studies have documented the benefits of pulmonary rehabilitation. In addition, non-invasive mechanical ventilation offers new alternatives for patients with acute or chronic failure.

Objective is to evaluate the impact of occupational exposure to lignite dust on respiratory system. 103 blue-collar workers exposed to lignite dust and 62 controls completed a questionnaire on respiratory symptoms and underwent spirometry. Levels of lignite dust in workplace were measured. Univariate and multivariate analysis of the data were performed. The concentration of lignite dust varied from 0.6 to 1.4 mg/m 3. Current smokers and workers exposed to lignite dust presented higher prevalence of chronic bronchitis symptoms and of FEV<80% and FEV1/FVC<70%. Multivariate analysis has shown that smoking and occupational exposure to lignite dust were independent predictors of chronic bronchitis symptoms, as well as of an obstructive ventilation pattern. Further analysis showed that exposed workers who were current smokers presented a five fold rate for developing an obstructive ventilation pattern in comparison to exposed workers non currently smokers. Occupational exposure to lignite dust and smoking were independent determinants of chronic bronchitis symptoms and obstructive ventilation pattern. There is some evidence for a combined effect of smoking and lignite dust exposure on respiratory system.

The relation of chronic respiratory symptoms and pulmonary function to formaldehyde (HCHO) in homes was studied in a sample of 298 children (6--15 years of age) and 613 adults. HCHO measurements were made with passive samplers during two 1-week periods. Data on chronic cough and phlegm, wheeze, attacks of breathlessness, and doctor diagnoses of chronic bronchitis and asthma were collected with self-completed questionnaires. Peak expiratory flow rates (PEFR) were obtained during the evenings and mornings for up to 14 consecutive days for each individual. Significantly greater prevalence rates of asthma and chronic bronchitis were found in children from houses with HCHO levels 60-120 ppb than in those less exposed, especially in children also exposed to environmental tobacco smoke. In children, levels of PEFR decreased linearly with HCHO exposure, with the estimated decrease due to 60 ppb of HCHO equivalent to 22% of PEFR level in nonexposed children. The effects in asthmatic children exposed to HCHO below 50 ppb were greater than in healthy ones. The effects in adults were less evident: decrements in PEFR due to HCHO over 40 ppb were seen only in the morning, and mainly in smokers, e

The syndrome of chronic obstructive pulmonary disease (COPD) consists of chronic bronchitis (CB), bronchiectasis, emphysema, and reversible airway disease that combine uniquely in an individual patient. Older patients are at risk for COPD and its componentsFemphysema, CB, and bronchiectasis. Bacterial and viral infections play a role in acute exacerbations of COPD (AECOPD) and in acute exacerbations of CB (AECB) without features of COPD. Older patients are at risk for resistant bacterial organisms during their episodes of AECOPD and AECB. Organisms include the more-common bacteria implicated in AECOPD/ AECB such as Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae. Less-common nonenteric, gram-negative organisms including Pseudomonas aeruginosa, gram-positive organisms including Staphylococcus aureus, and strains of nontuberculosis Mycobacteria are more often seen in AECOPD/AECB episodes involving elderly patients with frequent episodes of CB or those with bronchiectasis. Risk-stratified antibiotic treatment guidelines appear useful for purulent episodes of AECOPD and episodes of AECB. These guidelines have not been prospectively validated for the general population and especially not for the elderly population. Using a risk-stratification approach for elderly patients, first-line antibiotics (e.g., amoxicillin, ampicillin, pivampicillin, trimethoprim/sulfamethoxazole, and doxycycline), with a more-limited spectrum of antibacterial coverage, are used in patients who are likely to have a low probability of resistant organisms during AECOPD/AECB. Second-line antibiotics (e.g., amoxicillin/clavulanic acid, second-or third-generation cephalosporins, and respiratory fluoroquinolones) with a broader spectrum of coverage are reserved for patients with significant risk factors for resistant organisms and those who have failed initial antibiotic treatment. J Am Geriatr Soc 58:570-579, 2010.

Potential links between eczema and obstructive pulmonary diseases have been postulated. Previously we have reported the prevalence of upper and lower respiratory diseases and the relation to environmental and socio-economic factors in a randomly selected adult population in southern Sweden using a postal questionnaire. In the present study we wanted to analyse the prevalence of eczema and its relation to socio-economic status, heredity factors and environmental factors in an adult population. Self-reported eczema, upper and lower respiratory symptoms, asthma and Chronic Bronchitis Emphysema (CBE) were examined in 12,071 adults, aged 20-59 years, living in southern Sweden by using a postal questionnaire. There were comparable numbers of males and females in all age groups. Multiple logistic regression analysis (forward conditional) was applied to estimate the association between the proposed risk factors (heredity, self-reported asthma and CBE, nasal symptoms, socio-economic group, e...

Background In 2004, hog farming operations were introduced in the village of Sarsfield in the eastern part of Ottawa, Canada. This study evaluates the health-related quality of life (HRQOL), and the prevalence of respiratory conditions among adults and children who lived in proximity to this farm. Methods A cross-sectional survey was administered to a random sample of residents from seven rural communities in the eastern part of Ottawa, Canada. We analyzed self-reported questionnaire data obtained from 723 adults and 285 children/adolescents. HRQOL was assessed using the SF-36 survey instrument, while data were also collected for sociodemographic characteristics, the prevalence of selected health conditions, and lifestyle related behaviours (e.g., smoking) of participants. Variations in self-reported health according to the residential distance to the hog farm were evaluated using logistic regression and analysis of variance methods. Results For the most part, the prevalence of selected health conditions among adults and children was not associated with how far they lived from the farm. No associations were observed with migraines, respiratory conditions (asthma, rhinitis, sinusitis, and chronic bronchitis), and allergies. However, a higher prevalence of depression was noted among those who lived within 3 km of the farm relative to those who lived more than 9 km away (odds ratio = 2.01, 95% CI = 1.11, 3.65). Furthermore, individuals who lived closer to the IHF were more likely to worry about environmental issues such as water quality, outdoor and indoor smells, and air pollution. This level of worry also contributed to lower HRQOL scores for individuals who lived closer to the farm. It was also observed that the prevalence of depression was much higher among those who indicated a concern about environmental issues (18.2%) when compared to those who did not (8.0%). Conclusion While our findings suggest that living in close proximity to an IHF may adversely affect HRQOL these should be interpreted cautiously due to a lack of direct measures of environmental exposures, and possible biases inherent in the use of self-reported health measures.

Although sauna bathing causes various acute, transient cardiovascular and hormonal changes, it is well tolerated by most healthy adults and children. Sauna bathing does not influence fertility and is safe during the uncomplicated pregnancies of healthy women. Some studies have suggested that long-term sauna bathing may help lower blood pressure in patients with hypertension and improve the left ventricular ejection fraction in patients with chronic congestive heart failure, but additional data are needed to confirm these findings. The transient improvements in pulmonary function that occur in the sauna may provide some relief to patients with asthma and chronic bronchitis. Sauna bathing may also alleviate pain and improve joint mobility in patients with rheumatic disease. Although sauna bathing does not cause drying of the skin-and may even benefit patients with psoriasis-sweating may increase itching in patients with atopic dermatitis. Contraindications to sauna bathing include unstable angina pectoris, recent myocardial infarction, and severe aortic stenosis. Sauna bathing is safe, however, for most people with coronary heart disease with stable angina pectoris or old myocardial infarction. Very few acute myocardial infarctions and sudden deaths occur in saunas, but alcohol consumption during sauna bathing increases the risk of hypotension, arrhythmia, and sudden death, and should be avoided.

Epidemiology of chronic obstructive pulmonary disease: Health effects of air pollution VIEGI G, MAIO S, BALDACCI S. Respirology 2006; 11: 523-532 Abstract: COPD is one of the leading causes of morbidity and mortality in the industrialized and the developing countries. According to the prediction of the World Health Organization, COPD will become the third leading cause of mortality and the fifth cause of disability in 2020 worldwide. In epi- demiology, distinct phenotypic entities converge on the term COPD, so that prevalence and mortal- ity data may be inclusive of chronic bronchitis, emphysema and asthma; moreover, the assessment of prevalence rates may change considerably according to the diagnostic tools used. Thus, a consid- erable problem is to estimate the real prevalence of COPD in the general population. COPD is deter- mined by the action of a number of various risk factors, among which, the most important is cigarette smoking. However, during the last few decades, evidence...

L'objectif de cette Etude multicentrique, prospective, randomisEe, en double aveugle, 6tait de comparer l'efficacitd et la tolerance du cdfotiam hexdtit (CTM) h la dose de 400 mg matin et soir avec celles de l'amoxicilline/acide clavulanique (AAC) ~ la dose de 1 g matin et soir sur une pdriode de dix jours de traitement au cours d'une exacerbation de bronchite chronique. Cent cinquante sept patients adultes souffrant d'une exacerbation de bronchite chronique ont 6t6 inclus par des pneumologues. Les deux populations 6taient comparables l'inclusion en ce qui concerne les donnEes dEmographiques et la clinique. En fin de traitement, 92 % des patients du groupe cEfotiam hexEtil et 88 % du groupe amoxicilline/acide clavulanique 6taient guEris aprEs analyse en intention de traiter, respectivement 96 % versus 94 % aprEs analyse en per protocol. Le nombre d'effets secondaires a 6t6 moins frequent dans le groupe cdfotiam hexEtil (9 % versus 21%). Cette difference 6tait statistiquement significative (p = 0,03). En conclusion, le cEfotiam hexdtil 400 mg matin et soir peut ~tre considEr6 comme une bonne alternative thErapeutique dans le traitement des exacerbations de bronchite chronique de l'adulte avec une efficacit6 6quivalente et une tolerance meitleure que l'amoxicilline/acide clavulanique 1 g matin et soir.

Background: Chronic obstructive pulmonary disease (COPD) is characterized by chronic bronchitis, emphysema and irreversible airflow limitation. These changes are thought to be due to oxidative stress and an imbalance of proteases and antiproteases. Quercetin, a plant flavonoid, is a potent antioxidant and anti-inflammatory agent. We hypothesized that quercetin reduces lung inflammation and improves lung function in elastase/lipopolysaccharide (LPS)-exposed mice which show typical features of COPD, including airways inflammation, goblet cell metaplasia, and emphysema. Methods: Mice treated with elastase and LPS once a week for 4 weeks were subsequently administered 0.5 mg of quercetin dihydrate or 50% propylene glycol (vehicle) by gavage for 10 days. Lungs were examined for elastance, oxidative stress, inflammation, and matrix metalloproteinase (MMP) activity. Effects of quercetin on MMP transcription and activity were examined in LPS-exposed murine macrophages. Results: Quercetin-treated, elastase/LPS-exposed mice showed improved elastic recoil and decreased alveolar chord length compared to vehicle-treated controls. Quercetin-treated mice showed decreased levels of thiobarbituric acid reactive substances, a measure of lipid peroxidation caused by oxidative stress. Quercetin also reduced lung inflammation, goblet cell metaplasia, and mRNA expression of pro-inflammatory cytokines and muc5AC. Quercetin treatment decreased the expression and activity of MMP9 and MMP12 in vivo and in vitro, while increasing expression of the histone deacetylase Sirt-1 and suppressing MMP promoter H4 acetylation. Finally, co-treatment with the Sirt-1 inhibitor sirtinol blocked the effects of quercetin on the lung phenotype. Conclusions: Quercetin prevents progression of emphysema in elastase/LPS-treated mice by reducing oxidative stress, lung inflammation and expression of MMP9 and MMP12.

Background: Clarithromycin extended-release tablets are indicated for the treatment of adults with acute maxillary sinusitis caused by Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae; acute bacterial exacerbation of chronic bronchitis due to H influenzae, Haemophilus parainfluenzae, M catarrhalis, or S pneumoniae; or communityacquired pneumonia due to H influenzae, H parainfluenzae, M catarrhalis, S pneumoniae, Chlamydia pneumoniae, or Mycoplasma pneumoniae.

This cross-sectional, population-based study in- cluding males and females 20 to 69 years of age from the urban area of Pelotas, Rio Grande do Sul State, Brazil, aimed to verify characteristics associated with above-average number of medi- cal consultations. The mean number of physician consultations in the previous year was 3.2, with a standard deviation of 5.5. The analysis consid- ered two outcomes: individuals with more than eight physician visits per year (one SD above the mean) and more than 14 consultations (two SD above the mean). In the sample of 1,962 individ- uals, 183 (9.3%) reported more than eight physi- cian consultations in the previous year. Logistic regression compared the outcomes with the fol- lowing variables: sex, age, diabetes mellitus, hy- pertension, chronic bronchitis, minor psychiatric disorders, and hospitalization in the previous year. There were 57 individuals (2.9%) with more than 14 consultations during the year. Logistic regression showed significant...

Systemic and local inflammation is central to the pathophysiology of chronic obstructive pulmonary disease (COPD). Increased levels of inflammation have been linked to a more progressive course in COPD and have been shown to be present during an exacerbation. Decreases in inflammatory cytokines, C-reactive protein, and inflammatory cells have been observed with corticosteroid use, suggesting a possible mechanism for a therapeutic benefit of steroids. No available data support the routine use of systemic corticosteroids in stable COPD; however, short courses during exacerbations are likely to improve length of hospitalization, lung function, and relapse rate. Inhaled corticosteroids (ICS) decrease the rate of exacerbation and may improve the response to bronchodilators and decrease dyspnea in stable COPD. No study shows that ICS reduce the loss of lung function; however, recent data suggest a possible survival benefit when combined with long-acting beta agonists. There are limited da...

During the last decade, a growing interest in recycling of domestic waste has emerged, and action plans to increase the recycling of domestic waste have been agreed by many governments. A common feature of these plans is the implementation of new systems and equipment for the collection of domestic waste which has been separated at source. However, only limited information exists on possible occupational health problems related to such new systems. Occupational accidents are very frequent among waste collectors. Based on current knowledge, it appears that the risk factors should be considered as an integrated entity, i.e. technical factors (poor accessibility to the waste, design of equipment) may act in concert with high working rate, visual fatigue due to poor illumination and perhaps muscle fatigue due to high work load. Musculoskeletal problems are also common among waste collectors. A good deal of knowledge has accumulated on mechanical load on the spine and energetic load on the cardio-pulmonary system in relation to the handling of waste bags, bins, domestic containers and large containers. However, epidemiologic studies with exposure classification based on field measurement are needed, both to further identify high risk work conditions and to provide a detailed basis for the establishment of occupational exposure limits for mechanical and energetic load particularly in relation to pulling, pushing and tilting of containers. In 1975, an excess risk for chronic bronchitis was reported for waste collectors in Geneva (RuRner-Press et al., 1975) and data from the Danish Registry of Occupational Accidents and Diseases also indicate an excess risk for pulmonary problems among waste collectors compared with the total work force. Surprisingly few measurements of potentially hazardous airborne exposures have been performed, and the causality of work-related pulmonary problems among waste collectors is unknown. Recent studies have indicated that implementation of some new waste collection systems may result in an increased risk of occupational health problems. High incidence rates of gastrointestinal problems,

In 2004, hog farming operations were introduced in the village of Sarsfield in the eastern part of Ottawa, Canada. This study evaluates the health-related quality of life (HRQOL), and the prevalence of respiratory conditions among adults and children who lived in proximity to this farm.

The European Community Respiratory Heath Survey (ECRHS) was the first study to assess the geographical variation in asthma and allergy in adults using the same instruments and definitions. The database of the ECRHS includes information fromy140,000 individuals from 22 countries. The aim of this review is to summarize the results of the ECRHS to date.

Recent studies have demonstrated that angiogenesis and suppressed cell-mediated immunity (CMI) play a central role in the pathogenesis of malignant disease facilitating tumour growth, invasion and metastasis. In the majority of tumours, the malignant process is preceded by a pathological condition or exposure to an irritant which itself is associated with the induction of angiogenesis and/or suppressed CMI. These include: cigarette smoking, chronic bronchitis and lung cancer; chronic oesophagitis and oesophageal cancer; chronic viral infections such as human papilloma virus and ano-genital cancers, chronic hepatitis B and C and hepatocellular carcinoma, and Epstein±Barr virus (EBV) and lymphomas; chronic in¯ammatory conditions such as Crohn's disease and ulcerative colitis and colorectal cancer; asbestos exposure and mesothelioma and excessive sunlight exposure/sunburn and malignant melanoma. Chronic exposure to growth factors (insulin-like growth factor-I in acromegaly), mutations in tumour suppressor genes (TP53 in Li Fraumeni syndrome) and long-term exposure to immunosuppressive agents (cyclosporin A) may also give rise to similar environments and are associated with the development of a range of solid tumours. The increased blood supply would facilitate the development and proliferation of an abnormal clone or clones of cells arising as the result of: (a) an inherited genetic abnormality; and/or (b) acquired somatic mutations, the latter due to local production and/or enhanced delivery of carcinogens and mutagenic growth factors. With progressive detrimental mutations and growth-induced tumour hypoxia, the transformed cell, to a lesser or greater extent, may amplify the angiogenic process and CMI suppression, thereby facilitating further tumour growth and metastasis. There is accumulating evidence that long-term treatment with cyclo-oxygenase inhibitors (aspirin and indomethacin), cytokines such as interferon-a, anti-oestrogens (tamoxifen and raloxifene) and captopril signi®cantly reduces the incidence of solid tumours such as breast and colorectal cancer. These agents are anti-angiogenic and, in the case of aspirin, indomethacin and interferon-a have proven immunomodulatory eects. Collectively these observations indicate that angiogenesis and suppressed CMI play a central role in the development and progression of malignant disease. #

Objectives-To compare the usefulness of high resolution computed tomography (HRCT) with chest radiography (CR) in the diagnosis and assessment of severity of silicosis. Methods-27 workers exposed to silica underwent CR, HRCT, and pulmonary function tests. Two experienced readers independently evaluated CR by International Labour Office classification, and grouped the results into four categories. HRCT categories of nodule profusion and the extent of emphysema were graded on a four point scale; in 20 subjects the percentage distribution of lung densities were measured by HRCT. Results-Concordance between readers was higher for HRCT than for CR (K statistic = 0 49 and 0-29 respectively). There was poor concordance between CR and HRCT in the early stages of silicosis. No significant difference in pulmonary function tests was found among different CR categories, but forced expiratory volume in one second (FEV1), maximal expiratory flow at 50% and 75% of FVC the simultaneous presence of the associated COPD. 262 group.bmj.com on July 16, 2011 -Published by oem.bmj.com Downloaded from

Background: Little is known about the impact of COPD on lung deposition of inhaled drugs and the relationship between lung-dose and response of pulmonary function measurements. Methods: Nineteen patients with varying degrees of COPD were randomized to inhale single doses of formoterol (Oxis s ) Turbuhaler s 4.5, 9, 18, and 36 mg in a double blind, placebo-controlled, crossover design. Urinary excreted formoterol during 32 h was used to determine absolute lung deposition. Peak inspiratory flow (PIF) and inhaled volume (IV) were recorded to assess the patients' ability to use Turbuhaler. Efficacy was measured by spirometry, inspiratory capacity (IC), airway conductance (sG AW ), and absolute lung volumes. Results: Mean pulmonary bioavailability of formoterol was about 24% of the nominal delivered dose after inhalation for the different treatments. No significant correlations between lung deposition and baseline FEV 1 , PIF or IV were shown. All formoterol doses produced statistically significant increases in FEV 1 , FVC, IC, and sG AW relative to placebo. Linear dose/response relationships were observed for these variables, with more narrow limits of the slopes for the lung-dose/response relationships than for the nominal-dose/ response relationships. Moreover, 36 and 18 mg formoterol statistically significantly decreased functional residual capacity (FRC) and residual volume (RV) relative to placebo. Conclusions: This study could not show any difference in lung deposition of formoterol inhaled via Turbuhaler between patients with moderate and severe COPD. Moreover, the ARTICLE IN PRESS (E. Derom). The present publication is dedicated to the memory of Romain Pauwels.

The objectives of this study were to assess potential health and productivity benefits for the year 2010 with five scenarios for reducing particulate matter (PM 10 and PM 2.5 ) air pollution in the cities of Osaka, Houston, Bangkok and Seoul. Assuming a uniform 10% decline in ambient PM levels, the preventible cases of: (1) premature mortality ranged from 35 in Houston to 379 in Seoul, (2) chronic bronchitis ranged from 95 in Houston to 1,631 in Seoul, (3) cardiovascular disease ranged from 68 in Houston to 818 in Seoul, (4) pneumonia ranged from 28 in Houston to 336 in Seoul, (5) asthma attacks ranged from 388 in Osaka to 96,876 in Seoul, and (6) acute bronchitis ranged from 186 in Houston to 2,973 in Seoul. The per million population central estimate of the purchasing power parity adjusted value of health and productivity benefits ranged from $25 million in Bangkok to $160 million in Osaka. There was a wide variability in measured PM 10 levels across cities. Percentages of active monitors reporting concentrations above 50 µg/m 3 (annual average) or 150 µg/m 3 (24-hour average) in 2001-2002 were 0% in Houston, 5% in Osaka, 33% in Bangkok and 92% in Seoul. Assuming a non-uniform reduction in PM only at concentration hotspots with levels above air quality standards, the number of preventible cases of mortality ranged from 0 in Houston to 1,104 in Seoul. The central estimate of total benefits ranged from $0 in Houston to $240 million in Seoul.

Only few data have been published about non-responders in epidemiological studies on respiratory diseases. The aim of this study was to examine the characteristics of the non-responders and the reasons for non-response in a survey of respiratory health. All 9132 subjects, born 1925-1926, 1940-1941, 1955-1956 and 1970-1971 and living in eight representative areas in Norrbotten, Sweden, were invited to a prevalence study on asthma, chronic bronchitis and respiratory symptoms. The response rate was 85%. A sample of the non-responders from the cross-sectional postal questionnaire study was contacted by telephone and interviewed using the same questionnaire as had been used in the postal survey. Of the 1397 non-responders a stratified sample of 182 subjects were selected for this study and 144 agreed to participate. The response rate was increasing by increasing age. The main reason for non-response was that the subjects had forgotten to mail the questionnaire, lack of interest or lack o...

The optimal antibiotic therapy for patients with acute bacterial exacerbations of chronic bronchitis (ABECB) who have failed to respond to previous oral antimicrobial therapy is not known; however, newer macrolide and fluoroquinolone antibiotics may be appropriate. This multicenter, randomized, double-masked, doubledummy study was undertaken to compare the efficacy and tolerability of sparfloxacin with those of clarithromycin in the treatment of ABECB. In 43 centers in the United States, 298 patients (52% male; age range, 19 to 92 years) were randomly allocated to receive a 400-mg loading dose of sparfloxacin, followed by 200 mg once daily, or clarithromycin 500 mg twice daily, for a total of 10 days. Signs and symptoms of ABECB were assessed at each of 4 visits, including a follow-up visit approximately 1

Hog confinement workers are at high risk to develop chronic bronchitis as a result of their exposure to organic dust. Chronic bronchitis is characterized by inflammatory changes of the airway epithelium. A key mediator in inflammation is Toll-like receptor 2 (TLR2). We investigated the role of TLR2 in pulmonary inflammation induced by hog confinement dust. Normal Human Bronchial Epithelial Cells (NHBE) were grown in culture and exposed to hog confinement dust extract. Hog confinement dust upregulated airway epithelial cell TLR2 mRNA in a concentration and timedependent manner using real-time PCR. There was a similar increase in TLR2 protein at 48 hours as shown by Western blot. TLR2 was upregulated on the surface of airway epithelial cells as shown by flow cytometry. A similar upregulation of pulmonary TLR2 mRNA and protein was shown in a murine model of hog confinement dust exposure. Hog confinement dust is known to stimulate epithelial cells to produce IL-6. In order to determine whether TLR2 expression was being regulated by IL-6, the production of IL-6 was blocked using an IL-6 neutralizing antibody. This resulted in attenuation of the dust-induced upregulation of TLR2. To further demonstrate the importance of IL-6 in the regulation of TLR2, NHBE were directly stimulated with recombinant human IL-6. IL-6 alone was able to upregulate TLR2 in airway epithelial cells. Hog confinement dust upregulates TLR2 in the airway epithelium through an IL-6 dependent mechanism.

Safety thresholds for chemical impurities and leachables in consumer products such as foods and drugs have helped to ensure public health while establishing scientifically sound limits for identification and risk assessment of these compounds. The Product Quality Research Institute (PQRI) Leachables and Extractables Working Group, a collaboration of chemists and toxicologists from the U.S. Food and Drug Administration (FDA), industry, and academia, has developed safety thresholds for leachables and extractables in orally inhaled and nasal drug products (OINDP), for application in United States pharmaceutical submissions. The PQRI safety concern threshold (SCT) is 0.15 mg/day, and the qualification threshold is 5 mg/day. OINDP are important in the treatment of lung diseases such as asthma and chronic bronchitis, as well as systemic diseases such as diabetes. Analysis of extractables and minimization of leachables in OINDP are vital to ensuring the quality and safety of the final product. It is expected that the thresholds developed by the PQRI Leachables and Extractables Working Group will be used by both industry and regulators to ensure and assess such quality and safety in OINDP applications. In this article, we describe the importance of the PQRI safety thresholds in the OINDP pharmaceutical development process; the background and context of safety thresholds for consumer products; how these safety thresholds were developed using well-established, robust databases and quantitative risk assessment approaches; and how these thresholds can be applied in a pharmaceutical safety qualification process, including FDA regulatory perspectives on the use of safety thresholds for OINDP.

Kronik obstrüktif akciğer hastalığı (KOAH), kronik bronşit ve amfizeme bağlı ilerleyici ve genellikle irreversibl hava akımı kısıtlanması ile karakterize bir hastalıktır. Dünyada ölümler arasında altıncı sırayı almaktadır. Morbiditesi yüksek olan KOAH, aynı zamanda iş gücü kaybına ve tedavi maliyetinin yükselmesine neden olur. Hastalığın gelişimi boyunca, özellikle amfizemli hastalarda daha belirgin olmak üzere, diyafragmada önemli değişiklikler oluşmaktadır. Bu değişikliklerden biri hiperinflasyonun neden olduğu normal diyafragma yapısının bozulması; diğeri de KOAH'lı hastalarda prevalansı artan malnütrisyonun etkisiyle gelişen değişikliklerdir. Bu nedenle, hastalığın tedavisinde çeşitli farmakolojik ajanlar ve oksijen tedavisi yanında pulmoner rehabilitasyon programları ve beslenme desteği uygulanmaktadır. Bu çalışmada, amfizemli hastalarda diyafragma kontraktilitesinin yüzeyel elektromiyografi ile değerlendirilmesi planlandı.

Respiratory tract mucus is a viscoelastic gel, the rheological properties of which are determined mainly by its content of mucous glycoproteins and water. The rheology and quantity of mucus, in concert with ciliary factors, are the major determinants of mucociliary clearance.

The up-regulation of nitric oxide (NO) by inflammatory cytokines and mediators in central and peripheral airway sites can be easily monitored in exhaled air (F(E)NO). It is now possible to estimate the predominant airway site of increased F(E)NO i.e. large versus peripheral airway/alveoli, and its potential pathologic and physiologic role in obstructive lung disease. In asthma, six double-blind, randomized, controlled algorithm trials have reported only equivocal benefits of add-on measurements of F(E)NO to usual clinical guideline management including spirometry. Significant design issues, as emphasized by Gibson, may exist. However, meta-analysis of these six studies (Petsky et al 2012 Thorax 67 199-208) concluded that routine serial measurements of F(E)NO for clinical asthma management does not appear warranted. In COPD including chronic bronchitis and emphysema, despite significant expiratory airflow limitation, when clinically stable as well as during exacerbation, F(E)NO, j&#3...