Latest Treatments for Bronchitis

Relieve Your Bronchitis Cure

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Relieve Your Bronchitis Cure Overview


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Several advances have occurred in our knowledge of the natural history and management of bronchitis. The first step has been a classification of patients with chronic bronchitis into four groups (see Table 1) (1). Chronic bronchitis is a syndrome defined by cough and production of sputum on most days for at least 3 months a year for 2 consecutive years (2). It is often complicated by airway obstruction leading to the commonly used term chronic obstructive pulmonary disease (COPD). Acute bronchitis and acute exacerbation of chronic bronchitis account for about 14 million physician visits each year in the United States, making these conditions among the most common illnesses encountered by family physicians (3). Not only is there considerable morbidity from chronic bronchitis, there is also substantial mortality, as chronic obstructive lung disease is the fourth leading cause of death in the United States (4). Despite the common nature of chronic bronchitis, there has been, and...

Acute Bronchitis

Acute bronchitis is an inflammatory condition of the tracheobronchial tree usually associated with a generalized respiratory infection. Cough begins early in the course of the illness and is the most prominent feature of the condition. An initially dry cough may later result in sputum production which characteristically changes from clear to discolored in the later stages of the illness. The cough may last for a significant time. Patients with acute bronchitis usually have a viral respiratory infection with transient inflammatory changes that produce sputum and symptoms of airway obstruction. Acute bronchitis is essentially a diagnosis of exclusion. The history should include information on cigarette use, exposure to environmental toxins, as well as medication history (e.g., use of angiotensin converting enzyme inhibitors). The chronicity of the cough should be established to distinguish acute bronchitis from chronic bronchitis, as they have different treatments. Both acute bronchitis...

Problems with the Tricuspid Valve in the Right Side of the Heart

Is less commonly affected than the valves on the left side of the heart. It is most commonly affected if the right pumping chamber has to pump against high pressure in the lungs. This is called pulmonary hypertension. The common causes of this are bronchitis and emphysema caused by smoking. The right ventricle is not as strong or powerful as the left pumping chamber and so it stretches and enlarges if it has to pump against a high pressure. If the chambers stretch, the valve is stretched and may leak because the valve segments are pulled apart.

Specific Issues Relating To Chronic Obstructive Pulmonary Disease And Emphysema

Chronic obstructive pulmonary diseases (COPD) are characterized by reduced maximal expiratory flow and include various disease entities such as chronic obstructive bronchitis, asthmatic bronchitis, and emphysema. At least 14 million people in the United States suffer from COPD, and the prevalence of this disease seems to be increasing (13-16). As many as 2 million people suffer from emphysema, and the overall death rate for emphysema in the United States has been estimated at 20 000 yr, the fifth leading cause of death in North America (13,16-18). Exercise testing in patients with COPD has been stimulated by the increasing numbers of patients entering pulmonary rehabilitation programs (19), in addition to the availability of specific treatments for this condition, i.e., pulmonary transplantation and lung volume reduction surgery (LVRS).

But Some People Get Coronary Heart Disease And Have No Risk Factors

Coronary heart disease is very uncommon in people who have no risk factors. The risk factors listed above account for the vast majority of cases of coronary heart disease. Smokers often know of someone who smoked all his life and lived to a ripe old age Maybe so, but he (or she) may have had a bad chest with bronchitis and emphysema and may have died from his lung problems or cancer of the lung or another part of the body, before dying from a heart attack. Most smokers know that if they continue, it will catch up with them sooner than they would like.

Medication Dosage Problems

Baker is prescribed azithromycin for a lower respiratory tract infection. The nurse tells Mr. Baker to take the drug on an empty stomach. Azithromycin is available in 250-mg tablets. The primary health care provider has ordered 500 mg on the first day, followed by 250 mg on days 2 to 5. How many tablets would Mr. Baker take on the first day On the last day of therapy

Complications of GERD Esophagitis Stricture Barretts and Cancer

Gastroesophageal reflux disease (GERD) has become a very prevalent disorder in the United States and the Western hemisphere. It has been estimated that as many as 44 of adults in the United States experience GERD symptoms described as heartburn at least once a month.1 In addition, as many as 10 of adults in the United States experience daily heartburn.2 The true prevalence of reflux disease may be largely underestimated when taking into account atypical manifestations of the disease as well as those patients who self-medicate.3,4 Unfortunately, many of these atypical manifestations often go unrecognized, and may take the form of ear-nose-throat, pulmonary, or laryngeal manifestations such as laryngitis, sinusitis, asthma, bronchitis, chronic cough, chest pain, and halitosis.4 A study by Harding and col-leagues5 showed that among those patients studied with a diagnosis of asthma and who denied reflux symptoms, > 29 had abnormal esophageal pH studies. Irwin and Richter,6 when...

Assess Rates for Diseases Known Not to Be Affected by the Exposure

For most exposures of possible health relevance, we have sufficient background knowledge to delineate some health outcomes that are likely to be affected (typically the ones that motivate the study and similar diseases) and other health outcomes that are highly unlikely to be affected. The conventional wisdom is fallible, of course. There are notable historical examples of erroneous assumptions about health outcomes that were certain to be unaffected by a given exposure. For example, men with chronic bronchitis were selected as controls in early case-control studies of lung cancer because chronic bronchitis was believed to be unaffected by tobacco smoking. Humans have a way of surprising epidemiologists with unanticipated associations, but in general, we can specify some diseases that are very likely to be affected by the exposure of interest based on current knowledge and diseases that are very unlikely to be affected by that exposure. Within the bounds of random error, and in the...

Contraindications Precautions And Interactions

Both carvedilol and labetalol are contraindicated in patients with hypersensitivity to the drug, bronchial asthma, decompensated heart failure, and severe brady-cardia. The drugs are used cautiously in patients with drug-controlled congestive heart failure, chronic bronchitis, impaired hepatic or cardiac function, in those with diabetes, and during pregnancy (Category C) and lactation.

Bronchodilators Sympathomimetic

A bronchodilator is a drug used to relieve bron-chospasm associated with respiratory disorders, such as bronchial asthma, chronic bronchitis, and emphysema. These conditions are progressive disorders characterized by a decrease in the inspiratory and expiratory capacity of the lung. Collectively, they are often referred to as COPD. The patient with COPD experiences dyspnea (difficulty breathing) with physical exertion, has difficulty inhaling and exhaling, and may exhibit a chronic cough. The two major types of bronchodilators are the sym-pathomimetics and the xanthine derivatives. The anti-cholinergic drug ipratropium bromide (Atrovent) is used for bronchospasm associated with COPD, chronic bronchitis, and emphysema. Ipratropium is included in the Summary Drug Table Bronchodilators. Chapter 25

Ongoing Assessment

During the ongoing assessment, the nurse assesses the respiratory status every 4 hours and whenever the drug is administered. The nurse notes the respiratory rate, lung sounds, and use of accessory muscles in breathing. In addition, the nurse keeps a careful record of the intake and output and reports any imbalance, which may indicate a fluid overload or excessive diuresis. It is important to monitor any patient with a history of cardiovascular problems for chest pain and changes in the electrocardiogram. The primary health care provider may order periodic pulmonary function tests, particularly for patients with emphysema or bronchitis, to help monitor respiratory status.

Patient Selection And Preoperative Assessment

Operative candidates were selected on the basis of hyperinflation, heterogeneity of disease, pulmonary perfusion and ventilation deficits, and significant functional disability. Patients with morbid obesity, chronic bronchitis and or excessive sputum production, metastatic cancer, continued or recent cigarette smoking, or less-than-severe functional disability were excluded from consideration.

Administrative Interventions

Administrative mandates can be implemented to change physician behavior, with consequences including claim denial for inappropriate behavior, financial incentives, and penalties for specific behaviors. The first study to report a successful intervention to decrease total antibiotic use in ambulatory practice was a noncontrolled study from the New Mexico Experimental Medical Care Review Organization from 1972 to 1975 (31). In this study, provider education and strict review of practice was implemented to improve the use of injectable antibiotics for common respiratory tract infections. If strict prescription review indicated inappropriate use of antimicrobial agents, the payment was denied by the organization. Their initiative was associated with a modest reduction in total antibiotic use for bronchitis, influenza, and upper respiratory infections in this Medicaid population.

Ischemic heart disease

The risk of pulmonary complications can be attributed to various factors, both pulmonary and nonpulmonary. Minor pulmonary complications (atelectasis, bronchitis) are increased in patients who smoke or who have chronic cough or abnormal spirometry values. However, the risk for severe postoperative pulmonary complications (pneumonia, respiratory failure) is increased mainly in those patients with marked impairment in lung function (FEV-i < 1.5 L). Among the nonpulmonary factors that contribute to the risk for postoperative complications are age, obesity, longer duration of anesthesia, excessive sedation, poor patient effort, and the type of surgery. Respiratory dysfunction is less severe after orthopedic than after intraabdominal or thoracic surgery.

Multifaceted Interventions

The only study to examine a multifaceted approach in the outpatient setting focused on improving the treatment of uncomplicated acute bronchitis in adults (47). Four office practices were selected for the study one practice was provided with a full intervention, one practice received a limited intervention, and two practices served as the control sites. In the full intervention site, household educational materials were mailed to all patients (magnets, pamphlets, a letter from the medical director of the practice) regarding appropriate management of common infections. Office-based educational material specific for acute bronchitis was delivered to the office for the examination rooms. Clinicians were detailed on the patient education activities included in the intervention, and were provided with antibiotic prescribing rates for acute bronchitis at their site during the previous winter. They participated in an interactive educational session on evidence-based management of acute...

Surfactant Therapy of Other Lung Disease

There is limited information on the value of surfactant treatment of patients with COPD. In a single study of the effect of surfactant PL in COPD, patients with chronic bronchitis who received aerosolized PL three times daily for two weeks had a modest dose-related improvement in muco-ciliary transport and airflow compared to that in patients who received saline (166). The Discovery Labs has been developing an aerosolized surfactant solid form to treat hospitalized COPD patients. Work with aerosolized surfactant has demonstrated improved pulmonary function in such patients.

Adverse Events From Cannabis Administration

Smoked cannabis causes bronchodilation (probably by THC) (42), pulmonary irritation from inhalation of the smoke, and increased absorption of carbon monoxide (43,44). The latter leads to elevated blood carboxyhemoglo-bin levels, resulting in decreased oxygen delivery to tissues. These effects rarely cause clinically significant adverse events with the limited exposure usually involved in cannabis administration research studies (45). However, even a single cannabis cigarette may trigger coughing or breathing difficulty (dysnpea) in a susceptible subject, e.g., one with active asthma or bronchitis.

Predictors Of Decreased Survival After Lvrs Preoperative Factors

Our analysis also found an inverse relationship between preoperative FEV1 and survival. Although this observation appears counterintuitive upon initial consideration, there are at least two potential explanations for this finding. First, because fixed, severe impairments in FEV1 are more characteristic of pure advanced emphysema than chronic bronchitis (19), patients with higher FEV1 might represent a subgroup of patients with mixed disease (with a significant bronchitic component) which might not benefit as much from LVRS. Second, it is possible that this finding represents a degree of selection bias, because the most severely compromised patients (with the lowest FEV1) might have been subjected to stricter selection criteria, although those with higher FEV1 might have been accepted for LVRS despite lesser degrees of disease heterogeneity. Whatever the explanation, our findings support the continued use of significantly reduced FEV1 as an absolute requirement in the selection of...

Nutritional Therapy During Established Infection

Nutritional therapy has been employed in a large number of studies for many serious illnesses, but few have specifically focused on elderly subjects with infectious diseases. Several investigators have examined vitamin C (ascorbic acid) for the prevention and treatment of respiratory tract infections. One such study was performed in hospitalized elderly patients with bronchitis or pneumonia (48) and compared vitamin C 200 mg d vs placebo in 57 patients. Supplementation rapidly increased plasma and cellular vitamin C levels, and may have slightly improved respiratory functional status, particularly in those with the most severe illness on admission. However, variable follow-up, small numbers of patients, and unplanned subgroup analyses suggest these data must be interpreted with caution.

Iral Diseases of the Respiratory Tract

Respiratory infections are the most common afflictions of humans, and most are caused by viruses. Children contract on average about half a dozen respiratory illnesses each year, and adults perhaps two or three. Admittedly these are mainly trivial colds and sore throats, but they account for millions of lost working hours and a significant proportion of all visits to family physicians. More serious lower respiratory tract infections tend to occur at the extremes of life, and in those with preexisting pulmonary conditions. The most important human respiratory viruses are influenza and respiratory syncytial viruses (RSV), the former killing mainly the aged and the latter the very young. Of the estimated 5 million deaths from respiratory infections in children annually worldwide, at least 1 million are viral in origin. Whereas some viruses have a predilection for one particular part of the respiratory tract, most are capable of causing disease at any level, and the syndromes to be...

Arrival Of Pml Cases And An Electron Microscope

In the fall of 1962, a particularly stimulating consultation case was presented to me by the pathologist of a downtown Madison hospital. The patient, a 33-year-old woman with lupus erythematosus, had died after several weeks of progressive cerebellar disease. The slides showed a multifocal demyelinating disease with a most striking combination of giant tumor-like astrocytes and large numbers of oligodendrocytes with greatly enlarged nuclei deeply stained with hematoxylin. There were no distinct inclusion bodies as one sees with herpes viruses. I was fascinated and knew I had never seen this disease before. I showed the slides to a visiting neuropathologist and he, too, was at a loss. At that time I was in the midst of a very time-consuming experiment with a group of sophomore students. It involved the induction of brain tumors in chicken with Rous sarcoma virus. There was no time for a library search. However, I did show the slides to Dr. Chou, and to my utter surprise, and delight,...

Pathophysiology Of Emphysema

Ventilation Perfusion Ratio Emphysema

In general, reductions in or limitations to expiratory airflow arise from one of two mechanisms increased airways resistance or decreased elastic recoil (decreased driving pressure). In obstructive airways diseases such as asthma and chronic bronchitis, there is clearly increased resistance to airflow that occurs because the airway lumen is narrowed A hallmark of pure emphysema is that arterial blood Po2 and Pco2 levels are maintained to a greater degree than in patients with chronic bronchitis and a similar degree of pulmonary impairment. However, gas exchange is by no means normal in patients with emphysema. There are at least two mechanisms of hypoxemia at play in such patients. One is reduction in diffusing capacity (DLCO), which occurs because of the loss of alveolar surface area, which is part and parcel of the process of emphysema in the lungs. Although the reduction in diffusing capacity is straightforward to understand, isolated reductions in diffusion do not play a...

Respiratory Syncytial Virus Infection Control Guidelines

RSV appears to be an increasing cause of respiratory disease in this population, especially those in nursing care facilities. During outbreaks, the attack rate ranges from 10 to 40 and accounts for 5-27 of all respiratory tract infections in long-term care facilities. Individuals over the age of 60, typically, present with mild nasal congestion, but fever, anorexia, pneumonia, or bronchitis may develop (55-57).

The Bronchial Circulation

Bronchial arterial pressure is approximately the same as aortic pressure, and bronchial vascular resistance is much higher than resistance in the pulmonary circulation. Bronchial blood flow is approximately 1 to 2 of cardiac output but, in certain inflammatory disorders of the airways (e.g., chronic bronchitis), it can be as high as 10 of cardiac output.

Selective IgA Deficiency

IgA deficiency is the most common of all immunodeficiencies. Depending on the country, the incidence is between 1 400 and 1 3000. There is an increased incidence oflgA deficiency in subjects with defects in chromosome 18, connatal rubellasyndrome, andataxia telangiectasia(Mietens, 1983). Associatedwith the deficiency are recurrent bacterial infections, bronchitis, sinusitis, pneumonia, allergies, and autoimmune diseases (Schaffer etal., 1991). B-cell differentiation arrest preventing isotypic switching from IgG to IgA is the central defect in the immunodeficiency. CVID is a major antibody immunodeficiency characterized by recurrent upper, lower respiratory tract infections and, in a few patients, granulomatous disease (Cunningham-Rundles, 1994). Over 20 of the patientpopulations also develop autoimmune diseases (Vetrie etal., 1993).

Sequence On The Cough

In chronic bronchitis cough is accompanied with sputum. In chronic obstructive pulmonary disease (COPD) there is also wheeze, which is predominantly irreversible. In contrast, cough in asthma is associated with reversible wheeze, is usually worse in the early hours, i.e. between 2 and 4 a.m., and causes sleep disturbance in many patients. Prolonged bouts of coughing in chronic bronchitis may give rise to cough syncope (p. 189). Bronchitis (acute and chronic, l,e. COPD) Asthma Chronic bronchitis, COPD Chronic asthma

Resistance In Grampositive Bacteria

Pneumonia due to Streptococcus pneumoniae is one of the most frequent causes of lower respiratory tract infection in the United States. In the past, clinicians resorted to penicillin to treat this infection. The pneumococci were exquisitely susceptible (MIC < 0.1 g mL). Pneumococci that are intermediate resistant, resistant, and highly resistant have MICs to penicillin of 0.1-1.0 g mL, > 1.0-1.9 g mL, and > 2.0 g mL, respectively. Penicillin-resistant pneumococci (PRP) have now emerged as a significant threat in the therapy of the pneumonia in the elderly. This threat stems from the fear of outbreaks of pneumococcal infection in institutionalized settings. Studies by Millar and colleagues (42) and Denton and co-workers (43), were among the first to describe PRP infection in the elderly institutionalized, debilitated patients. Erythromycin, as a representative of the macrolide antibiotic class, has long been regarded as the most favorable alternative to penicillin in...

Preadministration Assessment

Because the bronchodilators or antiasthma drugs may be given for asthma, emphysema, or chronic bronchitis, the preadministration assessment of the patient requires careful observation and documentation. The nurse takes the blood pressure, pulse, and respiratory rate before therapy with a bronchodilator or antiasthma drug is initiated. Respiratory rates below 12 min or above 24 min are considered abnormal. It is important to assess the lung fields and carefully document the sounds heard before therapy is begun. The nurse notes any dyspnea, cough, wheezing (a musical sound of the respiratory tract caused by air passing through a narrowed bronchial tube), noisy respirations, or use of accessory muscles when breathing. If the patient is raising sputum, the nurse records a description of the sputum. The nurse notes and records the patient's general physical condition. It is important to record any signs of hypoxia (eg, mental confusion, restlessness, anxiety, and cyanosis bluish...

Parainfluenza Viruses

Primary infection, typically in a young child, generally manifests itself as coryza and pharyngitis, often with some degree of bronchitis and low fever. However, there are two more serious presentations which are seen in 2-3 of infections (Table 28-4). In an infant, especially under Ihe age of 6 months, parainfluenzavirus type 3 may cause bronchiolitis and or pneumonia clinically indistinguishable from that more commonly caused by the respiratory syncytia virus (see below). In somewhat older children (6 months to 5 years) parainfluenzavirus type 1 and, to a lesser extent, type 2 are the major cause of croup (Jaryngotracheobronchitis). The child presents with fever, cough, stridor, and respiratory distress which may occasionally progress to laryngeal obstruction requiring intubation or tracheotomy.

Further Investigations

In many cases it is possible to make a reliable diagnosis from the history and clinical examination. I his applies, for example, to conditions such as bronchial asthma, chronic bronchitis and lo some cases of pneumonia and pulmonary infarction. At other times clinical examination fails to reveal any abnormality and the diagnosis depends entirely on specialised investigations, particularly radiology. Essential Investigation In all III patients with respiratory problems. Partial pressure of oxygen (Pao2) low in severe asthma, pneumonia, pulmonary embolism and oedema (type I respiratory failure). Partial pressure of carbon dioxide also elevated In very severe asthma, severe chronic bronchitis and emphysema (type II respiratory failure), Hydrogen Ion concentration or pH allows assessment of degree of respiratory acidosis caused by carbon dioxide retention Forced expiratory volume in one second (FEV,) and forced vital capacity (FVC) measured by spirometry provide an accurate assessment of...

Assessing Whether Misclassification Is Differential By Exposure

More subtle forms of exposure-driven diagnosis can also result in differential disease misclassification, typically creating a spuriously strong association if the exposure increases the probability of more accurate or complete diagnosis. Tobacco use is a firmly established, major cause of a variety of diseases, including cancer of the lung and bladder, coronary heart disease, and chronic obstructive pulmonary disease. While several of these diseases have unambiguous diagnoses, such as advanced lung cancer, there are others such as chronic bronchitis or angina that can involve a certain amount of discretionary judgment on the part of the physician. Integration of the complete array of relevant data to reach a final diagnosis is likely to include consideration of the patient's smoking history. This can be viewed as good medical practice that takes advantage of epidemio-logic insights since the probabilities of one diagnosis or another are truly altered by the smoking history....

Emerging infectious diseases the publics view of the problem and what should be expected from the public health

The Burden Infectious Diseases 2016

Throughout the world in 2003 were caused by microbial agents 3 (Table 1). Leading the list are lower respiratory infections, responsible for 3.9 million deaths per year, followed by HIV AIDS (2.8 million), diarrhea (1.8 million), tuberculosis (1.6 million), and malaria (1.2 million) 3 . The true burden of death from infectious diseases, however, is much higher since underreporting remains a major factor, particularly in the developing world. Moreover, many deaths associated with infections are not categorized as infection related (e.g., deaths from cancers caused by infectious agents). Despite the continued dramatic impact of these global killers, they receive very limited media attention - having become commonplace compared to the new and exotic.

What Are The Effects Of Stress On Lifestyle

Smoking is a strong, independent risk factor for heart disease, lung cancer, bronchitis, and emphysema. Alcohol is fattening, increases the cholesterol and triglyceride fat levels, and increases the blood pressure. It is poisonous to the heart muscle, leading to heart enlargement, weakening of the heart muscle, and heart failure. It also irritates the heart, causing an irregular rhythm called atrial fibrillation, which may develop after a binge.


The fluoroquinolones are used in the treatment of infections caused by susceptible microorganisms. The fluoro-quinolones are effective in the treatment of infections caused by gram-positive and gram-negative microorganisms. They are primarily used in the treatment of susceptible microorganisms in lower respiratory infections, infections of the skin, urinary tract infections, and sexually transmitted diseases. Ciprofloxacin, norfloxacin, and ofloxacin are available in ophthalmic forms for infections in the eyes.

CT in LVRS Patients

The major role of chest CT in patients who are candidates for LVRS is to confirm the diagnosis of at least moderately severe pulmonary emphysema, as well as to evaluate any associated manifestations of chronic obstructive airway disease, e.g., bronchiectasis, chronic bronchitis, or respiratory bronchiolitis (57). Carcinoma of the lung, which has a reported prevalence of 2-5 as Stage 1 disease in LVRS candidates (32,58-61), also must be excluded.


The THC content of high quality cannabis might be in the range 0.5-1 for large leaves, 1-3 for small leaves, 3-7 for flowering tops, 5-10 for bracts, 14-25 for resin, and up to 60 in cannabis oil. Higher amounts of THC are produced in selected strains known as skunk cannabis, so named because of their powerful smell flowering tops from skunk varieties might contain 10-15 THC. The THC content in cannabis products tends to deteriorate on storage, an effect accelerated by heat and light. Cannabis leaf and resin stored under ordinary conditions rapidly lose their activity and can be essentially inactive after about 2 years. A major change which occurs is oxidation in the cyclohexene ring resulting in conversion of THC into CBN. THC is more potent when smoked than when taken orally, its volatility allowing rapid absorption and immediate effects, so smoking has become the normal means of using cannabis. Any cannabinoid acids will almost certainly be decarboxylated upon heating, and thus the...


Although the tetracycline antibiotics have a broad spectrum of activity spanning Gramnegative and Gram-positive bacteria, their value has decreased as bacterial resistance has developed in pathogens such as Pneumococcus, Staphylococcus, Streptococcus, and E. coli. These organisms appear to have evolved mechanisms of resistance involving decreased cell permeability a membrane-embedded transport protein exports the tetracycline out of the cell before it can exert its effect. Nevertheless, tetracyclines are the antibiotics of choice for infections caused by Chlamydia, Mycoplasma, Brucella, and Rickettsia, and are valuable in chronic bronchitis due to activity against Haemophilus influenzae. They are also used systemically to treat severe cases of acne, helping to reduce the frequency of lesions by their effect on skin flora. There is little significant difference in the antimicrobial properties of the various agents, except for minocycline, which has a broader spectrum of activity, and...

The History

The approach to history-taking in patients thought to have respiratory disease differs according to the nature of the illness, the main distinction being between an acute or subacute illness and a chronic respiratory disorder. The methods used to obtain a coherent account of the patient's symptoms arc. however, the same, Firstly, a narrative history is taken, as outlined in Chapter I. Specific enquiry is then made about any of the principal respiratory symptoms not mentioned in the narrative history. At this stage the clinician should consider all the conditions that might be responsible for the patient's symptoms. This will seldom be more than three or four options. A series of supplementary questions designed to provide evidence for and against each possible diagnosis should then be asked. This method of integrating and rationalising the history is important because it facilitates the recognition of certain characteristic symptom patterns, such as those presented by chronic...


It is important to assess the severity of breathlessness in terms of daily activities. If these are impaired, the precise limiting factor should be identified. For example, the exercise tolerance of an elderly patient may be more limited by intermittent claudication, angina pectoris or osteoarthritic hips than by breathlessness attributable to chronic bronchitis. Though grading systems exist to assess cardiac and respiratory disabilities (see Table 4.11), simple questions about daily activity provide an effective functional assessment of the severity of dyspnoea (see Table 4.12).

Occupational history

Can be complicated by pneumonia, particularly in early childhood, and cause 'wheezy bronchitis' or bronchiectasis Wheezy bronchitis or recurrent bronchitis in childhood In the past asthma in childhood was often diagnosed as bronchitis. Recurrence of asthma in adults who have a history ol childhood asthma or whee2y bronchitis Is common

Respiratory Symptoms

A dry, nonproductive cough, occurring with effort or at rest, may be related to the pulmonary congestion associated with heart failure (see Chap. 20). Although dyspnea is usually present, cough may dominate the clinical picture. The cough that accompanies acute pulmonary edema is often associated with frothy, pink-tinged sputum, whereas the sputum associated with chronic bronchitis is usually white and mucoid.2 The sputum associated with pneumonia is often thick and yellow, and that due to pulmonary infarction may be bloody, as may the sputum associated with cancer of the lung or bronchiolectasis. Cough also may be caused by angiotensin-converting enzyme inhibitors, which are often prescribed for heart failure or hypertension. Recurrent coughing due to heart failure is often thought to be due to bronchitis, and patients with chronic bronchitis may cough more when heart failure ensues.2 Patients with a high pulmonary blood flow due to congenital left-to-right shunts are subject to...

Chlamydia pneumoniae

This new chlamydial species (formerly TWAR chlamydiae) causes infections of the respiratory organs in humans that usually run a mild course influenzalike infections, sinusitis, pharyngitis, bronchitis, pneumonias (atypical). Clinically silent infections are frequent. C. pneumoniae is pathogenic in humans only. The pathogen is transmitted by aerosol droplets. These infections are

Antiasthma Drugs

Vanceril is contraindicated for the relief of symptoms that can be controlled by a bronchodilator and other nonsteroidal medications and in the treatment of nonasthmatic bronchitis. The corticosteroids are used cautiously in patients with compromised immune systems, glaucoma, kidney or liver disease, convulsive disorders, or diabetes, those taking systemic corticosteroids, and during pregnancy (Pregnancy Category C) and lactation. Ketoconazole may increase plasma levels of budesonide and fluticasone.

NKT Cells

Chlamydiae are obligate intracellular bacteria with a unique developmental cycle. Two chlamydial species, C. pneumoniae and C. trachomatis, commonly cause human diseases. C. pneumoniae is the causing agent of a wide spectrum of acute and chronic respiratory diseases such as bronchitis, sinusitis, and pneumonia, where as C. trachomatis causes ocular, respiratory, and sexually transmitted diseases. Chlamydial infections are very prevalent worldwide. In particular, up to 70 of healthy human individuals are positive for serum antibodies specific for C. pneumoniae. More recently, C. pneumoniae has been implicated in the pathogenesis of atherosclerosis, Alzheimer's disease, and multiple sclerosis. No vaccine is available for human chla-mydial infections. A clear understanding of the adaptive and innate immune responses to chlamydial infection is critical in the rational development of an effective vaccine to this infection. The differences in T cell cytokine patterns have been correlated...

T3 14 15 16 17 18

Common complications include otitis media, croup, bronchitis, and bronchopneumonia. Bacterial pneumonia is the usual cause of death when measles kills malnourished children. Immunologically deficient children can die from measles virus-induced giant-cell pneumonia or from acute progressive infectious encephalitis (measles inclusion body encephalitis) with no sign of a rash. However, the most dangerous complication of measles is acute postinfectious encephalitis, which occurs in about 1 in every 1000 cases and inflicts a mortality of about 15 , with permanent neurologic sequelae in many of the survivors. Subacute sclerosing panencephalitis (SSPE) is a very much rarer complication, developing in only about 1 in every 300,000 cases, some years after apparent recovery from the original infection.


The current strains of influenza A(H1N1), A(H3N2), and B are grown separately in the allantois of chick embryos, inactivated with an appropriate chemical such as p-propiolactone, then purified by zonal ultracentrifugation, disrupted with detergent, and pooled. The resulting polyvalent inactivated vaccine is inoculated each autumn. Although some countries direct their program at schoolchildren with a view to limiting the circulation of virus in the community, thereby protecting the whole population, most do not regard this as a realistic proposition. It is generally not considered cost-effective or necessary to immunize the whole community, but only the most vulnerable cohorts, namely, (1) the elderly (> 65 years), (2) residents of nursing homes and other chronic care facilities, (3) those (of any age) with chronic debilitating disease of the pulmonary, cardiovascular, renal, or endocrine systems (asthma, emphysema, chronic bronchitis, cystic fibrosis, diabetes, etc.), and (4) those...


In the case of inhalation tularemia, the primary target is macrophages resident in the lungs, but the bacteria make their way to regional lymph nodes as well. The lung tissues become generally inflamed and can develop various forms of pharyngitis, bronchitis, and other forms of lung infection. One form or another of pneumonia is the most common cause of death in fatal cases. Tularemia is one of those diseases that have a low index of suspicion among doctors and laboratory personnel, which could also be a factor in its selection by bioterrorists.


Photomicrograph Emphysema

Chronic bronchitis, asthma, and emphysema, the most common causes of respiratory failure, are together called chronic obstructive pulmonary disease (COPD). In addition to the more direct obstructive and restrictive aspects of these conditions, other pathological changes may occur. These include edema, inflammation, hyperplasia (an increase in the number of cells), zones of pulmonary fibrosis, pneumonia, pulmonary emboli (traveling blood clots), and heart failure. Patients with severe chronic bronchitis or

Atalantia monophylla

Tropane alkaloids inhibit the para-sympathetic nervous system, which controls involuntary bodily activities reduces saliva, gastric, intestinal and bronchial secretions, and also the activity of urinary tubules. Tropane alkaloids also increase the heart rate and dilate the pupils. These alkaloids are used as an additive to compound formulations for bronchitis, asthma, whooping cough, gastrointestinal hy-permotility, dysmenorrhoea, nocturnal enuresis and fatigue syndrome.

Chest Radiography

Saber Sheath Trachea Radiology

After Gough and Wentworth reported in 1949 the development of paper-mounted thin sections of whole lung for examination by the naked eye (15), correlations of radiologic and morbid anatomic findings in chronic bronchitis and emphysema were stimulated (16-18). However, false-positive and false-negative interpretations, as well as inter- and intraobserver variation among radiologists have been features of a number of CXR studies (9,13,16). Moreover, correlations of functional and CXR findings of pulmonary emphysema show a considerable range of variation (4,11,14).


The rhinoviruses, the causative pathogens of the common cold, infect the mucosa of the nasopharyngeal space (nose and throat). They remain strictly localized there and do not cause generalized infections. In rare cases, mainly in children, they are known to cause bronchitis or bronchopneumonia as well. The clinical picture is often worsened by bacterial superinfection.


The family Coronaviridae embraces over a dozen major host-specific pathogens of mammals and birds, displaying tropism for the respiratory tract (e.g., avian infectious bronchitis virus), the enteric tract (transmissible gastroenteritis virus of swine), or the liver and brain (murine hepatitis virus). No convincing evidence has yet been obtained to link human coronaviruses with serious disease affecting any of these systems, but they are an important cause of that trivial but annoying disease, the common cold. In addition, particles morphologically resembling coronaviruses are often seen by electron microscopy in feces, but it has yet to be established whether they cause gastroenteritis in humans. Coronaviruses have the largest genome of all the RNA viruses and exhibits a unique transcription strategy of considerable interest to molecular biologists.

Beta Blockers

They should not be given to patients who have a slow or abnormal conduction of electrical impulses down their heart (heart block), bronchitis and asthma or a very weak heart muscle. These side effects can be too much for some people and so around 30 of people cannot tolerate them and stop taking them (sometimes without telling their doctor).

Research Subjects

The major adverse medical effects of cannabis include increased heart rate, orthostatic hypotension, and respiratory irritation (from smoked cannabis). Thus, medical screening should include evaluation of the cardiovascular and respiratory systems. Individuals with a past or current condition that makes them less tolerant of increased heart rate (e.g., a cardiac arrhythmia, coronary artery disease), decreased blood pressure (e.g., history of syncope), or respiratory irritation (e.g., asthma, bronchitis) should be excluded.

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