Haematological effects of inhalation of N-formyl-methionyl-leucyl-phenylalanine in man.

BACKGROUND: N-Formyl-methionyl-leucyl-phenylalanine (FMLP) is a bacterial oligopeptide which stimulates neutrophil chemotaxis, degranulation and superoxide generation. Inhalation of FMLP produces bronchoconstriction in man; in the rabbit this is in part neutrophil dependent. The effects of inhalation of FMLP on peripheral blood leucocytes in normal subjects has been studied. METHODS: This was an open study in non-asthmatic subjects. Change in total peripheral white cell count were studied for 15 minutes after inhalation of 0.4 mumol FMLP in six subjects. Change in total and differential white cell count and spontaneous neutrophil chemiluminescence were then studied five and 30 minutes after inhalation of 0.4 mumol FMLP (n = 7) or diluent (n = 4). Finally, leucocytes from three subjects were labelled ex vivo with technetium-99m labelled sulphur colloid and reinfused. The effect of inhalation of FMLP or diluent on pulmonary neutrophil flux was studied by continuous gamma scanning of a pulmonary window. RESULTS: Leucopenia occurs rapidly after inhalation of FMLP, the nadir of the white cell count (53% of baseline) occurring at four minutes. This was followed by a rebound increase in white cell count evident at 15 minutes (154% of baseline). Five minutes after inhalation of 0.4 mumol FMLP, neutropenia (17% of baseline) and monocytopenia (40% of baseline) were seen followed again by a neutrophilia (213% of baseline at 30 minutes). The eosinophil count was significantly reduced at 30 minutes (24% of baseline). Neutrophil chemiluminescence was elevated (186% of baseline) at the time of the neutropenia. There was no influx of labelled cells to the lung during the period of neutropenia. CONCLUSION: FMLP inhalation activates circulating leucocytes. In vivo production of FMLP in the airway could contribute to bronchial inflammation during bacterial infection.     

健康教育干预在老年慢性支气管炎患者中的临床效果

目的探讨健康教育干预在老年慢性支气管炎患者中的效果。方法收集2011年10月～2014年3月我院治疗的152例慢性支气管炎患者,对其实施健康教育干预,内容包括疾病相关知识、饮食指导、加强锻炼、用药指导、心理指导。用统计学方法比较健康教育前后的临床效果。结果 （1）疾病相关知识知晓率：健康教育后疾病知识、慢性支气管炎诊断标准、健康膳食知识、吸烟危害及慢性支气管炎并发症知识知晓率高于健康教育前,差异有统计学意义（P〈0.05）。（2）健康行为情况：健康教育后合理膳食、戒烟行为患者比例高于健康教育前,差异有统计学意义（P〈0.05）。结论老年慢性支气管炎患者实施健康教育可以提高疾病相关知识知晓率,改变不健康生活习惯,使病情发展延缓。     

Follow-up study of disability among elderly patients discharged from hospital with exacerbations of chronic bronchitis.

Chronic bronchitis is a common reason for admitting an old person to hospital. Government statistics measure the impact of admission only in terms of mortality. A follow-up study of disability among the elderly admitted to hospital wih an exacerbation of chronic bronchitis is described. One month after discharge about 30% of patients were unable to walk as far on the flat or climb as many steps as they did before admission and 90% were unable to do all previous household chores or social activities. After a further two months, although the proportion of patients unable to do all previous household chores or social activities had decreased significantly the proportion with restricted ambulation or ability to climb stairs had not decreased. The proportion of patients admitting to anxiety or depression and being dissatisfied with their progress also remained high. We conclude that there is a need for graduated rehabilitation programmes, which have been shown to increase the walking distance of elderly bronchitics, to be extended to cover all aspects of disability and for home rehabilitation to become an integral part of the care of all elderly bronchitics discharged from hospital.     

Pathogenic organisms in the sputum of patients with chronic bronchitis

Bacteriological examination of the early morning sputum from 54 patients with chronic bronchitis, half of whom received chemoprophylaxis with oxytetracycline, was made regularly for periods up to four and a half years. Nasal and perineal swabs were taken for periods up to three and a half years. There was no evidence that frequent or dangerous proliferation of drug-resistant organisms occurred in the sputum of patients on prolonged chemoprophylaxis with oxytetracycline nor that a serious increase of the carriage of drug-resistant Staphylococcus pyogenes occurred in the nares or on perineal skin. In patients receiving oxytetracycline there was a significant reduction in the frequency of identification of Streptococcus pneumoniae, but the organism was not eradicated: no significant change in the frequency of identification of Haemophilus influenzae was found. From year to year there was sometimes variation in the frequency of identification of Strep. pneumoniae and Strep. pyogenes in the sputum of these patients.     

Effects of nifedipine in patients with chronic obstructive bronchitis and pulmonary hypertension undergoing artificial respiration

During an acute decompensation of chronic obstructive pulmonary disease (COPD) associated with pulmonary arterial hypertension (PAHP), the right cardiac ventricle is unable to tolerate the increased workload required to overcome the increase in pulmonary arterial pressure (Ppa). As a result, the cardiac (CI) and systolic (SI) indices decrease much more than in those patients without PAHP. This study aimed to evaluate the effects of nifedipine on haemodynamic parameters and oxygen availability (QO2) when given to mechanically ventilated COPD patients with PAHP during an acute decompensation. The series included 14 patients aged 68 +/- 8 yr, admitted to an intensive care ward for an acute decompensation of COPD, with Ppa greater than 20 mmHg. They remained haemodynamically stable throughout the study period. The measurements were made 20 min after the Swan-Ganz and radial artery catheters were set up (t0), and one hour after administration of 10 mg sublingual nifedipine (t1). Thereafter this agent was given three times a day. A further set of measurements were carried out in seven patients, 24 h after the first dose of nifedipine (t2). At t1, there was a significant increase in CI (+12.3%) and QO2 (+14.1%), whereas Ppa, indexed pulmonary vascular resistances, indexed systemic vascular resistances (SVRI) and PaO2 decreased significantly (-9.2%; -20%; -12.8% and -6.4% respectively). At t2, QO2 was significantly higher (+18.4%), whereas Ppa and SVRI were significantly lower, than at t0. PaO2 and the shunt fraction (Qs/Qt) returned to basal values, with a significant decrease in Qs/Qt when compared with t1.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cellular characteristics of sputum from patients with asthma and chronic bronchitis.

The reproducibility of sputum cell counts was examined and the cell counts in patients with asthma were compared with those in patients with chronic bronchitis. Three groups of subjects were studied. Sputum from eight patients with chronic asthma and with sputum production were studied to determine the reproducibility of sputum cell counts. The findings in 10 non-smokers with asthma uncomplicated by other airway disease examined at the time of an exacerbation with sputum (group 2) were compared with those from eight smokers with chronic cough and sputum but no features of asthma (group 3). Sputum plugs were selected by microscopy to ensure their origin from the lower respiratory tract. A total cell count was performed on a trypsinised suspension, and differential and metachromatic cell counts were performed on undiluted plugs. The within specimen and test-retest reproducibility of these measurements was high (reliability coefficient, R, = 0.99 and 0.89). The sputum of the asthmatic patients was characterised by eosinophilia (69%, range 46-92%) and the presence of formaldehyde blockable metachromatic cells (1.5%, range 0.6-2.8%). In comparison, the sputum of the patients with chronic bronchitis had few eosinophils (0.5%) or metachromatic cells (0.14%); the dominant cell type was the macrophage (83%). It is concluded that sputum cell counts are reproducible in the short term, the inflammation of asthma is characterised by eosinophilia and metachromatic cells in sputum, and sputum may provide a useful source of cells for investigating the cellular characteristics of airway inflammation.     

Exertion of stairclimbing in normal subjects and in patients with chronic obstructive bronchitis.

The exertion of stairclimbing has been studied in 10 normal young men, 10 healthy middle-aged men, and 10 middle-aged men with chronic bronchitis. Subjects climbed a staircase with a total vertical ascent of 40.8 m. They were allowed to adopt the most comfortable pattern of ascent, the patients having to stop at intervales for rest pauses. Work rate was determined by timing the raising body weight over measured sections of the staircase. Perception of exertion estimated with a numerical scale, heart rate, and increase of blood lactate concentration were closely similar in all three groups at the top of the staircase. In the patients, average power output was directly dependent on lung function, as indicated by the forced expired volume in 1 second. Stairclimbing offers a simple way of studying a patient's spontaneous activity pattern in a 'real life' environment. Studies of the kind described here could usefully complement formal exercise testing in the laboratory.     

Effects of naftidrofuryl on breathlessness and exercise tolerance in chronic bronchitis.

Naftidrofuryl enhances oxidative phosphorylation and might therefore be expected to improve exercise tolerance and breathlessness in advanced chronic bronchitis. This hypothesis was tested in a four-week placebo-controlled trial in 11 bronchitic patients. Seven patients completed the study. There was no evidence of any benefit from naftidrofuryl either subjectively or after a 12-minute walking test.     

Bronchography in chronic bronchitis.

Bronchograms were made in eight men, chosen on clinical grounds as representative of three grades of severity in a series of 67 male bronchitis studied prospectively over a period of 10 years, with the object of ascertaining the anatomical condition at the end of this period. In the stationary group the bronchograms showed only a mild mucous reaction, and peripheral filling was generally good. In the slowly progressive group, mucous obstruction was evident and fairly widespread, and organic changes were present, though not widespread or severe. In the progressive group, both mucous obstruction and organic change were widespread. It was noted that when both mucous obstruction and organic changes were observed the upper lobes were seen to be relatively normal with the exception of the progressive cases in which all changes were more severe. The bronchographic abnormalities were found to be closely correlated with the grades of clinical severity.     

Peripheral nerve function in patients with chronic bronchitis receiving almitrine or placebo.

A double blind prospective study of the effect of almitrine bismesylate and placebo on peripheral-nerve function was carried out in 12 patients with chronic bronchitis and arterial hypoxaemia (mean (SD) FEV1% predicted 38 (16), arterial oxygen tension (PaO2) 7.56 (0.76) kPa). Of the seven patients who took placebo, none developed symptoms or signs of peripheral neuropathy. One patient who had abnormal lower limb sensory nerve conduction initially showed improvement of sensory conduction but deterioration in motor conduction during the 12 month study period. Two further patients developed some slowing of motor conduction velocities in their right lateral popliteal nerve. Five patients received almitrine and all showed an improvement in PaO2 (mean from 7.0 to 7.9 kPa). None had symptoms or signs of peripheral neuropathy on entry to the study; one patient had evidence of impaired nerve conduction on electrophysiological testing. Three patients developed symptoms and signs of peripheral neuropathy during the 12 months of the study and a fourth developed peripheral neuropathy at 18 months, having continued to receive almitrine. Studies of nerve physiology showed abnormalities in the lower limbs of all four patients. Recovery was poor, possibly because of the long half life of almitrine. The studies suggest that almitrine may precipitate peripheral neuropathy in patients with chronic obstructive pulmonary disease. Patients should be warned of this potential complication so that the drug can be stopped as soon as symptoms develop.     

An analysis of the physiological strain of submaximal exercise in patients with chronic obstructive bronchitis.

An increasing work rate was performed by 40 patients with chronic obstructive bronchitis, split into two groups according to FEV1 (group M, mean FEV1 1-451. and group S, mean FEV1 0-621.), and by 20 normal, non-athletic men of similar age to the patients. Values for cardiac frequency and ventilation were interpolated to standard oxygen uptakes of 0-75, 1-0, and, where possible, 1-5 min-1. The tidal volume at a ventilation of 20 and 30 1 min-1 was also determined. The cardiac frequencies at oxygen uptake of 0-75 and 1-01 min-1 were significantly higher in the patient groups than in the normal men, and were highest in patient group S. The cardiac output when related to the oxygen uptake was in the normal range in all three groups of subjects, so that the patients had smaller stroke volumes than the normal men. Ventilation at oxygen uptakes of 0-75 and 1-01 min-1 was significantly higher in both patient groups than in the normal subjects; there were no significant differences between the two patient groups, Values for dead space/tidal volume ration, alveolar-arterial oxygen gradient, and the percent venous admixture measured during a constant work rate test were significantly greater than normal in the patient groups. Possible factors limiting exercise tolerance in these patients were assessed by extending the increasing work rate test from submaximum to maximum exercise. Changes in blood gas tensions and blood lactate concentrations from resting levels were small, and probably did not limit exercise performance. Measurements at maximum exercise did not add appreciably to the analysis of the disturbed cardiopulmonary function. This study has shown that major disturbances in cardiopulmonary function can be demonstrated without the need for stressing a patient to the limit of his effort tolerance.     

A search for mycoplasma infections in patients with chronic bronchitis

Throat and bronchoscopy specimens for mycoplasma isolation studies were collected from 22 patients with chronic bronchitis and 20 patients without chronic bronchitis. Twenty-six of 50 patients attending a chronic bronchitis clinic had throat, nasal, or sputum specimens collected for attempted mycoplasma isolation, and all of these patients had multiple serum samples taken for mycoplasma antibody studies. Mycoplasmas were recovered from throat and bronchoscopy specimens of the chronic bronchitic and non-bronchitic patients with about equal frequency. The concentration of organisms in the bronchoscopy specimens of two patients with chronic bronchitis was greater than in their throat specimens, suggesting downward spread and multiplication of mycoplasmas rather than contamination by passage of the bronchoscope. Eighty-three per cent of the rises in mycoplasma antibody titre in chronic bronchitic patients occurred during or immediately after an acute respiratory illness, and this relationship of rise in antibody titre to acute illness was significantly more frequent than rises in antibody titre not associated with illness. We suggest that mycoplasmas may be present in the bronchi of some patients suffering from chronic bronchitis and that, while such mycoplasma infections are often silent, they may become sufficiently active during infection by other agents to stimulate a mycoplasma antibody response.     

Hypoxaemia in chronic obstructive bronchitis.

Arterial blood gas tensions were studied for six years in 85 patients (59 men, 26 women, mean age 58.8 years) with hypoxaemia associated with chronic bronchitis. All patients who died had a precipitous fall of arterial oxygen tension (PaO2) breathing air. In patients dying within two years of the first appearance of ankle oedema the mean rate of fall of PaO2 was 0.11 kPa/month. Patients who survived two years appeared to deteriorate more slowly (0.017 kPa/month) until some months before death, when they too deteriorated rapidly. Hypoxaemic patients with obstructive airways disease suffer a terminal rapid decline in arterial oxygen tension, which probably indicates real pathological change in the lungs and has important implications for long-term domiciliary oxygen treatment.     

A study of plasma proteins in the sol phase of sputum from patients with chronic bronchitis.

We have studied the sputum/serum protein concentration ratios from 23 patients with bronchitis both in the stable clinical state and during acute chest infections. During the stable state there was a significant negative correlation (2 P less than 0.005) between the ratio and protein size. The ratios of IgG, IgA, C3, and alpha 1-antichymotrypsin were significantly displaced from this relation suggesting local production in the lung. IgM was found in all samples and alpha 2-macroglobulin in 55% of non-infected samples which may be the result of local production rather than transudation from serum, because of their larger size. During acute chest infections the albumin content of sputum rose from a mean sputum/serum ratio of 0.83 (SE +/- 0.08) X 10(-2) to 13.77 (SE +/- 3.21 X 10(-2) suggesting increased transudation from the blood. In the presence of increased transudation, local production of protein appears to be less significant.     

Local IgA production in patients with chronic bronchitis: effect of acute respiratory infection.

The immunoglobulin A and secretory IgA concentrations were studied in the serum and sputum of patients with chronic bronchitis to determine the effect of active chest infection and inflammation upon the estimation of local IgA production. The sputum/serum albumin ratio was higher during chest infection (5.51; SE+/-1.60x10(-2)) than in the non-infected samples (0.75; SE+/-0.14x10(-2);p less than 0.01) suggesting increased transudation as a result of inflammation. There was a similar increase in sputum/serum IgA during infection from 9.47 (SE+/-1.87)x10(-2) to 41.21 (SE+/-6.92)x10(-2)(p less than 0.01). However, the proportion of IgA locally produced when assessed by conventional techniques was unchanged. There was a significant inverse relationship between the estimated local IgA production of the infected samples and the degree of inflammation (r= -0.972;2p less than 0.001) indicating that inflammation was a major determinant of local IgA production. However, the secretory IgA concentrations of the samples were independent of the degree of inflammation. Furthermore, secretory IgA was found in samples that appeared to have failure of local IgA production using the method of Soutar. Clearer information about local IgA production can be obtained by measuring protein components unique to the bronchial secretions rather than applying correction factors to estimate the contribution of serum components, particularly in the presence of inflammation.