Irritant induced cough as a model of intrapulmonary airway reactivity

Theophylline, papaverine and isoprenaline produced dose-related inhibition of citric acid induced cough. In addition, cough susceptibility correlated well with the susceptibility of intrapulmonary airways to constrict whether aerosolised citric acid or intravenous histamine were used as the agonists. The anti tussive activity of isoprenaline could be inhibited with propranolol whereas that of theophylline was unaffected. Atropine and propranolol alone failed to modify citric acid induced cough. We suggest that the reactivity of intrapulmonary airway smooth muscle dictates the cough response following inhalation of a citric acid mist.     

Mechanisms of bronchial hyperreactivity in normal subjects after upper respiratory tract infection.

Inhalation of histamine diphosphate aerosol (1.6 per cent, 10 breaths) produced a 218 +/- 54.6 per cent (mean +/- SE) increase in airway resistance in 16 normal subjects with colds compared with a 30.5 +/- 5.5 per cent increase in 11 healthy control subjects (P less than 0.01). There was no significant difference in mean baseline airway resistance between the two groups. Inhalation of saline produced no significant change in airway resistance in either group. Isoproterenol hydrochloride (0.5 per cent, 1 breath) or atropine sulfate aerosol (0.2 per cent, 20 breaths) each reversed and prevented the increase in airway resistance by histamine, indicating that the bronchoconstriction was caused by smooth muscle contraction and that post-ganglionic, cholinergic pathways were involved in the mechanism. In 6 subjects with colds, citric acid aerosol (10 per cent, 5 breaths) caused bronchoconstriction that lasted up to 30 sec after inhalation, a significantly greater effect than that observed in control subjects or in the same subjects after recovery (P less than 0.05). Prior inhalation of atropine aerosol (0.2 per cent, 20 breaths) prevented the bronchoconstriction after citric acid aerosol in all 6 subjects. The threshold concentration of citric acid that produced cough in 7 subjects with colds was significantly lower than that in control subjects or in the 7 subjects after recovery (P less than 0.05), suggesting that the exaggerated cholinergic response was due to a decreased threshold for stimulation of the rapidly adapting sensory receptors in the airways. We have provided evidence that respiratory viral infections that produce airway epithelial damage temporarily cause these subjects to develop more bronchoconstriction after inhaling smaller doses of histamine than do healthy subjects. The fact that atropine prevents this response and that the threshold to cough is temporarily decreased is compatible with our hypothesis that airway epithelial damage by infection exposes and, thus, "sensitizes" the rapidly adapting airway receptors to inhaled irritants, causing increased bronchoconstriction via a vagal reflex. Damage to the airway epithelium may occur as a result of mechanical factors, inhaled chemicals, and pollutants, such as ozone, infections, or perhaps as a result of the action of materials released endogenously (e.g., from mast cells, white blood cells, or platelets). "Sensitization" of rapidly adapting sensory receptors in the airways may be an important factor in asthma and in other diseases of airways.     

疏风解毒胶囊治疗老年急性上呼吸道感染的前瞻性研究

目的研究疏风解毒胶囊治疗老年急性上呼吸道感染的临床效果。 方法于2010年5月至2012年4月4所研究中心按照入排标准共纳入120例患者,对诊断明确的上感患者服用疏风解毒胶囊治疗4粒,3/日,连服3天,记录治疗前、治疗中、治疗后生命体征及发热、咽痛、头胀痛、鼻塞、流浊涕、咳嗽、咽黏膜充血等症状变化。分别对疾病疗效、体温疗效及单项症状疗效(分为痊愈、显效、有效、无效)行统计学分析,并进行量化评分,评价其安全性。 结果最终完成试验114例,其中男性54例,女性60例;疗效分析示总有效率94.7%(108/114),治疗3天后93.8%(107/114)患者体温恢复正常,中位体温起效时间为4.0 h。单项症状观察指标变化结果显示,咽痛、咳嗽、头胀痛、鼻塞、流浊涕和咽黏膜充血治疗总有效率(例)分别为：82.4%(94/114)、82.4%(94/114)、81.6%(93/114)、79.2%(89/114)、79.2%(89/114)和79.2%(89/114)。进一步量化分析后显示对发热、咽痛缓解明显,咳嗽、头胀痛、鼻塞、流浊涕和咽黏膜充血也有较好的缓解效果。对体温、呼吸频率、舒张压亦有改善。 结论疏风解毒胶囊对于老年急性上呼吸道感染有显著的治疗效果,可作为老年急性上呼吸道感染的选择。     

Vitamin A deficiency alters airway resistance in children with acute upper respiratory infection

Objective

To assess whether vitamin A deficiency alters the recovery of total respiratory resistance (TRR) following acute upper respiratory tract infection (URI).

Methods

This is a case control study of children, age 4–6 years and grouped as: URI, (n = 74), URI and wheezing, (URI‐wheezing, n = 52), and healthy controls (n = 51). Vitamin A and total respiratory resistance (TRR) were assessed using the modified relative dose response (MRDR) and forced oscillometry, respectively.

Results

Children with URI and URI‐wheezing had lower retinol, 32.4 ± 13.12 and 18.3 ± 6.83 µg/dl respectively, compared to controls, 56.9 ± 29.82 µg/dl (ANOVA, P < 0.001). The MRDR was elevated in children in the URI or URI‐wheezing groups 0.066 ± 0.045 and 0.021 ± 0.021, respectively, compared to controls 0.007 ± 0.006 (ANOVA, P < 0.0001). The TRR in the URI and URI‐wheezing groups differed from controls. During convalescence, the TRR failed to decline in the URI‐group only when the MRDR was >0.06. In the URI‐wheezing group, TRR declined independently of retinol and MRDR.

Conclusion

Vitamin A contributes to preservation of airway function during and in recovery after upper respiratory infection in children. Pediatr Pulmonol. 2013; 48:481–489. © 2012 Wiley Periodicals, Inc.

     

Cold air provocation of airway hyperreactivity in patients with cystic fibrosis

Thirty-four patients with cystic fibrosis (CF) were assessed for baseline pulmonary functions before, and 5 and 15 minutes after cold air challenge (CACh). Most of the patients had no change in forced expiratory volume in 1 second (FEV1) and maximum expiratory flow at 25% vital capacity (Vmax25%VC) post-CACh. Five patients responded with reduced FEV1 and 13 with reduced Vmax25%VC. However, paradoxical increases were noted in 10 patients for FEV1 and in 5 for Vmax25%VC. Paradoxical responses were most frequent in patients with severe lung disease. The explanation for this variability may lie in the varying degrees of airway instability and volume of airway contribution (VAC) to early flows, resulting from the damage caused by chronic infection. Conventional challenges may be useless in determining the true incidence of bronchial hyperreactivity in patients with CF.     

Use of a sibilant phoneme registration protocol to prevent upper airway collapse in patients with TMD

Patients with temporomandibular dysfunction (TMD) require antero-posterior (AP) correction of mandibular position inter alia. Determination of the limit of the AP correction using a sibilant phoneme registration (SPR) protocol is essential in not increasing muscular tonus. The aim of this study is to investigate the effect of a SPR protocol on the upper airway. Using acoustic pharyngometry data, mean airways of 46 adults undergoing treatment for TMD were reconstructed in 3-D and analyzed using finite element analysis and principal components analysis. When the mean baseline functional residual capacity (FRC) airway was compared to the mean collapsed residual volume (RV) airway, a 25% reduction in the 3-D upper airway was demonstrable (p < 0.01). When the mean baseline FRC airway was compared to the mean airway with SPR (FRC–SPR), a 12% increase was found at the oropharyngeal junction of the 3-D airway, but this finding failed to reach statistical difference. Similarly, when the mean FRC–SPR airway was compared to the mean RV–SPR airway, the amount of collapse was reduced to 16% but again no statistical difference was found. In contrast, when the mean RV airway was compared to the mean RV–SPR airway, a 15–18% increase was found (p < 0.05). It is concluded that the use of a SPR protocol may be useful in improving upper airway RV in patients, during treatment for TMD.     

炎琥宁与病毒唑治疗小儿急性上呼吸道感染的疗效比较

目的观察炎琥宁与病毒唑治疗小儿急性上呼吸道感染的临床疗效。方法 56例急性上呼吸道感染患儿随机分为两组,观察组(n=28)采用炎琥宁治疗,对照组(n=28)采用病毒唑治疗,两组疗程均为2周,治疗结束后比较两组的疗效。结果观察组治疗总有效率为92.6%,对照组治疗总有效率为78.6%,两组治疗总有效率比较有明显差异性(P<0.05);观察组临床症状和血常规恢复正常时间明显较对照组缩短(P<0.05)。结论炎琥宁治疗小儿急性上呼吸道感染疗效显著,可明显改善患儿的临床症状,值得临床推广应用。     

Health-related quality of life of adults with upper respiratory tract infections

OBJECTIVE: To determine the impact that upper respiratory tract infections have on patients' physical, social, and emotional functioning, we measured the health-related quality of life (HRQL) of adults with upper respiratory tract infections. SETTING: Acute care clinic from November 2001 to February 2002. DESIGN: Prospectively administered survey. To measure HRQL, we used the Acute Form of the Short Form-36, version 2 (SF-36). For all 8 SF-36 subscales, we used norm-based scoring, in which the general U.S. population has a mean of 50. PATIENTS: Adults who had symptoms for fewer than 30 days completed the SF-36; and were diagnosed with nonspecific upper respiratory infection, viral syndrome, otitis media, sinusitis, nonstreptococcal pharyngitis, streptococcal pharyngitis, or acute bronchitis. MEASUREMENTS AND MAIN RESULTS: The sample of 318 patients was 63% female, 81% white, and had a mean age of 35 years. The primary diagnoses were nonspecific upper respiratory infection (42%), acute bronchitis (16%), sinusitis (12%), viral syndrome (9%), nonstreptococcal pharyngitis (8%), otitis media (7%), and streptococcal pharyngitis (6%). Patients had a mean general health subscale score of 50.9, which is not significantly different from the mean population value of 50 (P =.09). However, there were significant decrements in the remaining 7 subscales of the SF-36: physical functioning (45.5), role-physical (38.5), bodily pain (42.6), vitality (40.8), social functioning (37.8), role-emotional (46.8), and mental health (46.8; P <.0001 for all 7 subscales compared with normative values). Results were similar for the subset of patients with no comorbid illnesses (P <.001 for the same 7 subscales) and patients diagnosed with nonspecific upper respiratory infection (P <.001 for the same 7 subscales). These decrements were similar in magnitude, but somewhat different in subscale pattern, to those of adults with chronic lung disease, osteoarthritis, and depression. CONCLUSIONS: Physicians should remember that adults who seek care for upper respiratory tract infections have measurable, significant decrements in HRQL. For researchers, HRQL is an attractive, potential measure of outcome in future trials of established and novel therapies for upper respiratory tract infections.     

孕妇上呼吸道感染与TORCH感染的相关研究

目的探讨孕妇上呼吸道感染与TORCH感染的相关性。方法采用ELISA法检测165例上呼吸道感染孕妇的TORCH IgM,同期选择180例正常无上呼吸道感染的孕妇作为对照组。结果上呼吸道感染孕妇的TORCH IgM(+)总阳性率为10.30%(17/165),显著高于对照组TORCH IgM(+)总阳性率3.33%(6/180)(P<0.05)。结论有上呼吸道感染的孕妇是TORCH感染筛查的高危人群。     

Pulmonary hypertension and acute pulmonary edema in a 23-year-old male with a history of an upper respiratory tract infection

The pathophysiology of upper-airway obstruction (UAO) is complex. Possible causes of UAO that may lead to acute respiratory failure, are as follows: infections like acute epiglottitis and croup, obstructing tumors in the base of the tongue, larynx or hypopharynx, aspirated food or liquid contents, obesity and anatomical variations. Management changes according to the pathogenesis of the disorder. In patients with severe carbon dioxide retention or apnea, emergency endotracheal intubation must be carried out. Hereby, we describe a 23-year-old patient with susceptible upper-airway anatomy and UAO occurred following an upper respiratory infection and complicated with pulmonary hypertension and pulmonary edema. Our patient seems to be one of the complicated UAO cases, with an unusual but critical clinical presentation, evaluated in a wide spectrum and nicely returned to life.     

Detection of viral and bacterial pathogens in acute respiratory infections

Objectives

The role of bacteria in acute respiratory illnesses (ARI) of adults and interactions with viral infections is incompletely understood. This study tested the hypothesis that bacterial co-infection during ARI adds to airway inflammation and illness severity.

Methods

Two groups of 97 specimens each were randomly selected from multiplex-PCR identified virus-positive and virus-negative nasal specimens obtained from adults with new onset ARI, and 40 control specimens were collected from healthy adults. All specimens were analyzed for Haemophilus influenzae(HI), Moraxella catarrhalis(MC) and Streptococcus pneumoniae(SP) by quantitative-PCR. General linear models tested for relationships between respiratory pathogens, biomarkers (nasal wash neutrophils and CXCL8), and ARI-severity.

Results

Nasal specimens from adults with ARIs were more likely to contain bacteria (37% overall; HI = 28%, MC = 14%, SP = 7%) compared to specimens from healthy adults (5% overall; HI = 0%, MC = 2.5%, SP = 2.5%; p < 0.001). Among ARI specimens, bacteria were more likely to be detected among virus-negative specimens compared to virus-positive specimens (46% vs. 27%; p = 0.0046). The presence of bacteria was significantly associated with increased CXCL8 and neutrophils, but not increased symptoms.

Conclusion

Pathogenic bacteria were more often detected in virus-negative ARI, and also associated with increased inflammatory biomarkers. These findings suggest the possibility that bacteria may augment virus-induced ARI and contribute to airway inflammation.     

疏风解毒胶囊治疗急性病毒性上呼吸道感染对患者血清淀粉样蛋白A的影响

目的探讨疏风解毒胶囊治疗急性病毒性上呼吸道感染时对患者血清淀粉样蛋白A(SAA)的影响,并判断其疗效。方法急性病毒性上呼吸道感染患者220例,进行随机分组,其中110例为实验组(疏风解毒胶囊+常规治疗组),110例为对照组(常规对症治疗组),急诊就诊时和治疗72h及治疗1周检测血清淀粉样蛋白A(SAA)。结果实验组(疏风解毒胶囊组)治疗72h和1周血清SAA分别为(98.44±7.90)mg/L和(8.21±0.77)mg/L,对照组分别为(160.57±12.28)mg/L和(25.38±2.34)mg/L,差异有统计学意义(72h的F=2.42,P<0.05,1周的F=9.24,P<0.05)。愈显率实验组为68.00%,对照组为67.33%,差异无统计学意义(χ2=0.33,P>0.05)。疏风解毒胶囊的止咳作用优于常规对症治疗(χ2=13.71,P<0.05)。结论疏风解毒胶囊治疗急性病毒性上呼吸道感染具有降低患者血清淀粉样蛋白A(SAA)作用,且止咳作用显著。     

Etiology of acute severe lower respiratory tract infection in hospital-based patients.

Acute respiratory infections are common childhood illnesses. Most are mild and self-limiting. Five percent are lower respiratory tract diseases and are potentially serious. A prospective study was conducted to ascertain the etiology of community-acquired severe lower respiratory tract infections (LRTI) in hospital based patients. Mycoplasma was the most frequently identified agent (33%). This was followed by viruses (28%) and bacteria (15%). Twenty-four percent of children had no identified causative agent.     

阿比多尔治疗急性病毒性上呼吸道感染的随机双盲对照临床研究

目的评价国产阿比多尔片治疗急性病毒性上呼吸道感染的疗效与安全性.方法采用随机双盲对照试验设计,将急性病毒性上呼吸道感染病人分为两组,试验组每次服用阿比多尔片200 mg,对照组每次服用利巴韦林片150 mg,用法均为口服,每日3次,疗程5～7天.结果66例病人入组并完成试验,试验组33例,对照组33例.试验组临床控制率、有效率在治疗第4天分别为27.3%、97.0%,治疗结束后分别为97.0%、100%;对照组治疗第4天分别为33.3%、84.9%,治疗结束后分别为78.8%、90.9%;两组临床控制率和有效率比较差异无显著性.试验组出现2例不良反应,包括1例中度口干和1例轻度嗜睡,3天内自行消失.两组不良反应发生率比较差异无显著性.结论阿比多尔片治疗急性病毒性上呼吸道感染疗效确切,不良反应轻,可以临床推广.