Multidimensional analysis of the symptoms of chronic bronchitis and emphysema

Subjective symptoms and experiences were explored within a group of 146 severe, chronic bronchitis and emphysema patients. Eighty-nine symptoms and experiences, derived from initial interviews with 29 patients, were rated according to the frequency of occurrence during breathing difficulties. Key cluster analyses were used to derive a Bronchitis-Emphysema Symptom Checklist (BESC) measuring 11 symptom categories: Helplessness-Hopelessness, Decathexis, Fatigue, Poor Memory, Peripheral-Sensory Complaints, Dyspnea, Congestion, Sleep Difficulties, Irritability, Anxiety, and Alienation. The BESC symptom categories are highly reliable and the relationships among categories are stable across two subgroups of patients. The BESC provides one way to describe how patients cope with and experience chronic bronchitis and emphysema.     

Effect of closed mitral valvotomy on spirometric pulmonary function tests in mitral stenosis

The effect of closed mitral valvotomy on the spirometric pulmonary functions was studied in 25 patients with mitral stenosis. The tests were performed before and after operation, the latter at varying intervals (4 to 6 weeks and 8 to 12 months). The preoperative values were considerably low. After 4 to 6 weeks following surgery, further significant reduction in Forced Vital Capacity (FVC) and Forced Expiratory Volume in one second (FEV1) was observed. This was ascribed to the residual healing process and thoracotomy pain. However, Forced expiratory flow rate during mid segment of FVC (FEF25-75%), which reflects obstruction in small airways, did not show any variation. There was improvement in all the above parameters, 8-12 months after surgery. This suggests definite reversibility in the pulmonary functions following valvotomy.     

Effects of spirometric screening in the community on smoking cessation

In the years 1998-2000 in the Centre of COPD and Respiratory Failure in Bydgoszcz a group of tobacco smokers at risk of COPD (over 40 years of age, with smoking history of more than 10 packyears) were studied. Every patient filled-in a simple questionnaire on clinical signs of COPD and tobacco habit, had a spirometry performed according to ATS standards and received a short antitobacco counseling together with a booklet on how to quit smoking. Out of 1072 patients studied in 1998, airway obstruction was found in 200. Eighty seven of these were current smokers (studied group-S). Another 90 current smokers with normal spirometry served as a control group-C. Both groups of smokers were invited in 1999 and 2000 to perform spirometry. Changes in smoking habit were recorded at each yearly visit. After one year 13 patients (15%) from the S group and 4 (4.5%) from the C group permanently stopped smoking. In 2000 24 patients (28%) in S group and 13 (14.7%) in C group permanently quit smoking. CONCLUSION: Spirometric screening in smokers at risk of COPD together with a minimal antismoking intervention seems to be a promising method of smoking cessation.     

Specific skin tests in subjects with chronic bronchitis exposed to pigeons

We have studied the diagnostic reliability of the specific skin tests done in 30 subjects who presented with chronic bronchitis (CB) as the only clinical manifestation related to exposure to pigeons and in 21 subjects with CB and known risk factors. Additionally, two control groups were included (24 asymptomatic subjects exposed and sensitized to pigeons and 10 subjects not exposed and not sensitized to pigeons). The skin prick tests with pigeon scrum were negative in all the subjects tested. The intradermal skin tests showed an immediate positive reaction in 16 of the 30 CB-affected patients and in six of the control group of exposed asymptomatic subjects (chi square: 3.376) ( P <0.1; nearly significant); after 6 h, a positive reaction was recorded in 14 of the CB-affected patients and in three subjects of the control group (chi square: 5.187) ( P < 0.005). A delayed reaction was seen in 10/30 CB patients and in only three of the 24 subjects of the control group (chi square: 2.218) (nonsignificant). In the group of the 21 CB patients with known risk factors and not sensitized to pigeons, only two patients showed immediate skin reactivity; the remaining readings were negative. Lastly, in the control group of 10 unexposed, nonsensitized subjects, the intradermal skin tests in the different readings were negative. Our results show that although the skin tests with pigeon serum have low sensitivity, they can be a useful supplement in distinguishing cases of CB attributable to chronic pigeon exposure from those cases attributable to another cause, especially in the consideration of immediate and late readings.     

The prognostic value of haemodynamic tests in chronic bronchitis (author's transl)

The prognostic value of several functional respiratory and haemodynamic variables was studied in a group of 212 patients with chronic bronchitis, who were examined in steady state, without cardiac or respiratory failure, at rest and when possible during moderate exercise (195 patients). Follow-up interval ranged from 5 to 12 years. Results were processed using two methods: estimation of actuarial survival rate and discriminant analysis. Survival rate curves for the patients showed a reduction relative to the general population of the same ages: 74% within five years compared to 91% in the general population, 56% within nine years compared to 82%. Survival rate was significantly lower in patients with PPA above 30 mmHg, or driving pressure (PPA--PW) above 15 mmHg, or pulmonary vascular resistance higher than 210 dyn . s . cm-5, or when PPA increased more than 10 mmHg during exercise. Discriminant analysis underlined the predictive value of three haemodynamic variables: PPA change from rest to exercise, pressure developed by the right heart (PPA--PRVED) and stroke volume: together, they predict the death of 3 over 4 patients with the criteria chosen.     

Effect of smoking on immunity in human chronic periodontitis

Aim

Evaluate the effects of smoking on dendritic cells (DCs), cytokines, clinical periodontal parameters, and number of teeth in samples of human chronic periodontitis (CP).

Material and methods

Gingival samples were obtained from 24 smokers and 21 non-smokers with CP. Periodontal examination was carried out. Immunohistochemical staining was performed to identify Factor XIIIa+ immature, CD1a+ immature, and CD83+ mature DCs. The inflammatory infiltrate was counted, and IL-2, IL-10, IL-4, IL-6, IFN-γ, TNF-α, and IL-17A were measured using the cytometric bead array (CBA). Inflammatory infiltrate, DCs, cytokines, classification of CP, clinical periodontal parameters, number of teeth, smoking habit in years (SH/years), and number of cigarettes smoked per day (C/day) were correlated and compared.

Results

CD83+ mature DCs decreased in the smokers group. Negative correlations could be observed between the number of C/day with levels of IL-17A and number of teeth. Correlations between smoking, periodontal disease status, and other cytokines were not observed.

Conclusions

Smoking decreases mature DCs in chronic periodontitis. Moreover, a dose-dependent relation can be observed between C/day and number of teeth and levels of IL17A observed. Smokers show a different modulation of the CP immune response.     

寒冷,吸烟对小鼠慢性支气管炎发生发展的影响

目的：研究小鼠在寒冷与室温不同的条件下慢性支气管炎的发生发展情况。方法：在寒冷与室温不同的条件下单纯用香烟熏吸造成小鼠的慢性支气管炎。结果：在寒冷吸烟慢性支气管炎的病理改变比室温条件下更严重。结论：实验结果显示寒冷吸烟易加重慢性支气管炎病变的发生和发展。     

Morphology and pathogenesis of chronic bronchitis

Histologic and ultrastructural features of the chronic catarrhal bronchitis are presented and its pathogenetic mechanisms are discussed. An important role in the development of bronchitis of the mucociliary transport system damage, retention of the mucus and bacterial contamination of the respiratory tract is analysed. Current hypothesis of the chronic bronchitis development based on the disturbance of the protease-antiprotease and oxidative-antioxidative balance is presented. The data on the role of the specific and non-specific local immune mechanisms of the lung defence in the development of the exacerbations are given.     

Effect of grain exposure and smoking on the longitudinal changes in immediate skin reactivity

The study was carried out to investigate the effect of occupational exposure and smoking on the longitudinal changes of immediate skin reactivity over 3 years in working populations. A total of 480 grain elevator workers and 707 transit and ferry (control) workers were included because they had allergy skin tests on both surveys. Skin-prick texts using three common allergens and a negative and histamine controls were administered during both surveys. The reaction was considered positive if the mean weal size was 3 mm or greater than that of the negative control. Conversion was defined as a change from the non-atopic state in the initial survey to the atopic state in the follow-up survey. Reversion was defined as a change from the atopic state in the initial survey to the non-atopic state in the follow-up survey. The findings showed that grain workers had two times risk of conversion than control workers. Recent smokers, who changed their habit from non-smoker/ex-smoker to smoker in the follow-up survey, were at a three times risk of conversion than non-smokers. The reversion of skin-test reactivity was not associated with age, smoking habits, or working exposure. When investigating studies of longitudinal changes in immediate skin reactivity, the effects of age, changes in smoking habit and occupational exposure should be considered.     

Predictors of success in smoking cessation among participants of spirometric screening for COPD

The aim of the study was to evaluate factors that could predict smoking cessation after a minimal antismoking counseling during spirometric screening for COPD. Every subject filled-in a simple questionnaire on clinical signs of COPD and tobacco habit, had a spirometry performed according to ATS standards and received a short antitobacco counseling together with a booklet on how to quit smoking. Out of 800 smokers over 40 years of age, smoking history of more than 10 packyears, screened for COPD in 1999, four hundred were invited a year later for a follow-up spirometry and evaluation of anti-smoking intervention. Of 383 patients, who responded to the invitation (208 M and 175 F, mean age 56.6 +/- 10.7 yrs), 52 (13.6%) quit smoking for one year and another 48 (12.5%) quit smoking temporarily and than resumed smoking. Smokers who permanently succeeded in quitting smoking were older (60.5 vs 55.9 years p < 0.01), started smoking later (age at starting smoking 22 vs 19.5 years p < 0.001), had a shorter tobacco exposition (28.8 vs 34.3 packyears p < 0.05), had lower lung function (FEV1%pred 80.5 vs 89.2% p < 0.05) and were less nicotine dependent (FTQ score 1 vs 4.8 p < 0.00001).