Pilot study of factors associated with exacerbations in chronic bronchitis

Fisher, Mary M.; Akhtar, Abbasi J.; Calder, Margaret A.; Moffat, Mandy; Stewart, Sheila M.; Zealley, Helen; Crofton, John

doi:10.1136/bmj.4.5677.187

Cited by 58 publications

(22 citation statements)

References 15 publications

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“…One study did find an increase in the frequency with which bacteria were isolated from the same patients during exacerbations compared to stable periods [32], but this has not been a uniform finding. Greater bacterial numbers may be isolated during an exacerbation compared to a stable phase.…”

Section: Bacteriology Of Acute Exacerbations Of Chronic Obstructive Pmentioning

confidence: 99%

Bacteria, antibiotics and COPD

Wilson

2001

Eur Respir J

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Bacterial infection is one of several important causes of exacerbations of chronic obstructive pulmonary disease (COPD) that may coexist. COPD is a heterogeneous condition and the incidence of bacterial infection is not uniform; mucus hypersecretion may be an important risk factor.The bacteriology of infections varies depending on the severity of the underlying airway disease. There is now a much better understanding of the pathogenesis of bacterial infections of the respiratory mucosa. Lower airway bacterial colonization may be a stimulus for chronic inflammation and may influence the interval between exacerbations.Antibiotic resistance has increased in all the major pathogens. Antibiotics are an important part of the treatment of acute exacerbations of COPD and the decision about whether to give an antibiotic can be made on clinical grounds. It is more difficult to decide, on the available evidence, whether patient characteristics and the risk of antibiotic resistance should influence choice of empiric antibiotic treatment.Most new antibiotics are modifications of existing structures, suggesting that every effort should be made to conserve the sensitivity of current antibiotics by using them appropriately.

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Section: Bacteriology Of Acute Exacerbations Of Chronic Obstructive Pmentioning

confidence: 99%

Bacteria, antibiotics and COPD

Wilson

2001

Eur Respir J

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“…5 We have observed that Hparainfluenzae is clinically indistinguishable from non-capsulated H influenzae, suggesting that H parainfluenzae is pathogenic in the respiratory tract of adults.6 Subdivision of H influenzae and H parainfluenzae into biotypes is now possible' 8 and, although this has been performed in childhood illnesses,2 our aim was to determine the epidemiological and clinical value of haemophilus biotyping in adult respiratory diseases. …”

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confidence: 99%

Haemophilus biotypes in respiratory disease.

Rhind¹,

Gould²,

Ahmad³

et al. 1987

Thorax

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Haemophilus influenzae may cause serious illness in childhood, particularly capsulated Pittman type b organisms.1-3 In the respiratory tract of adults the organism is usually non-capsulated4 and is frequently isolated during acute episodes or exacerbations of respiratory diseases. 5 We have observed that Hparainfluenzae is clinically indistinguishable from non-capsulated H influenzae, suggesting that H parainfluenzae is pathogenic in the respiratory tract of adults.6 Subdivision of H influenzae and H parainfluenzae into biotypes is now possible' 8 and, although this has been performed in childhood illnesses,2 our aim was to determine the epidemiological and clinical value of haemophilus biotyping in adult respiratory diseases. MethodsUsing the laboratory records for 1983 we undertook a retrospective study of the case notes of patients who had had Haemophilus species isolated from the respiratory tract. Sputum specimens were routinely inoculated on to horse blood agar and heated horse blood agar containing 10 units of bacitracin/ml and incubated for 18 hours at 37°C in 7% carbon dioxide. Specimens from patients with suspected anaerobic infections were incubated anaerobically for 48 hours. Non-haemolytic haemophilus organisms were identified by their morphological and colonial appearance and the demonstration of satellitism with Staphylococcus aureus. Differentiation between H influenzae and H parainfluenzae was then achieved by the ability of the organism to metabolise 6-amino laevulinic acid (HP +, HI -). H influenzae and H parainfluenzae were further subdivided into their biotypes by the method of Kilian.7 8The following variables were recorded and analysed: (i) distribution of H influenzae and Hparainfluenzae biotypes in different diagnostic groups; (ii) antibiotic sensitivities, determined by a standard disc susceptibility technique; (iii) frequency of isolation of multiple organisms; (iv) pus cell counts in undiluted sputum-samples being taken from the most purulent part of the specimen-were scored (1-10 cells/high power field (HPF) = 1, [11][12][13][14][15][16][17][18][19][20] After exclusion of 105 isolates from general practice (showing the same biotype distribution as isolates from hospital) and repeat specimens, 574 separate clinical episodes were studied. The diagnostic groups were: chronic bronchitis (n = 201), asthma (n = 63), bronchial carcinoma (n = 107), bronchiectasis (n = 52), pneumonia (n = 38), and "others' (n = 113). In the last group 37% of patients had pre-existing pulmonary disease and 36% had undergone thoracic surgery. All diagnostic groups showed a similar biotype distribution (H influenzae I 15%, II 33%, III 17%, IV 6%, V 4%, VI 2%, VII < 1%; H parainfluenzae 1 6%, 11 1%, III 6%). Recurring clinical episodes were not always attributable to the same biotype, though multiple specimens from a single clinical episode usually (but not invariably) had the same single biotype. Biotype had no bearing on the symptoms recorded in all diagnostic groups, and biotype distribution was similar both ...

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“…Bacterial infection is by no means always present (Fisher et al, 1969) and the role of viral infection is difficult to establish. Since most exacerbations occur during the winter months changes in atmospheric pollutants may play some part (Ogilvie, 1967).…”

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confidence: 99%

Neuraminic acid content of sputum in chronic bronchitis

Keal¹,

Reid²

1972

Thorax

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The neuraminic acid content of sputum from 48 men with early chronic bronchitis has been estimated in samples collected over a period of three years. The results are compared with those from 29 advanced bronchitic patients and are related to the clinical features of both groups and to the physical and biological properties of the sputum. A seasonal variation in neuraminic acid content has been noted for the first time with higher levels during the winter months. Clinical assessment of sputum pourability correlated well with measured viscosity. The viscosity of mucoid sputum was related to its neuraminic acid content but also to the yield of dry macromolecular material. In the early bronchitic group whose sputum was assessed for purulence at monthly intervals pus was more often present in those men whose mucoid sputum contained higher levels of neuraminic acid. These findings are discussed in relation to the cause of exacerbations of chronic bronchitis.

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Pilot study of factors associated with exacerbations in chronic bronchitis

Cited by 58 publications

References 15 publications

Bacteria, antibiotics and COPD

Bacteria, antibiotics and COPD

Haemophilus biotypes in respiratory disease.

Neuraminic acid content of sputum in chronic bronchitis

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