首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到20条相似文献,搜索用时 31 毫秒
1.
In the district of Merseburg, characterized by a very high degree of air pollution, we have examined 4445 children of the following 4 age-groups 5.-6., 8.-9., 11.-12., and 14.-16. years of life. As a result we found 3,04% of them suffering from recurrent bronchitis, 0,34% from chronic bronchitis and 0,43% from bronchial asthma. The frequency of morbidity on recurrent and chronic bronchitis lowered with increasing age of the children. In asthma, however, this relation did not exist. There were no differences of the frequency of chronic or recurrent bronchitis between the two sexes, but boys suffered much more often from asthma than girls. In places with a high degree of air pollution the frequency of morbidity was significantly higher than in places with somewhat lower air pollution.  相似文献   

2.
Asthma and chronic bronchitis are inflammatory diseases with extracellular matrix (ECM) remodeling and collagen deposition. Collagen homeostasis is controlled by metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs). We evaluated MMP and TIMP balance in induced sputum of 10 control, 31 untreated asthmatic, and 16 chronic bronchitic subjects. We first performed zymographic analysis to identify the profile of MMPs. Zymography revealed a similar MMPs profile in all populations studied and that MMP-9 was the major enzyme released. We then measured, using enzyme immunoassay, the concentrations of MMP-9 and of its inhibitor TIMP-1 and evaluated whether airflow limitation may be associated with an imbalance between these enzymes. MMP-9 and TIMP-1 concentrations were greater in sputum of patients with asthma and chronic bronchitis than in control subjects. The molar ratio between MMP-9 and TIMP-1 was lower in asthmatics and chronic bronchitics than in control subjects, and positively correlated with FEV1 values. In asthma, MMP-9 levels were significantly correlated with the number of macrophages and neutrophils. This study shows that airway inflammation in asthma and chronic bronchitis is associated with an imbalance between MMP-9 and TIMP-1 which may have a role in the pathogenesis of ECM remodeling and airflow obstruction.  相似文献   

3.
Although the prevalence of asthma has risen significantly during the last 30 yr, it is not clear whether this has occurred primarily in persons with a strong genetic predisposition to asthma and atopy or in other sections of the population. We have investigated outcomes in children of nuclear families selected through probands previously characterized by studies in 1964 and 1989 as having histories of persistent childhood onset atopic asthma, transient childhood wheezy bronchitis, and no respiratory symptoms or atopy. Children of wheezy bronchitic probands had a significantly better symptomatic outcome in adolescence, irrespective of the atopic status of the parent proband, than do children of either asthmatic or asymptomatic probands, suggesting that this may be a syndrome that shows familial aggregation and is distinct from asthma. Total serum IgE levels were significantly lower in children of nonatopic asymptomatic probands, including those with wheezing symptoms. In contrast children of nonatopic asymptomatic probands had an unexpectedly high prevalence of wheezing (33%), positive skin prick tests (56%), and positive specific serum IgE to common allergens (48%) that was similar to that found in children of atopic asthmatic probands. Our findings support the concept that wheezy bronchitis is a separate syndrome from atopic asthma. High total serum IgE levels within our population appear to be an important marker of genetic predisposition to atopy. Our data also suggest that much of the increase in asthma prevalence is associated with specific IgE sensitization and is occurring in persons previously considered to be at low risk of developing asthma or atopy.  相似文献   

4.
OBJECTIVE: To determine whether antibiotic and bronchodilator treatment of acute bronchitis in patients without lung disease is efficacious. DESIGN: A MEDLINE search of the literature from 1966 to 1995 was done, using "Bronchitis" as the key word. Papers addressing acute bronchitis in adults were used as well as several citations emphasizing pediatric infections. A manual search of papers addressing the microorganisms causing acute bronchitis was also done. Data were extracted manually from relevant publications. SETTING: All published reports were reviewed. Papers dealing with exacerbations of chronic bronchitis were excluded in this review. RESULTS: Although acute bronchitis has multiple causes, the large majority of cases are of viral etiology. Mycoplasma pneumoniae, Chlamydia pneumoniae, and Bordetella pertussis are the only bacteria identified as contributing to the cause of acute bronchitis in otherwise healthy adults. Nine double-blind, placebo-controlled trials were reviewed. Four studies showed no advantage for doxycycline and one study showed no advantage for erythromycin. One study using erythromycin and one study using trimethoprim and sulfamethoxazole showed that these antibiotics were slightly better than placebo. Two other studies showed an impressive superiority for liquid or inhaled albuterol when compared with erythromycin. CONCLUSIONS: Most studies showed no significant difference between drug and placebo, and the two studies that did showed only small clinical differences. Albuterol had an impressive advantage over erythromycin. Antibiotics should not be used in the treatment of acute bronchitis in healthy persons unless convincing evidence of a bacterial infection is present.  相似文献   

5.
In a primary care setting, nurse-midwives will collaboratively manage common lower respiratory conditions that require pharmacologic therapy. As such, they must maintain up-to-date knowledge about the indications, use, and potential side effects of these medications. This article reviews the drugs most commonly used for the out-patient treatment of pneumonia, asthma, tuberculosis, and bronchitis (both acute and chronic). Differences among common oral antibiotics recommended by the American Thoracic Society are described. Inhaled bronchodilator and anti-inflammatory medications are covered, as well as systemic corticosteroids. The use of isoniazid preventive therapy for latent tuberculous infection is described in detail, with brief mention made of other drugs used for active tuberculosis. Adjunct treatments including immunotherapy, vaccines, oxygen supplementation, and nicotine replacement for smoking cessation also are discussed.  相似文献   

6.
BACKGROUND: The prevalence of asthma is rising and there are recent reports of increasing asthma rates among top level skiers and runners in the Nordic countries. METHODS: The lifetime occurrence of pulmonary diseases (asthma, chronic bronchitis, emphysema) and current bronchitis symptoms was compared in former elite male athletes (n = 1282) who represented Finland between 1920 and 1965 at least once in international competitions and controls (n = 777) who, at the age of 20, were classified as healthy and who responded to a questionnaire in 1985. The presence of disease and symptoms was identified from the questionnaire and, in the case of asthma, also from a nationwide reimbursable medication register. The death certificates of the subjects of our original cohort who died between 1936 and 1985 were also investigated to determine the cause of death. RESULTS: The occurrence of the pulmonary diseases was associated with age, smoking habits, occupational group, and a history of exposure to chemicals. After adjusting for these variables, athletes who participated in mixed sports (odds ratio (OR) 0.46, 95% confidence interval (CI) 0.23 to 0.92) and power sports (OR 0.43, 95% CI 0.21 to 0.87) had lower odds ratios for emphysema, and endurance sports athletes had a lower odds ratio for the presence of at least one pulmonary disease (OR 0.53, 95% CI 0.28 to 0.98) when compared with controls. Athletes also tended to have fewer reimbursable medications for asthma and fewer current symptoms for chronic bronchitis. Between 1936 and 1985 two controls but none of the athletes died of asthma. CONCLUSIONS: The lifetime occurrence of asthma or other pulmonary diseases is not increased in former elite athletes, and exercise alone, even in a cold environment, did not appear to increase the prevalence of asthma, at least up to the mid 1980s.  相似文献   

7.
Further advances in the ability to diagnose GER disease by use of ambulatory pH monitoring have unveiled a host of extraesophageal manifestations of GERD. These include pulmonary symptoms of asthma, recurrent pneumonia, cough or bronchitis, and infant apnea. Many of these symptoms may be the sole presentations of GER in these patients. It is important that the clinician is aware of these atypical presentations of GERD. The expanding use of ambulatory pH monitoring is helping to clarify the underlying pathophysiology of these disorders as well as to improve the ability to diagnose the atypical manifestations of GERD.  相似文献   

8.
The aim of the study was to determine the occurrence of airflow limitation and the frequency of significant reversibility in respiratory infections in adults without known asthma or chronic obstructive pulmonary disease (COPD). We also wanted to study the association between airflow limitation and aetiological agents diagnosed by serological analyses. Spirometry was performed in 574 adult general practice patients with upper or lower respiratory tract infection, and follow-up measurement was obtained in 429 of them. In the latter group, we also obtained paired sera for analysis of anti-bodies against respiratory viruses, chlamydial and mycoplasmal agents. Median forced expiratory volume in one second (FEV1) in all patients included was 90% of predicted; significantly lower in patients with an established diagnosis of asthma or COPD, compared to those without, 77 and 91% predicted, respectively. Among the patients without known asthma or COPD there was a strong association between low FEV1 and the symptoms cough and dyspnoea. Both acute-phase and follow-up FEV1 was measured in 395 of the patients without known asthma or COPD, and a significant increase in median value from 92 to 96% was registered. A reversibility of FEV1 of > 15% was measured in 23% of the 395 patients, uninfluenced by anti-asthma treatment in the great majority. Patients with an established viral, mycoplasmal or chlamydial infection had a significantly lower FEV1 at entry and a greater reversibility, compared to those without such aetiological diagnosis. We conclude that reversible obstruction was particularly common in the patients diagnosed as having acute bronchitis, but that it was found in the patients patients diagnosed as having upper respiratory tract infection.(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

9.
To see whether effects of air pollutants and other environmental factors on the respiratory tract can be detected by the Swiss sentinel reporting system, two years' data of asthma bronchiale and exacerbation of chronic bronchitis were analyzed. On average, 16 cases of asthma and 9 cases of bronchitis were reported per week. The respective figures expressed as mean percentages of all consultations were 0.12% and 0.065%. Data of SO2, NO2, ozone and total suspended particles were used to measure air pollution. Additionally, meteorologic parameters such as air temperature and atmospheric pressure were used, as well as the appearance of the most important pollen groups in Switzerland: grass, birch tree and mugwort. Environmental data were summarized using the mean or sum of all measuring stations. Autocorrelations in the time series were accounted for statistically. Our analysis could not establish any relationship between reports of asthma or exacerbation of chronic bronchitis and air pollutants or other environmental data. This result, which is partly contradicted by the literature, could be explained by low numbers of reports due to patient's self administration of medication and an imprecise determination of true exposure.  相似文献   

10.
BACKGROUND: Primary care physicians frequently use antibiotics for nonindicated conditions and conditions for which antibiotics have not been shown to be effective. The intention of this study was to determine whether shifting the costs from the insurer to physicians in a staff model health maintenance organization (HMO) influenced antibiotic prescribing. METHODS: A random sample of patients in whom upper respiratory infections (URIs) (n = 334) or acute bronchitis (n = 218) were diagnosed within a 12-month period was selected from a large multispecialty group practice whose population was predominantly fee-for-service (FFS) and from a staff model HMO. Detailed chart reviews were performed to verify the diagnosis and note secondary diagnoses, identify whether an antibiotic or other medication was prescribed, assess whether diagnostic testing was performed, and determine the specialty of the clinician. RESULTS: After excluding patients seen with sinusitis, otitis media, or streptococcal pharyngitis, 334 patients with URIs and 218 patients with acute bronchitis remained for analysis. For URIs, antibiotic prescribing was higher in the HMO population than in the FFS group (31% vs 20%, P = .02). In patients with acute bronchitis, HMO patients were also more likely to have an antibiotic prescribed, but the difference was not statistically significant (82% vs 73%, P = .11). Further analyses showed that while HMO physicians were more likely to prescribe antibiotics, they were less likely to prescribe other medications for acute bronchitis or use diagnostic tests for evaluation of patients with URIs or bronchitis. CONCLUSIONS: Shifting costs from insurer to physicians through managed care appears to reduce diagnostic testing for URIs and acute bronchitis, but does not decrease excessive use of antibiotics and may actually increase antibiotic use for URIs.  相似文献   

11.
OBJECTIVE: To assess changes in the severity of physician-diagnosed asthma between 1983 and 1988. DESIGN: Cross-sectional studies examining the frequency of markers of asthma severity: hospitalizations, ICU admissions, hospital emergency department visits, multiple physician contacts, and referrals to specialists in patients aged 0 to 14 years, 14 to 34 years, and > or = 35 years separately. SETTING: Physicians' claims data from the universal Provincial Health Insurance Plan for fiscal years 1983 and 1988. PATIENTS: All patients with the diagnosis of asthma, bronchitis, and COPD identified from the Manitoba Health database. MEASUREMENTS: The markers of severity were related to the prevalence of patients seeing a physician and receiving a diagnostic label of asthma, COPD, or bronchitis. RESULTS: The number of patients with physician-diagnosed asthma increased by 36.4% over the 5 years. In 1983, 11% of asthmatics were hospitalized during the year and 8% were hospitalized in 1988 (-2.5%; 95% confidence interval [CI], -3.2 to -1.8%). During both years, about 75% of the patients hospitalized were in hospital once only. Mean and median duration of hospital stay declined. The percentage of asthmatics seen in the hospital emergency departments declined slightly in all age groups, the total being 21% in 1983 and 18% in 1988 (-3.5%; 95% CI, -4.5 to -2.5%). About one third of the patients with asthma were seen only once by a physician during both of the years examined, 43 to 45% of them being seen on three or more occasions during both years. Referrals to specialists for all asthmatics increased from 12 to 14% (1.9%; 95% CI, 1.0 to 2.8%) from 1983 to 1988. This was almost entirely due to an increase from 11 to 16% (5.1%; 95% CI, 4.0 to 6.2%) in the youngest age group, an increase not accompanied by an increase in any other marker of severity. Changes in asthma severity were similar to changes in the severity in patients with bronchitis and COPD. CONCLUSION: No increase in severity of asthma was seen between 1983 and 1988, but the prevalence of the diagnostic label of asthma increased substantially.  相似文献   

12.
13.
Gastroesophageal reflux may cause a variety of airway diseases such as asthma, aspiration pneumonia, chronic bronchitis, posterior laryngitis, and ulceration or polyp formation on the vocal cords. Among these asthma seems most common and important clinically. Reflux not only may trigger and aggravate an episode of airway obstruction but also may contribute to nocturnal symptoms. Both clinical and experimental observations suggest that the pathogenetic mechanism may be a vagal reflux following stimulation of lower esophageal receptors and/or microaspiration of gastric acid into the trachea. Diagnosis is usually based on clinical history of asthma and symptoms of gastroesophageal reflux, but in some cases, diagnostic tests such as 24-hour esophageal pH monitoring may be necessary. General measures to avoid reflux and an H2-receptor antagonist together with supportive gastric medications may be the standard treatment. If symptoms persist, proton pump inhibitor may be helpful. Antireflux surgery may provide long-term improvements. Although surgical treatment is indicated only in patients with intractable esophagitis at present, it may be used more commonly through a laparoscopic approach in the near future.  相似文献   

14.
Occupational respiratory diseases have been reported following exposure to metal working fluids. We report a spectrum of respiratory illnesses occurring in an outbreak in 30 workers of an automobile parts engine manufacturing plant. Workers presented with respiratory complaints and, after clinical and laboratory evaluations, were classified as those having hypersensitivity pneumonitis, occupational asthma, or industrial bronchitis, or those without occupational lung disease. Hypersensitivity pneumonitis affected seven workers, with six exhibiting serum precipitins to Acinetobacter Iwoffii. Occupational asthma and industrial bronchitis affected 12 and six workers, respectively. Oil-mist exposures were below current recommendations. Gram-negative bacteria, but no fungi, Thermophiles, or Legionella, were identified. Although specific agents responsible for each individual case could not be identified, probably both specific sensitizing agents and non-specific irritants from metal working fluids, additives, or contaminants contributed to this spectrum of occupational respiratory illness.  相似文献   

15.
BACKGROUND: Cohorts born at different times of year differ in their risk of exposure to seasonal respiratory infections in early life, but are likely to have similar socioeconomic status and lifestyle thereafter. METHODS: We investigated the long-term consequences of acute chest illness in infancy for later development of chronic respiratory disease by analysing variations by month of birth in hospital admissions for respiratory illness (total n = 49,866), chronic respiratory symptoms and ventilatory function among British school children (n = 11,482) and middle-aged adults (total n = 55,829). RESULTS: Admission for bronchiolitis in the first year of life was three times more common for infants born September to November (autumn) than those born March to May, yet people born in the autumn experienced fewer respiratory symptoms and had better ventilatory function. In two surveys of middle-aged men, forced expiratory volume in one second/forced ventilatory capacity (FEV1/FVC) was significantly (P = 0.025) higher among autumn births. Hospital admissions for chronic bronchitis/emphysema and pneumonia varied little with season of birth. Admissions for asthma were significantly (P < 0.05) more common among children and young adults born in the autumn. CONCLUSIONS: These findings do not support the hypothesis of a causal link between chest illness in infancy and the later development of chronic bronchitis and emphysema. The variation in asthma admissions with month of birth deserves further investigation.  相似文献   

16.
From 1982 to 1984, the authors conducted a population-based case-control study of lung cancer in men and women nonsmokers in New York State. In-person interviews were completed for 437 lung cancer cases (197 never smokers, 240 former smokers) and 437 matched population controls. Cases and controls were asked to report any history of physician-diagnosed nonmalignant lung disease; cases were more likely than controls to report such a history. Statistically significant associations were found for emphysema (odds ratio (OR) = 1.94, 95% confidence interval (CI) 1.10-3.43), chronic bronchitis (OR = 1.73, 95% CI 1.10-2.72), and the combined endpoint of emphysema, chronic bronchitis, or asthma (OR = 1.82, 95% CI 1.26-2.63). After adjustment for active and passive tobacco smoke exposure, emphysema, chronic bronchitis, and asthma (each condition and the combined endpoint) were significantly associated with lung cancer risk. The risk was more marked for squamous cell carcinomas and for subjects who were diagnosed at older ages, and it remained significant when surrogate interviews were excluded. These results are consistent with the hypothesis that certain prior lung conditions increase the risk of lung cancer in men and women nonsmokers.  相似文献   

17.
The objective of this work was to determine whether the prevalence of respiratory symptoms differed among workers exposed to different types of metal-working fluids. As part of a mandatory surveillance system for occupational illness, from 1988-1994, the Michigan Department of Public Health received, 86 occupational disease reports of work-related asthma secondary to exposure to metal-working fluids. As part of a public health program, follow-up industrial hygiene inspections, including medical interviews of the workforce, were performed at companies where the reported cases had become ill. Metal-working fluids were the second most common cause of work-related asthma reported in the state. Most of the reports were from the automobile industry. Follow-up inspections were conducted at 37 facilities where the individuals with work-related asthma had worked. Seven hundred and fifty-five workers at these facilities were interviewed. Only one facility was above the allowable oil mist standard. Despite the exposure levels being within the legal limits, approximately 20% of the fellow workers of the reported cases had daily or weekly respiratory symptoms suggestive of work-related asthma. Workers exposed to emulsified, semisynthetic, or synthetic machining coolants were more likely to have chronic bronchitis; to have visited a doctor for shortness of breath; to have visited a doctor for a sinus problem; to be bothered at work by nasal stuffiness, runny nose, or sore throat; and to have an increased prevalence of respiratory symptoms consistent with work-related asthma, compared to workers exposed to mineral oil metal-working fluids. These findings were found in individuals who currently smoked, had never smoked or were ex-cigarette smokers. Further research to determine the chemical components or microbial contaminants responsible for these findings is needed.  相似文献   

18.
Epidemiological data demonstrate that viral infections are the most important trigger for acute asthma symptoms in children, and this association persists in many adults with asthma. Studies on volunteers experimentally infected with rhinoviruses (RV) suggest that atopy alone does not predispose to unusually severe symptoms. In contrast, experimental models combining viral infection and allergen exposure have identified potential links between virus-induced and allergen-induced inflammation. While in vitro studies suggest that cytokines may be an important part of this association, their role must be verified by sampling lower airway fluids and tissues in vivo after experimental and/or natural rhinovirus infections. Although it has long been recognized that the common cold is a potent trigger for symptoms of asthma, the mechanisms underlying the association between upper respiratory infection and increased lower airway obstruction remain obscure. The use of experimental infection of volunteers with or without respiratory allergies has enabled direct comparisons of common cold symptoms in these two groups. Furthermore, techniques such as bronchoalveolar lavage and segmental antigen challenge have been used to directly sample lower airway fluids and tissues during acute viral infection.  相似文献   

19.
The prevalence of patients with acute severe asthma appears to be increasing in many countries. In the present review, we summarize data in the literature relating to the prevention and treatment of fatality-prone asthmatics. The underlying assumption is that increased understanding of near-fatal asthma will increase our understanding of the pathophysiology of severe asthma, and lead to interventions that could reduce the mortality rate from asthma. Recognition of acute life-threatening asthma attacks by any physician is mandatory, since lack of such diagnosis and appropriate treatment has been shown to have devastating consequences. The characteristics that allow identification of asthmatics prone to die in ambulatory settings (i.e. previous admissions, type of therapy, etc.) as well as the principal precipitating factors of acute near-fatal and fatal attacks of asthma are reviewed. Predisposing factors, such as lack of appropriate treatment, lack of compliance or poor preventive measures are debated. Finally, we discuss current therapeutic approaches in emergency facilities, based on the major pathophysiological findings in near-fatal asthma.  相似文献   

20.
Topochemistry and activity of NADP-H diaphorase co-localized with NO synthase was examined in operative material of lungs from patients with bronchial asthma (BA), chronic nonobstructive bronchitis (CNO) and chronic obstructive bronchitis. The enzyme activity was found to be dependent upon the types of obstruction and inflammation. In CNO the state of NO synthase was not changed. In conditions of progressive irreversible airway obstruction the enzyme activity was augmented in small bronchi epithelium and alveolar macrophages (AM). In reversible obstruction the activity of NO synthase was not changed in the epithelium but appeared high in resident cells of inflammation--AM and mast cells.  相似文献   

设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号