Bronchitis Food List

Dealing With Bronchitis

Dealing With Bronchitis

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Bronchitis is an inflammation of the mucous membrane that lines the breathing, or bronchial, tubes. Acute bronchitis follows a cold or flu when the viral infection moves to the chest. Chronic bronchitis is a result of smoking or exposure to polluted air or allergens. Bacteria is present if phlegm is yellow-green in color. Eating spicy foods liquifies the mucus and helps to open air passages. Identify allergens if they are the cause. Avoid dairy products as they contain components that suppress fluid secretions that thin mucus in the respiratory tract.

Chronic Bronchitis

Chronic bronchitis is an inflammation of the bronchi that persists for a long period of time or repeatedly occurs. It is a form of COPD. Smoking is the main cause for bronchitis. Second-hand smoke may also cause chronic bronchitis. Air pollution, infection, and allergies make it worse. Patients who develop chronic bronchitis have excess mucous production that irritates the bronchial causing the patient to have a persistent productive cough.

Setting up the mechanical ventilator Tidal volume

Conventionally set at 7-10ml kg, though recent data suggest lower values (6-7ml kg) may be better in severe acute respiratory failure, reducing barotrauma and improving outcome. In severe airflow limitation (e.g. asthma, acute bronchitis) smaller VT and minute volume may be needed to allow prolonged expiration.

Inspiratory flow resistance

The expiratory resistance may also influence the distribution of ventilation. Chronic obstructive lung disease (asthma, chronic bronchitis, emphysema) causes airway narrowing that may become apparent mainly or solely during expiration because of an expiratory muscle activity that compresses the lung and the airways. Lung regions that have not emptied completely because of an expiratory resistance exert an increased elastic recoil which will impede the inspiration of gas to those regions. It is not clear to what extent this has any bearing on acute lung disease requiring intensive care.

Brief Evolutionary Perspectives

Genetic mutation has led to a family of mouse Paneth cell a-defensins, numbering perhaps 20 or more, that differ at a limited number of amino acid positions and have significant differences in peptide properties 94 , The importance of mutations in the (3-defensin gene family can be demonstrated as well with the association between single nucleotide polymorphisms in the hBD-1 gene and COPD in Japanese populations, most specifically with an increased risk of chronic bronchitis (OR 6.1, (2-18.3)) 95 ,

Mycoplasma pneumoniae pneumonia

Clinically apparent M. pneumoniae pneumonia accounts for 3 to 10 per cent of infected persons. However, severe diseases, often mimicking necrotizing bacterial pneumonia, have been described. Peribronchial and perivascular lymphoid infiltrates, and bronchitis and bronchiolitis with variable consolidation of alveoli, have been observed in cases that have gone to autopsy. Infection appears to be acquired via inhalation of infected material after exposure to an acutely ill coughing individual. The incubation period is 2 to 3 weeks.

Mucus Secretion and Clearance

The rate of removal of mucus from the airways is determined by such factors as mucus viscosity, the amount of mucus produced, and the degree of ciliary activity. These processes may be influenced by a variety of diseases, including asthma, cystic fibrosis, and chronic bronchitis 82,83 . In patients suffering from cystic fibrosis or chronic bronchitis, mucus hypersecretion is evident and mucociliary function is impaired. The failure to clear mucus from the airways leads to airway obstruction and to chronic colonization of the airways with bacterial organisms (which leads to lung infections and airway inflammation and damage). In asthmatic subjects, airway mucus is more viscous and ciliary transport mechanisms are inhibited 82,83 . In these diseases, the therapeutic objective is to improve mucus clearance from the airways. For example, aerosols of water or saline (especially hypertonic saline) promote clearance of mucus by

Hongming Zhuang MD PhD Jian Q Yu MD Abass Alavi MD

Numerous reports have demonstrated increased FDG uptake at the sites of infection and inflammation. FDG is applicable to almost any type of infection or inflammation or any anatomic location, including the following abscesses 11-17 , pneumonia 18-20 , tuberculosis 21-25 , Mycobacterium avium-intracellulare infection 26-28 , cryptococcosis 29 , mastitis 30 , enterocolitis 31-33 , infectious mononucleosis 34 , parasitic disease 35 , Clostridium perfringens infection 36 , osteomyelitis 37-42 , infection or loosening following arthrop-lasty 43-45 , fever of unknown origin (FUO) 46-48 , thrombosis 49-51 , amyloidosis 52 , sarcoidosis 53,54 , asthma 55 , bronchitis 56 , encephalitis 57 , costochondritis 58 , radiation pneumonitis 59 , esophagitis 60,61 , pancreatitis 62 , thyroiditis 63-65 , sinusitis 66 , myositis 67 , mediastinitis 68 , gastritis 69 , lobular panniculitis 70 , dental cavity 71 , and inflammation caused by foreign body 72-74 . Despite all of these findings, however,...

On Pulmonary Inflammation

Experimental epidemiological and clinical evidence indicates that CS is a primary risk factor for chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema. These two conditions result from obstruction of airflow and usually coexist. An increased proteolytic activity in the lung due to an imbalance between proteases, especially elastase and alfal-protease inhibitor (alfa-I-PI, an antielastase), has been suggested as a primary cause for COPD caused by CS. This occurs for three reasons. First, CS causes the generation of chemotactic factors (such as che-mokines) (38), which recruit inflammatory cells (such as neu-trophils and macrophages) to the lung, and these cells release proteolytic enzymes. Second, free radicals present in CS can either inactivate alfa-I-PI by oxidation of an active site methionyl residue present in the protein sequence or damage macromolecules to make them more susceptible to proteoly-sis. Third, components in CS can suppress...

In Vitro Detection And Imaging

Semiconductor quantum dots have received considerable attention due to their novel optical and electronic properties (Figure 4.4). By varying the size and composition, QDs with visible and near-IR fluorescence 400-2000 nm (Bruchez et al., 1998) have been produced (Bailey and Nie, 2003 Kim et al., 2003 Wehrenberg et al., 2002 Zhong et al., 2003a, 2003b). Due to their broad absorption profile, the same light source can excite QDs emitting at different wavelengths, which makes them ideal for multiplexed biological detection. QDs are also photostable (Gao et al., 2005) and have large excitation coefficients 105-106 M-1cm-1 (Chan et al., 2002). A new development is the ultrasensitive detection and molecular analysis of single intact viruses, especially the human respiratory syncytial virus (RSV), which causes serious lower respiratory infections in children and the immune-compromised (Agrawal et al., 2005). In this application, two antibodies to different surface proteins on...

Ivoxidative Damage By Cigarette Smoke

Cigarette smoke has been implicated as major risk factor in COPD such as chronic bronchitis and emphysema, in chemical carcinogenesis, and in atherosclerotic arterial diseases. The mechanisms of the adverse biological effects of CS appear, in part, to include oxidative damage to essential biological constituents. The CS increases the number ofphagocytes in the blood and lungs (40), decreases plasma levels of high-density lipoproteins (HDL) (41), and induces lipid peroxidation of LDL (42). Several plasma proteins have been shown to undergo modification by exposure to CS (43,44). In CS-bubbled buffers, H2O2 and hydroxyl radical were generated from aqueous extracts of tar (45,46). A superoxide radical was an intermediate in these reactions. Superoxide formed from CS impairs active oxygen generation from neutrophils.

Molecular Basis of Disease

Ducts and subsequent scarring and destruction of exocrine functions. Neonatal meconium ileus occurs in approximately 15 of newborns with CF. Other manifestations include chronic sinusitis, nasal polyps, liver disease, pancreatitis, and congenital bilateral absence of the vas deferens (CBAVD). Males with CBAVD are azoospermic and have an increased frequency of mutations in one or both CFTR alleles or an incompletely penetrant mutation (the intron 8 variant 5T allele) in a noncoding region of CFTR. These men usually have no pancreatic disease and may have normal, borderline, or elevated sweat electrolytes. A small subset of patients with atypical CF have chronic Pseudomonas bronchitis, normal pancreatic function, and normal or intermediate sweat electrolytes.

Diagnosis and initial antimicrobial treatment

Acute bronchitis is associated with cough, mucoid sputum and wheeze. In previously healthy patients a viral aetiology is most likely and there is often an upper respiratory prodrome. Symptomatic relief is usually all that is required. Likely organisms in acute on chronic bronchitis include Strep. pneumoniae, H. in. uenzae or Staph. aureus. Appropriate antibiotics include cefuroxime or ampicillin and .ucloxacillin. Viral pneumonia may be confused by the presence of bacteria in the sputum but secondary bacterial infection is common.

Lower Respiratory Disorders

Lower respiratory disorders are conditions that obstruct or restrict tracheobronchial tubes and prevent the exchange of gas within the lungs. These conditions are referred to as chronic obstructive pulmonary disease (COPD) and include chronic bronchitis, bronchiectasis, emphysema, and asthma.

Scrub typhus tsutsugamushi fever

A few days after the infection, in about 40 of cases, a small nodule can be seen at the site of the mite bite. The nodule will become necrotic and suppurate. About a week after the appearance of disease symptoms (general malaise, headache, fever, regional lymphadenitis, etc.) a spotted fever exanthema usually appears on the trunk, on the extremities and in the face. There is often bronchitis and encephalitis. Pneumonia, encephalitis, and heart failure are serious complications and may indicate fatal cases. During serious epidemics the mortality rate of untreated cases can exceed 60 . Scrub typhus has been, and may continue to be, of great importance in military medicine.

Tuberculosis and Other Mycobacteria Donald E Gardner PhD Fellow ATS

Pulmonary disease due to M. avian complex (MAC) typically occurs in white males, 45-65 years old with some preexisting lung disease such as chronic bronchitis, emphysema, a previous TB lesions, bronchiectasis, or pneumoconiosis. Patients with AIDS may have either a focal or disseminated MAC infection. MAC is commonly isolated from sputum or stool cultures from patients with HIV infection. It is thought that MAC is acquired and colonizes in either the gastrointestinal or respiratory tract before dissemination in HIV-infected patients. MAC infectious may also involve the peripheral lymph nodes. Bacteremia occurs in almost all such patients, and the organism can be found in the circulating monocytes (29).

Overview Of Gene Vector Systems

The ideal method of DNA delivery should maintain the integrity of the gene and yield high gene expression in the target tissue without compromising the safety of the patient. Genetically engineered viruses, commonly used in clinical and preclinical pulmonary gene therapy protocols, are based on vectors that have evolved over millions of years to produce high levels of gene expression. As a result, viral vectors are easily the most advanced and most effective in terms of gene delivery. Of the 600 completed, ongoing, or pending gene therapy clinical trials recorded in September 2001, 72 involved a viral vector 2 . Cationic liposomes were the next most popular vector (13 ). Unfortunately, some viral vectors have been associated with inflammatory immune responses 20-25 , which can be detrimental to the health of patients suffering from lung diseases such as cystic fibrosis, chronic obstructive pulmonary disorder, and asthma. A clinical trial involving an adenovirus gene vector injected...

Alterations In The Alveolar Space

To COPD since the intracellular iron content of alveolar macrophages is increased in cigarette smokers and is increased further in those who develop chronic bronchitis, compared with nonsmokers (32). In addition, macrophages obtained from smokers release more free iron in vitro than those from nonsmokers (33). In some studies, both in stable (34) and mild exacerbations of bronchitis (35), eosinophils have been shown to be prominent in the airway walls. Bronchoalveolar lavage (BAL) from patients with COPD has also been shown to contain increased levels of eosinophilic cationic protein (24). Furthermore, peripheral blood eosinophilia is also considered to be a risk factor for the development of airway obstruction in patients with chronic bronchitis and is an adverse prognostic sign (36,37). However, despite the presence of increased number of eosinophils, EPO-mediated generation of specific 3-bromotyrosine has not been detected in COPD patients (19). This does not provide support for a...

Cellular Targets of Cigarette Smoke Induced Microvascular Dysfunction

The organism undergoes an inflammatory-type response with every cigarette smoked. This is caused either by combustion products, reactive oxygen species, and other compounds that are inhaled with the cigarette smoke, or by reactive oxygen species and inflammatory mediators released from the organism in response to cigarette smoking (particularly from phagocytic cells that are sequestered in the pulmonary microcirculation in response to cigarette smoke). This is most obviously reflected in an activation of white blood cells. Although leukocyte adhesion and emigration are involved in host defense and phagocytosis and thus serve a beneficial role during a well-contained inflammatory response, leukocytes may also turn against the host and contribute to tissue damage, characterized by the breakdown of capillary perfusion, the loss of endothelial integrity, and the extravasation of fluid and macromolecules into the interstitial space 6 . A feature common to the pathomechanisms of most...

Effects of oxygen in disordered gas exchange

Where BP is barometric pressure, then predicts the arterial PO2 (in mmHg). Patients with decompensated chronic bronchitis and emphysema are often admitted to the intensive care unit (ICU) with respiratory failure characterized by both hypoxemia and hypercapnia. Relatively small increases in FiO 2, often to less than 0.4,

Oxidative Stress And Susceptibility To Copd

Polymorphisms of various genes have been shown to be more prevalent in smokers who develop COPD (214). A number of these polymorphisms may have functional significance, such as the association between the TNF-a gene polymorphism (TNF2), which is associated with increased TNF levels in response to inflammation, and the development of chronic bronchitis (216). Relevant to the effects of cigarette smoke is a polymorphism in the gene for microsomal epoxide hydrolase, an enzyme involved in the metabolism of highly reactive epoxide intermediates that are present in cigarette smoke (218). The proportion of individuals with slow microsomal epoxide hydrolase activity (homozygotes) was significantly higher in patients with COPD and a subgroup of patients shown pathologically to have emphysema (COPD 22 emphysema 19 ) compared with control subjects (6 ) (218). These data have, however, not been reproduced in other patient populations (219). Similarly, the polymorphism of another antioxidant gene...

Thiol Compounds Xxiiia Nacetyl Lcysteine

Pharmacological approaches, particularly with thiol antioxidants, such as NAC have been used in an attempt to enhance lung GSH in patients with COPD with varying success (228230). There have also been studies of patients with COPD where the administration of NAC has led to a conflicting result the number of exacerbations of COPD having been modified (231,232). This probably arose as a result of differing dosage regimens and disease severity in these studies (230,233). A multicenter study using NAC by metered dose inhalers in patients with chronic cough failed to show a positive effect on well being, sensation of dyspnea, cough, or lung function (233). Van Schoo-ten et al. (234) have reported that supplementation of oral dose of 600 mg twice daily for a period of 6 months in a randomized, double-blind, placebo-controlled, Phase II chemoprevention trial reduced various plasma and BALF oxidative biomarkers in smokers. Furthermore, the results of Phase III trial on the multicenter...

Xxiiic Nisobutyrylcysteine

Because NAC becomes hydrolyzed in biological systems, the measured bioavailability of the drug is low. Thus, it was speculated that a drug might be synthesized that possessed greater bioavailability than NAC, and could be used as a more effective treatment for chronic bronchitis. N-isobutyrylcysteine (NIC) is an NAC-like compound that does not undergo effective first-pass hydrolysis, and therefore has a higher oral bioavailability than NAC. This oral bioavailability can be as high as 80 , dependent on food intake. However, when evaluated as a therapy for exasperations of chronic bronchitis, NIC performed no better than placebo drugs, and not as well as NAC. Recently, a study of N-isobutyrylcysteine, a derivative of N-acetylcysteine, also failed to reduce exacerbation rates in patients with COPD (240).

Cotton and Other Textile Dusts James A Merchant MD

Response to cotton dust exposure (89). It must be emphasized that these beneficial physiologic effects occur without similar documentation in regard to symptoms. Thus, while the bronchoconstricting effect of these organic dusts, which is usually not severe, may be blocked or reversed, there is no evidence that use of these drugs will necessarily suppress byssinosis symptoms or retard the progression of cotton-dust-induced obstructive airway disease. Therefore, these drugs cannot be considered preventive measures. Management of severe cases of byssinosis does not differ from that for chronic bronchitis and emphysema. Schilling and Goodman reviewed pathologic observations on lungs of workers with long cotton dust exposure, as made by several early investigators, and concluded that the pulmonary pathology was that of chronic bronchitis and emphysema (6). In one report lungs were fixed in inflation from 10 autopsies of workers with over 20 years of cotton dust exposure. Nine of these...

Miscellaneous Topical Antifungal Agents

A 55-year-old obese woman with adult-onset diabetes mellitus has been receiving amoxicillin for treatment of an acute exacerbation of chronic bronchitis. After a week of therapy, the patient develops dysuria and increased urinary frequency. Urinalysis shows 10 to 50 white blood cells per high-power field, and Gram stain of urine shows many budding yeasts. Which antifungal agent would be best in treating this patient for Candida cystitis

CT Quantification of Emphysema

Noncalcified Nodule

Emphysema is commonly included with asthma and chronic bronchitis in the group of diseases that together make up chronic obstructive pulmonary disease (COPD). ''The term 'COPD' is generally used in clinical discourse to describe individuals diagnosed with one or more of the following conditions asthmatic bronchitis, chronic bronchitis, chronic obstructive bronchitis and emphysema,'' according to a National Heart, Lung and Blood Institute Workshop on the subject 17 . Airflow obstruction is common to all forms of COPD. In emphysema and chronic bronchitis, the airflow obstruction does not markedly change over months and is largely fixed or irreversible, while in asthma the airflow obstruction is largely reversible, except in chronic, long-standing asthma where airflow obstruction may also become fixed 18,19 . Of the approximately 15 million people in the United States with COPD, approximately 1.65 to 2 million have emphysema 18 .

Anatomy and Physiology

Head Capillaries

In 1988, researchers in Helsinki, Finland, reported that patients with coronary artery disease, meaning arteriosclerosis of the arteries that supply the heart muscle, commonly had antibodies against Chlamydia pneumoniae.This organism is a tiny obligate intracellular bacterium that is responsible for a variety of upper and lower respiratory infections including sinusitis and pneumonia.The infections are common, and most

Factors determining available inspiratory muscle energy Energy supply

Respiratory failure may result from a failure of the lungs due to airway obstruction (status asthmaticus, chronic bronchitis, emphysema), parenchymal disease (cardiogenic or non-cardiogenic edema, severe infections, pneumonia, pulmonary fibrosis), or a failure of the pump. Failure of the respiratory muscles can result in acute respiratory failure.

Differential diagnosis of elevated central venous pressure

Acute tamponade must be differentiated from other conditions with an acutely elevated central venous pressure, such as acute right ventricular failure, chronic obstructive lung disease, constrictive pericarditis, pulmonary embolism, and acute exacerbation of chronic bronchitis. It must also be differentiated from a high central venous pressure following excessive or too rapid fluid administration, abdominal distention from paralytic ileus or ascites, increased intrathoracic pressure from pneumothorax or hemothorax, airway obstruction, infusions of vasopressors, and a clotted or non-functional central venous pressure line.

Secondary or compensatory polycythemia

This involves red cell proliferation, with measurable increases in red cell volume, and is almost always secondary to arterial hypoxemia. Cyanotic heart disease, chronic bronchitis, emphysema, and other pulmonary causes of arterial hypoxemia are particularly prominent. In these disorders the polycythemia represents a beneficial natural reaction to the hypoxemia leading to a hypervolemic erythrocytosis. This, in association with hematocrit values of 0.55 to 0.65 and a red cell volume

Supplemental Reading

Alan Aldrich is a 67-year-old white man who goes to the emergency department with lethargy, increased thirst, and increased urination for 3 days. His family states that he has been somewhat confused for the past day and is not eating or drinking as much as he should. He has a history of chronic bronchitis, a 60-pack year history of smoking, and has lost 12 lb over the past month. Physical examination reveals an arousable thin elderly white man in no acute distress. Blood pressure is 110 60 pulse is 88 respiration rate is 22 temperature is 100.3 F (37.9 C). Chest radiography reveals chronic obstructive pulmonary disease with a questionable subpleural mass on the right. His initial blood chemistry revealed serum Ca++, 13.8 mg dL alkaline phosphatase, 489 and elevated liver functions. What is the likely cause of his condition, and how would you treat it

Bronchodilator Agents

The bronchodilators are agents that cause expansion of the air passages of the lungs. This allows the patient to breathe more easily and are of value in overcoming acute bronchospasms. They are employed as adjuncts in prophylactic and symptomatic treatment of the individual complications of obstructive pulmonary diseases such as asthma, bronchitis, and emphysema. Most of these agents have been discussed in other lessons of the pharmacology series. (3) (Epinephrine (Adrenalin ). Epinephrine is used as a bronchodilator because of its beta effects on the bronchi and a pharmacologic antagonist of histamine. Epinephrine is employed for the treatment of acute attacks of bronchospasms associated with emphysema, bronchitis, or anaphylaxis. The inhalation route is not the preferred route of administration, however, it may be used. Epinephrine is usually administered subcutaneously when used and is fairly effective at reducing bronchospasms. (6) Isoproterenol (Isuprel )....

Muscle Relaxant Yeast Infections

Advanced Reference Term normally applied to the lungs in which the alveoli are grossly enlarged and can eventually be destroyed. Found in those suffering from asthma, bronchitis and being associated with smoking and air pollution. The main symptoms are breathlessness. The alveoli can become so damaged that air exchange is barely adequate. Advanced Reference Used mainly in the treatment of asthma, chronic bronchitis and hypotension, especially during spinal anaesthesia.

Differential diagnosis

Acute bronchitis or pneumonia can present with fever, constitutional symptoms and a productive cough. Patients with pneumonia often have rales. When pneumonia is suspected on the basis of the presence of a high fever, constitutional symptoms or severe dyspnea, a chest radiograph should be obtained. Differential Diagnosis of Acute Bronchitis Chronic bronchitis B. Asthma should be considered in patients with repetitive episodes of acute bronchitis. Patients who repeatedly present with cough and wheezing can be given spirometric testing with bronchodilation to help differentiate asthma from recurrent bronchitis.

Therapeutic Uses Of Aerosols

Aerosol preparations of drugs are most commonly used for the treatment of diseases involving airway obstruction, namely bronchodilators and antiinflammatory agents in asthma, bronchitis, and emphysema. Other uses of aerosol therapies include mucolytics (for decreasing the thickness or viscosity of mucus in diseases involving abnormal mucus secretion, e.g., pneumonia, bronchitis, cystic fibrosis) and antibiotics (for treatment of lung infections). In addition, aerosols may be used for clinical investigation and diagnosis, an example of which is delineation of airway reactivity using bronchoconstrictors. In general, current therapeutic uses of aerosols exploit the ability of an aerosol to deliver a high concentration of a drug locally to the airways without eliciting the side effects that otherwise attend administration by alternative routes.

Indications For An Immunologic Workup

Mucocutaneous Separation

Should be compared with the incidence for that age group in the community, but the exposure history also needs to be taken into consideration. For example, a 40-year-old who lives alone and sits in front of a computer screen all day would be expected to have a different degree of exposure to infectious agents than a kindergarten teacher, day care worker, or pediatric office nurse. College students moving from home to the dormitory for the first time and military recruits often have sharp increases in infectious disease exposure. Similarly, a first-born baby at home often has a very different degree of exposure than a similar-aged child in day care or with many siblings. Generally, the frequency of respiratory infection among school-aged children in the United States is about six to eight upper respiratory infections per year, but as many as one a month while school is in session is not unusual. About half of these are primary bacterial infections or secondary bacterial sequelae, such...

Nosocomial pneumonia

The diagnosis of nosocomial pneumonia poses both clinical and microbiological challenges, particularly in the intubated patient. The classical findings of fever, purulent sputum, leukocytosis, and a new pulmonary infiltrate actually represent infection in only about 45 per cent of bacterial pneumonias in ventilator-dependent patients. Clearly, better methods of detecting nosocomial pneumonia are needed. This issue is fundamental because it can be very difficult to distinguish colonization from infection, or bronchitis from pneumonia, in patients who are infected. The analysis of tracheal sputum aspirates collected via a conventional suction catheter is notoriously unreliable. Such specimens are often contaminated with upper airway flora and may not be representative of flora deep within the lung. Numerous invasive techniques have been described to circumvent these shortcomings. The advent of fiber-optic bronchoscopy has led to the development of additional techniques. The simple...

Mucus Hypersecretion

Chronic bronchitis is associated with hyperplasia of both epithelial goblet cells and submucosal glands in the airways. Mucins, which are complex glycoproteins that provide the viscoelastic properties of mucus, are an essential protective mechanism in the upper airways. The regulation of mucins is altered in the lungs of COPD patients. The airways of smokers contain more goblet cells than do those of nonsmo-kers and goblet-cell activation results in mucus hypersecretion leading to airway plugging (125). Cigarette smoke can activate epidermal growth factor (EGF) receptors by tyrosine

Nickel and Its Surprising Impact in Nature

Nickel is widely employed in modern industry in conjunction with other metals for the production of alloys for coins, jewellery, and stainless steel it is also used for plating, battery production, as a catalyst, etc. Workers are exposed to nickel at all stages of the processing of nickel-containing products through air, water or skin contacts. For example, the exposure to airborne nickel-containing particles has long been known to cause acute respiratory symptoms ranging from mild irritation and inflammation of the respiratory system to bronchitis, asthma, and pulmonary fibrosis and edema. Another well-known adverse effect is allergic contact dermatitis. The indicated health problems caused by nickel exposure are mediated by an active change in the expression of genes that control inflammation, the response to stress, cell proliferation or cell death. All this and more is covered in Chapter 16. However, the most serious health effects beyond nickel toxicity relate to carcinogenesis...

Gland Cells

Located in the submucosa of cartilage-containing airways and in the lamina propria of the trachea are glands that secrete mucus into the airway lumen 17 . Each mucous gland consists of four regions the ciliated duct, collecting duct, mucous tubules, and secretory tubules 18 . The ciliated duct opens to the lumen of the airways and is lined by ciliated epithelial cells. It merges with the collecting duct, the walls of which comprise columnar cells. Mucous cells line the mucous tubules that lead from the collecting duct. Serous cells (which contribute to the more liquid component of mucus) line the blind-ended serous tubules that are located at the distal ends of the mucous tubules. Several secretory tubules feed into the collecting duct. Mucus is secreted via the collecting and ciliated ducts into the lumen of the airways. Goblet cells, located in the epithelium of the larger central airways, secrete mucus directly into the airway lumen 19 . The number and or size of mucous glands and...

Pulmonary Toxicity

Exposure of the lungs to xenobiotics may result in a number of disease conditions including bronchitis, emphysema, asthma, hypersensitivity pneumonitis, pneu-moconiosis, and cancer. During repair, damaged lung alveolar epithelium may be replaced by fibrous tissue that does not allow for gas exchange, which intensifies the damage caused by the initial lesion.


A normal appearance of the upper airway on examination by fiber-optic bronchscopy does not always exclude inhalation injury. Distal airway and alveolar injury caused by finely particulate smokes which do not precipitate in the large-caliber airways can be missed by this modality. Therefore patients who are considered at risk for inhalation injury, yet have a negative bronchoscopic examination, should undergo xenon-133 scanning. Serial scintigraphs taken following intravenous injection of this radiolabeled inert gas document elimination via the lung. Retention of the isotope for more than 90 s after injection indicates injury of the small airways. Pre-existing chronic obstructive pulmonary disease or acute inflammatory processes such as bronchitis due to aspiration or infection can result in false-positive examinations. A combination of fiber-optic bronchoscopy with xenon-133 scanning detects inhalation injury with an accuracy to 93 per cent.

Clinical Uses

Ephedrine is useful in relieving bronchoconstriction and mucosal congestion associated with bronchial asthma, asthmatic bronchitis, chronic bronchitis, and bronchial spasms. It is often used prophylactically to prevent asthmatic attacks and is used as a nasal decon-gestant, as a mydriatic, and in certain allergic disorders. Although its bronchodilator action is weaker than that of isoproterenol, its oral effectiveness and prolonged duration of action make it valuable in the treatment of these conditions. Because of their oral effectiveness and greater bronchiolar selectivity, terbutaline and albuterol are replacing ephedrine for bronchodilation.

Diagnostic studies

The appearance of sputum is not predictive of whether a bacterial infection is present. Purulent sputum is most often caused by viral infections.Microscopic examination or culture of sputum generally is not helpful. Since most cases of acute bronchitis are caused by viruses, cultures are usually negative or exhibit normal respiratory flora. When M. pneumoniae or C. pneumoniae infection is present, routine sputum cultures are still negative. 2. Acute bronchitis can cause transient pulmonary function abnormalities which resemble asthma. Therefore, to diagnose asthma, changes that persist after the acute phase of the illness must be documented. When pneumonia is suspected, chest radiographs and pulse oximetry may be helpful.


Physicians often treated acute bronchitis with antibiotics, even though scant evidence exists that antibiotics offer any significant advantage over placebo. Antibiotic therapy is beneficial in patients with exacerbations of chronic bronchitis. Oral Antibiotic Regimens for Bronchitis


Infection frequently causes bronchitis exacerbations and is associated with increased or purulent sputum, increased cough, chest congestion and discomfort, and increased dyspnea and wheezing. Chills and fever suggest pneumonia. Acute bacterial episodes tend to be seasonal, appearing more frequently in the winter.


In most individuals infected with mycobacterium tuberculosis (by respiratory aerosols), the primary pulmonary infection occurs early in life, and the organism is contained by host defenses. The primary infection usually resembles pneumonia or bronchitis, and the infection usually resolves without treatment.

Signs and symptoms

Most children with laryngeal RRP present with dysphonia and stridor, less commonly with chronic cough, recurrent pneumonia, dyspnoea, and acute life-threatening events 178,240,587 . Delay, due to mistaken diagnoses, such as bronchitis, asthma, and other allergic manifestations, may lead to gradual respiratory distress and urgent tracheotomy, which is associated with more frequent extension into the tracheobronchial tree. The overall mortality rate of patients with

Phase III trials

Retinol induces differentiation and inhibits malignant transformation. It acts at the promotion stage of carcinogenesis and there is evidence that it antagonizes a number of growth factors. It is an immune stimulant and it may actually be cytotoxic (transretinoic acid has been shown to be effective in the treatment of acute myelo-monocytic leukaemia). N acetyl cysteine has been used widely in chronic bronchitis in Europe and works in a totally different way from retinol. It is a potent anti-oxidant and increases intracellular glutathione. It has been shown in laboratory animals to be an anti-carcinogen.


Tetracyclines are the first broad-spectrum antibiotic that was used to halt the growth of many gram-positive and gram-negative bacteria. It is used to treat a variety of infections including acne vulgaris, actinomycosis, anthrax, bronchitis, and other systemic bacterial infections including bacterial urinary tract infections.

Lifestyle and health

The effects on health of behaviours such as smoking(22) and high alcohol use(23) are well documented. There is overwhelming evidence that smokers not only are much more likely to die from lung cancer and other cancers but also have much higher rates of cardiovascular disease and chronic respiratory disorders, particularly emphysema and chronic bronchitis. Moreover, the disease risk is dose related in that higher levels of smoking are more strongly associated with all these diseases. With sustained high levels of alcohol use a different but equally unpleasant spectrum of health problems can be seen. Drinking is a major cause of accidents particularly motoring accidents and can cause liver damage as well as having detrimental effects on brain functioning. (1)

Surfactant Aerosol

Surfactant aerosol also has been tested in chronic bronchitis the modest improvement in FEV1 was small, and its expense would not justify use based on these data 175 . In tests of aerosol surfactant in adults with CF treated over 5 days, no improvement was found 176 . Although instilled surfactant has become common practice for the neonatal respiratory distress of premature infants, aerosol delivery is not yet adequately developed. A recent study showed no difference in outcome for spontaneously breathing newborns who inhaled either surfactant or placebo via a CPAP mask 177 . There continues to be great appeal for the use of surfactant in adults because of the apparent success in neonates, but its use should not become practice until well-controlled trials document clinically meaningful efficacy.

Dairy Products

Because milk contains saturated fat and cholesterol, especially concentrated in cheese, it is recommended that low-fat or nonfat products be consumed. The protein in milk can adversely affect some individuals by aggravating health conditions such as asthma, sinusitis, and bronchitis. It can also irritate an already overactive immune system in cases of allergies and other autoimmune disorders. Milk products that are not organic may contain residues of drugs and hormones that have been fed to dairy cows.


Ipratropium bromide (Atrovent) is an anticholinergic drug that inhibits vagalmediated response by reversing the action of acetylcholine, producing smooth muscle relaxation. It is a newer medication that dilates bronchioles with few systemic effects. Ipratropium bromide (Atrovent) is used five minutes before glu-cocorticoid (steroid) or cromolyn are inhaled so the bronchioles dilate enabling the steroids to be deposited in the bronchioles. Sometimes ipratropium bromide is combined with albuterol sulfate (Combivent) to treat chronic bronchitis for more effective and longer duration than if each is used alone.

Mucolytic Agents

Mucolytic agents such as N-acetylcysteine (NAC) have been used by aerosol delivery in an attempt to aid in sputum clearance. Supplied in sufficient quantity, acetylcysteine will help liquefy tenacious secretions and make their clearance easier. A review of studies on the use of NAC in CF concluded the evidence does not support its use, either via nebulizer or by mouth 93 . Intravenous NAC was tested and found not useful in acute respiratory distress syndrome 94 . In one study, patients with chronic bronchitis who took oral NAC had fewer exacerbations and better symptom improvement than did control patients 95 . In the United States, there is no use of NAC by any route for chronic bronchitis. These data need more examination and further study before any such use might be considered. A newer mucolytic agent, nacystelyn, has been developed for delivery via a dry powder inhaler. Deposition in adults and children with CF was 16 and 23 , respectively 94 .


Reversible airways disease does not always represent asthma. Wheezing may persist for weeks after an acute bronchitis episode. Patients with chronic obstructive pulmonary disease may have a reversible component superimposed on their fixed obstruction. Etiologic clues include a personal history of allergic disease, such as rhinitis or atopic dermatitis, and a family history of allergic disease.

Hans Anton Lehr

Cigarette smoke contains large amounts of carcinogenic and cocarcinogenic substances that explain the increased burden of malignant tumors in smokers, particularly in the lungs, the upper gastrointestinal system, and the urinary bladder. Nonneoplastic diseases associated with cigarette smoking include chronic bronchitis and pulmonary emphysema, gastrointestinal ulcers, and a significantly increased risk of cardiovascular diseases, ranging from peripheral artery disease to myocardial infarction and cerebrovascular incidences. Although the exact pathophysiological link between cigarette smoking and cardiopulmonary disease progression remains incompletely understood, it has been recognized that a key role is played by effects on diverse aspects of the microcirculation both in terms of morphological (i.e., vessel wall injury, capillary loss) and functional aspects. The latter concerns predominantly changes in tissue perfusion and its regulatory mechanisms (i.e., reactive hyperemia,...

Cancer Risk Factors

Tobacco smoking, the single most lethal human carcinogen, remains the largest single avoidable cause of premature death worldwide.20 Estimates connect at least 16 of all cancers in developed countries to tobacco use, with a higher proportion of tobacco-related cancers among men (25 ) than women (4 ). Tobacco-related cancers include those of the oral cavity, pharynx, larynx, lung, bladder, pancreas, kidney, renal pelvis, and endometrium. However, in the last case, reduced rather than increased risk is thought to result from antiestrogenic effects of tobacco use rather than exposure to the more than 55 carcinogenic compounds identified by the International Agency for Research on Cancer.21 For more than 40 years, it has been clear that prevention of smoking would lead to substantial reductions in death associated with lung and other cancers and heart disease, bronchitis, emphysema, and other conditions. Nonetheless, tobacco-related disease has increased in many parts of the world,...


Selective deficiency of IgA (or P2A or y1A according to previous terminology) was described by Giedion and Scheidegger (1957), Fudenberg et al. (1962), and West et al. (1962). Interestingly, these initial reports contained descriptions of patients whose symptoms presaged the clinical profiles of patients with IgA deficiency as defined in later, more extensive studies of the condition. Some of the patients, for instance, had respiratory infections and thus predicted the major clinical manifestation of IgA deficiency, that is, chronic upper and lower respiratory infections leading in the untreated state to bronchiectasis and respiratory failure. In addition, one patient had steatorrhea and malabsorption and was therefore representative of another symptom complex in IgA deficiency, a non-gluten-sensitive sprue-like syndrome marked by villous atrophy, malabsorption, and at times, intestinal nodular lymphoid hyperplasia. The origin of this symptom complex, initially described in depth by...

Airway closure

Closing capacity include a loss of elastic recoil due to lung disease (chronic bronchitis, emphysema) or an increase in airway tone (asthma). Decrease in FRC can also be seen during anesthesia which may promote closure of airways and impede ventilation in dependent lung regions. Long-standing closure of airways will promote resorption atelectasis. While collapse of a lung unit will take several hours if it is filled with air, gas resorption and subsequent atelectasis may occur within 10 min on oxygen breathing. Breathing oxygen at very low lung volume, close to or at residual volume, further promotes atelectasis formation. Atelectasis is also a common finding in anesthetized subjects, and it can be hypothesized that any acute lung failure accompanying a small lung volume is sensitive to the composition of the respiratory gases. It is possible that the administration of oxygen and nitrous oxide contributes to the pathology of the lung as seen on CT scans.

Fibrogenic Reactions

There are few symptoms and signs attending chronic simple silicosis. The diagnosis is usually made by chest radiographs, which reveal small round opacities (less than 10 mm in diameter) in both lungs, with a predilection for the upper lung zones. If an adequate occupational history is obtained from the patient along with a thorough review of the chest radiographs, the diagnosis of silicosis should not present any great difficulty. Pulmonary function tests in patients with simple silicosis usually are normal, but a mild obstructive impairment is occasionally found because of chronic dust-induced bronchitis. With complicated silicosis involving progressive fibrosis (nodules more than 10 mm in diameter), increasing dyspnea is noted, initially with exertion and progressing to dyspnea at rest. Complicated chronic silicosis is associated with reduced lung volumes, decreased diffusing capacity, and hypoxemia with exercise.