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Aspergillus spp. isolated from non-BAL cultures of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) patients may reflect colonization rather than infection. Sera (n  = 181) from 49 adult ICU CAPA patients (24 probable and 25 possible CAPA) with bronchial secretions (BS) culture positive for Aspergillus spp. were collected and tested for Aspergillus DNA detection by species-specific real-time PCR. Overall, 30/49 (61%) patients were PCR positive. BS culture/serum PCR agreement was moderate (21/30; 70%). Based on serum PCR positive patients, all CAPAs were due to A. fumigatus (80%), A. flavus (10%), and A. terreus (10%). No A. niger / A. nidulans or mixed infections were found despite positive BS cultures. [ABSTRACT FROM AUTHOR]

Cystic fibrosis (CF) is the most common severe autosomal recessive disorder in Caucasians. A homozygous change of the CF transmembrane regulator gene causes viscosity in pancreatic and bronchial secretion. Obstruction of secretion is responsible for liver and biliary tract symptoms. Congenital cystic adenomatoid malformation (CCAM) is a rare lung disorder of unknown etiology affecting the distal bronchi. It is important because of the risk of recurrent lung infections and malignancy. A 3-month-old female patient was brought to our hospital with symptoms of insufficient weight gain and pale appearance. The patient was hospitalized with a pre-diagnoses of malnutrition, hemolytic anemia, and cholestasis. She was diagnosed with CF liver disease and congenital adenomatoid malformation following thorough evaluation. Our patient with CF liver disease and pancreatic involvement was found to have a deltaF508 homozygous change. Our case is reported because of the rare association of hereditary CF disease and CCAM of unknown cause. [ABSTRACT FROM AUTHOR]

Aqueous root extract of Cryptolepis sanguinolenta has been used traditionally to treat many upper respiratory tract disorders. Besides its well-known broad spectrum antimicrobial activity, we had reasoned that cryptolepine can directly attenuate the symptoms of asthma. Therefore, this study evaluates cryptolepine, the main compound of the aqueous extract of Cryptolepis sanguinolenta, on early and late-phase symptoms of asthma attack. In the early phase study, isolated cryptolepine was evaluated on its ability to reverse histamine-induced bronchoconstriction and reduce histamine release from mast cells and bronchial mucus secretion. In the late phase study, cryptolepine was evaluated on its ability to affect airway inflammation and hypersensitivity as well as its ability to attenuate airway remodeling induced by ovalbumin. In the early asthma phase study, Cryptolepine (10–100 mg/kg) significantly and dose dependently inhibited Histamine-induced bronchoconstriction in guinea pigs. The protection lasted beyond 24 h. It also decreased the volume and optical density of bronchial secretions in mice. Cryptolepine (10–100 µg /mL) stabilized mesentery mast cells in vitro against Compound 48/80 -induced degranulation. In the late phase study, cryptolepine (10–100 mg/kg) prevented ovalbumin-induced airway obstruction and basal membrane smooth muscle hypertrophy. It significantly reduced systemic leukocytosis and inflammatory cell infiltration into airways in antigen-sensitized animals. Using the skin prick test, cryptolepine reduced the hypersensitivity to allergen challenge in antigen-sensitized animals. Cryptolepine's effects in the late phase was similar to dexamethasone (1 mg/kg) used as standard drug. Cryptolepine attenuates both early and late phase symptoms of asthma. It reduces bronchospasms, bronchial secretions, airway remodeling and hypersensitivity. This gives scientific credence to the traditional usage of cryptolepis extracts in upper respiratory tract disorders.

Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neurodegenerative disease that inevitably affects the respiratory system, and part of its treatment focuses on improving symptoms and minimizing its respiratory complications which are the main cause of death; thus, the purpose of the following review is to describe the pulmonary involvement of ALS, to propose diagnostic/monitoring guidelines, and to expose its therapeutic options. The alveolar hypoventilation syndrome and the poor management of bronchial secretion are the main respiratory difficulties secondary to ALS and they are due to the weakness of the muscles that generate respiration; in this way, the periodic assessment of respiratory function is imperative for monitoring and detecting these complications in early stages. The care of patients with ALS should be multidisciplinary and ideally should be performed in specialized centers; non-invasive mechanical ventilation and assisted cough (manual or mechanical) are the two most cost/effective techniques to treat alveolar hypoventilation and poor secretion management to increase survival, improve symptoms, and increase quality of life. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: The aim of our study was to assess the safety, efficacy and feasibility of an Expiratory Flow Accelerator (EFA) device, Free Aspire, in reducing the need for daily suctions in tracheostomised (TCS) patients. Methods: Twenty‐five patients (13 males, 12 females, aged 69.88 ± 9.06 years) were investigated. The number of superficial/deep suctions, shallows, arterial blood gas (ABG) analysis, perception of mucus encumbrance (Visual Numeric Scale, VNS) and adverse event were recorded for five days. On the first two days (T1‐T2), suctioning was performed as usual, on the following three days (T3, T4, T5), patients were treated also with Free Aspire (20 min, 3 times a day). Results/Conclusion: The use of the non‐invasive device was associated with a decrease of total number of aspirations from T2 to T5 (8.48 ± 2.62 vs 4.48 ± 3.08, P = 0.0003). Total number of daily aspirations decreased over the five days (8.68 ± 3.64 vs 4.48 ± 3.08, P = 0.0009). Deep aspirations decreased from T1 to T5 (6.16 ± 3.53 vs 1.80 ± 1.50, P = 0.0001). ABG data confirmed that no significant side effects occurred. VNS score decreased from 7.03 ± 1.42 at T1 to 4.05 ± 1.80 at T5 (P < 0.0001). These data suggest that EFA may be useful for managing secretions in TCS patients, as it can reduce the number of daily suctions, particularly the deep ones, and may improve the perception of mucus encumbrance, without side effects. More studies are needed to confirm these data and to understand in which categories of TCS patients this device can be introduced. [ABSTRACT FROM AUTHOR]

Aim: To identify effective treatments and risk factors associated with death rattle in adults at the end of life. Background: The presence of noisy, pooled respiratory tract secretions is among the most common symptoms in dying patients around the world. It is unknown if "death rattle" distresses patients, but it can distress relatives and clinicians. Treatments appear unsatisfactory, so prophylaxis would be ideal if possible. Design: Quantitative systematic review and narrative summary following Cochrane Collaboration guidelines. Data sources: CINAHL, MEDLINE, Health Source Nursing and Web of Science were searched for international literature in any language published from 1993 - 2016 using MeSH headings and iterative interchangeable terms for "death rattle". Review methods: Randomized controlled trials were appraised using the Cochrane Collaboration's tool for assessing risk of bias. Non-randomized studies were assessed using ROBINS-I tool for assessing risk of bias in non-randomized studies of interventions. Instances of treatment and risk were extracted and relevant key findings extracted in line with Cochrane methods. Results: Five randomized trials and 23 non-randomized studies were analysed. No pharmacological or non-pharmacological treatment was found superior to placebo. There was a weak association between lung or brain metastases and presence of death rattle, but otherwise inconsistent empirical support for a range of potential risk factors. Conclusions: Clinicians have no clear evidence to follow in either treating death rattle or preventing it occurring. However, several risk factors look promising candidates for prospective analysis, so this review concludes with clear recommendations for further research. [ABSTRACT FROM AUTHOR]

Aim: Identification of risk factors predicting the development of death rattle. Background: Respiratory tract secretions, often called death rattle, are among the most common symptoms in dying patients around the world. It is unknown whether death rattle causes distress in patients, but it has been globally reported that distress levels can be high in family members. Although there is a poor evidence base, treatment with antimuscarinic medication is standard practice worldwide and prompt intervention is recognized as crucial for effectiveness. The identification of risk factors for the development of death rattle would allow for targeted interventions. Design: A case-control study was designed to retrospectively review two hundred consecutive medical records of mainly cancer patients who died in a hospice inpatient setting between 2009-2011. Fifteen potential risk factors including the original factors weight, smoking, final opioid dose and final midazolam dose were investigated. Methods: Binary logistic regression to identify risk factors for death rattle development. Results: Univariate analysis showed death rattle was significantly associated with final Midazolam doses and final opioid doses, length of dying phase and anticholinergic drug load in the pre-terminal phase. In the final logistic regression model only Midazolam was statistically significant and only at final doses of 20 mg/24 hrs or over (OR 3.81 CI 1.41-10.34). Conclusions: Dying patients with a requirement for a high dose of Midazolam have an increased likelihood of developing death rattle. [ABSTRACT FROM AUTHOR]

We present a comparison of the flow characteristics in an idealized smooth trachea model and a second model which has a roughness simulating cartilaginous rings. We use refractive index-matched particle image velocimetry (PIV) to measure the velocity field in a two-generation model of the trachea and main bronchi. The flow rate has a trachea-based Reynolds number Re =2800, which is comparable to a resting state. Our results show considerable differences between both cases, the most important of which is the size and magnitude of recirculation zones at the inlet of both bronchi. The smooth case shows a larger separation bubble at the bronchi entrance, which may retain aerosols and have different effects on particles of different sizes. Furthermore, the smooth case displays a higher vorticity along the bottom walls of the bronchi, while a higher vorticity is seen along the trachea walls in the ׳ringed׳ model. These findings suggest that modeling the trachea and main bronchi as smooth tubes may not be justified, since the flow conditions in lower generations will be affected by these differences. [ABSTRACT FROM AUTHOR]

Background: Management of secretions in children with cerebral palsy is often problematic due to severe deformation of the rib cage, impaired cough, and patients'inability to collaborate with chest physiotherapy. Assessing the effectiveness of different methods and techniques of secretion clearance is hampered by the lack of direct outcome measures and by limited patient cooperation. This observational study was planned to evaluate the efficacy of Free Aspire, a device that utilizes a special method to remove secretions from the bronchial tree in hypersecretive patients. Case presentation: Cerebral palsy patients were selected who had experienced more than 3 episodes of respiratory exacerbations in the latest year despite therapeutic optimization (including bronchial clearance techniques) and who had received at least one antibiotic course or underwent at least one access to the Emergency Room (ER) or admission to hospital in the 6 months prior to the study. Patients with congestive heart failure or contraindications for Free Aspire were excluded. We prospectively enrolled 8 patients (mean age 8.25 ± 6.11 years) who had been using in the past techniques for clearance secretions different from Free Aspire. The treatment with Free Aspire consisted of at least two 20-min sessions per day. The observational study period was 18 months. In the 6 months prior to start the treatment (T0), patients had a mean number of 4.0 ± 2.23 visits from the primary care pediatrician (PCP), spent 14 ± 20 days in hospital, and received antibiotics for 35 ± 17 days. After the first 6 months of treatment (T1), they had 1.7 ± 0.73 PCP visits, no days spent in hospital, and 9.75 ± 10.4 days of antibiotic therapy. At 12 months of treatment (T2), PCP visits were 1.7 ± 0.70, days in hospital 1.12 ± 0.3, and days of antibiotics 10.25 ± 10. At 18 months of treatment (T3) no hospitalizations had occurred, PCP visits were 0.25 ± 0.70, and days of antibiotic therapy 4.8 ± 12.62. The technique proved to be safe and well tolerated. Conclusion: Our findings show that Free Aspire for bronchial secretion clearance in cerebral palsy patients with limited capacity to collaborate is safe and effective in reducing the impact of respiratory exacerbations in terms of number of PCP visits, days spent in hospital, and days of antibiotic therapy; its regular use maintains this effect in time. [ABSTRACT FROM AUTHOR]

Aspergillus spp. isolated from non-BAL cultures of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) patients may reflect colonization rather than infection. Sera (n = 181) from 49 adult ICU CAPA patients (24 probable and 25 possible CAPA) with bronchial secretions (BS) culture positive for Aspergillus spp. were collected and tested for Aspergillus DNA detection by species-specific real-time PCR. Overall, 30/49 (61%) patients were PCR positive. BS culture/serum PCR agreement was moderate (21/30; 70%). Based on serum PCR positive patients, all CAPAs were due to A. fumigatus (80%), A. flavus (10%), and A. terreus (10%). No A. niger/A. nidulans or mixed infections were found despite positive BS cultures., (© The Author(s) 2022. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.)

The aim of this study was to compare the sensitivity of different in vivo and post-mortem samples collected from finishing pigs under field conditions on Mycoplasma hyopneumoniae detection by PCR. Results suggested that tracheobronchial secretions and bronchial swabs conferred the highest sensitivity in vivo and post-mortem , respectively. • Samples from finishing pigs were compared for M.hyopneumoniae detection by PCR. • Laryngeal swabs and tracheobronchial secretions were collected in vivo. • Lung tissue and bronchial swabs represented the post mortem samples. • Tracheobronchial secretions showed higher sensitivity compared to laryngeal swabs. • Bronchial swabs presented higher sensitivity compared to lung tissue. [ABSTRACT FROM AUTHOR]

The aim of this critical review was to assess the literature regarding the treatment of death rattle at the end of life to provide an update information regarding this difficult issue. To provide suggestions for future research agenda, the approach was analytic and based on clinical considerations, rather than on raw evidence only. Both published and unpublished reports from an extensive search of electronic databases. Any randomized-controlled trial or clinical reports with a significant number of patients was considered. Eleven reports fulfilled the inclusion criteria in this systematic review. Four controlled studies, four comparative audits, and three clinical reports with a significant number of patients were selected. Despite anticholinergic or antimuscarinic medications are the drugs of choice in practice, there is a lack of supporting evidence for the use of anticholinergics to treat death rattle. Regardless of the methodological limitations of existing studies, an a priori observation was missed. Most studies were performed with the intent to treat rather than to prevent death rattle. However, from a pharmacological perspective, anticholinergic agents are unable to reduce the secretions once they are formed, but may just limit a further production. In conclusion, studies on the use of antisecretive agents provided only minor evidence of efficacy, ultimately raising questions about the routine inclusion of anticholinergic treatment in end of life pathways for the treatment of death rattle. However, this observation could be confuted by the use of these same drugs used earlier in a prophylactic perspective, in the context of a comprehensive management of the dying patients. [ABSTRACT FROM AUTHOR]

Objectives: (1) To present a rare case of stridor secondary to prolonged laryngospasm in a patient with Parkinson's disease, and (2) to review the literature on stridor in Parkinson's disease. Methods: We report a 73-year-old Parkinson's disease patient who developed acute stridor due to prolonged laryngospasm triggered by overspill of excessive secretions. The literature was reviewed, following a Medline search using the keywords 'Parkinson's disease' and 'stridor' or 'airway obstruction' or 'laryngospasm' or 'laryngeal dystonia' or 'bilateral vocal cord palsy'. Result: Only 12 previously reported cases of stridor in Parkinson's disease patients were identified. Causes included bilateral vocal fold palsy (eight cases), laryngospasm (five), and dystonia of the jaw and neck muscles (two). The mechanism of laryngospasm in our patient was similar to 'dry drowning', and has not previously been described. Conclusion: Laryngospasm can be triggered in Parkinson's disease by excessive secretions entering the larynx. The mechanism is similar to 'dry drowning'. Treatment focuses on reducing secretions. The use of botulinum toxin to reduce spasm is inappropriate in this situation. This case emphasises the importance of recognising different causes of stridor in Parkinson's disease patients, as this affects management. [ABSTRACT FROM AUTHOR]

Abstract: Part of the innate defence of bronchial epithelia against bacterial colonization is secretion of salt and water which generally depends on coordinated actions of receptor-mediated cAMP- and calcium signalling. The hypothesis that Staphylococcus aureus-virulence factors interfere with endogenous signals in host cells was tested by measuring agonist-mediated changes in [Ca2+]i in S9 cells upon pre-incubation with bacterial secretory products. S9 cells responded to mAChR-activation with calcium release from intracellular stores and capacitative calcium influx. Treatment of cells with culture supernatants of S. aureus (COL) or with recombinant α-hemolysin (Hla) resulted in time- and concentration-dependent changes in [Ca2+]i. High concentrations of Hla (2000ng/ml) resulted in elevations in [Ca2+]i elicited by accelerated calcium influx. A general Hla-mediated permeabilization of S9 cell membranes to small molecules, however, did not occur. Lower concentrations of Hla (200ng/ml) induced a reduction in [Ca2+]i-levels during the sustained plateau phase of receptor-mediated calcium signalling which was abolished by pre-incubation of cells with carboxyeosin, an inhibitor of the plasma membrane calcium-ATPase. This indicates that low concentrations of Hla change calcium signalling by accelerating pump-driven extrusion of Ca2+ ions. In vivo, such a mechanism may result in attenuation of calcium-mediated cellular defence functions and facilitation of bacterial adherence to the bronchial epithelium. [Copyright &y& Elsevier]

Airway colonization with Pseudomonas aeruginosa is frequent in severe chronic obstructive pulmonary disease (COPD) and may lead to progressive inflammatory damage. Inhaled Tobramycin Nebulizer Solution (TNS; a preservative-free formulation) is an effective therapy in chronic P aeruginosa infection in cystic fibrosis and bronchiectasis. In this study we aimed to investigate the effects of a TNS short course on inflammatory markers in bronchial secretions from multiresistant P aeruginosa-colonized patients with severe COPD. To the authors’ knowledge, this is the first study to examine this in cases of severe COPD. Thirteen COPD patients (GOLD criteria 3–4; mean age 72.7± 8 years; mean basal forced expiratory volume in 1 second (FEV1) 34.8%±8.1%; mean FEV1/forced vital capacity 0.6±0.1) were enrolled. All patients were colonized with P aeruginosa and resistant to oral/intravenous specific antibiotics. Eosinophilic cationic protein (ECP), interleukin-1 beta (IL-1β), interleukin-8 (IL-8), tumor necrosis factor alfa (TNF-α), and cell counts were measured in spontaneous secretions before and after a 2-week TNS course (300 mg twice daily). The TNS course induced a significant reduction in IL-1β ( P<0.03), IL-8 ( P<0.02), ECP ( P<0.01) concentrations, and in eosinophil count ( P<0.01). TNF-α levels, and neutrophil and lymphocyte counts were not significantly affected. The second week of treatment proved crucial in terms of efficacy. P aeruginosa density was lowered after 6 months; severe acute exacerbations were reduced by 42%. TNS reduced the inflammatory impact of P aeruginosa in multiresistant, P aeruginosa-colonized patients with severe COPD. A therapeutic role for TNS can be strongly suggested in these particular conditions. [ABSTRACT FROM AUTHOR]

The evidence base for diagnosis and management of ALS is still weak, and curative therapy is lacking. Nonetheless, early diagnosis and symptomatic therapy can profoundly influence care and quality of life of the patient and relatives, and may increase survival time. This review addresses the current optimal clinical approach to ALS. The literature search is complete to December 2006. Where there was lack of evidence but consensus was clear we have stated our opinion as good practice points. We conclude that a diagnosis of ALS can be achieved by early examination by an experienced neurologist. The patient should be informed of the diagnosis by the consultant. Following diagnosis, a multi-diciplinary care team should support the patient and relatives. Medication with riluzole should be initiated as early as possible. PEG is associated with improved nutrition and should be inserted early. The operation is hazardous in patients with VC <50%: RIG may be a better alternative. Non-invasive positive pressure ventilation improves survival and quality of life but is underused in Europe. Maintaining the patient's ability to communicate is essential. During the course of the disease, every effort should be made to maintain patient autonomy. Advance directives for palliative end of life care are important and should be discussed early with the patient and relatives if they so wish. [ABSTRACT FROM AUTHOR]

Despite being one of the most devastating diseases known, there is little evidence for diagnosing and managing patients with amyotrophic lateral sclerosis (ALS). Although specific therapy is lacking, correct early diagnosis and introduction of symptomatic and specific therapy can have a profound influence on the care and quality of life of the patient and may increase survival time. This document addresses the optimal clinical approach to ALS. The final literature search was performed in the spring of 2005. Consensus recommendations are given graded according to the EFNS guidance regulations. Where there was lack of evidence but consensus was clear we have stated our opinion as good practice points. People affected with possible ALS should be examined as soon as possible by an experienced neurologist. Early diagnosis should be pursued and a number of investigations should be performed with high priority. The patient should be informed of the diagnosis by a consultant with a good knowledge of the patient and the disease. Following diagnosis, the patient and relatives should receive regular support from a multidisciplinary care team. Medication with riluzole should be initiated as early as possible. PEG is associated with improved nutrition and should be inserted early. The operation is hazardous in patients with vital capacity <50%. Non-invasive positive pressure ventilation improves survival and quality of life but is underused. Maintaining the patients ability to communicate is essential. During the entire course of the disease, every effort should be made to maintain patient autonomy. Advance directives for palliative end of life care are important and should be fully discussed early with the patient and relatives respecting the patients social and cultural background. [ABSTRACT FROM AUTHOR]

Exacerbations often complicate the progressive course of chronic obstructive pulmonary disease (COPD), mainly due to infectious agents. The precise role of bacterial infections in the course and the pathogenesis of COPD has been a source of controversy for decades. Also viruses and other non-infectious causes of exacerbation play a relevant role and also contribute to persisting airway inflammation. Usually, the etiologic identification of the infective causes of COPD require considerable time and costs. The development of more rapid, reliable, and widely applicable methods to promptly define the etiology of COPD exacerbations should represent a relevant issue in devising earlier and more specific strategies for their effective therapeutic control. Aim: of the study was to assess the predictive role of some pro-inflammatory cytokines measured in spontaneous bronchial secretions in discriminating the main infectious causes of COPD exacerbations. Methods: 124 subjects with moderate COPD (51–79 y; mean basal FEV 1 = 49.6% pred. &PlusMinus; 4.6 sd; FEV1 reversibility + 3.9% from baseline &PlusMinus; 4.8 sd after salbutamol 200 mcg) were studied during acute exacerbation. Respiratory viruses were isolated from bronchial secretions in 21 cases; common bacteria (CFU = 10 6 /ml) in 28 cases; Pseudomonas Aeruginosa (Ps.Ae.; CFU = 10 6 /ml) in 20 cases. The cytokines IL1ß, IL8, and TNFa (pg/ml; Immulite; Diagnostic Product Corp, Los Angeles, CA, USA), and neutrophils (% total count) were measured in bronchial secretions of all patients. Statistics: a two-stage logistic model was chosen for discriminating the different causes of COPD exacerbations (such as: non-infectious, or viral, bacterial, or due to Ps.Ae. ). Results: At the first decisional step, the two-stage logistic model proved that TNFa levels in bronchial secretions recognise clearly patients belonging to the Ps.Ae . group from those of all othergroups (Area under ROC curve = 0.96; 95% CI = 0.91–0.99), and that, at the second decisional step, IL8 + IL1ß levels discriminate patients with bacterial causes (such as all bacteria) from the non-infected ones and from those with a viral cause of exacerbation (Area under ROC curve = 0.87; 95% CI = 0.77–0.94). Neutrophil percent count did not support any contribution in discriminating the different subgroups of COPD subjects. Conclusions: when exacerbated, COPD subjects express different patterns of pro-inflammatory mediators in bronchial secretions, which appear modulated according to the etiological cause of the exacerbation. In particular, TNFa concentration per se enables recognition of COPD exacerbations due to Ps.Ae. , while IL8 + IL1ß levels prove helpful in discriminating those to common bacteria from those to viral agents and to non-infectious causes. When present data are further confirmed, the use of a decisional rule based on cytokine measurements might be regarded as a helpful predictive tool. As measures of pro-inflammatory cytokines are low-cost, simple, and faster to perform, they could support rapid clinical decision making at the bedside regarding therapeutic strategy for COPD exacerbations, in particular when they are needed for severe COPD patients. [ABSTRACT FROM AUTHOR]

The drug level was calculated in the plasma, the lung tissue and bronchial secretion using ciprofloxacin as the drug with erosion-controlled dosage forms. A numerical model was built and tested for this calculation. It takes into account the following stages: the kinetics of drug release along the gastrointestinal tract time, the absorption into and elimination out of the plasma, the diffusion through the lung tissue and convection into the bronchial secretion. Emphasis is placed upon the effect of patient's non-compliance on the drug levels, with intake omission, intake omission followed by double dosing, wrong frequency. Calculation with erosion-controlled dosage form with a long time of full erosion able to remain in the gastrointestinal over a period of time much longer than the usual gastrointestinal tract time shows the interest of bioadhesion. [ABSTRACT FROM AUTHOR]

Establishes the nature and the precise distribution of glutathione S-transferase isoenzymes in the bronchiolar epithelium of rats and mice. Differences in intracellular compartmentalization of these enzymes; Epithelial lining fluid; Secretory granules; Interspecies differences in the sensitivity of particular lung cells to toxins.

Examines chloride secretion and the function of serous and mucous cells of human airway glands. Levels of mediator-induced chlorine secretion in mucous cells; Levels of cystic fibrosis transmembrane conductance regulator.

The immunological identity of a uteroglobin-like protein, occurring in respiratory tract secretions and tissue, with uteroglobin from rabbit endometrial secretion is demonstrated. A uteroglobin-like antigen has been localized in bronchial epithelial cells and in bronchioles by immunofluorescence. This secretory protein is, in contrast to the authentic uteroglobin, hormone-independent, as far as estrogens and progesterone are concerned. The possible significance of comparative studies on uteroglobin and the uteroglobin-like antigen is discussed, taking into account cytological, endocrinological, and molecularbiological aspects. [ABSTRACT FROM AUTHOR]

Twenty patients with stable chronic bronchitis entered a double-blind study in which changes in clinical and respiratory function and biochemical and rheological variations were examined after treatment with the mucoregulator S-carboxy-methyl-cysteine (S.C.M.C.). After one week of single-blind placebo, a two week double-blind study was initiated with placebo or oral S.C.M.C. 3 g/24h. After two weeks, a significant clinical improvement was observed in patients treated with S.C.M.C. During treatment, there was no change in respiratory function, although a drop in FEV/VC was noted in the placebo group. A significant increase in the viscosity of the expectorations was observed after treatment with S.C.M.C. for two weeks. The levels of secretory IgA and of serum albumin in the expectorations remained stable, whereas in the placebo group, there was a slight but significant increase in serum albumin. In this group of non-infected chronic bronchitic patients, S.C.M.C. appeared to normalize the secretory function of the bronchial mucosa by preventing inflammation and enhancing the viscoclastic properties of bronchial secretions. [ABSTRACT FROM AUTHOR]

Fibreoptic and rigid bronchoscopy are widely used diagnostic and therapeutic tools in pulmonary medicine, but there is little available knowledge regarding the classification of bronchoscopy findings. We aimed to propose a practical classification, to reveal interrelationship among endoscopic findings and to demonstrate demographic characteristics in our region. We analysed 2,698 consecutive bronchoscopy reports, retrospectively. Bronchoscopic findings were divided into four classes: direct tumour findings (malignant or benign), indirect tumour findings, chronic bronchitic changes and findings of mucosal injury. Bronchial secretions were classified into four categories: serous, seromucous/mucous, purulent/mucopurulent, and haemorrhagic/haemorrhage/coagulum. There was no endobronchial pathology in 18.3% of the patients. The frequency of the findings of direct tumour, indirect tumour, mucosal injury, and chronic bronchitic changes were 19.1%, 20.2%, 14.8%, and 27.6%, respectively. The frequencies of seromucous/mucous and purulent/mucopurulent secretions were lowest in the patients who had direct tumour findings. Mucosal injury findings were most common concomitant observation in the group of indirect tumour findings. All types of secretions except haemorrhagic were strongly associated with mucosal injury findings. We think that it is necessary for a classification of endoscopic findings to be developed to optimise clinical practice. [ABSTRACT FROM AUTHOR]

Mast cells play a critical role in the pathogenesis of allergic asthma. Histamine is a central mediator released from mast cells through allergic reactions. Histamine plays a role in airway obstruction via smooth muscle contraction, bronchial secretion, and airway mucosal edema. However, previous clinical trials of H1 receptor antagonists (H1RAs) as a treatment for asthma were not successful. In recent years, type 2 innate immunity has been demonstrated to be involved in allergic airway inflammation. Allergic asthma is defined by IgE antibody-mediated mast cell degranulation, while group 2 innate lymphoid cells (ILC2) induce eosinophilic inflammation in nonallergic asthma without allergen-specific IgE. Anti-IgE therapy has demonstrated prominent efficacy in the treatment of severe allergic asthmatics sensitized with specific perennial allergens. Furthermore, recent trials of specific cytokine antagonists indicated that these antagonists were effective in only some subtypes of asthma. Accordingly, H1RAs may show significant clinical efficacy for some subtypes of allergic asthma in which histamine is deeply associated with the pathophysiology. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the pharmacokinetic profile of moxifloxacin (MXF) in serum and sputum/bronchial secretions of 22 patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) hospitalized in the ward and intensive care unit (ICU). The data showed that ICU patients had lower concentrations in secretions ( P = 0.01). However, no other statistically significant differences were observed in pharmacokinetic parameters and penetration in secretions between ward and ICU patients. MXF showed a favorable pharmacokinetic profile, and the pharmacodynamic targets for common pathogens for AECOPD were achieved., (Copyright © 2019 American Society for Microbiology.)

The article offers a guide on handling end-of-life emergencies. The importance of anticipating and planning management of possible symptoms and/or emergencies in maintaining patients at home at the end of life is cited. Some treatments to consider for specific symptoms such as excess bronchial secretions, breathlessness and pain are provided.

The objective of the study was to evaluate the ability of meropenem to reach the bronchial lumen. 24 patients undergoing fibreoptic bronchoscopy for exploratory purposes were given a single dose of meropenem 1 g as an (i.v.), infusion over 30 min. Plasma (P) sampling times were: 0, 0.5, 1, 2 and 3 h. Bronchial secretions (BS) were collected by fibreoptic bronchoscopy at the same sampling times (except for 0 and 0.5 h) in three groups of 8 patients. Meropenem was measured by bioassay using E. coli ATCC 39118 as the test-organism. The results showed that meropenem had reached a high plasma concentration at the first sampling time (59.8 mg · 1) and then the plasma level decreased rapidly to 10.6 mg · 1 and 2.7 mg · 1 at 2 and 3 h respectively. The highest concentration achieved in bronchial secretion was 0.53 mg · 1 in the third hour, ie 20% of the serum level. The data indicate significant penetration of meropenem into bronchial secretions and achievement of a local level sufficiently high to eradicate most respiratory pathogens. [ABSTRACT FROM AUTHOR]

Airway submucosal gland cell (SMGC) secretions are under the control of various secretagogues. Mechanisms of interactions between PGE2 and ACh in activating mucus cell ion current responses are examined in this study. PGE2 pretreatment sensitized ACh-induced short-circuit current (Isc) that were mediated by EP2 receptors and mimicked by forskolin. PKA inhibitors, 14-22 amide PKI (PKI) and Rp-cAMPs, prevented the effect of PGE2. Treatment with 0 [Ca2+]o or Ca2+ entry blocker, SKF96365, shifted the ACh concentration-response relationships to the right, but did not abolish PGE2-induced sensitization of the ACh response. An IP3 receptor antagonist and the Ca2+ entry blocker, 2-APB, abolished the ACh-induced response. Under whole-cell patch clamp, IP3, dialyzed in the cytosol via patch pipette upon whole-cell formation, induced immediate increases in both KCa and CaCC currents that were prolonged by simultaneous inclusion of cAMP in the internal solution. The plateau phases of both currents were related to Ca2+ entry, abolishable by treatments with 0 [Ca2+]o, Gd3+, 2-APB, or SKF96365, and were also enhanced by membrane hyperpolarization. Abundant mRNA expressions for TRPC channels (TRPC-1>>3≈6>4) were detected in the mucus cells using real-time RT-PCR. Thus, PGE2, via EP2 receptors and the cAMP/PKA, pathway, enhances ACh-induced, Ca2+-mediated ionic currents in mucus cells through activating Ca2+-entry independent mechanisms that are primarily responsible for sensitization of the ACh response. ACh-induced Ca2+ entry via non-selective cation channels was also enhanced by cAMP treatment, important for sustaining the ACh-induced response. [ABSTRACT FROM AUTHOR]