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When should you avoid antibiotics for acute bronchitis--and when are they necessary? Are bronchodilators helpful? What's the next step when cough persists? Perplexing--but answerable--questions. Although acute bronchitis remains one of [...]

Does each acute exacerbation of chronic bronchitis require antibiotic therapy? Which antibiotic is best? Some of the answers may surprise you. Chronic bronchitis is a condition characterized by recurring cough [...]

NANCY WALSH D'EPIRO ARTICLE CONSULTANTS KEITH B. ARMITAGE, MD, is Assistant Professor, Department of Internal Medicine, Case Western Reserve University School of Medicine; and Program Director, Internal Medicine Residency Training [...]

Hemoptysis or hematemesis? Findings in the history and physical examination are more reliable indicators than are the color, character, or pH of the blood. Findings that suggest hemoptysis. . . [...]

1. Brief stimuli were delivered to the carotid body chemoreceptors or the carotid sinus baroreceptors at different phases of the respiratory cycle in anaesthetized dogs. Chemoreceptor stimulation was achieved by injecting small volumes (0·2‐0·5 ml.) of warmed saline equilibrated with CO2near to the carotid bodies on both sides. Baroreceptor stimulation was achieved by injecting larger volumes (2‐5 ml.) of saline equilibrated with air into the region of the carotid bifurcation on both sides, after first clamping the common carotid arteries.

We assessed the importance of Streptococcus pneumoniaeand immunologic response to 14-valent pneumococcal vaccine in a randomized (saline placebo or vaccine) double-blind pilot study involving 103 patients with chronic obstructive pulmonary disease (COPD). Antibody titers, the flora of the sputum, respiratory infections or pneumonias, and deaths were monitored. The patients’ antibody titers before immunization were higher than healthy control subjects. Titers rose normally in those vaccinated but declined more rapidly. Differences between the group receiving placebo and vaccine were not significant at 12 and 24 months. The incidence of pneumonia was high before and after vaccine (47/1,000 vs 41/1,000 patient-years). Nonpneumococcal causes predominated (73 percent of pneumonias; 83.4 percent of lethal pneumonias). Isolates from sputum were predominantly nonvaccine types (50 to 62.5 percent). Twenty-seven patients died; pneumonia occurred in six (one pneumococcal in a vaccinated patient) as a terminal complication of other diseases. Thus, although pneumonia occurred frequently in these patients with COPD and contributed to mortality in 22 percent (six) of the 27 deaths, the predominance of nonpneumococcal causes and the data on antibodies and sputum suggest that pneumococcal vaccine may not be as beneficial for patients with COPD as was hoped. More observations are needed.