Chest
Volume 108, Issue 2, Supplement, August 1995, Pages 53S-57S
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Outcome Predictors in Bronchitis

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PATHOPHYSIOLOGY

The hypersecretion of mucus in chronic bronchitis is due to hypertrophy of the submucosal glands and increase in the numbers of goblet cells in the epithelium at the expense of ciliated cells. Epithelial metaplasia also occurs, and together with abnormalities of ciliary function and mucus rheology, these changes lead to impairment of mucociliary clearance,4 an important first-line defense mechanism of the airways. Bronchoalveolar lavage and biopsy studies have provided evidence for the

A VICIOUS CIRCLE HYPOTHESIS OF BACTERIAL INFECTION IN CHRONIC BRONCHITIS

A variety of circumstances, singularly or in concert, may create permissive circumstances that allow bacteria in the respiratory tract to increase in number and spread. This may involve, for example, viral infection or inhalation of airborne pollutants, which cause inflammation and perturb mucosal defenses. Bacterial toxins (eg., ciliotoxins or IgAl proteases) contribute to the infection by overcoming residual host defenses and damaging the epithelium, and the variability of the surface of

ARE SOME PATIENTS PRONE TO RECURRENT INFECTIONS?

It has been suggested recently that some patients with chronic bronchitis are prone to recurrent acute exacerbations, while others with apparently similar degrees of lung damage are not.15 In this study, there were no differences in age, sex, or symptoms in the two groups, and the smoking history was greater in the noninfection-prone group. In a second-year follow-up study, nearly 80% of patients retained their original classification. If these observations15 are correct, then comparisons

OUTCOME PREDICTORS IN CHRONIC BRONCHITIS

Studies of community-acquired pneumonia have identified various criteria predictive of severity of disease and response to antibiotic therapy.17, 18 These have permitted the development of prognostic indices and scoring systems based on statistical analysis.17, 19, 20 However, severity classifications based on the symptoms of exacerbations of chronic bronchitis thus far produced21, 22, 23, 24, 25 have been largely empirical and have not been validated by clinical trials. An example of one such

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