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The Korean Journal of Internal Medicine Nov 2022DW1601, an oral fixed dose combination syrup composed of DW16011 and Pelargonium sidoides, was developed to enhance the symptom relief effect in patients with acute... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND/AIMS
DW1601, an oral fixed dose combination syrup composed of DW16011 and Pelargonium sidoides, was developed to enhance the symptom relief effect in patients with acute bronchitis. We evaluated the efficacy and safety of DW1601 compared to DW16011 or P. sidoides for treatment of acute bronchitis using a randomized, double-blind, placebocontrolled, multi-centre trial design.
METHODS
A total of 204 patients with acute bronchitis was randomized 1:1:1 to receive DW1601 (n = 67), DW16011 (n = 70), or P. sidoides (n = 64) for 7 days. The primary outcome was efficacy of DW1601 compared to DW16011 or P. sidoides in reducing the total bronchitis severity score (BSS) at day 4 of treatment. Secondary endpoints were changes in total and symptomspecific BSS, response rate and patient satisfaction rate. Safety analysis was assessed at day 7.
RESULTS
At 4 days after medication, decrease of total BSS from baseline was significantly greater in the DW1601 group than in the DW16011 group (-3.51 ± 0.18 vs. -2.65 ± 0.18, p = 0.001) or P. sidoides group (-3.56 ± 0.18 vs. -2.64 ± 0.19, p < 0.001). In addition, the BSS total score at day 7 and the BSS cough and sputum component scores at days 4 and 7 were significantly more improved with DW1601 treatment compared with the DW16011 group or P. sidoides group. Participants treated with DW1601 showed higher rates of response and satisfaction than control groups (response rate, DW1601, 100% vs. DW16011, 85.7% vs. P. sidoides, 85.9%; satisfaction rate, DW1601, 92.6% vs. DW16011, 82.9% vs. P. sidoides, 81.2%). Significant adverse events were not observed in the DW1601 group.
CONCLUSION
DW1601 is superior to DW16011 or P. sidoides in improving symptoms of acute bronchitis.
Topics: Humans; Phytotherapy; Plant Extracts; Treatment Outcome; Pelargonium; Bronchitis; Acute Disease; Double-Blind Method
PubMed: 36153858
DOI: 10.3904/kjim.2022.104 -
Acute Cough Due to Acute Bronchitis in Immunocompetent Adult Outpatients: CHEST Expert Panel Report.Chest May 2020Evidence for the diagnosis and management of cough due to acute bronchitis in immunocompetent adult outpatients was reviewed as an update to the 2006 "Chronic Cough Due...
BACKGROUND
Evidence for the diagnosis and management of cough due to acute bronchitis in immunocompetent adult outpatients was reviewed as an update to the 2006 "Chronic Cough Due to Acute Bronchitis: American College of Chest Physicians (ACCP) Evidence-Based Clinical Practice Guidelines."
METHODS
Acute bronchitis was defined as an acute lower respiratory tract infection manifested predominantly by cough with or without sputum production, lasting no more than 3 weeks with no clinical or any recent radiographic evidence to suggest an alternative explanation. Two clinical population, intervention, comparison, outcome questions were addressed by systematic review in July 2017: (1) the role of investigations beyond the clinical assessment of patients presenting with suspected acute bronchitis, and (2) the efficacy and safety of prescribing medication for cough in acute bronchitis. An updated search was undertaken in May 2018.
RESULTS
No eligible studies relevant to the first question were identified. For the second question, only one relevant study met eligibility criteria. This study found no difference in number of days with cough between patients treated with an antibiotic or an oral nonsteroidal antiinflammatory agent compared with placebo. Clinical suggestions and research recommendations were made based on the consensus opinion of the CHEST Expert Cough Panel.
CONCLUSIONS
The panelists suggested that no routine investigations be ordered and no routine medications be prescribed in immunocompetent adult outpatients first presenting with cough due to suspected acute bronchitis, until such investigations and treatments have been shown to be safe and effective at making cough less severe or resolve sooner. If the cough due to suspected acute bronchitis persists or worsens, a reassessment and consideration of targeted investigations should be considered.
Topics: Acute Disease; Bronchitis; Cough; Humans; Outpatients
PubMed: 32092323
DOI: 10.1016/j.chest.2020.01.044 -
The Cochrane Database of Systematic... Jun 2017Chronic bronchitis and chronic obstructive pulmonary disease (COPD) are serious conditions in which patients are predisposed to viral and bacterial infections resulting... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Chronic bronchitis and chronic obstructive pulmonary disease (COPD) are serious conditions in which patients are predisposed to viral and bacterial infections resulting in potentially fatal acute exacerbations. Chronic obstructive pulmonary disease is defined as a lung disease characterised by obstruction to lung airflow that interferes with normal breathing. Antibiotic therapy has not been particularly useful in eradicating bacteria such as non-typeable Haemophilus influenzae (NTHi) because they are naturally occurring flora of the upper respiratory tract in many people. However, they can cause opportunistic infection. An oral NTHi vaccine has been developed to protect against recurrent infective acute exacerbations in chronic bronchitis.
OBJECTIVES
To assess the effectiveness of an oral, whole-cell NTHi vaccine in protecting against recurrent episodes of acute exacerbations of chronic bronchitis and COPD in adults. To assess the effectiveness of NTHi vaccine in reducing NTHi colonising the respiratory tract during recurrent episodes of acute exacerbations of COPD.
SEARCH METHODS
We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (2017, Issue 1), MEDLINE (1946 to January 2017), Embase (1974 to January 2017), CINAHL (1981 to January 2017), LILACS (1985 to January 2017), and Web of Science (1955 to January 2017). We also searched trials registries and contacted authors of trials requesting unpublished data.
SELECTION CRITERIA
We included randomised controlled trials comparing the effects of an oral monobacterial NTHi vaccine in adults with recurrent acute exacerbations of chronic bronchitis or COPD when there was overt matching of the vaccine and placebo groups on clinical grounds. The selection criteria considered populations aged less than 65 years and those older than 65 years.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trial quality and extracted data from original records and publications for incidence and severity of bronchitis episodes and carriage rate of NTHi measured in the upper respiratory tract, as well as data relevant to other primary and secondary outcomes.
MAIN RESULTS
We identified six placebo-controlled randomised controlled trials with a total of 557 participants. These trials investigated the efficacy of enteric-coated, killed preparations of H influenzae in populations prone to recurrent acute exacerbations of chronic bronchitis or COPD. The vaccine preparation and immunisation regimen in all trials consisted of at least three courses of formalin-killed H influenzae in enteric-coated tablets taken at intervals (e.g. days 0, 28, and 56). Each course generally consisted of two tablets taken after breakfast over three consecutive days. In all cases the placebo groups took enteric-coated tablets containing glucose. Risk of bias was moderate across the studies, namely due to the lack of information provided about methods and inadequate presentation of results.Meta-analysis of the oral NTHi vaccine showed a small, non-statistically significant reduction in the incidence of acute exacerbations of chronic bronchitis or COPD (risk ratio (RR) 0.79, 95% confidence interval (CI) 0.57 to 1.10; P = 0.16). There was no significant difference in mortality rate between the vaccine and placebo groups (odds ratio (OR) 1.62, 95% CI 0.63 to 4.12; P = 0.31).We were unable to meta-analyse the carriage levels of NTHi in participants as each trial reported this result using different units and tools of measurement. Four trials showed no significant difference in carriage levels, while two trials showed a significant decrease in carriage levels in the vaccinated group compared with the placebo group.Four trials assessed severity of exacerbations measured by requirement for antibiotics. Three of these trials were comparable and when meta-analysed showed a statistically significant 80% increase in antibiotic courses per person in the placebo group (RR 1.81, 95% CI 1.35 to 2.44; P < 0.001). There was no significant difference between the groups with regard to hospital admission rates (OR 0.96, 95% CI 0.13 to 7.04; P = 0.97). Adverse events were reported in five trials but were not necessarily related to the vaccine; a point estimate is suggestive that they occurred more frequently in the vaccine group, however this result was not statistically significant (RR 1.43, 95% CI 0.70 to 2.92; P = 0.87). Quality of life was not meta-analysed but was reported in two trials, with results at six months showing an improvement in quality of life in the vaccinated group (scoring at least two points better than placebo).
AUTHORS' CONCLUSIONS
Analyses demonstrate that NTHi oral vaccination of people with recurrent exacerbations of chronic bronchitis or COPD does not yield a significant reduction in the number and severity of exacerbations. Evidence was mixed, and the individual trials that showed a significant benefit of the vaccine are too small to advocate widespread oral vaccination of people with COPD.
Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bronchitis, Chronic; Disease Progression; Haemophilus Vaccines; Haemophilus influenzae; Humans; Middle Aged; Pulmonary Disease, Chronic Obstructive; Randomized Controlled Trials as Topic; Secondary Prevention; Tablets, Enteric-Coated
PubMed: 28626902
DOI: 10.1002/14651858.CD010010.pub3 -
Respiratory Medicine Aug 2016In airway infections, biofilm formation has been demonstrated to be responsible for both acute and chronic events, and constitutes a genuine challenge in clinical... (Review)
Review
OBJECTIVES
In airway infections, biofilm formation has been demonstrated to be responsible for both acute and chronic events, and constitutes a genuine challenge in clinical practice. Difficulty in eradicating biofilms with systemic antibiotics has led clinicians to consider the possible role of non-antibiotic therapy. The aim of this review is to examine current evidence for the use of N-acetylcysteine (NAC) in the treatment of biofilm-related respiratory infections.
METHODS
Electronic searches of PUBMED up to September 2015 were conducted, searching for 'biofilm', 'respiratory tract infection', 'N-acetylcysteine', 'cystic fibrosis', 'COPD', 'bronchiectasis', 'otitis', and 'bronchitis' in titles and abstracts. Studies included for review were primarily in English, but a few in Italian were also selected.
RESULTS
Biofilm formation may be involved in many infections, including ventilator-associated pneumonia, cystic fibrosis, bronchiectasis, bronchitis, and upper respiratory airway infections. Many in vitro studies have demonstrated that NAC is effective in inhibiting biofilm formation, disrupting preformed biofilms (both initial and mature), and reducing bacterial viability in biofilms. There are fewer clinical studies on the use of NAC in disruption of biofilm formation, although there is some evidence that NAC alone or in combination with antibiotics can decrease the risk of exacerbations of chronic bronchitis, chronic obstructive pulmonary disease, and rhinosinusitis. However, the usefulness of NAC in the treatment of cystic fibrosis and bronchiectasis is still matter of debate. Most of the studies published to date have used oral or intramuscular NAC formulations.
CONCLUSIONS
Evidence from in vitro studies indicates that NAC has good antibacterial properties and the ability to interfere with biofilm formation and disrupt biofilms. Results from clinical studies have provided some encouraging findings that need to be confirmed and expanded using other routes of administration of NAC such as inhalation.
Topics: Acetylcysteine; Administration, Inhalation; Biofilms; Bronchiectasis; Bronchitis; Bronchitis, Chronic; Cystic Fibrosis; Expectorants; Humans; Injections, Intramuscular; Pulmonary Disease, Chronic Obstructive; Respiratory Tract Infections
PubMed: 27492531
DOI: 10.1016/j.rmed.2016.06.015 -
Complementary Therapies in Medicine Dec 2020Antibiotics are widely prescribed for acute bronchitis in the UK. Herbal medicine could be used instead to provide symptom relief. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Antibiotics are widely prescribed for acute bronchitis in the UK. Herbal medicine could be used instead to provide symptom relief.
AIM
To explore the views of patients and health professionals on using herbal medicine for acute bronchitis instead of antibiotics.
DESIGN AND SETTING
This was a nested qualitative study, conducted alongside a feasibility randomised clinical trial which ran from July 2018 to May 2019 in 20 GP practices in Wessex, UK.
METHOD
We conducted telephone semi-structured interviews with patients and with health professionals. The interview data were transcribed and analysed thematically.
RESULTS
Overall, 40 interviews were conducted with 29 patients, six GPs and five nurses. While some patients believed antibiotics are more effective, most were aware of resistance and were keen to try an alternative, including herbal medicine. Several patients believed herbals would be "less intrusive" than antibiotics, whereas a few disliked the taste or experienced side-effects after taking a herbal. Professionals were concerned about potential interactions with conventional medicines. Many patients trusted herbals because of their long history of use, while some did not understand them. Availability of herbals without a prescription enables patients to use them for self-care, but their cost was a barrier for some. Many patients were willing to take a herbal if advised by their GP. Most GPs were happy to recommend a herbal, if endorsed by evidence-based guidelines.
CONCLUSION
Many patients and health professionals would consider using herbal medicine for acute bronchitis, if based on trustworthy advice and evidence-based guidelines respectively.
Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Attitude of Health Personnel; Bronchitis; Feasibility Studies; Female; Health Personnel; Humans; Male; Middle Aged; Phytotherapy; Plant Preparations; Practice Patterns, Physicians'; Qualitative Research; United Kingdom
PubMed: 33221589
DOI: 10.1016/j.ctim.2020.102613 -
La Revue Du Praticien Oct 2022Similarly to many respiratory viruses, respiratory syncytial virus (RSV) is surprising in its ability to reinfect children and adults who have already been immunized. It...
Similarly to many respiratory viruses, respiratory syncytial virus (RSV) is surprising in its ability to reinfect children and adults who have already been immunized. It is not so much in the evolution of its genome that we must look for the cause, but more probably in the structure/function of its viral proteins, which are capable of interfering with the immune response and memory. After an incubation of three to eight days, RSV infection most often results in nasopharyngitis with little or no fever. RSV infection of the respiratory epithelium is characterized by marked mucus production, desquamation of infected respiratory cells and persistent impairment of mucociliary transport. The extension of the infection to the lower respiratory tract therefore contributes to the formation of mucous plugs obstructing the lumen of the bronchioles. This is the cause of the clinical most commonly associated with RSV infection: bronchiolitis in newborns and infants which is a frequent reason for hospitalization due to secondary respiratory and digestive complications. The recent data from the literature, however, indicate that by far the most frequent complication is a community infection: acute otitis media. RSV infections are therefore a very common reason for the prescription of antibiotics.
Topics: Infant; Child; Adult; Infant, Newborn; Humans; Respiratory Syncytial Viruses; Respiratory Syncytial Virus Infections; Bronchiolitis; Hospitalization
PubMed: 36512000
DOI: No ID Found -
Der Internist Nov 2017Methicillin-resistant strains of Staphylococcus aureus (MRSA) are of particular significance for the management of patients with airway infections, since the disease... (Review)
Review
Methicillin-resistant strains of Staphylococcus aureus (MRSA) are of particular significance for the management of patients with airway infections, since the disease course is often complicated and treatment rendered difficult by multiple resistance. Their prevalence is now slowly declining, but still alarmingly high. Hospital-acquired infections are predominant, but hospital-associated and community-acquired infections do occur, as do rare infections with livestock-acquired strains. Non-nosocomial strains are characterized by different pathogenic factors and a different spectrum of antibacterial resistance; they often have a threatening disease course. Anti-infectives with activity against MRSA are unusual and have particular toxicity profiles. On the other hand, MRSA colonization is eliminated spontaneously in healthy people and acute bronchitis is treatable by common oral antibiotics. However, chronic airway infection in bronchiectasis and other forms of structural airway damage requires a complex systemic and local treatment approach for pathogen elimination.
Topics: Anti-Bacterial Agents; Bronchiectasis; Bronchitis, Chronic; Cross Infection; Drug Resistance, Multiple, Bacterial; Humans; Methicillin-Resistant Staphylococcus aureus; Pandemics; Pneumonia, Bacterial; Respiratory Tract Infections; Sputum; Staphylococcal Infections
PubMed: 28929236
DOI: 10.1007/s00108-017-0328-7 -
Family Practice Nov 2022Most antibiotic prescribing for upper respiratory tract infections (URTIs) and acute bronchitis is inappropriate. Substantive and sustained reductions in prescribing are...
BACKGROUND
Most antibiotic prescribing for upper respiratory tract infections (URTIs) and acute bronchitis is inappropriate. Substantive and sustained reductions in prescribing are needed to reduce antibiotic resistance. Prescribing habits develop early in clinicians' careers. Hence, general practice (GP) trainees are an important group to target.
OBJECTIVES
We aimed to establish temporal trends in antibiotic prescribing for URTIs and acute bronchitis/bronchiolitis by Australian GP trainees (registrars).
METHODS
A longitudinal analysis, 2010-2019, of the Registrars Clinical Encounters in Training (ReCEnT) dataset. In ReCEnT, registrars record clinical and educational content of 60 consecutive consultations, on 3 occasions, 6 monthly. Analyses were of new diagnoses of URTI and acute bronchitis/bronchiolitis, with the outcome variable a systemic antibiotic being prescribed. The independent variable of interest was year of prescribing (modelled as a continuous variable).
RESULTS
28,372 diagnoses of URTI and 5,289 diagnoses of acute bronchitis/bronchiolitis were recorded by 2,839 registrars. Antibiotic prescribing for URTI decreased from 24% in 2010 to 12% in 2019. Prescribing for acute bronchitis/bronchiolitis decreased from 84% to 72%. "Year" was significantly, negatively associated with antibiotic prescribing for both URTI (odds ratio [OR] 0.90; 95% confidence interval [CI]: 0.88-0.93) and acute bronchitis/bronchiolitis (OR 0.92; 95% CI: 0.88-0.96) on multivariable analysis, with estimates representing the mean annual change.
CONCLUSIONS
GP registrars' prescribing for URTI and acute bronchitis/bronchiolitis declined over the 10-year period. Prescribing for acute bronchitis/bronchiolitis, however, remains higher than recommended benchmarks. Continued education and programme-level antibiotic stewardship interventions are required to further reduce registrars' antibiotic prescribing for acute bronchitis/bronchiolitis to appropriate levels.
Topics: Humans; General Practitioners; Inappropriate Prescribing; Anti-Bacterial Agents; Practice Patterns, Physicians'; Australia; Respiratory Tract Infections; Bronchitis; Acute Disease; Bronchiolitis
PubMed: 35640041
DOI: 10.1093/fampra/cmac052 -
Journal of Environmental and Public... 2016Two foundational methods for estimating the total economic burden of disease are cost of illness (COI) and willingness to pay (WTP). WTP measures the full cost to... (Review)
Review
Two foundational methods for estimating the total economic burden of disease are cost of illness (COI) and willingness to pay (WTP). WTP measures the full cost to society, but WTP estimates are difficult to compute and rarely available. COI methods are more often used but less likely to reflect full costs. This paper attempts to estimate the full economic cost (2014$) of illnesses resulting from exposure to dampness and mold using COI methods and WTP where the data is available. A limited sensitivity analysis of alternative methods and assumptions demonstrates a wide potential range of estimates. In the final estimates, the total annual cost to society attributable to dampness and mold is estimated to be $3.7 (2.3-4.7) billion for allergic rhinitis, $1.9 (1.1-2.3) billion for acute bronchitis, $15.1 (9.4-20.6) billion for asthma morbidity, and $1.7 (0.4-4.5) billion for asthma mortality. The corresponding costs from all causes, not limited to dampness and mold, using the same approach would be $24.8 billion for allergic rhinitis, $13.5 billion for acute bronchitis, $94.5 billion for asthma morbidity, and $10.8 billion for asthma mortality.
Topics: Acute Disease; Asthma; Bronchitis; Cost of Illness; Fungi; Humans; Humidity; Rhinitis, Allergic; United States
PubMed: 27313630
DOI: 10.1155/2016/2386596 -
International Journal of Medical... Aug 2023Acute respiratory diseases are a leading cause of morbidity and mortality in children. Cough is a common symptom of acute respiratory diseases and the sound of cough can... (Review)
Review
BACKGROUND
Acute respiratory diseases are a leading cause of morbidity and mortality in children. Cough is a common symptom of acute respiratory diseases and the sound of cough can be indicative of the respiratory disease. However, cough sound assessment in routine clinical practice is limited to human perception and the skills of the clinician. Objective cough sound evaluation has the potential to aid clinicians in acute respiratory disease diagnosis. In this systematic review, we assess and summarize the predictive ability of machine learning algorithms in analyzing cough sounds of acute respiratory diseases in the pediatric population.
METHOD
Our systematic search of the Scopus, Medline, and Embase databases on 25 January 2023 identified six articles meeting the inclusion criteria. Quality assessment of the included studies was performed using the checklist for the assessment of medical artificial intelligence.
RESULTS
Our analysis shows variability in the input to the machine learning algorithms, such as the use of various cough sound features and combining cough sound features with clinical features. The use of the machine learning algorithms also varies from conventional algorithms, such as logistic regression and support vector machine, to deep learning techniques, such as convolutional neural networks. The classification accuracy for the detection of bronchiolitis, croup, pertussis, and pneumonia across five articles is in the range of 82-96%. However, a significant drop is observed in the detection accuracy for bronchiolitis and pneumonia in the remaining article.
CONCLUSION
The number of articles is limited but, in general, the predictive ability of cough sound classification algorithms in childhood acute respiratory diseases shows promise.
Topics: Child; Humans; Cough; Artificial Intelligence; Algorithms; Pneumonia; Bronchiolitis; Machine Learning
PubMed: 37224643
DOI: 10.1016/j.ijmedinf.2023.105093