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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A cross-sectional assessment of indoor air quality in Nepal and its health effects revealed that solid biomass fuels (animal dung, crop residue, and wood) were the main sources of indoor air pollution affecting health. The average smoke level (PM10) in kitchens using biomass fuels was about three times higher than that in those using cleaner fuels (kerosene, LPG, and biogas). Respondents in 98 randomly selected households included 168 who cooked daily meals, of whom 94% were disadvantaged women. Biomass smoke caused significantly more respiratory disorders than did cleaner fuels. Categorized data analysis demonstrated significant associations between biomass smoke pollution and respiratory symptoms such as cough; phlegm; breathlessness; wheezing; and chronic respiratory diseases such as COPD and asthma. The prevalences of respiratory illnesses and symptoms were considerably higher in those living in mud and brick houses compared with concrete houses. Prevalences were also higher in those living on hills and in rural areas compared with flatland and urban areas.
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PMID:Indoor air pollution from biomass fuels and respiratory health of the exposed population in Nepalese households. 1587 91

Lung function testing (spirometry) is crucial for the diagnosis of COPD, as irreversible airway obstruction is the main feature of chronic airway inflammation. Spirometry not only is essential in making the diagnosis but also in grading the disease according to FEV1 measurements. Therapeutic interventions and prognostic evaluations are made according to the grading of the disease. Diagnostic procedures aim to evaluate symptoms and disability in the course of COPD. The most important influence on the course of the disease are acute exacerbations. The diagnosis of acute exacerbations is based on clinical observations of sputum production, cough and dyspnoea. Grading of exacerbations according to the severity of symptoms is important for the treatment and in particular for the need of hospitalisation. Exclusion of other lung diseases with similar symptoms necessitates a number of other examinations. Optimal treatment of COPD needs clinical and objective documentation of the course of the disease. Not only spirometry but also quantification of clinical symptoms and exercise capacity measurements are appropriate approaches to follow this chronic disease.
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PMID:[The diagnosis of COPD]. 1588 88

Acute exacerbations of COPD have a broad range of effects on the patients in addition to cough and sputum production. These include malaise, increased dyspnea, diminished tolerance and social restriction. No single clinical or physiological measure captures this multiplicity of effects adequately. Health status measurement using instruments erroneously termed ;quality of life' questionnaires can provide this integrative function. Validation studies have shown that these scores reflect exercise capacity, respiratory symptoms, disability in daily life, and impaired mood. Furthermore they relate to levels of arterial hypoxaemia in COPD and blood leucocyte count in patients with bronchiectasis. Health status scores have been shown to predict hospital readmission or death in patients with COPD. Recent studies have shown that whilst sputum color and volume recover within a week of starting treatment, full recovery of health status may take over three months. This is consistent with the observation that exacerbation frequency is strongly related to health status and a recent report that the rate of decline in health status over time is related to the frequency of exacerbations. Health status instruments were developed originally to measure treatment efficacy, but they also provide insights into acute exacerbations of COPD and their clinical importance.
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PMID:Impact of lower respiratory tract infections on health status. 1608 24

Organising pneumonia (OP) is a rare syndrome that has been associated with a variety of underlying disorders, including infections, collagen vascular diseases, toxic fumes, cancer, drugs and radiotherapy. Cryptogenic form is also observed. Steroids are usually effective in the treatment of OP, but other treatment regimens have been used as well. We present 5 women with OP, age ranged 57-76 years (mean - 67 years). Two of them were smokers and three were non-smokers. One patient was treated because of hyperthyreosis, one of COPD, and four had a hypertension. Four of them were diagnosed by the open lung biopsy and one by transbronchial lung biopsy. Dyspnoea (100%), cough (100%), fever (80%), weight loss (40%), chest pain (20%), were the most frequently noticed symptoms. All patients had bilateral consolidations with areas of ground glass attenuations at chest x-ray and HRCT. Migratory pattern of them was observed in four patients. Significant elevation of antibodies titers against Chlamydia pneumoniae was revealed in two patients. In all patients clarithromycin in a dose 0.5 g b.d. was administrated. Complete clinical and radiological remission was obtained after 3 months of clarithromycin therapy in 3 patients (one had Chlamydia antibodies). Two patients had not obtained significant improvement during the first two weeks of therapy so prednisolone in a dose 0.5 mg/kg/d was introduced. Also complete remission was noticed in these patients. The observation period ranged from 8 months to 4 years (mean - 34 months). Our study confirms that OP can be treated by the use of clarithromycin. It may be the alternative treatment, particularly for patients in whom probability of adverse reactions in the course of steroid treatment is high.
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PMID:[Organizing pneumonia--own experiences with clarithromycin treatment]. 1632 49

Mechanical ventilation is required if ventilatory insufficiency is present. This is typically indicated by hypercapnea. Hypoxemia occurs secondary to hypoventilation. Usually overload of the respiratory muscles (ventilatory pump) will be the underlying mechanism, for the most part caused by acute or chronic disease. In case of sole hypoxemia mechanical ventilation will only be indicated if the oxygen-content (equals oxygen saturation x haemoglobin x 1.39) drops below a critical threshold or if ventilatory pump failure is imminent on account of the underlying disease (eg. pneumonia). The background of our recommendations is to avoid potential damage caused by mechanical ventilation. Especially high inspiratory pressures and oxygen concentrations can be harmful to the lung. Therefore every case has to evaluated for individual target parameters of ventilation. The use of the oxygen-content instead of the arterial oxygen pressure as the target parameter will usually lead to a more careful ventilation. Cardiogenic pulmonary oedema is an exception to this rule since inspiratory positive pressure and PEEP will result in improved diffusion as well as reduction of preload and work of breathing. In recent years progress has been made on the field of ventilation access especially in severe and acute cases. Non-invasive ventilation is superior to invasive ventilation in patients with exacerbated COPD since it improves outcome effectively. This is being caused by a decline in ventilator associated pneumonias, most likely because non-invasive ventilation allows patients to clear their secretions by coughing, resulting in improved lung clearance. Controlled ventilation allows optimal unloading of the respiratory muscles which have been overloaded by the underlying disease. Application of a controlled ventilation mode in acute disease will usually require some kind of sedation. Assisted ventilation will result in improved gas exchange but only incomplete unloading of respiratory muscles and therefore delayed restitution. Permanent controlled ventilation under sedation for a prolonged period (days) requires intermittent periods of assisted- or spontaneous breathing in order to avoid atrophy of the respiratory muscles. This review summarizes background information on the nature of the derangement, the relation between oxygen supply and consumption under special consideration of respiratory muscle insufficiency and impact of different ventilation modes.
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PMID:[Pathophysiological basis of mechanical ventilation]. 1646 51

Acute bronchitis is usually caused by a virus, while the chronic form is due to inhalative noxae (in most cases decades of cigarette smoking). Both varieties are diagnosed on a clinical basis. Treatment of acute bronchitis is symptomatic. A sore throat is treated locally, and a troublesome, in particular nocturnal, cough with antitussive agents applied for a limited period (14 days). If bronchial mucus is viscous and difficult to clear, short-term treatment with a secretolytic or mucolytic substance is justified. Management of chronic bronchitis consists primarily in the elimination of the noxae. Treatment with antibiotics (usually oral) makes good sense only when there is a bacteriological infection of the upper or lower airways in an acute stage, such as infection-driven exacerbation of chronic obstructive bronchitis (COPD).
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PMID:[Acute bronchitis: when are antibiotics, and when is symptomatic treatment indicated?]. 1661 Apr 9

Exacerbations in COPD patients are characterized by an acute aggravation of the condition with an increase in symptoms (labored breathing, cough, expectoration, tightness of the chest and, rarely, fever). The major cause is a bronchial infection. The medications of choice are inhalative bronchodilators, in particular beta-2 sympathomimetics and/or anticholinergic agents, together with systemic glucocorticosteroids, and also theophylline. COPD patients experiencing exacerbations and showing clinical signs of bacterial airway infection can benefit from antibiotic treatment. In the presence of an acute partial respiratory insufficiency, administration of oxygen is indicated, while respiratory insufficiency with hypercapnea and acidosis necessitates the use of noninvasive positive pressure ventilation. For the prevention of acute exacerbations, risk factors must be eliminated, in particular cigarette smoking. Furthermore, optimized management including structured patient education is to be recommended.
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PMID:[COPD--how to deal with an acute exacerbation]. 1661 Apr 10

Lower respiratory tract infection is easily suggested on clinical signs (cough and sputum) associated with fever. To discriminate between pneumonia and acute bronchitis is crucial because of the mortality associated with pneumonia and of its specific management. Chest X-ray is a key exam for the diagnosis and should be performed on the basis of validated clinical signs that are however of weak diagnostic value. Clinical as well as radiological signs cannot be reliably used to identify the causative germ. Sputum examination, the search for pneumococcal and legionella urinary antigens are of good diagnostic value. An associated COPD may lead to an acute respiratory failure. Acute exacerbation of chronic bronchitis results from various causes but infection is involved in about 50% of the cases, mostly viral and most often due to a rhinovirus. Viral infection can be associated to bacterial infection and the most frequently isolated germs are Streptococcus pneumoniae, Haemophilus influenzae, and B. catarrhalis. Severity assessment relies on the value of basal FEV1 that is often non available. Therefore Afssaps suggests using a dyspnea index to assess exacerbation severity.
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PMID:[Definition of low respiratory tract infections]. 1683 58

Chronic cough with established diagnostic protocols has been well described in secondary and tertiary centres. Little information is available about adult patients to a general respiratory clinic where no such protocols exist. The objective of this study is to determine clinical characteristics, laboratory findings, diagnostic spectrum and outcomes of specific therapy in adult patients with chronic cough in a general respiratory clinic. In this prospective, longitudinal, descriptive study for patients with chronic cough defined as more than 8 weeks, we studied, according to a questionnaire, chest radiography, spirometry and reversibility, methacholine challenge and other measures. Treatment was prescribed on the basis of diagnosis informed by investigation results.We evaluated 147 patients (102 females) of a mean age of 48 years and complaining of cough an average of 24 weeks. On the basis of a successful response to treatment, the causes of cough were determined in 92% and the frequencies were asthma in 39%, COPD in 11%, chronic upper airway cough syndrome (CUACS) in 9%, gastro-oesophageal reflux disease (GERD) in 9% and no diagnosis in 8%. Cough was due to one condition in 82%. Our treatment success rate was 92%. The most frequent causes of chronic cough (asthma, COPD, CUACS and GERD) could be determined in a general respiratory clinic with a sequential approach. The frequencies are different from those in a tertiary cough clinic, but outcome of specific therapy is successful in our patients.
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PMID:A prospective longitudinal study of clinical characteristics, laboratory findings, diagnostic spectrum and outcomes of specific therapy in adult patients with chronic cough in a general respiratory clinic. 1685 53

COPD is commonly under-diagnosed, in part because people at risk are unaware of the relevant risk factors and do not recognize related symptoms. Providing this information might permit earlier disease identification but the questions chosen should identify those with spirometrically defined airflow obstruction. Using a population-based data set, we have determined which questions identify persons most likely to have airflow obstruction. Potential questions were selected by review of COPD risk factors and clinical features. Validation was by retrospective analysis of the NHANES III data set, a population-based U.S. household survey that included spirometry. We examined the predictive ability of individual questions in a multi-variate framework to correctly discriminate between persons with and without spirometric airway obstruction (defined as FEV1/FVC < 0.70). We then tested the discriminatory ability of the questions in combination. The following items showed significant predictive ability: increased age, smoking status, pack-years, cough, wheeze, and prior diagnosis of asthma or COPD. The best performing combination was age, smoking status, pack-years smoked, wheeze, phlegm, body mass index, and prior diagnosis of obstructive lung disease. Using this combination in a population of current and former smokers aged 40 and over, we achieved a sensitivity of 85% and specificity of 45%, with a positive predictive value of 38% and a negative predictive value of 88%. Performance of this tool is comparable to other screening methods designed for use in a general population. Symptom-based questionnaires can be a viable method to identify persons likely to have COPD in the general population. Dissemination of such tools should raise awareness among at-risk persons and help identify COPD patients in the primary care setting.
COPD 2005 Jun
PMID:Development of a population-based screening questionnaire for COPD. 1713 49


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