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Abstracts

Abstracts

Antibiotics (Bronchitis)

Antibiotics        

Although antibiotics do not effectively treat bronchitis and other disorders, they continue to be overused. Recent studies have shown that approximately 60% of patients with common colds continue to receive prescriptions for antibiotics. One study found the incidence of prescribing unindicated antibiotics was significantly lower in a practice in which patients paid for the medication.

Antibiotic Overprescribing: The Problem Continues, Emergency Medicine, November, 1997;30,35.

COPD 1

Chronic Obstructive Pulmonary Disease (COPD) 1

Although increasing attention has been paid to "nutritional" aspects in ("COPD"), limited information is available regarding the prevalence and consequences of nutritional depletion in an out-patient population.

Studied body composition in relation to respiratory and peripheral skeletal "muscle" function, forced expiratory volume in one second (FEV1).

Patients were characterized by the degree of body weight loss and "fat"-free mass depletion. According to this definition, 14% of the group suffered from both loss of body weight and depletion of fat-free mass, whereas 7% had one of these conditions.

A substantial number of COPD out-patients suffer from nutritional depletion, preferentially affecting peripheral skeletal muscle function.

Nutritional depletion in relation to respiratory and peripheral skeletal muscle function in out-patients with COPD. Engelen-MP; Schols-AM; Baken-WC; Wesseling-GJ; Wouters-EF. Eur-Respir-J. 1994 Oct; 7(10): 1793-7.

COPD 2

Chronic Obstructive Pulmonary Disease ("COPD") 2

"Malnutrition" is reported in a significant percentage of COPD patients and may contribute to acute respiratory failure. Weight loss is due to the decrease of caloric support caused by breathlessness, "digestive" alterations due to hypoxemia and to the increase of energy expenditures caused by increased baseline requirements and diet induced "thermogenesis" (DIT).

Malnutrition limits the ability to produce surfactant, leads to reduced "protein" synthesis, reduces "cell" mediated "immune" responses raising the patient's susceptibility to "lung" "infection" and affects the functioning of peripheral and respiratory muscles. The combination of malnutrition and COPD has devastating effects.

The nutritional program should follow an assessment of nutritional status; the correct food "calories" and composition help patients through the different clinical stages of the disease.

Studies that have assessed the role of nutritional supplementation in patients with (COPD) have demonstrated improved respiratory muscle strength and exercise capacity following intensive and costly nutritional support programmes under controlled conditions.

Patients were simply advised (by a dietician) on increasing their daily caloric intake by a minimum of 50% above estimated daily energy expenditure.

Achieving weight gain and improving lung function by means of simple out-patient nutritional programmes in a clinical setting is difficult.

An out-patient nutritional supplementation programme in COPD patients. Sridhar-MK; Galloway-A; Lean-ME; Banham-SW. Eur-Respir-J. 1994 Apr; 7(4): 720-4.

COPD 3

Chronic Obstructive Pulmonary Disease ("COPD") 3

"Nutrition" is intimately linked to pulmonary function and an understanding of these relationships has therapeutic utility. Malnutrition is known to be associated with impaired mechanical function of the lung in both chronic and acute respiratory insufficiency. Refeeding results in improvement in functional characteristics and may be critical in the weaning of patients from mechanical ventilation. In contrast, overfeeding may result in an increased ventilatory demand resulting in the inability to wean from respiratory support.

Nutrition care of patients with acute and chronic respiratory failure [see comments] Grant-JP. Nutr-Clin-Pract. 1994 Feb; 9(1): 11-7

IgG Subclass Deficiency

IgG Subclass Deficiency

Recurrent bronchitis is defined as 3 or more episodes a year for 2 consecutive years There is a correlation between recurrent bronchitis in childhood and IgG subclass deficiencies. IgG subclass deficiency and recurrent bronchitis are frequent in young children but rare in older children.

"IgG Subclass Deficiency in Children With Recurrent Bronchitis", De Baets, F. et al, European Journal of Pediatrics, 1992;151:274-278.

N-Acetylcysteine 1

N-Acetylcysteine 1

"N-acetylcysteine" has significant mucokinetic properties when inhaled in large concentrations. The reduction in the number of exacerbations in chronic bronchitis could be ascribed to its anti-"inflammatory" potential. The phagocytic capacity of alveolar macrophages is improved by means of the inhalation of small amounts of N-acetylcysteine from a pressurized metered dose inhaler.

"Clinical Recognition of N-Acetylcysteine in Chronic Bronchitis", Larson, M., European Respiratory Reviews, 1992;2(7):5-8.

N-Acetylcysteine 2

N-Acetylcysteine 2

"N-acetylcysteine" did not seem to have any benefit in the treatment of chronic bronchitis.

"N-Acetylcysteine by Metered Dose Inhaler in the Treatment of Chronic Bronchitis: A Multi-Center Study", Dueholms, M., et al, Respiratory Medicine, 1992;86:89-92.

Bronchopulmonary Dysplasia

Bronchopulmonary Dysplasia

The goal of optimal nutrition in infants with bronchopulmonary "dysplasia" is to enhance tissue repair and overall organ growth as they begin to "outgrow" their "lung disease". Classic nutritional paradigms are fluid management, requirements of fat, "carbohydrates" and "proteins", vitamin and mineral status, nutritional monitoring, enteral nutrition and varying stages of the disease. Important "nutrients" include vitamins E, A and C, as well as "calcium" and "phosphorus".

One study reported a slightly lower incidence of bronchopulmonary dysplasia in infants who received "vitamin E" injections another study showed no benefit.

"Vitamin A" has been proposed because of its ability to heal tissue after injury by stimulation of differentiation of basal "epithelial cells". If vitamin A deficiency occurs, healing may be retarded and a squamous metaplasia may result. This metaplasia forms scar tissue in the tracheo-bronchial tree of the infant. Premature infants are frequently deficient in vitamin A. They are born with lower "liver" reserve levels of vitamin A. The intramuscular route was chosen because of problems with intravenous "delivery" of vitamin A.

"Calcium" is important for maintenance of cell membranes, neuromuscular activities, coagulation function and "bone" mineralization. Phosphorous is important in many "metabolic" reactions in organs and tissues. Phosphorous is involved with calcium "metabolism" in the process of bone accretion of these two minerals. Premature infants have low stores of these two nutrients. They are deposited mostly in the third trimester. A supply every day of 220-250 mg/kg of calcium and 120/150 mg/kg of phosphorus allows premature infants to achieve optimal bone mineralization. Precipitation of these elements in solution can be a problem.

Bronchopulmonary Dysplasia: Chapter V. Nutrition and Bronchopulmonary Dysplasia, Lund, Carolyn, RN, "MS", and Boatright Collier, Sharon, 1991;75-110.

Cysteine

Cysteine

Because factors that predispose infants to persistent pulmonary "hypertension" of the newborn (PPHN) may cause oxidant "stress", which in turn may increase demands for "cysteine" and glutathione, we investigated the availability of cysteine and its precursors in PPHN and related disorders.

We speculate that the role of cysteine, in bioactivation of nitric oxide and as a precursor of glutathione, may be relevant to the pathogenesis and evolution of PPHN and respiratory distress syndrome.

Plasma cysteine concentrations in infants with respiratory distress. White-CW; Stabler-SP; Allen-RH; Moreland-S; Rosenberg-AA. J-Pediatr. 1994 Nov; 125(5 Pt 1): 769-77.

Nutritional Support

Nutritional Support

Advanced pulmonary disease (APD), often secondary to emphysema or chronic bronchitis, is generally a progressive, incurable condition, ultimately leading to death. The condition is associated with significant, distressing symptoms. Most APD patients are underweight, which has numerous implications including accentuation of reduced physical capacity during daily life, increased risk of other secondary diseases, e.g. infections and osteoporosis, and a higher mortality during exacerbations with acute respiratory failure. Consequently, careful nutritional support is crucial both in enhancing physical well-being and function, and in reducing the risk of acute respiratory failure. Knowledge concerning the exact nutritional needs in APD is still very sparse.

Thomsen C: Nutritional support in advanced pulmonary disease. Respir Med, 1997 May, 91:5, 249-54.