Assessment of the effect of pharmacotherapy in common cold/acute bronchitis - the Bronchitis Severity Scale (BSS).

BACKGROUND: Acute bronchitis (AB) is a highly contagious infection of the airways, presenting mostly in connection with common cold (CC). There is a high variance in duration and course of symptoms which, sooner or later, also may disappear spontaneously and change during the course of the disease. Therefore, assessment of treatment outcome is difficult. METHODS: Composite outcome measures are commonly used to examine the effects of pharmacotherapy in complex diseases. We discuss the features of the Bronchitis Severity Scale (BSS) on the basis of the available literature. RESULTS: For the BSS the five most important symptoms of AB are rated by the patient and the physician. Since its introduction in 1996, the BSS has been used in many clinical trials evaluating treatment effects of AB. Its score correlates well with clinical findings. As thorough validation analyses revealed, this applies even more to the BSS subscales "cough domain" and "sputum domain". CONCLUSION: The validated BSS appears to be a reliable tool to assess therapeutic effects in CC/AB. The BSS and its subscales are recommended as outcome measures for future drug trials in CC/AB, but also help physicians to focus their consultation in patients with CC/AB.

[Epidemiology and costs of bronchial asthma and chronic bronchitis in Germany]. / Epidemiologie und Kosten von Asthma bronchiale und chronischer Bronchitis in Deutschland.

BACKGROUND AND OBJECTIVE: Asthma bronchiale (AB) and chronic bronchitis (CB) are common chronic disorders with high rates of prevalence. We performed a cost of illness study that aimed to assess the economic burden of these disorders in Germany. PATIENTS AND METHODS: Costs were estimated in 1996. In a retrospective analysis we calculated direct and indirect costs based on secondary data from governmental institutions as well as from the pharmaceutical industry. To the best of our knowledge, this is the first study which uses data for the Federal Republic of Germany following its reunification. RESULTS: Total estimated costs were DM 5.81 billion related to AB, and DM 20.17 billion related to CB. We did not include outpatient physician services in the calculation of direct costs due to a lack of adequate data. Therefore, direct costs represented only 33% and 22% of total estimated costs, respectively. The most important cost driver of direct costs were outpatient prescribed medicines, followed by hospitalization. Outpatient prescribed medicines accounted for 55% and 63% of the direct costs, respectively. Of the indirect costs of AB 43% were associated with early retirement. The largest single cost driver of indirect costs due to CB was by far loss of work, amounting to 75%. CONCLUSIONS: The data suggest that therapeutic progress and cessation of smoking can provide distinctive savings of direct costs and even more of indirect costs of AB and CB.

[Epidemiology and costs of lung cancer in Germany]. / Epidemiologie und Kosten des Bronchialkarzinoms in Deutschland.

OBJECTIVE: Lung cancer shows the leading incidence of all cancers among men in the developed world and an increasing incidence among women. We performed a cost of illness study that aimed to assess the economic burden of lung cancer in Germany and to identify the main cost drivers. METHODS: Costs were estimated for the year 1996. In a retrospective analysis we calculated direct and indirect costs based on secondary data from governmental institutions as well as from the pharmaceutical industry. We chose the cost perspective of sickness funds to estimate direct costs. The human capital approach was applied for the calculation of indirect costs. RESULTS: Total estimated costs were DM 8.31 billion per year. The indirect costs of DM 7.40 billion accounted for 89 % of total estimated costs. The most important cost driver of the indirect costs, early death, represented on its own DM 4.85 billion, according to 58 % of total estimated costs. Of the direct costs, 93 % were due to hospitalization, amounting to DM 0.85 billion. CONCLUSIONS: This cost of illness study concerning lung cancer illustrates the outstanding importance of the indirect costs, mostly due to early death, for total costs. Based on these findings and on the leading role of smoking in the etiology of lung cancer, we suggest that studies dealing with the net costs of smoking to society should include indirect costs.

Definition and assessment of asthma.

Bronchial obstruction, its reversibility, airway hyperreactivity and inflammation are key variables of asthma. In clinical practice they can be assessed with repeated noninvasive lung function measurements (spirometry and mucociliary clearance). The asthmatic inflammation in contrast to chronic bronchitis is characterized by increased IgE and eosinophils depending on the disease state (seasonal, perennial, chronic symptomatic or asymptomatic asthma). Based on the above-mentioned clinically applicable measurements, a classification of asthma, chronic (obstructive) bronchitis, and emphysema is proposed because the three groups of diseases have different etiology and need different prophylactic and symptomatic treatment.

Dextromethorphan and codeine: objective assessment of antitussive activity in patients with chronic cough.

Dextromethorphan, the most widely used cough suppressant in the U.S.A., was compared with codeine, the traditional European antitussive, in a double-blind, crossover trial using both an objective and subjective assessment of efficacy in sixteen patients with chronic, stable cough. Both preparations, at a dose of 20 mg, were similarly effective in reducing cough frequency. Dextromethorphan lowered cough intensity to a greater degree than codeine (p less than 0.0008) and was considered the better antitussive by the majority of patients (p less than 0.001). In view of its lack of side-effects, its safety even in overdose and its non-narcotic status, the increasing trend in Europe to use dextromethorphan as a substitute for codeine in the treatment of cough is to be welcomed.

Long-term study of the protective effect of ketotifen in children with allergic bronchial asthma. The value of a provocation test in assessment of treatment.

The effect of ketotifen on allergic symptoms and parameters of respiratory function were studied in 23 allergic children during a period of 6 months therapy. A reduction in nocturnal dyspnea and dyspnea during exercise was observed in 17 patients. Improvement of the FVC, PEF and FEV1 was detected in 14, 15 and 19 patients, respectively. Following a 4-day treatment with ketotifen, a further 15 patients with allergen-induced bronchospasm were challenged by inhalative provocation test, comparing the protective effects of ketotifen and of DSCG in a randomized double-blind crossover study. 7 of 15 patients showed an improved allergen tolerance to the immediate hypersensitivity with ketotifen and 5 patients with DSCG. A protective effect with respect to the delayed hypersensitivity reaction was observe in 2 of 8 patients with ketotifen and in 1 with DSCG.