Chest physical therapy in patients with acute exacerbation of chronic bronchitis: effectiveness of three methods.

OBJECTIVE: To compare the short-term effects of postural drainage (PD), oscillating positive expiratory pressure (using the FLUTTER device), and expiration with the glottis open in the lateral posture (ELTGOL) on oxygen saturation, pulmonary function, and sputum production in patients with an acute exacerbation of chronic bronchitis. DESIGN: A prospective, randomized study. SETTING: A clinical ward. PATIENTS: Ten patients with chronic bronchitis exacerbation received PD, FLUTTER, and ELTGOL by the same respiratory therapist at about the same time of day on separate days and in random order. MAIN OUTCOME MEASURES: Oxygen saturation and pulmonary function were measured before, immediately after, and 15 minutes and 1 hour after each treatment. Improvement in sputum production was measured by total sputum wet weight immediately after and for 1 hour after treatment. INTERVENTIONS: PD consisted of positioning the patients in a posture that allows bronchial drainage by gravity. FLUTTER is a device that is claimed to combine oscillating positive expiratory pressure with oscillations of the airflow. ELTGOL is an airway clearance technique that uses lateral posture and different lung volumes to control expiratory flow rate to avoid airway compression. The total time spent for treatments was 30 minutes. RESULTS: All techniques were well tolerated, and oxygen saturation and pulmonary function did not change significantly during and after treatments. Thirty minutes after the beginning of treatment, sputum production increased significantly with all techniques, but during the 1 hour after the end of treatment, it was significantly larger with FLUTTER (from 15.0 +/- 8.6g to 19.0 +/- 9.3g, p < .01) and ELTGOL (from 17.0 +/- 7.0g to 20.6 +/- 6.9g, p < .02) than with PD (from 15.5 +/- 4.0g to 17.5 +/- 3.7g, NS). CONCLUSIONS: All three treatments were safe and effective in removing secretions without causing undesirable effects on oxygen saturation, but FLUTTER and ELTGOL techniques were more effective in prolonging secretion removal in chronic bronchitis exacerbation than was the PD method.

[Levels of sIgA in patients suffering from chronic bronchitis at the breakthrough stage, treated with rokitamycin]. / Livelli di sIgA in pazienti affetti da bronchite cronica in fase di riacutizzazione trattati con rokitamicina.

In the present study, besides the clinical activity and safety of rokitamycin in patients with episodes of breakthrough chronic bronchitis, its influence on the production of secretory immunoglobulins of group A (sIgA) at the bronchial level was studied. Fifteen patients (12M, 3F), of mean age 51.0 years 7.0 SD were treated with rokitamycin in 400 mg tablets (2 tabs/day) for 10 days. The results attained confirmed the therapeutic efficacy of rokitamycin, with a clear improvement of symptoms already by the 5th day. The levels of sIgA in bronchial secretions showed on the 10th day a statistically significant increase, superior to that reported in the literature for other antibiotics, passing from 18.2 microg/mL 0.9 SEM at the baseline to a value of 19.4 microg/mL 0.9 SEM. The high therapeutic safety of rokitamycin should be emphasised: it determined no variations in the laboratory parameters considered; in the course of treatment no patients suffered adverse events. The results attained, which confirm the clinical efficacy of rokitamycin and complete its pharmacodynamic profile, allow us to advise the use of this macrolid with 16 carbon atoms in acute infective pathologies of the respiratory tract.

Efficacy and tolerability of brodimoprim od versus norfloxacin bid in the treatment of bacterial urinary tract infections.

The efficacy and tolerability of brodimoprim OD versus norfloxacin BID were studied in patients affected by bacterial urinary tract infections. The study was performed in 203 patients divided into two parallel randomized groups orally given either brodimoprim 400 mg OD on the first day followed by 200 mg OD for 2 days, or norfloxacin 400 mg BID respectively. The efficacy of treatment was evaluated by the bacterial cultures, tolerability, analysis of signs and symptoms, a complete physical examination and from laboratory data. The results showed that brodimoprim and norfloxacin in the majority of patients resulted in a reduction of fever and symptoms caused by the infective process. Of the 103 patients enrolled in the brodimoprim OD group, 99 had a complete course of therapy with a positive outcome. There was only one case of failed treatment and 3 cases which could not be evaluated because of voluntary interruption of treatment. Of the 100 patients treated with norfloxacin BID, 94 completed therapy with a positive clinical outcome and there were 4 cases of treatment failure. Thus the efficacy of brodimoprim OD appears comparable to that of norfloxacin BID in the treatment of urinary tract infections.