Wednesday, 27 November 2013

Lower respiratory tract infection (Respiratory Disease) – Bronchitis – The complications

Lower respiratory tract infection
The lower respiratory tract infection are the infection consisting of the trachea (wind pipe), bronchial tubes, the bronchioles, and the lungs, including the bronchitis and pneumonia. According to  The World Health Report 2004 – Changing History(1), in 2002 lower respiratory track infection were still the leading cause of deaths among all infectious diseases, and accounted for 3.9 million deaths worldwide and 6.9% of all deaths that year.
Bronchitis is defined as a condition of an inflammation of the mucous membranes of the bronchi, the larger and medium-sized airways that carry airflow from the trachea into the lung parenchyma(7). Most cases of Bronchitis are as a result of recurrent injure to the airways caused by inhaled irritants and cigarette smoking(6).
C. The complications
1. Increased risk of early viral lower respiratory infections of the new born
There isan increased risk of hospitalisation for acute lower respiratory infection up to age 2 years in children delivered by elective caesarean section. In the study to examine the associations between the number of hospital admissions for bronchiolitis and pneumonia and elective caesarean delivery, showed that Delivery by elective caesarean was independently associated with infant admissions for bronchiolitis but not pneumonia. Elective caesareans or delivery without labour may result in impaired immunity in the newborn leading to increased risk of early viral lower respiratory infections(27).
2. Autoimmune rheumatic diseases
Patients suffering from autoimmune rheumatic diseases have significantly higher risk of developing various infections compared to the healthy population. In the study included patients suffering from systemic lupus erythematosus (n = 30), rheumatoid arthritis (n = 37) or Sjögren’s syndrome (n = 32), with stable underlying diseases status. In November 2010, 47 patients, including 35 subjects vaccinated annually during 2006-2010, found that the incidence of influenza or bacterial complications (bronchitis) among vaccinated patients was significantly lower, compared to the non-vaccinated group. Importantly, there was no case of exacerbation of the underlying disease. The last vaccination in 2010 reduced the risk of influenza by 87%, but previous bacterial infections (bronchitis and pneumonia) increased influenza risk significantly(28).
3. Asthma
In the study to investigate whether chronic bronchitis, asthma, or baseline methacholine airway responsiveness can explain the heterogeneity in lung function response to boilermaker work, showed that although chronic bronchitis and asthma were associated with a greater loss in lung function in response to hours worked as a boilermaker, and therefore they acted as effect modifiers of the exposure-lung function relationship, airway hyperresponsiveness did not. However, the high prevalence of airway hyperresponsiveness found in the cohort may be a primary consequence of long-term workplace exposure among boilermakers(29).
4. Bronchiectasis
According to the study of Risk of infections in bronchiectasis during disease-modifying treatment and biologics for rheumatic diseases by Rheumatology B Department, Cochin Hospital, Paris France, lower respiratory tract infectious events are frequent among patients receiving biologics for chronic inflammatory rheumatic disease associated with bronchiectasis. Biologic treatment and pre-existing sputum colonization are independent risk factors of infection occurrence(30).
5. Cystic fibrosis, airway hyperresponsiveness and neutrophilic bronchitis
There is a report of four patients with asthma, airway hyperresponsiveness and neutrophilic bronchitis who harboured abnormal cystic fibrosis transmembrance conductance regulator (CFTR) gene mutations. It serves both to alert clinicians to consider CFTR-related disease in both young and elderly patients with persistent neutrophilic bronchitis, and to highlight the potential utility of future genetic testing for CFTR abnormalities in patients with asthma and recurrent bronchitis or pansinusitis, and the role of nebulized hypertonic saline as a therapeutic option in these patients(31).
6. Recurrent haemoptysis
There is a report of an 8-year-old boy presented with recurrent chest pain and haemoptysis since 3 years of age. He had taken multiple courses of antitubercular treatment without any symptomatic relief. His chest x-ray showed opacity consistent with right sided lung collapse. Further detailed work-up including high-resolution CT scan of thorax, pulmonary angiogram and radionucleide study confirmed intrathoracic gastrogenic cyst(31a).
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