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).
F. Treatments
F.1. In conventional medicine perspective
The aim of the treatment is to relive the symptoms, such as cough, pain, breathing, etc.
A. Acute bronchitis
Cough is the most common symptom bringing patients to the primary care
physician’s office, and acute bronchitis is usually the diagnosis in
these patients. Getting more rest, taking over-the-counter pamedicine
to relieve the symptoms, drinking fluids, breathing in warm, moist air.
According to the study by Hartford Hospital, Hartford, acute bronchitis
should be differentiated from other common diagnoses, such as pneumonia
and asthma, because these conditions may need specific therapies not
indicated for bronchitis. Symptoms of bronchitis typically last about
three weeks. The typical therapies for managing acute bronchitis
symptoms have been shown to be ineffective, and the U.S. Food and Drug
Administration recommends against using cough and cold preparations in
children younger than six years. The supplement pelargonium may help
reduce symptom severity in adults. As patient expectations for
antibiotics and therapies for symptom management differ from
evidence-based recommendations, effective communication strategies are
necessary to provide the safest therapies available while maintaining
patient satisfaction(49).
B. Chronic bronchitis
The syndrome of chronic obstructive pulmonary disease (COPD) consists of
chronic bronchitis (CB), bronchiectasis, emphysema, and reversible
airway disease that combine uniquely in an individual patient. Older
patients are at risk for COPD and its components–emphysema, CB, and
bronchiectasis. Bacterial and viral infections play a role in acute
exacerbations of COPD (AECOPD) and in acute exacerbations of CB (AECB)
without features of COPD(50).
Beside over counter medince to reduce symptoms of the disease, prescriptions medication may include
1. Antibiotics
Antibiotics are medication used to fight against the bacetrial invasion.
Gemifloxacin is a fluoroquinolone antibiotic with broad spectrum of
antibacterial activity. In the study to to evaluate the comparative
effectiveness and safety of gemifloxacin for the treatment of patients
with community-acquired pneumonia (CAP) or acute exacerbation of chronic
bronchitis (AECB), found that gemifloxacin 320 mg oral daily is
equivalent or superior to other approved antibiotics in effectiveness
and safety for CAP and AECB. The development of rash represents
potential limitation of gemifloxacin(51). But other suggested that older
patients are at risk for resistant bacterial organisms during their
episodes of AECOPD and AECB. Organisms include the more-common bacteria
implicated in AECOPD/AECB such as Haemophilus influenzae, Moraxella
catarrhalis, and Streptococcus pneumoniae. Using a risk-stratification
approach for elderly patients, first-line antibiotics (e.g.,
amoxicillin, ampicillin, pivampicillin, trimethoprim/sulfamethoxazole,
and doxycycline), with a more-limited spectrum of antibacterial
coverage, are used in patients who are likely to have a low probability
of resistant organisms during AECOPD/AECB. Second-line antibiotics
(e.g., amoxicillin/clavulanic acid, second- or third-generation
cephalosporins, and respiratory fluoroquinolones) with a broader
spectrum of coverage are reserved for patients with significant risk
factors for resistant organisms and those who have failed initial
antibiotic treatment(52).
Side effects are ot limit to rash, diarrhea, abdominal pain,
nausea/vomiting, drug fever, hypersensitivity (allergic) reactions, etc.
2. Blockade of the Epidermal growth factors receptors (EGFR) therapy
In the study to examine the expression patterns of EGF and their
receptors (EGFR1 and c-erbB2) in the bronchial mucosa from the biopsy
specimens harvested from smoking and non-smoking CB patients, compared
with their expression in normal controls, indicated that blockade of the
EGFR pathway can be an alternative successful therapy(53).
3. Surgery
Chronic bronchitis is a common but variable phenomenon in COPD. It has
numerous clinical consequences, including an accelerated decline in lung
function, greater risk of the development of airflow obstruction in
smokers, a predisposition to lower respiratory tract infection, higher
exacerbation frequency, and worse overall mortality(54). Lung reduction
surgery can be potential helpful in removing the damage lung area.
According to the study by University of Pennsylvania,
lung-volume-reduction surgery increases the chance of improved exercise
capacity but does not confer a survival advantage over medical therapy.
It does yield a survival advantage for patients with both predominantly
upper-lobe emphysema and low base-line exercise capacity(55).
4. Etc.
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Sources
(1) http://www.who.int/whr/2004/en/
(6) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC130746/
(7) http://www.lung.org/lung-disease/bronchitis-chronic/understanding-chronic-bronchitis.html
(49) http://www.ncbi.nlm.nih.gov/pubmed/21121518
(50) http://www.ncbi.nlm.nih.gov/pubmed/20398122
(51) http://www.ncbi.nlm.nih.gov/pubmed/22490497
(52) http://www.ncbi.nlm.nih.gov/pubmed/20398122
(53) http://www.ncbi.nlm.nih.gov/pubmed/23303019
(54) http://www.ncbi.nlm.nih.gov/pubmed/23204254
(55) http://www.ncbi.nlm.nih.gov/pubmed/12759479
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