Abstract
Broad spectrum antibiotic treatment was given on 21 occasions to 15 patients with bronchiectasis who regularly produced purulent, elastase positive secretions. Although the results showed that sputum clearing--that is, changing from purulent to mucoid--largely depended on the pathogenic organism isolated, this was not exclusively the case and in some cases sputum growing sensitive organisms failed to clear whereas clearing occurred in other samples containing resistant organisms or no obvious pathogens. Clearing of sputum was achieved eventually in 12 of the patients and this was associated with the disappearance of elastase activity, although it returned in 10 patients within one week of stopping treatment. There was no change in sputum elastase where the sputum failed to clear. The clearance of elastase activity was associated with a decrease in protein transudation into the lung secretions. The sputum:serum albumin concentration ratio fell (p less than 0.005) from a mean (SD) of 2.32 (1.56) X 10(-2) in these 12 patients before treatment to 1.09 (0.40) X 10(-2) within the first week of treatment, but rose again to 2.07 (1.29) X 10(-2) within one week of stopping treatment. The results suggest that antibiotic treatment when patients are in a stable state may have a beneficial effect on the pathogenic nature of lung secretions and inflammation within the lung.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Cole P. J., Roberts D. E., Davies S. F., Knight R. K. A simple oral antimicrobial regimen effective in severe chronic bronchial suppuration associated with culturable Haemophilus influenzae. J Antimicrob Chemother. 1983 Feb;11(2):109–113. doi: 10.1093/jac/11.2.109. [DOI] [PubMed] [Google Scholar]
- High-dose amoxycillin. Lancet. 1983 Nov 26;2(8361):1258–1259. [PubMed] [Google Scholar]
- Jackson A. H., Hill S. L., Afford S. C., Stockley R. A. Sputum sol-phase proteins and elastase activity in patients with cystic fibrosis. Eur J Respir Dis. 1984 Feb;65(2):114–124. [PubMed] [Google Scholar]
- Lieberman J., Kaneshiro W. Inhibition of leukocytic elastase from purulent sputum by alpha 1 -antitrypsin. J Lab Clin Med. 1972 Jul;80(1):88–101. [PubMed] [Google Scholar]
- Lourenço R. V., Loddenkemper R., Carton R. W. Patterns of distribution and clearance of aerosols in patients with bronchiectasis. Am Rev Respir Dis. 1972 Dec;106(6):857–866. doi: 10.1164/arrd.1972.106.6.857. [DOI] [PubMed] [Google Scholar]
- Ohlsson K., Tegner H. Granulocyte collagenase, elastase and plasma protease inhibitors in purulent sputum. Eur J Clin Invest. 1975 Jun 12;5(3):221–227. doi: 10.1111/j.1365-2362.1975.tb00448.x. [DOI] [PubMed] [Google Scholar]
- Roberts D. E., Cole P. Use of selective media in bacteriological investigation of patients with chronic suppurative respiratory infection. Lancet. 1980 Apr 12;1(8172):796–797. doi: 10.1016/s0140-6736(80)91295-7. [DOI] [PubMed] [Google Scholar]
- Stockley R. A., Burnett D. Alpha,-antitrypsin and leukocyte elastase in infected and noninfected sputum. Am Rev Respir Dis. 1979 Nov;120(5):1081–1086. doi: 10.1164/arrd.1979.120.5.1081. [DOI] [PubMed] [Google Scholar]
- Stockley R. A., Hill S. L., Morrison H. M., Starkie C. M. Elastolytic activity of sputum and its relation to purulence and to lung function in patients with bronchiectasis. Thorax. 1984 Jun;39(6):408–413. doi: 10.1136/thx.39.6.408. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Stockley R. A., Mistry M., Bradwell A. R., Burnett D. A study of plasma proteins in the sol phase of sputum from patients with chronic bronchitis. Thorax. 1979 Dec;34(6):777–782. doi: 10.1136/thx.34.6.777. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Stockley R. A. Proteolytic enzymes, their inhibitors and lung diseases. Clin Sci (Lond) 1983 Feb;64(2):119–126. doi: 10.1042/cs0640119. [DOI] [PubMed] [Google Scholar]
- Tegner H., Ohlsson K., Toremalm N. G., von Mecklenburg C. Effect of human leukocyte enzymes on tracheal mucosa and its mucociliary activity. Rhinology. 1979 Sep;17(3):199–206. [PubMed] [Google Scholar]
- Wiggins J., Elliott J. A., Stevenson R. D., Stockley R. A. Effect of corticosteroids on sputum sol-phase protease inhibitors in chronic obstructive pulmonary disease. Thorax. 1982 Sep;37(9):652–656. doi: 10.1136/thx.37.9.652. [DOI] [PMC free article] [PubMed] [Google Scholar]