Bronchopulmonary tract

The metered valve delivers a fixed volume of suspension that after propellant evaporation, releases the active drug in the upper respiratory tract. Owing to its small diameter size, about 10% of the drug reaches the bronchopulmonary tract and provides therapeutic activity. 

Gould VE, Linnoila RI, Memoli VA, Warren WH. NE components of the bronchopulmonary tract Hyperplasias, dysplasias and neoplasias. Lab Invest. 1983 49 519-537. 

Lee I, Gould VE, Moll R, Wiedemann B, Frank WW. Synaptophysin expressed in the bronchopulmonary tract neuroendocrine cells, neuroepithehal bodies and neuroendocrine neoplasms. Differentiation 1987 34 115-125. 

Palivizumab is used to prevent serious lower respiratory tract infection due to RSV. It is used only in high-risk children who are younger than 24 months of age and have bronchopulmonary dysplasia or chronic lung disease that required treatment in the previous 6 months. It is also indicated for premature infants (less than 32 weeks gestation) until the age of 6 to 12 months. Palivizumab can reduce the incidence of RSV-related hospitalization by approximately half. The safety and efficacy of palivizumab in the treatment of RSV disease have not been established. 

B. Indications and use Synagis is indicated for the prevention of serious lower respiratory tract disease caused by RSV in infants and children with bronchopulmonary dysplasia (BPD) or a history of premature birth (< 35 weeks gestation) who are under 24 months of age at the time of first administration. 

Prevention of serious lower respiratory tract infection caused by respiratory syncytial virus in children less than 24 months of age with bronchopulmonary dysplasia or a history of prematurity (less than or equal to 35 weeks gestation)... 

This multifactorial weakness in defence allows bacterial penetration of the ascitic fluid to be effected by (1.) transmural migration in portal hypertension with greater permeability of the intestinal wall, (2.) systemic bacteraemia in terms of haematogenic dispersion (particularly in urinary tract and bronchopulmonary infections), above all in the presence of intrahepatic and extrahepatic shunts (so-called portal vein bacteraemia), (3.) invasion of bacteria via the Fallopian tubes, and (4.) lymphatic flow into the ascitic fluid (e.g. via leaks in the lymph vessels or lymph nodes). 

There have been few comparisons of the efficacy of trimethoprim and co-trimoxazole. In uncomplicated urinary tract, bronchopulmonary, and ear infections, no advantage of co-trimoxazole over trimethoprim has been documented (7,8). However, in complicated urinary tract infections most studies have shown better results with co-trimoxazole than with trimethoprim alone (9). Despite the widespread use of co-trimoxazole for about 35 years, bacterial resistance has not emerged as a major problem (10,11). 

Respiratory syncytial virus (RSV) infection represents a major cause of pediatric respiratory hospitalizations. RSV is the most common cause of lower respiratory tract infection in infants. Palivizumab (Synagis) is a humanized monoclonal antibody to the fusion protein of RSV, and is active in animal models for prevention of pulmonary RSV replication [241]. Based on a phase I/II multicenter, randomized, double-blind, placebo-controlled, dose escalation trial by Subramanian et al. in premature infants or infants with bronchopulmonary dysplasia, it was found that the mean half-life of 20 days was comparable with that of other immunoglobulin G preparations. Mean trough serum concentrations 30 days after infusion were 6.8, 36.1, and 60.6pg/mL for the 3-, 10-, and 15-mg/kg dose groups, respectively. Mean serum concentrations of palivizumab that have been shown to produce a 2-log reduction in pulmonary RSV titer in cotton rats were maintained when 10- or 15-mg/kg palivizumab was given every 30 days to pediatric patients at high risk... 

Mutoh T, Bonham AC, load JP (2000) Substance P in the nucleus of the solitary tract augments bronchopulmonary C fiber reflex output. Am J Physiol Regul Integr Comp Physiol 279 R1215-R1223... 

Fungal Infections Although fxmgal upper respiratory tract colonisation and infections are known adverse effects of inhaled corticosteroids, only recently a fxmgal lower respiratory fracf infection, and more specifically a case of Candida pneumonia in a neonate, was attributed to ICS [11 ]. The neonate received inhaled beclomethasone therapy (400 xg, six times a day) for bronchopulmonary dysplasia. After 20 days of freafment, the patient developed a lower respiratory tract infection. Klebsiella pneumoniae was isolated in fhe fracheal aspirate and treated with amnxirillin-clavulanate without clinical improvement. A week later, bronchoscopy was performed and extended candidiasis was found and treated successfully with fluconazole. Candida pneumonia secondary to airway colonisation is rare and in this case, it was likely provoked by the ICS treatment. 

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