We report about two patients, who have been sent to our hospital with exacerbation of a chronic bronchitis. Both of thern were over forty years old (A: 43, farmer; B:41, housewife) and were suffering of chronic bronchitis for years. Both had sputum cultures positive for Pseudomonas aeruginosa (pa), Staphylococcus aureus and Aspergillus fumigatus (At). Patient A had a normal lung function test and normal blood gases, whereas patient B had moderate bronchial obstruction and hypoxemia. In patient B a diagnosis of allergic bronchopulmonary Aspergillosis (ABPA) was made, based on positive skin prick test and specific lgE and IgG against Af-antigens. Both patients were diagnosed for cystic fibrosis (CF) for the first time. Diagnosis was based on mutation analysis of the CF- genes. We treated both patients with intravenous antipseudoinonaj combination therapy with the goal to eradicate pa or at least diminish pseudomonal activity in the lung. Beside, both patients were accepted for a pulmonary rehabilitation programme (respiratory physiotherapy, daily treadmill exercise and other physical activity). They were also instructed for a high calorie nutrition by a nutritionist.Conclusions:(1) Pulrnonologists see more and more patients with CF, especially with milder forms, who often are diagnosed late in their life. (2) Hospital based pulmonary rehabilitation gives the possibility of treating chronic pulmonary infections on a iv. basis, which is necessary to eradicate pseudomonas infections.(3)Combining treatment and rehabilitation is important and can be performed cost effectively in the same specialised hospital.
Full conference title:
7th European Respiratory Society Annual Conference
- ERS 17th (2007)