Diffuse panbronchiolitis progresses insidiously and the prognosis, especially after Pseudomonas aeruginosa superinfection, is generally poor. Recently, low dose long-term erythromycin (EM) treatment has become the preferred therapy for chronic lower respiratory tract disease, including DPB. That erythromycin may act as an anti-inflammatory agent is indicated by recent reports that it raises natural killer cell activity and has potent capacity to suppress the polymorphonuclear leukocyte (PMN) chemilumi-nescence induced by N-formyl-methionyl-leucyl-phenylalanine (FMLP), opsonized zymosan, and the calcium ionophore, A23187.
The mechanism responsible for the therapeutic action of EM, however, is still unclear. Our recent finding indicated marked neutrophil accumulation in the lung of patients with DPB. Accordingly, in an attempt to elucidate this mechanism, we investigated the effect of EM on neutrophil migration, and we attempted to characterize the neutrophil chemotactic factors in the bronchoalveolar lavage (BAL) fluid of patients with DPB online antibiotics.
We evaluated neutrophil chemotactic activity (NCA) in 13 patients with DPB (10 men and 3 women; mean age 39.2 ±4.9 years) who satisfied the diagnostic criteria for DPB set out by the Japanese Ministry of Health and Welfare. All the patients had the following clinical features: (1) symptoms of chronic cough with sputum production and exertional dyspnea, (2) physical signs of coarse crackles and rhonchi, (3) typical radiologic features on chest roentgenogram of diffuse nodular shadows and hyperinflation, (4) chronic paranasal sinusitis, and (5) pulmonary function tests showing ventilatory defects that were obstructive, or rarely restrictive, and hypoxemia with or without hypercapnia.
In 9 of the 13 patients the disease was histologically confirmed in open lung biopsies; in the remaining four patients, it was diagnosed clinically. All the patients were nonsmokers. When patients had signs or roentgenographic findings suggesting pneumonia or acute exacerbation of the disease before enrollment in the study, adequate antibiotics were administered. Thus, none of the patients had a pulmonary infection in the 1 month before enrollment in the study. For comparison, five healthy nonsmoking volunteers also were evaluated.