RESPIRATORY DISEASE AND INFECTION - A NEW INSIGHT Edited by Bassam H Mahboub and Mayank Vats Respiratory Disease and Infection - A New Insight http://dx.doi.org/10.5772/46040 Edited by Bassam H Mahboub and Mayank Vats Contributors Fernando Saldias, Orlando Díaz, Pablo Aguilera, Anna Breborowicz, Irena Wojsyk - Banaszak, Carlos Cabello Gutiérrez, Maria Eugenia Manjarrez, Dora Patricia Rosete, Luis Horacio Gutiérrez-González, Isabel Hagel, Maira Cabrera, Maria Cristina Di Prisco, Jaume Torres, Wahyu Surya, Al-Jumaily, Iara Maria Sequeiros, Nabil Jarad, Sameera M Al Johani, Javed Akhter, Sara E Cruz-Morales, Jennifer Lira-Mandujano, M Carmen Míguez-Varela Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2013 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work Any republication, referencing or personal use of the work must explicitly identify the original source Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher No responsibility is accepted for the accuracy of information contained in the published chapters The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book Publishing Process Manager Iva Simcic Technical Editor InTech DTP team Cover InTech Design team First published January, 2013 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Respiratory Disease and Infection - A New Insight, Edited by Bassam H Mahboub and Mayank Vats p cm ISBN 978-953-51-0968-6 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface VII Section Viral Infections Chapter Pathogenesis of Viral Respiratory Infection Ma Eugenia Manjarrez-Zavala, Dora Patricia Rosete-Olvera, Luis Horacio Gutiérrez-González, Rodolfo Ocadiz-Delgado and Carlos Cabello-Gutiérrez Chapter Virology and Molecular Epidemiology of Respiratory Syncytial Virus (RSV) 33 Sameera Al Johani and Javed Akhter Chapter Structural and Functional Aspects of Viroporins in Human Respiratory Viruses: Respiratory Syncytial Virus and Coronaviruses 47 Wahyu Surya, Montserrat Samsó and Jaume Torres Section Bacterial Infections 77 Chapter Biophysical Effects on Chronic Rhinosinusitis Bacterial Biofilms 79 Mohammed Al-Haddad, Ahmed Al-Jumaily, John Brooks and Jim Bartley Chapter Clinical Diagnosis and Severity Assessment in Immunocompetent Adult Patients with Community-Acquired Pneumonia 99 Fernando Pafiel Saldías, Orlando Díaz Patiđo and Pablo Aguilera Fuenzalida Chapter Pneumonia in Children 137 Irena Wojsyk-Banaszak and Anna Bręborowicz VI Contents Chapter Cystic Fibrosis Pulmonary Exacerbation – Natural History, Causative Factors and Management 173 Iara Maria Sequeiros and Nabil Jarad Section Helminthic Infections of Lung 205 Chapter Helminthic Infections and Asthma: Still a Challenge for Developing Countries 207 Isabel Hagel, Maira Cabrera and Maria Cristina Di Prisco Section Smoking Cessation and Lung 229 Chapter Psychological Approaches to Increase Tobacco Abstinence in Patients with Chronic Obstructive Pulmonary Disease: A Review 231 Jennifer Lira-Mandujano, M Carmen Míguez-Varela and Sara E Cruz-Morales Preface Medicine is an ever-changing science Every day we are encountered with the new develop‐ ments and knowledge in the pathogenesis, mechanism of disease, newer diagnostic modali‐ ties, treatment options and new challenges in the management of the various diseases The same holds true for respiratory diseases with the emergence of new respiratory pathogens having significant impact on the respiratory system Respiratory Diseases are an important contributor to the morbidity and mortality of man‐ kind since antiquity and its prevalence is on rise in with new disease are being recognized, however little importance has been given to the respiratory disease due to low level of awareness in physicians and general public This book has been designed to deliver the detailed knowledge about the various respirato‐ ry infections including viral, bacterial, and helminthic infections The first section covers the updated pathogenesis of the respiratory viral infections The chap‐ ters covers the comprehensive view of the virology and molecular epidemiology of RSV, the commonest respiratory pathogen in children and in adults as well In the same section detailed discussion has been done about the structural and functional aspects of viroporins The section on bacteriology primarily emphasize upon the very important but often over‐ looked cause of bacterial infection of the lung, the biofilm which acts as a persistent reser‐ voir for the bacterial load and gives rise to frequent exacerbation in all population Appropriate weightage has been given to the Clinical diagnosis and severity assessment of community acquired pneumonia which is a very common cause of morbidity and mortality in all age groups especially at extremes of age including the latest guidelines and recom‐ mendation from various professional societies Various challenges associated with the diagnosis and management of Helminthic infections and lung especially patients with asthma has been dealt in a very concise way As the prevalence of smoking has increased remarkably worldwide hence a dedicated chap‐ ter has been included on Smoking Cessation focusing on the Psychological approach to increase Smoking abstinence, which is very important component in any smoking cessa‐ tion programme The authors and the publishers of this book have made sure that the contents and the knowledge delivered by the book is evidence based, updated and comprehensive and taken from the reliable sources The experience and knowledge of each of the editors have been directed to ensure that all specialized aspects of respiratory diseases and infection have been expertly covered and VIII Preface well presented in view of scientific content After undergoing peer review, the book aspires to provide a readable and updated coverage of all the latest updates in respiratory diseases and infection The book Respiratory Disease and Infections- A New Insight has been intended for the in‐ ternists, general practitioners and the respiratory physicians in order to broaden the horizon of knowledge about the respiratory diseases and infection We owe a great deal to all authors who worked hard to contribute the chapters in the book We are greatly indebted to all and especially InTech publisher for their dedicated efforts and close collaboration with all the authors to publish the book for the advancement of knowl‐ edge and new insight in the field of Respiratory Disease and Infections Lastly, we owe a great deal to our family, who provided constant aspiration, encouragement, peace of mind and unwavering support to us to complete the editorial work of this book Editor: Dr Bassam H Mahboub Director, Department of Pulmonary Medicine and Allergy, Rashid Hospital & Dubai Hospital, Assistant Professor, Dept of Medicine & Respiratory Disease & Allergy, University of Sharjah, UAE Co-editor: Dr Mayank Vats Specialist - A, Pulmonary Medicine, Intensive Care Medicine & sleep Medicine, AL Qassimi Hospital, Sharjah, UAE Section Viral Infections 238 Respiratory Disease and Infection - A New Insight Wagena, Knipschild, Huibers, Wouters and van Schayck [34] explored the efficacy of bu‐ propion and nortriptyline in smokers at risk of COPD versus smokers with COPD In a randomized placebo-controlled, double blind trial, 255 adults at risk for COPD or with COPD were assigned to one of three groups that received different smoking cessation in‐ tervention: a) bupropion (15 mg twice daily), b) nortriptyline (75 mg once daily) for 12 weeks and c) placebo bupropion All patients received advice to quit smoking The main indicator of outcome was prolonged abstinence from smoking from to 26 weeks after beginning the date of withdrawal The results showed that bupropion (27.9%) and nor‐ triptyline (25%) had high rates of prolonged abstinence at 26 weeks follow-up compared with placebo (14.6%), significant differences between bupropion and placebo were detect‐ ed (p = 0.03), 13.1% [95% CI: -1.2% to 25.1%], and no differences for nortriptyline 10.2% [95% CI: 1.7% to 22.2%) In patients with COPD, bupropion (27.3%) and nortriptyline (21.2%) were equally effective in prolonged abstinence rates (differences with placebo 18.9% [95% CI: 3.6% -34.2%], for bupropion and 12.9% [95% CI: -0.8% to 26.4%] for nor‐ triptyline) In subjects with COPD risk, no statistically significant differences were detect‐ ed compared with placebo in prolonged abstinence rates (bupropion= 28.6% vs nortriptyline= 32.1% vs placebo = 22%) The authors conclude that bupropion combined with smoking cessation counselling is an effective treatment for smoking cessation in pa‐ tients with COPD and nortriptyline is a useful alternative van Schayck, et al [35] conducted a randomized, double-blind placebo-controlled trial to evaluate the efficacy of bupropion and nortriptyline in combination with behavioral cogni‐ tive intervention in smokers with COPD risk in Netherlands Smokers (n=255) with COPD risk between 30-70 years, were counseled to quit smoking (three sessions of 20 minutes and calls of minutes) They were randomly allocated to one of three groups: bupropion, nor‐ triptyline or placebo for 12 weeks The results showed prolonged abstinence rate (defined by report of participants have not smoked in week to 52 after the beginning of abstinence) for bupropion (20.9%), nortriptyline (20%) and placebo (13.5%) Significant differences were ob‐ tained between bupropion and placebo [relative risk (RR) = 1.6, 95%, confidence interval (CI) 0.8-3.0], in contrast, the differences between nortriptyline and placebo were not signifi‐ cant The severity of the airway obstruction did not influence the significance of abstinence The social costs were € 1368 with bupropion, € 1906 with nortriptyline and € 1212 with pla‐ cebo The authors concluded that bupropion and nortriptyline are equally effective, but bu‐ propion was more cost effective compared with placebo and nortriptyline One possible reason for the high cost of nortriptyline may be that participants who used nortriptyline ex‐ perienced more side effects from treatment Finally, one study evaluated varenicline combined with psychological intervention In 27 cen‐ ters a randomized, controlled, double blind, trial in patients (N=504) with mild to moderate COPD the efficacy of varenicline was evaluated [36] The intervention consisted in 12 weeks of varenicline with 40 weeks follow-up All participants received an educational booklet on smoking cessation information and brief counseling sessions (10 minutes) at each telephone call or visit at the clinic The primary endpoint to confirm the continuous abstinence rate with the carbon monoxide level was week to 12 The secondary endpoint was week to 52 The re‐ Psychological Approaches to Increase Tobacco Abstinence in Patients with Chronic Obstructive Pulmonary http://dx.doi.org/10.5772/53265 sults showed that the rate of continuous abstinence from week 9-12 was significantly higher for patients in the varenicline group (42.3%) than for placebo patients (8.8%) (OR: 8.40, 95% CI: 4.99 -14.14, p