Sinobronchial Syndrome. Clinicopathology and Macrolide Therapy.

Sinobronchial syndrome (SBS) is a clinical entity in which chronic sinusitis is accompanied by chronic inflammation of the lower airway.This paper describes the clinicopathological characteristics of a new SBS entity in patients with HTLV-1 associated bronchopneumopathy (HAB) accomponied frequently chronic sinusitis, or primary ciliary dyskinesia.We investigated the mechanism of clinical effectiveness of low-dose and long-term erythromycin (EM) or roxithromycin (RXM) treatment for SBS and HAB by studying the effects of these drugs on neutrophil function and on mucociliary transport function.These drugs inhibited neutrophil adhesion to surfaces of cultured vascular endothelial cells and active oxgen production in neutrophils taken from both venous blood and nasal discharge of patients after drug therapy.The effect of these drugs on ciliary function was studied in monolayer cultures of human respiratory cells with a differential interference microscope equipped with a high speed video system; however, no marked change of ciliary movement was observed in this experimental series.On the other hand, lectin histochemistry of nasal mucosa showed that the increased amounts of glycoconjugates, such as sialic acid and fucose, were returned to within the normal range by drug therapy of patients with chronic sinusitis.The improvement of chronic respiratory inflammation is probably dependent not only on the antimicrobial effect of macrolide antibiotics but also on their antiinflammatory effect, regulation of the hyperimmune response and normalization of glycoconjugate composition in airway secretion.