Chronic bronchitis in the 1990s: up-to-date treatment.
Prevention is the key to eradicating chronic bronchitis. Smoking is the prime factor involved. Quitting smoking is difficult even with modern aids such as counselling, filters, substitutes, hypnosis and acupuncture, and the success rate is only 20%. Passive smoking is also injurious. The role of atmospheric pollution is less well quantified. Other risk factors include lower social class, occupation, area of residence, housing, temperature, and childhood respiratory illness. Influenza vaccination gives 60-70% immunity. With exacerbations of chronic bronchitis, beta-lactamase-producing bacteria are important, though the overall need for antibiotics is uncertain judging by placebo-controlled studies. Inhaled beta 2-agonist bronchodilators may improve airflow obstruction, as may anticholinergic drugs (e.g. ipratropium), the two being additive. Oral theophyllines have a narrow therapeutic window, serious side-effects and only two thirds of the effect of beta 2-agonists. A corticosteroid trial for 2 weeks may relieve refractory airway obstruction in 17-23% of chronic bronchitis, to be followed by inhaled steroids. Mucolytic drugs remain controversial and are difficult to monitor successfully. Oxygen therapy may be indicated for hypoxic chronic bronchitis, including long-term usage in cor pulmonale. Pulmonary rehabilitation by exercise training has recently been appreciated, and may be used in combination with the above treatment modalities.
Royal Free Hospital, London, UK.
S W
SW
Clarke
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001991:Bronchitis / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002908:Chronic Disease; D006801:Humans
D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents