Time course of recovery of health status following an infective exacerbation of chronic bronchitis.
BACKGROUND
The magnitude and time course of effect of an acute exacerbation of chronic bronchitis (AECB) on health status are not known. Data from the GLOBE study, a randomised double blind trial of antibiotic therapy, were used to investigate these effects.


METHODS
438 patients with AECB received either gemifloxacin 320 mg once daily for 5 days (214 patients) or clarithromycin 500 mg twice daily for 7 days (224 patients) and were followed up for 26 weeks. St George's Respiratory Questionnaire (SGRQ) scores were obtained at baseline and after 4, 12, and 26 weeks.


RESULTS
At presentation during an exacerbation SGRQ scores were worse (Total score difference 5.4 units, 95% CI 1.9 to 8.8, p=0.002) in patients who had a subsequent exacerbation during follow up. The greatest improvement in SGRQ score occurred within the first 4 weeks (mean 8.9 units, 95% CI 6.5 to 11.5, p<0.0001). Subsequently, scores improved more rapidly in patients with no further exacerbations. At 26 weeks the difference between the two groups was 9.6 units (95% CI 5.7 to 13.4, p<0.0001). In patients with no further exacerbations the SGRQ score improved between 4 and 12 weeks by a further 4.1 units (95% CI 2.2 to 5.9, p<0.0001).


CONCLUSIONS
A single infective AECB has a sustained effect on health status. The recovery period is long even in patients who have no further exacerbations. A second episode within 6 months limits recovery markedly. Treatments that reduce exacerbation frequency could have a significant impact on health status.
Spencer
S
S
Department of Physiological Medicine, St George's Hospital Medical School, London SW17 0RE, UK. sspencer@sghms.ac.uk
Jones
P W
PW
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D019540:Area Under Curve; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy*; D001991:Bronchitis / Q000150:complications / Q000188:drug therapy*; D002908:Chronic Disease; D004311:Double-Blind Method; D005260:Female; D024841:Fluoroquinolones; D000077735:Gemifloxacin; D006304:Health Status; D006801:Humans; D018942:Macrolides; D008297:Male; D009287:Naphthyridines / Q000627:therapeutic use*; D012907:Smoking / Q000009:adverse effects; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D024841:Fluoroquinolones; D018942:Macrolides; D009287:Naphthyridines; D000077735:Gemifloxacin