Acute exacerbation of chronic bronchitis: a primary care consensus guideline.
OBJECTIVE
To develop consensus on appropriate treatment for acute exacerbation of chronic bronchitis (AECB). CHARACTERISTICS AND ETIOLOGY: Patients with chronic bronchitis have an irreversible reduction in maximal airflow velocity and a productive cough on most days of the month for 3 months over 2 consecutive years. An AECB is characterized by a period of unstable lung function with worsening airflow and other symptoms. Most (80%) cases of AECB are due to infection, with half due to aerobic bacteria. The remaining 20% are due to noninfectious causes such as environmental factors or medication nonadherence.


RESULTS
Supportive care should be provided to all patients, which might include removal of irritants, use of a bronchodilator, oxygen, hydration, use of a systemic corticosteroid, and chest physical therapy. Antibacterial treatment should be reserved for patients with at least 1 key symptom (ie, increased dyspnea, sputum production, sputum purulence) and 1 risk factor (ie, age > or = 65 years, forced expiratory volume in 1 second < 50% of the predicted value, > or = 4 AECBs in 12 months, 1 or more comorbidities). A newer macrolide, extended-spectrum cephalosporin, or doxycycline is appropriate for an exacerbation of moderate severity, and high-dose amoxicillin/clavulanate or a respiratory fluoroquinolone should be used for a severe exacerbation. There has been increasing antibacterial resistance by the 3 most prevalent pathogens (Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis).


CONCLUSIONS
Although all AECB patients should receive supportive care, only patients with at least 1 key symptom and 1 risk factor should receive antibiotic therapy.
Brunton
Stephen
S
Department of Family Medicine, University of California, Irvine, Calif, USA.
Carmichael
Blaine P
BP
Colgan
Richard
R
Feeney
A Susan
AS
Fendrick
A Mark
AM
Quintiliani
Richard
R
Scott
Gregory
G
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D029481:Bronchitis, Chronic / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D017408:Guidelines as Topic; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011320:Primary Health Care
D000900:Anti-Bacterial Agents