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PubMed2006

Pulmonary embolism in patients with unexplained exacerbation of chronic obstructive pulmonary disease: prevalence and risk factors.

BACKGROUND: Diagnosis of pulmonary embolism (PE) is difficult in patients with chronic obstructive pulmonary disease (COPD) and exacerbation. OBJECTIVE: To evaluate PE in patients with COPD and exacerbation of unknown origin and explore factors associated with PE. DESIGN: Prospective cohort study. SETTING: University-affiliated hospital in France. PATIENTS: 211 consecutive patients, all current or former smokers with COPD, who were admitted to the hospital for severe exacerbation of unknown origin and did not require invasive mechanical ventilation. MEASUREMENTS: Spiral computed tomography angiography (CTA) and ultrasonography within 48 hours of admission and assessment of the Geneva score. Patients were classified as PE positive (positive results on CTA or negative results on CTA and positive results on ultrasonography) or PE negative (negative results on CTA and negative results on ultrasonography or negative results on CTA and no recurrence of PE at follow-up 3 months later). RESULTS: 49 of 197 patients (25% [95% CI, 19% to 32%]) met the diagnostic criteria for PE. Clinical factors associated with PE were previous thromboembolic disease (risk ratio, 2.43 [CI, 1.49 to 3.94]), malignant disease (risk ratio, 1.82 [CI, 1.13 to 2.92]), and decrease in PaCO2 of at least 5 mm Hg (risk ratio, 2.10 [CI, 1.23 to 3.58]). A total of 9.2% (CI, 4.7% to 15.9%) of patients with a low-probability Geneva score received a diagnosis of PE. An exploratory analysis suggested that substituting malignant disease for recent surgery in the Geneva score might improve its performance in excluding PE in this sample who were more likely to have malignant disease than to have had recent surgery. However, this improvement seems insufficient to exclude PE with enough certainty to withhold therapy for low-risk patients on the basis of the modified score. LIMITATIONS: This study was done in only 1 center. Patients with COPD requiring invasive mechanical ventilation in the intensive care unit were not included. The upper bound of the 95% CI for the low probability of PE according to the Geneva score is too high to rule out PE. The classification of COPD exacerbation of unknown origin was based on the clinician's assessment, not on a standard evaluation for all patients. CONCLUSION: This study showed a 25% prevalence of PE in patients with COPD hospitalized for severe exacerbation of unknown origin. Three clinical factors are associated with the increased risk for PE. The Geneva score and the modified Geneva score should be prospectively evaluated in patients with COPD.

Aged↗
PubMed2000

[The correlation between the exacerbation of bronchial asthma and picornavirus (human rhino virus) infection in throat gargles by RT-PCR].

Viral infection is one of important factors to cause the exacerbation of bronchial asthma. We have investigated 167 adults of asthmatics to clarify the correlation between viral infection and exacerbation of asthma. Patients were classified to four group by the symptoms of common cold and asthma attack. Furthermore, we have examined Picornavirus and Human rhino virus RNA from throat gargles of patients using RT-PCR (reverse transcription--polymerase chain reaction) method. Forty of 65 (61.5%) asthmatics with common cold revealed asthma attack and common cold was significantly associated with acute exacerbation of asthma (p < 0.01). We identified Picornavirus RNA, which include 113 of Human rhino virus serotypes and enterovirus, from the samples of 16 of 52 (30.8%) patients who had acute exacerbation. It was significantly higher than the detection rate of viral RNA from patient without asthma attack. Furthermore, we analyzed Human rhino virus RNA from the same samples by RT-PCR and 93.7% of Picornavirus were identified as Human rhino virus. Taken together, these findings suggest that common cold is significantly associated with the exacerbation of bronchial asthma. Human rhino virus infection might be one of important virus in this procedure.

Adult↗
PubMed2001

[Clinical significance of measuring inferior vena cava dimension in patients with acute exacerbation of chronic heart failure].

OBJECTIVES: This study determined the clinical significance of measuring the inferior vena cava dimension in patients with heart failure. METHODS: The subjects were 373 patients admitted due to acute exacerbation of chronic heart failure. The relationships were examined between inferior vena cava dimension in the end-expiratory phase on admission and in the stable state and etiology of heart failure, age, New York Heart Association (NYHA) functional classification in the stable state (before exacerbation), body weight, grade of tricuspid regurgitation, left ventricular end-diastolic dimension and left ventricular ejection fraction measured by two-dimensional echocardiography in the stable state and on admission, severity of lung congestion (Killip's classification) on admission, and clinical course during treatment. RESULTS: The inferior vena cava dimension was not correlated with etiology, age, NYHA functional classification, body weight, left ventricular end-diastolic dimension or left ventricular ejection fraction, but was correlated with the grade of tricuspid regurgitation (r = 0.78, p < 0.0001 in the stable state, r = 0.60, p < 0.0001 and on admission). The severity of lung congestion did not correlate with inferior vena cava dimension on admission or the increase in inferior vena cava dimension. The increase in body weight on admission was correlated with the increase in inferior vena cava dimension (r = 0.83, p < 0.0001), but did not correlate with inferior vena cava dimension on admission. Tricuspid regurgitation grade and inferior vena cava dimension were restored to the stable state when body weight reached stable state after treatment in patients (n = 202) with inferior vena cava dimension increased by over 5 mm on admission. CONCLUSIONS: Inferior vena cava dimension in patients with heart failure is correlated with the tricuspid regurgitation grade in the stable state and at acute exacerbation. The increase in inferior vena cava dimension between stable and exacerbated states, but not the actual value, is clinically useful to evaluate patients with acute exacerbation of chronic heart failure.

Chronic Disease↗
PubMed2002

[Serum paraoxonase activity, total antioxidant potential and lipid peroxidation products in children with bronchial asthma exacerbation].

The aim of this study was to investigate serum paraoxonase (PON) activity, total antioxidant capacity and serum level of lipid peroxidation products in children with exacerbated bronchial asthma. The study was performed in 23 children (17 males and 6 females, age 3-17 years) admitted to the hospital with asthma exacerbation. Aliquots of serum were collected before administration of any treatment. Control group comprised of 22 children (11 males, 11 females, age 3-17 years) admitted to the Department of Orthopedics for planned surgery, none of them demonstrated symptoms of asthma or other allergic diseases. Paraoxonase activity demonstrated right-skewed distribution both in control and in experimental group. The mean PON activity was 15% lower in asthmatic group but the difference was not significant. Total antioxidant potential of assayed sera as ferric reducing ability was significantly decreased in the group with asthma (-23.8%) and near-significantly correlated with number of days of hospitalization (r = -0.42; p = 0.07). The concentration of thiobarbituric acid-reactive substances (TBARS), a marker of lipid peroxidation, was 115.3% higher in asthmatic than in control group. TBARS correlated positively with eosinophils count in peripheral blood (r = 0.49; p < 0.01) and negatively with antioxidant capacity (r = -0.53, p < 0.05). We conclude that serum concentration of lipid peroxidation products is increased in children with bronchial asthma exacerbation. Total antioxidant capacity of serum is depressed during exacerbation of asthma. Serum paraoxonase activity tends to decrease in children during exacerbation of bronchial asthma, but the difference is not significant.

Adolescent↗
PubMed2003

[Comparative analysis of the effectiveness and costs of azithromycin and cefoperazone treatment of patients during COPD exacerbation].

UNLABELLED: The effectiveness and costs of azithromycin and cefoperazone treatment of COPD exacerbation have been analysed in this study. Forty patients at the mean age of 65.9 (+/- 11.5) years were enrolled. The subjects were randomly selected and treated either with cefoperazone 2 x 1.0 g i.v. daily (group I = 20 persons) or with azithromycin 1 x 0.5 g (group II = 20 persons), in sequential method. Body temperature, cough intensity, quality and quantity of expectorated sputum, number of breaths per minute and adverse events were recorded daily. The values of pulmonary function tests and leucocytosis were assessed three times during the study. Statistically significant differences between both groups have been found with respect to the mean time of staying in hospital (9.1 days--group I vs 6.1 days--group II), mean total duration of antibiotic therapy (10.1 days--group I vs. 6.6 days--group II) and duration of intravenous antibiotic therapy only [7.5 days (group I) vs 2.9 days (group II)] (p < 0.05). Taking into account the duration of hospitalization, it was shown that the mean total costs of treatment of COPD exacerbation with azithromycin was significantly lower than that of treatment with cefoperazone (2375.9 PLN and 1663.7 PLN, respectively) (p < 0.05). CONCLUSIONS: The effectiveness of treatment with azithromycin in patients with COPD exacerbation was evident. The total costs of treatment of COPD exacerbation with azithromycin is lower than with cefoperazone. Both azithromycin and cefoperazone are safe in the treatment of exacerbation of COPD.

Acute Disease↗
PubMed2003

An outreach programme for patients with an exacerbation of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease is a common clinical condition characterised by airflow obstruction. The clinical course of the disease is characterised by intermittent exacerbations. In Ireland exacerbations of chronic obstructive pulmonary disease are a common cause of admission to acute medical hospitals. The Beaumont Hospital COPD Outreach Programme was designed to provide care at home for patients with an exacerbation of COPD that would otherwise require hospitalisation. Patients recruited to the programme were discharged home within 72 hours of admission and reviewed by the Outreach Team over a two week period. In addition to monitoring clinical progress the Team provided education, smoking cessation and medication advice. Analysis of the outcome of the first 100 patients recruited to the study show that one third of patients admitted to Hospital with an exacerbation of COPD are eligible for this programme and the average length of Hospital stay was 2.6 days. During the fourteen day follow up there was one death (non-respiratory) and six patients were re-admitted to hospital. Forty percent of smokers had abstained from smoking at the end of three months. In summary, the COPD Outreach programme is a safe and effective alternative to acute hospital care for selected patients with exacerbations of COPD.

Home Care Services, Hospital-Based↗
PubMed2003

Prophylaxis for acute exacerbations of chronic bronchitis using an antibacterial sublingual vaccine obtained through mechanical lysis: a clinical and pharmacoeconomic study.

Chronic obstructive bronchitis (COB) complicated by acute exacerbations, or exacerbations, triggered by episodes of infection is the most demanding respiratory disease in our country today, to the extent that the implementation of every possible prevention strategy, in terms of both behaviour and prophylactic vaccination, is fully justified. From this point of view, in addition to the classic anti-viral vaccines, increasing importance is also being placed on antibacterial vaccines obtained by mechanically crushing pathogen bacteria (without the use of chemicals to denature the antigenic structures), which can be sublingually administered. In this study, conducted on 57 patients aged over 75 suffering from COB and affected by at least one exacerbation over the past 12 months, we evaluated the incidence of these exacerbations during a follow-up period, subsequent to prophylaxis with polyvalent bacterial mechanical lysate. As well as the absolute number of episodes, we also evaluated the seriousness of the episodes, the length of any antibiotic therapy and the overall cost of this therapy and of the prophylactic treatment. We then compared this data with that of the same period for the previous year, during which time no antibacterial prophylaxis had been administered. Both the absolute number of exacerbations, their length and seriousness were shown to be significantly reduced during the period of treatment compared to the control period. Similarly, the need to use antibiotic treatments, as well as the overall cost of the treatment of these patients, were shown to be reduced during the period of treatment compared to the control period.

Acute Disease↗
PubMed2003

[Administration of acute exacerbation of chronic obstructive pulmonary disease].

We have to consider the exacerbation of chronic obstructive pulmonary disease(COPD) may be caused not only by infection, but also by acute exacerbation of chronic heart failure, pulmonary embolism, pneumothorax, or other cardiopulmonary complications. Because it is characteristic that the exacerbation of COPD is often recurensive, the most important thing is the administration during stable status. Approximately 40% of pathogens of the acute infectious exacerbation of COPD are Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, Pseudomonas aeruginosa, Staphylococcus aureus, and Echelisia coli. Also, approximately 15% is exacerbated by atypical pathogens such as Chlamydia pneumoniae and approximately 30% is by viral infection. We should contemplate the possibility of pathogens according to the statistics, when we choose antibiotics empirically.

Acute Disease↗
PubMed2004

[Two cases of asthmatic exacerbation caused by parainfluenza virus 3 infection].

Although viral respiratory tract infections are considered to be the most frequent causes of asthmatic exacerbation, respiratory viruses can rarely be detected in the adult population. We describe 2 cases, in a 43-yr-old man with severe atopic asthma and in a 69-yr-old man with moderate non-atopic asthma. After the onset of nasal discharge, sore throat and fever, the asthma had become exacerbated in both cases during the summer of 2002. In both cases, parainfluenza virus (PIV) 3 viral RNA could be detected from oral gargling by RT-PCR, and the serum viral antibody titer against PIV 3 increased significantly. These cases were therefore diagnosed as undergoing asthmatic exacerbation caused by PIV 3 infection and were successfully treated with systemic steroids. During summer, 2002, in our outpatient clinic, PIV 3 infection was demonstrated in approximately half of the asthmatic exacerbations associated with upper respiratory symptoms, including the present cases. Collectively, PIV 3 seems to represent an important viral cause of asthma exacerbation in summer.

Adult↗
PubMed2004

[Perioperative lung injury: acute exacerbation of idiopathic pulmonary fibrosis and acute interstitial pneumonia after pulmonary resection].

The mortality rate after surgical resection for lung cancer has been reported to range between 1% and 3%, with 30% caused by acute exacerbation of idiopathic pulmonary fibrosis (IPF) or acute interstitial pneumonia (AIP). Approximately 20% of patients with IPF have lung cancer, while 2% to 4% of lung cancer patients have IPF. The incidence of postoperative acute exacerbation of IPF is about 20%. Some investigations in Japan revealed that 10% to 17% of lung cancer patients undergoing lung resection, who have not been diagnosed with IPF preoperatively, have localized-usual interstitial pneumonia (Lo-UIP) lesions. Approximately 20% of patients with Lo-UIP show postoperative acute exacerbation, while about 0.5% of those without Lo-UIP develop AIP after surgery. There is no confirmed treatment or prophylaxis. Most patients who develop postoperative acute exacerbation or AIP are treated with methylpredonisolone (1,000 mg/day x 3 days), but the mortality rate is 50% or greater. We emphasize that more efforts should be made to develop strategies to prevent postoperative acute exacerbation of IPF and AIP.

Acute Disease↗
PubMed1992

[Infectious agents associated with exacerbations of chronic obstructive bronchopneumopathies and asthma attacks].

Infections of the respiratory airways are frequently responsible for exacerbations of chronic obstructive pulmonary disease (COPD) and attacks of asthma. However, the causal infectious agents in practice are rarely precisely identified. We have undertaken a prospective study with the aim of researching into the bacteria and viruses associated with these exacerbations. Forty-seven patients who were in hospital between 1987 and 1989 for attacks of asthma (13 episodes) or exacerbations of COPD (35 episodes) were included in this study. The microbiological analysis consisted of: 1) the bacteriology of expectorated material or the products aspirated by fibroscopy with direct examination, quantitative cytology and culture; 2) samples taken from the nasal airways to identify and isolate pneumotropic viruses and mycoplasma; 3) serial serology looking for antibodies against pneumotropic bacteria and viruses. One of more infectious agents were shown in 47% of the episode studies of which 57% were exacerbations of COPD and treated 23% attacks of asthma. In the cases COPD bacteria were identified in 13 cases including Haemophilus influenzae [3], Streptococcus pneumoniae [3], Pseudomonas aeruginosa [3]. Amongst the 14 viruses recovered, the influenza virus [8] and the respiratory syncytial virus (VRS) [4] predominated. In 14 cases of acute asthma only 4 infectious agents were shown; Mycoplasma pneumoniae, influenza A, VRS and parainfluenza virus. The influenza virus was the agent most frequently discovered (26%) during the course of exacerbation of COPD and of asthma.

Bacteria↗
PubMed2004

[Active tobacco smoking as determinant of costs of inpatient treatment of COPD exacerbations].

The aim of the study was assessment of the influence of tobacco smoking on direct costs of in-hospital treatment of chronic obstructive pulmonary disease exacerbations (COPD). 112 men who underwent in-hospital treatment of exacerbation of moderate COPD in the years 2001-2002 were included in the study. The patients were qualified into one of three groups: I--never-smoking patients (n=40); II--former smokers (n=42); III--active smokers (n=30). The mean age of patients was 70.9 +/- 8.9 years (I--74.8 +/- 7.4; II--68.4 +/- 9.4; III--69.4 +/- 9.8). The mean direct cost of COPD patient treatment was PLN 2162.00 +/- 920.90 (I--PLN 2025.50 +/- 681.30; II--PLN 1875.80 +/- 608.70; III--PLN 2744.60 +/- 1266.20). The mean period of smoking was 18.3 pack-years in the group II and 27.7 pack-years in the group III. No significant differences in FEV1 were found between the groups. No significant differences were found in the treatment costs between the groups I and II. It was demonstrated that the costs of in-hospital COPD treatment are significantly higher in the group III than in the groups I and II. A linear regression formula was calculated, showing a linear relationship between each consecutive pack-year of addiction and the costs of exacerbation treatment in the group III (R=0.39, R2=0.13, standardized BETA index = 24.0; p<0.03). No similar relationship was found in the former smokers' group. The analysis of the data shows that: (1) active tobacco smoking by patients is related to significantly higher direct costs of in-hospital treatment of COPD exacerbations than in case of never-smoking patients or patients who smoked in the past, and (2) the costs of in-hospital treatment of COPD exacerbations in case of people who have stopped smoking are comparable to the costs of hospitalization of never-smoking patients with COPD.

Acute Disease↗
PubMed2005

Noninvasive positive-pressure ventilation in patients with milder chronic obstructive pulmonary disease exacerbations: a randomized controlled trial.

OBJECTIVES: To determine the effect of the addition of noninvasive positive-pressure ventilation (NPPV) to standard medical therapy on length of hospital stay among patients presenting with mild exacerbations of chronic obstructive pulmonary disease (COPD) requiring hospitalization. DESIGN: Randomized controlled unblinded study with concealed allocation. SETTING: Respiratory ward of a single-center, academic, tertiary-care hospital. PARTICIPANTS: Patients with a prior history of COPD who presented with a recent onset of shortness of breath and a pH of > 7.30 were eligible for inclusion in the study. INTERVENTIONS: NPPV daily for 3 days for intervals of 8, 6, and 4 hours, respectively, plus standard therapy, versus standard therapy alone. MEASUREMENTS: Borg dyspnea index at baseline, 1 hour, and daily. Length of hospital stay, endotracheal intubation, hospital survival. RESULTS: We found that NPPV was generally poorly tolerated, with only 12 of 25 patients wearing it for the prescribed 3 days. With the exception of a decrease in dyspnea at 1 hour and 2 days, significant between-group differences were not seen for any measured variable. CONCLUSIONS: The effectiveness and cost-effectiveness of the addition of NPPV to standard therapy in milder COPD exacerbations remains unclear. P(aCO(2)) related to this increased WOB that requires intervention with some form of assisted ventilation. All patients developing an exacerbation of COPD that requires hospitalization have an increased WOB and, we hypothesize, potentially develop some degree of associated respiratory muscle fatigue. We further hypothesize that adding intermittent NPPV during the initial days of hospital stay would afford respiratory muscle rest for patients with milder COPD exacerbations and that this rest would allow these patients to recover more quickly and to be discharged home earlier. The objective of this trial was to determine whether the addition of NPPV to standard therapy during the first 3 days of admission in milder COPD exacerbations could decrease length of hospital stay.

Aged↗
PubMed2005

[Q fever in acute exacerbation of chronic lower respiratory tract infection].

We studied the effect of Q fever in acute exacerbation of chronic lower respiratory tract infection. The subjects consisted of 80 cases with acute exacerbation of chronic lower respiratory tract infection treated during the period from March 2002 till October 2004. Q fever was diagnosed using a PanBio Coxiella burnetii ELISA test kit. Two cases (2.5%) were positive for IgM in the acute stage, and were diagnosed as having acute infection by C. burnetii. They were elderly women with bronchiectasis, aged 76 and 82. They had no history of keeping cats or dogs, but the onset of acute exacerbation of chronic lower respiratory tract infection was June and March which is the breeding seasons for cats and dogs. Acute exacerbation of chronic lower respiratory tract infection were considerd to be a mixed infection with Pseudomonas aeruginosa (the 76-year-case) and Haemophilus influenzae (the 82-year-case). It is concluded that C. burnetii can induce exacerbation of chronic lower respiratory tract infection, their cases were considerd to be mixed infection with C. burnetii and other bacteria.

Acute Disease↗
PubMed2006

Heliox and noninvasive positive-pressure ventilation: a role for heliox in exacerbations of chronic obstructive pulmonary disease?

Evidence-based respiratory therapy for exacerbations of chronic obstructive pulmonary disease (COPD) includes oxygen, inhaled bronchodilators, and noninvasive positive-pressure ventilation. Examining the physics of gas flow, a case can be made either for or against the use of helium-oxygen mixture (heliox) in the care of patients with COPD. The evidence for the use of heliox in patients with COPD exacerbation is not strong at present. Most of the peer-reviewed literature consists of case reports, case series, and physiologic studies in small samples of carefully selected patients. Some patients with COPD exacerbation have a favorable physiologic response to heliox therapy, but predicting who will be a responder is difficult. Moreover, the use of heliox is hampered by the lack of widespread availability of an approved heliox delivery system. Appropriately designed randomized controlled trials with patient-important outcomes, such as avoidance of intubation, decreased intensive-care-unit and hospital days, and decreased cost of therapy, are sorely needed to establish the role of heliox in patients with COPD exacerbation, including those receiving noninvasive positive-pressure ventilation. Lacking such evidence, the use of heliox in patients with COPD exacerbation cannot be considered standard therapy.

Biophysical Phenomena↗
PubMed2006

[Value of serum procalcitonin in diagnosing bacterial lower respiratory tract infections in people with exacerbation of Chronic Obstructive Pulmonary Disease].

OBJECTIVE: To investigate the changes and clinical implications of serum procalcitonin in exacerbation of chronic obstructive pulmonary disease (COPD). METHODS: We have evaluated PCT measurement in 45 patients with an exacerbation of COPD (group A) and 25 patients with stable COPD (group B), quantitative sputum culture was performed, too. PPMs were only regarded as significant if they reached a growth of > or =10(7) cfu/mL, indicating the presence of bacterial infection. RESULTS: In patients with an exacerbation, 15 patients, sputum yielded a high (> or =10(7) cfu/mL) bacterial load (group A1), 30 patients, sputum yielded a low (<10(7) cfu/mL) bacterial load or a negative bacterial culture (group A2). The levels of procalcitonin in sera from patients of group A1 were significantly higher than those from group A2 and group B [0.24 (0.17, 0.28) microg/L vs. 0.125 (0.10, 0.18) microg/L vs. 0.12 (0.10, 0.145) microg/L, P= 0.000, 0.000]. The levels of procalcitonin in sera from patients of group A2 were similar to those from group B (P>0.05). Using a cut-off point of 0.155 microg/L for PCT, the sensitivities and specificities for bacterial infection in patients with an exacerbation of COPD were 93.3% and 60% respectively. CONCLUSION: Serum procalcitonin measurements in patients of an exacerbation of chronic obstructive pulmonary disease play a role in the diagnosis of bacterial infection.

Aged↗
PubMed1987

[Features of the immune status of patients with infectious-allergic bronchial asthma before the onset of an exacerbation].

A study was made of the immune status in patients with infectious-allergic bronchial asthma in the phase of clinical manifestations before the onset of exacerbation 2 mos after examination, and in patients with a favorable course of disease without exacerbations during the same period of time. The assessment of the immune status was based on a study of the balance of interrelationships in a set of immunological parameters including the chief indices of cellular and humoral immunity (T- and B-lymphocytes, phagocytosing and rosette-forming neutrophils, indices of cell activity in exercise tests, the levels of serum and secretory immunoglobulins--a total of 33 indices). Sharp changes in values and direction of interrelationships in numerous combinations of parameters, especially in those which included the content of immunoglobulins in the sputum, indices of the activity of neutrophils and exercise tests were noted in the patients with exacerbation for 2 mos after examination as compared to those who developed no exacerbations. A special table for prediction of a course of infectious-allergic bronchial asthma was based on a study of the balance of interrelationships. Data obtained from the table corresponded to considerable changes revealed in the balance of interrelationships among components of the immune system 1-2 mos before the appearance of the clinical signs of exacerbation of the disease.

Adult↗
PubMed1987

Acute bacterial exacerbations in bronchitis and asthma.

Symptomatic exacerbations are frequent problems in the management of chronic bronchitis and bronchial asthma. Identification of a bacterial etiology as the cause of specific exacerbations should be based on changes in clinical symptoms and documentation of significant bronchial bacterial flora and a neutrophilic inflammatory response. Most acute bacterial exacerbations in patients with bronchitis or asthma are caused by Hemophilus influenzae, Streptococcus pneumoniae, or Branhamella catarrhalis. Treatment with ampicillins, synthetic tetracyclines, or trimethoprim/sulfamethoxazole is successful in 80 to 90 percent of bacterial exacerbations. Emergence of resistant Hemophilus species and pneumococci motivates development of new orally administered antimicrobial drugs. Appropriate treatment depends on the prompt recognition that bacterial infection is present. Once instituted, antimicrobial therapy should be continued for a minimum of 10 to 14 days, which should increase the duration of the infection-free period until the next bacterial exacerbation. Adequate response should be evaluated by the return of symptoms to pre-infectious levels and by decreased sputum bacterial flora and neutrophilic inflammation.

Anti-Bacterial Agents↗