Acute exacerbations of chronic bronchitis: Diagnosis and therapy

• Objective: To review the diagnosis and treatment of acute exacerbations of chronic bronchitis (AECB). • Methods: Qualitative assessment of the literature. • Results: The physician must first make an accurate determination of the cause of the AECB. Antibiotics are appropriate only for patients proven or suspected of having a bacterial infection. Patients with purulent sputum and multisymptom exacerbations have a greater likelihood of a bacterial pathogen and will benefit most from antibiotic therapy. When choosing an antibiotic, it is important to stratify patients with regard to clinical features suggesting a higher likelihood of treatment failure or of a shorter disease-free interval. Various classes of antibiotics are available for treatment of uncomplicated and complicated AECB, which allows the physician flexibility in treating the patient who recently has been exposed to a class of antibiotics. Given the increased likelihood of resistant isolates in such a patient, an agent from an alternate class may be ideal. Oral steroids are also an important component of therapy in AECBs, particularly in exacerbations of greater severity. Measures to reduce the risk of recurrence (ie, bronchodilators, steroids) should be considered as a means to prevent deterioration in health status and pulmonary function. • Conclusion: Given the negative effects of AECBs on patients' health status, appropriate treatment of AECBs and institution of interventions to prevent recurrent exacerbations is an important component in the management of patients with chronic obstructive pulmonary disease.