Chest
Outcome Predictors in Bronchitis
Section snippets
PATHOPHYSIOLOGY
The hypersecretion of mucus in chronic bronchitis is due to hypertrophy of the submucosal glands and increase in the numbers of goblet cells in the epithelium at the expense of ciliated cells. Epithelial metaplasia also occurs, and together with abnormalities of ciliary function and mucus rheology, these changes lead to impairment of mucociliary clearance,4 an important first-line defense mechanism of the airways. Bronchoalveolar lavage and biopsy studies have provided evidence for the
A VICIOUS CIRCLE HYPOTHESIS OF BACTERIAL INFECTION IN CHRONIC BRONCHITIS
A variety of circumstances, singularly or in concert, may create permissive circumstances that allow bacteria in the respiratory tract to increase in number and spread. This may involve, for example, viral infection or inhalation of airborne pollutants, which cause inflammation and perturb mucosal defenses. Bacterial toxins (eg., ciliotoxins or IgAl proteases) contribute to the infection by overcoming residual host defenses and damaging the epithelium, and the variability of the surface of
ARE SOME PATIENTS PRONE TO RECURRENT INFECTIONS?
It has been suggested recently that some patients with chronic bronchitis are prone to recurrent acute exacerbations, while others with apparently similar degrees of lung damage are not.15 In this study, there were no differences in age, sex, or symptoms in the two groups, and the smoking history was greater in the noninfection-prone group. In a second-year follow-up study, nearly 80% of patients retained their original classification. If these observations15 are correct, then comparisons
OUTCOME PREDICTORS IN CHRONIC BRONCHITIS
Studies of community-acquired pneumonia have identified various criteria predictive of severity of disease and response to antibiotic therapy.17, 18 These have permitted the development of prognostic indices and scoring systems based on statistical analysis.17, 19, 20 However, severity classifications based on the symptoms of exacerbations of chronic bronchitis thus far produced21, 22, 23, 24, 25 have been largely empirical and have not been validated by clinical trials. An example of one such
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Cited by (46)
Infections of the lower respiratory tract
2010, Antibiotic and Chemotherapy: Expert ConsultPharmacologic therapy for acute exacerbations of chronic obstructive pulmonary disease: A review
2004, Critical Care Nursing Clinics of North AmericaCitation Excerpt :In those who require ICU admissions or who have FEV1 ≤ 35% predicted, gram-negative enteric bacteria may be common [90,91]. Published clinical opinion calls for further randomized, prospective trials and standardized methods to better characterize patient-specific and outcome-specific criteria for benefits of antibiotic therapy and especially to address hospital admission prevention, work loss, and quality-of-life issues [71,79–83,89,91,94]. Given this confusion, no definitive criteria exists for when and how to prescribe antibiotics in acute exacerbations of COPD.
The chronic obstructive pulmonary disease exacerbation
2000, Clinics in Chest MedicineCitation Excerpt :To reduce the risk for treatment failure, antibiotics should be selected according to pertinent clinical data and the potential for antimicrobial resistance. Several schemes have been proposed to stratify the patient's risk and select the most appropriate therapy.14,53,72,134 The simplest, and most recent, classification system is presented in Table 3.
Antibiotics are associated with lower relapse rates in outpatients with acute exacerbations of COPD
2000, ChestCitation Excerpt :Inasmuch as the relapse rates for patients with AECB are high, there are several schemes that have been proposed to risk stratify these patients. Some risk factors that have been suggested are age, presence or severity of underlying obstructive lung disease, comorbid conditions, frequency of exacerbations, and severity of symptoms at presentation.29,3233,3435 Although these proposed classifications have not been validated by a prospective randomized trial, some of these criteria have been studied in an attempt to identify risk factors predictive of treatment failure.36,3738,3949