Chest
Clinical InvestigationsCOPDAntibiotics Are Associated With Lower Relapse Rates in Outpatients With Acute Exacerbations of COPD
Section snippets
Materials and Methods
All patients with discharge diagnostic codes for COPD and bronchitis from our emergency department (ED) from December 1, 1995, to June 30, 1997, were included for review. Patients’ charts were evaluated if they had a pulmonary function test (PFT) within 3 years of their visit that met the criteria for COPD defined as FEV1 ≤ 80% predicted and FEV1 to FVC ratio ≤ 75%.1 The severity of each patient's COPD was classified as stage I (mild) if FEV1 was ≥ 50% predicted, stage II (moderate) if FEV1 was
Results
A total of 1,754 visits to the ED were assigned diagnostic codes for COPD or bronchitis during the 18-month study period. There were 632 patient-visits (36%) for which PFTs were available; 506 had criteria for COPD, and 362 of these met the study criteria and qualified for this analysis. Table 1 summarizes the specific reasons for excluding visits. The vast majority of exclusions were because no PFTs were available to support the diagnosis of COPD, even though they were coded as, and treated
Discussion
The major finding of our study is that patients with AECB who were given antibiotics at dismissal had a significantly lower 14-day relapse rate. The second important point is that patients who received amoxicillin had the highest relapse rate, even higher than the group not receiving antibiotics. Neither the severity of the patients’ underlying disease nor the severity of presenting symptoms were predictors of relapse. Despite their higher relapse rates, the patients who received either no
Conclusion
Patients with documented COPD, even with mild symptoms at presentation, benefit from antibiotic therapy. However, the choice of antibiotic is important (because resistant organisms are increasing and are likely contributing to treatment failures) and should probably be based on the resistance profile to antibiotics in the institution where the patient is being treated. We feel that this retrospective study raises many questions about the current treatment recommendations for AECB, and supports
ACKNOWLEDGMENT
The authors thank Francisco Villegas for assisting with the collection of data for this study.
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