Chest
Volume 112, Issue 6, Supplement, December 1997, Pages 310S-313S
Journal home page for Chest

Part 1: Beating Bronchitis
Guidelines for the Treatment of Acute Exacerbations of Chronic Bronchitis

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BACTERIAL PATHOGENS

Gump et al13 demonstrated that two thirds of all exacerbations are bacterial in origin. Haemophilus influenzae is the most commonly isolated organism from sputum in patients with acute exacerbations of chronic obstructive lung disease, but other Haemophilus species, Streptococcus pneumoniae, and Moraxella catarrhalis may also be found.14 Two studies utilizing the protected specimen brush technique, in which pure lower respiratory tract samples were obtained, indicated that the organisms

DEFINITION OF RISK FACTORS

It would be preferable to define a target population at risk based on severity of disease as has been done for patients with pneumonia.20 For example, patients with significant compromise of lung function may develop acute respiratory failure as a consequence of an acute exacerbation. Among these patients, 20 to 60% require mechanical ventilation, average hospital and ICU length of stays are long and expensive, and hospital mortality rates range from 10 to 30%.21 In North America, factors

STRATIFICATION OF PATIENTS ACCORDING TO RISK FACTORS

Therapeutic failure might be expected to lead to more hospitalizations, increased costs due to extra physician visits, prolonged absences from work, further diagnostic tests, and repeated courses of antibiotics in high-risk individuals. Routine chemotherapy fails in 13 to 25% or more of exacerbations.25, 26 Simple stratification of patients into risk categories should allow the physician to identify high-risk individuals and select targeted antimicrobial therapy to prevent some of these

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