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Bronchitis: Patients
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Patients with chronic obstructive bronchitis usually have a daily cough, sputum production, shortness of breath (dyspnea), and sometimes wheezing. These symptoms typically appear in the age range from forty-five to sixty and gradually progress, particularly if cigarette smoking continues. In advanced cases, chronic respiratory failure may occur. Acute exacerbations of chronic bronchitis are intermittent episodes of increasing cough with discolored sputum, shortness of breath, and wheezing that typically occur one or two times each year. Viral or bacterial infection is a common cause of these episodes.
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Antibiotic therapy is of clinical benefit in certain patients with acute exacerbations of chronic bronchitis (AECB). In this randomised, investigator-blinded, multicentre trial, azithromycin (500mg once a day (qd) for 3 days) was compared with moxifloxacin (400mg qd for 5 days) for the treatment of outpatients with AECB (forced expiratory volume in 1s (FEV(1)) >35%). Of 342 patients randomised to either treatment, 169 received azithromycin and 173 received moxifloxacin. The mean age in the azithromycin and moxifloxacin groups was 56.4 years and 55.5 years, respectively. In the intent-to-treat analysis, clinical success rates for azithromycin and moxifloxacin were comparable at Days 10-12 (90% versus 90%, respectively) and Days 22-26 (81% versus 82%, respectively). Among patients who were culture-positive at baseline for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis or Haemophilus parainfluenzae, clinical efficacy for azithromycin versus moxifloxacin at Days 10-12 was 93% versus 84%, respectively, and at Days 22-26 it was 89% versus 73%, respectively.
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Chronic bronchitis can be categorized as simple chronic bronchitis, chronic mucopurulent bronchitis, or chronic bronchitis with obstruction. Mucoid sputum production characterizes simple chronic bronchitis. Persistent or recurrent purulent sputum production in the absence of localized suppurative disease, such as bronchiectasis, characterizes chronic mucopurulent bronchitis. Chronic bronchitis with obstruction must be distinguished from chronic infective asthma. The differentiation is based mainly on the history of the clinical illness. Patients who have chronic bronchitis with obstruction present with a long history of productive cough and late onset of wheezing, whereas patients who have asthma with chronic obstruction have a long history of wheezing with late onset of productive cough.
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Simple cases of acute bronchitis are treated like a common cold. The patient is told to drink plenty of fluids, to rest, and to avoid smoking. An air humidifier should be used to increase moisture in the air. Acetaminophen (pronounced uh-see-tuh-MIN-uh-fuhn, trade names Datril, Tylenol, Panadol) should be taken for fever and pain. Aspirin should not be given to children because it may cause the serious illness Reye's syndrome (see Reye's syndrome entry).
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A few patients with acute bronchitis suffer from persistent cough beyond seven to ten days, requiring management with inhaled bronchodilators such as albuterol. Persistent cough along with sore throat (pharyngitis) may suggest infection from Mycoplasma pneumoniae or Chlamydia pneumoniae, prompting treatment with an antibiotic (doxycycline, erythromycin, clarithromycin, or azithromycin). A persistent, violent, barking cough may be a clue to infection from Bordetella pertussis. This fairly common problem may respond to a one- or two-week course of antibiotic treatment with erythromycin. A cough that persists for more than three weeks is termed "chronic cough." Occasionally chronic cough follows an episode of acute bronchitis.
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Chronic bronchitis is the most common condition in the category of chronic obstructive pulmonary disease (COPD). It has been estimated that 14 to 15 million persons in the United States have COPD and that of those, 12 million have chronic bronchitis. Although emphysema is sometimes considered synonymous with COPD, it accounts for only a minority of patients with COPD; indeed, it is often seen in conjunction with chronic bronchitis. It is ... worth noting that unlike chronic bronchitis, emphysema is a pathologic rather than a clinical diagnosis.
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