Acute exacerbation of chronic bronchitis (AECB)

- Chronic bronchitis - productive cough for at least 3 months/year for at least 2 consecutive years.

- Criteria for acute exacerbation of chronic bronchitis:

• ↑ sputum volume

• ↑ sputum purulence

• ↑ dyspnea.

- Antibiotic therapy is only recommended if two or more of above criteria are present.

- Approximately 50% of acute exacerbations of chronic bronchitis are viral in etiology.

- No class of antibiotic has been shown to be superior to amoxicillin in the management of AECB.

- Adjunctive therapy is essential to management:

• smoking cessation

• bronchodilators:

  • Ipratropium (Atrovent^®) and short acting B-agonists (fenoterol, salbutamol, terbutaline) are effective in combination.

  • Long acting B-agonists (formoterol, salmeterol) or anticholinergics (tiotropium) are not currently indicated in the management of AECB but may be useful in chronic COPD.

• corticosteroids:

  • Systemic corticosteroids are indicated in most cases (prednisone 0.5-1mg/kg/d for 3-14 days).

  • Inhaled corticosteroids are not indicated in the management of AECB but may be useful in chronic COPD.

• O₂ therapy.

- COPD patients should be given annual influenza vaccine, and pneumococcal vaccine where indicated.

- The role of Mycoplasma pneumoniae and Chlamydia pneumoniae in AECB has not been fully established. Empiric therapy for these organisms is not recommended.