Q J Med 1995; 88: 61-68
© 1995 Association of Physicians
Acute infective exacerbations of chronic bronchitis
1 Infectious Diseases Dept, Victoria Hospital Kirkcaldy 2 Dept of Occupational and Environmental Medicine, Royal Brompton National Heart and Lung Institute London 3 Bayer plc, Bayer House Newbury 4 Host Defence Unit, Royal Brompton National Heart and Lung Institute London, UK
Address correspondence to Dr R. Wilson, Host Defence Unit, Department of Thoracic Medicine, Royal Brompton National Heart and Lung Institute, Emmanuel Kaye Building, Manresa Road, London SW3 6LR
Received 4 May 1994 Accepted for publication 21 October 1994.
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Abstract |
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Patients with an acute infective exacerbation of chronic bronchitis (AECB) (n = 471) were enrolled into a computer-based general-practice study to determine whether features of past history, presenting symptoms, or findings on examination were predicitive of failure to recover. The median age was 68, 56.3% were male, and 82% were current or ex-smokers. All had daily sputum production and 57.5% had moderate or severe airflow obstruction. During the AECB 11.5% were pyrexial, and 80.7% had abnormal auscultatory findings; about half had moderate to severe increases in dyspnoea and airflow obstruction, and the majority had increases in sputum volume and/or purulence. The median number of AECBs in the previous year was three, and one-third of patients had cardiopulmonarydisease. The only factors significantly (p<0.05) predicting failure to recover from an AECB were historical. Neither clinical features at presentation nor antibiotic treatment affected recovery. Coexistent cardiopulmonary disease was a risk factor for returning with a chest problem and for being referred to hospital. The number of chest infections in the previous 12 months was a risk factor for returning with a chest problem. The higher the number of chest infections, the higher the odds of returning with a chest problem. The best combination predicting return with a chest problem was history of cardiopulmonary disease and more than four previous AECBs in the last 12 months. The sensitivity was 75% and specificity 47%.
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