Patient evaluation profiles for acute exacerbations of chronic bronchitis

The use of antibiotics for treatment of patients with acute exacerbations of chronic bronchitis has been controversial. Consideration of outcome factors that assist in predicting a patient's response to therapy is a useful approach to optimal care. Host factors (eg, age, frequency of exacerbations); underlying illness (eg, type of pathogens, resistance patterns); type of treatment (first-line vs second-line antibiotics); and outcome measures (eg, definition of success vs failure) must all be considered when treating and evaluating the outcome of a patient with an acute exacerbation. Recently proposed classification systems, including the Canadian guidelines, have recommended stratifying patients based on the degree of their illness (ie, simple, complicated, complicated with comorbidity). The proposed benefits of stratifying patients by degree of illness include appropriate selection of first-line versus second-line antibiotics, minimizing the emergence of antibiotic-resistant pathogens, and providing more cost-effective therapy.