Acute exacerbations of chronic bronchitis: Diagnosis and therapy

Diagnosis of an acute exacerbation of chronic bronchitis is based on a subjective assessment of symptoms and is confirmed when other diseases, such as pneumonia, bronchiectasis, and tuberculosis, are ruled out. Increased dyspnea, sputum production, and sputum purulence are the cardinal symptoms. A careful history and physical examination are usually sufficient in making the diagnosis, although a chest radiograph, sputum culture, or arterial blood gas analysis may be indicated in select patients. In patients with at least 2 of the cardinal symptoms, empiric antibiotic therapy with a macrolide, second-generation cephalosporin, or doxycycline is indicated. Patients with risk factors for poor outcome may benefit from amoxicillin-clavulanate or a newer fluoroquinolone. Because many exacerbations are attributed to infection, stratification of patients based on risk factors can help identify likely pathogens and guide treatment.