Advertisement

Severe Acute Exacerbations of COPD: Epidemiology and Antimicrobial Treatment

  • S. Ewig
  • N. Soler
  • A. Torres

Abstract

Severity criteria for exacerbations of chronic obstructive pulmonary disease (COPD) have not yet been defined as they have for pneumonia. Therefore, investigators have usually adopted pragmatic criteria to define their study populations according to the subject of the study. For example, studies addressing modalities of ventilatory support have used acute severe hypoxemia and/or hypercapnic failure as entry criteria [1-5]. Most studies evaluating antimicrobial treatment have characterized the populations studied by the severity of airflow limitation in stable states and/or during exacerbations [6-9]. However, patients with severe airflow limitation (e.g. forced expiratory volume in one second - FEV1 - < 35% predicted) in stable states or during an exacerbation may or may not present with acute respiratory failure and vice versa. On the other hand, a recent study has provided evidence that patients with severe airflow limitation may be more likely to have an infection by gram-negative enterobacteriaceae (GNEB) or Pseudomonas aeruginosa [9] but it is not known whether the type of pathogen independently predicts severe exacerbations.

Keywords

Chronic Obstructive Pulmonary Disease Acute Exacerbation Antimicrobial Treatment Severe Exacerbation Moraxella Catarrhalis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Jeffrey AA, Warren PW, Flenley DC (1992) Acute hypercapnic respiratory failure in patients with chronic obstructive lung disease: risk factors and use of guidelines for management. Thorax 47:34–40PubMedCrossRefGoogle Scholar
  2. 2.
    Bott J, Carroll MP, Conway JH, Keilty SE, Ward EM, Brown AM, Paul EA, Elliott MW, Godfrey RC, Wedzicha JA (1993) Randomized controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet 341:1555–1557PubMedCrossRefGoogle Scholar
  3. 3.
    Seneff MG, Wagner DP, Wagner RP, et al. (1995) Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbations of chronic obstructive pulmonary disease. JAMA 274:1852–1857PubMedCrossRefGoogle Scholar
  4. 4.
    Brochard L, Mancebo J, Wysocki M, et al. (1995) Non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 333:817–822PubMedCrossRefGoogle Scholar
  5. 5.
    Moran JL, Green JV, Homan SD, Lesson RJ, Leppard PI (1998) Acute exacerbations of chronic obstructive pulmonary disease and mechanical ventilation: a reevaluation. Crit Care Med 26:71–78PubMedCrossRefGoogle Scholar
  6. 6.
    Nicotra MB, Rivera M, Awe RJ (1982) Antibiotic therapy of acute exacerbations of chronic bronchitis. Ann Intern Med 97:18–21PubMedGoogle Scholar
  7. 7.
    Anthonisen NR, Manfreda J, Warren CPW, Hershfield ES, Harding GKM, Nelson NA (1987) Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 106:196–204PubMedGoogle Scholar
  8. 8.
    Sachs APE, Koeter GH, Groenier KH, van der Waaij D, Schiphuis J, Meyboom-de Jong B (1995) Changes in symptoms, peak expiratory flow, and sputum flora during treatment with antibiotics of exacerbations in patients with chronic obstructive pulmonary disease in general practice. Thorax 50:758–763PubMedCrossRefGoogle Scholar
  9. 9.
    Eller J, Ede A, Schaberg T, Niederman MS, Mauch H, Lode H (1998) Infective exacerbations of chronic bronchitis. Relation between bacteriology etiology and lung function. Chest 113:1542–1548PubMedCrossRefGoogle Scholar
  10. 10.
    American Thoracic Society Statement (1995) Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 152:S97–S106Google Scholar
  11. 11.
    Fuso L, Incalzi RA, Pistelli R, Muzzolon R, Valente S, Pagliari G, Gliozzi F, Ciappi G (1995) Predicting mortality of patients hospitalized for acutely exacerbated chronic obstructive pulmonary disease. Am J Med 98:272–277PubMedCrossRefGoogle Scholar
  12. 12.
    Connors AF, Dawson NV, Thomas C, Harrell FE. Jr, Desbiens N, Fulkerson WJ, Kussin P, Bellamy P, Goldman L, Knaus WA. for the SUPPORT Investigators (1996) Outcomes following acute exacerbation of severe chronic obstructive lung disease. Am J Respir Crit Care Med 154:959–967PubMedGoogle Scholar
  13. 13.
    Fagon JY, Chastre J, Trouillet JL, Domart Y, Dombret MC, Bornet M, Gibert C (1990) Characterization of distal bronchial microflora during acute exacerbations of chronic bronchitis. Am Rev Respir Dis 142:1004–1008PubMedGoogle Scholar
  14. 14.
    Soler N, Torres A, Ewig S, Gonzalez J, Celis R, El-Ebiary M, Hernandez C, Rodriguez-Roisin R (1998) Bronchial microbial patterns in severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation. Am J Respir Crit Care Med 157:1498–1505PubMedGoogle Scholar
  15. 15.
    Beaty CD, Grayston JT, Wang SP, Kuo CC, Reto CS, Martin TR (1991) Chlamydia pneumoniae, strain TWAR, infection in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 144:1408–1410PubMedGoogle Scholar
  16. 16.
    Blasi F, Legnani D, Lombardo VM, Negretto GG, Magliano E, Pozzoli, Chiodo F, Fasoli F, Allegra L (1993) Chlamydia pneumoniae infection in acute exacerbations of COPD. Eur Respir J 6:19–22PubMedGoogle Scholar
  17. 17.
    Gump DW, Phillips CA, Forsyth BR, Mcintosh K, Lamborn KR, Stouch WH (1976) Role of infection in chronic bronchitis. Am Rev Respir Dis 113:465–474PubMedGoogle Scholar
  18. 18.
    Saint S, Bent S, Vittinghoff E, Grady D (1995) Antibiotics in chronic obstructive pulmonary disease exacerbations. A meta-analysis. JAMA 273:957–960PubMedCrossRefGoogle Scholar
  19. 19.
    Ewig S, Soler N, Gonzalez J, El-Ebiary M, Celis R, Torres A (2000) Evaluation of antimicrobial treatment in mechanically ventilated patients with severe COPD exacerbations. Crit Care Med (in press)Google Scholar

Copyright information

© Springer-Verlag Italia 2000

Authors and Affiliations

  • S. Ewig
    • 1
  • N. Soler
    • 2
  • A. Torres
    • 1
  1. 1.Department of Internal Medicine and Respiratory DiseasesUniversity of BonnBonnGermany
  2. 2.Hospital Clinic i Provincial, Department of Respiratory Diseases and AllergologyUniversity of BarcelonaBarcelonaSpain

Personalised recommendations