Management of acute exacerbation of chronic bronchitis.

In chronic bronchitis, a common respiratory illness marked by chronic productive cough and caused largely by cigarette smoking, bacterial exacerbations are thought to be a common cause of progressive airway damage. Common bacterial pathogens, found in 50% to 60% of episodes, include Haemophilus influenzae (the most common), as well as Haemophilus parainfluenzae, Streptococcus pneumoniae and Moraxella catarrhalis. Bacterial resistance to antibiotics, especially beta-lactam drugs such as amoxicillin, is increasingly common in these pathogens. In this illness, clinical risk stratification based on age, history and comorbidity is an important strategy. Patients in the lowest risk group likely have viral infections and require no specific treatment. Patients in the higher risk groups require aggressive treatment to avoid treatment failure, which can lead to prolonged hospitalization and complications. Preventive therapies (smoking cessation and influenza vaccination) are worthwhile measures for these patients.