What is bronchitis allergy

Allergic Rhinitis and Bronchitis in Rabbits

Summary Information
Diseases / List of Miscellaneous / Metabolic / Multifactorial Diseases / Disease summary
Alternative Names
Disease Agents Allergens, unidentified. (B601.7.w7)
Infectious Agent(s)
Non-infectious Agent(s)
Physical Agent(s)
General Description
  1. Signs of respiratory tract disease (epiphora, rhinitis, sneezing, conjunctivitis, chronic bronchitis) in the absence of other causes of such signs.

    (B601.7.w7, B602.17.w17, J60.6.w1, P3.2000b.w2)

Further Information
  1. It is significant to law out other causes of respiratory disease before making a diagnosis of allergic rhinitis/bronchitis. (B601.7.w7, P3.2000b.w2)
  2. This is a diagnosis based on consistent clinical signs and the absence of other definitive diagnosis. (P3.2000b.w2)
Treatment
  • If possible, identify and eliminate the allergen(s) from the rabbit’s environment.

    (B602.17.w17, J60.6.w1)

    1. Dusty hay, pollen and wood shavings may be sources of allergens for outdoor rabbits. (J60.6.w1)
    2. For indoor rabbits, aerosols, cigarette smoke, air fresheners, perfumes etc. may be present in their environment. (J60.6.w1)
  • Antihistamines or corticosteroids to reduce inflammation. (B601.7.w7, B602.17.w17, J60.6.w1, P3.2000b.w2)
  • Antihistamines can be used at the same doses as in cats of similar size. (P3.2000b.w2)
  • Note: do not use corticosteroids in rabbits with chronic pasteurellosis (Pasteurellosis in Lagomorphs).

    What is bronchitis allergy

    (B601.7.w7, B602.17.w17)

  • Use corticosteroids with care due to their immunosuppressive and possible hepatotoxic effects. (B601.7.w7)
    1. Chodosh S. Clinical significance of the infection-free interval in the management of acute bacterial exacerbations of chronic bronchitis. Chest. 2005;127(6):2231-6. [PMID:15947342]

      Comment: Author discusses a new goal with antibiotics for AECB: delay in the time to the next exacerbation or the infection — free — interval (IFI).

    2. Dimopoulos G, Siempos II, Korbila IP, et al. Comparison of first-line with second-line antibiotics for acute exacerbations of chronic bronchitis: a metaanalysis of randomized controlled trials.

      Chest. 2007;132(2):447-55. [PMID:17573508]

      Comment: First line agents (ampicillin, TMP-SMX and doxycycline) vs. 2nd line (amox-CA, macrolides, quinolines and 3d gen cephalosporins). First line agents were inferior (RR 0.5).

    3. Murphy TF, Brauer AL, Grant BJ, et al. Moraxella catarrhalis in chronic obstructive pulmonary disease: burden of disease and immune response. Am J Respir Crit Care Med. 2005;172(2):195-9. [PMID:15805178]

      Comment: The Buffalo group has studied this cohort of 104 pts with COPD for 10 years with monthly sputum cultures.

      In this study they showed M. catarrhalis was newly detected in 57 of 560 exacerbations. This was accompanied by a serologic response and clearance. They conclude M. catarrhalis causes 10% of exacerbations.

    4. Wilson R, Jones P, Schaberg T, et al. Antibiotic treatment and factors influencing short and endless term outcomes of acute exacerbations of chronic bronchitis. Thorax. 2006;61(4):337-42. [PMID:16449273]

      Comment: Patients with AECB were randomized to treatment with moxifloxacin or placebo.

      Clinical cure was significantly associated with antibiotic treatment (OR 1.5) and negatively associated with age >65, and bronchodilator use. The conclusion was that the benefit of moxifloxacin was seen primarily in those >65 yrs.

    5. Han MK, Tayob N, Murray S, et al. Predictors of chronic obstructive pulmonary disease exacerbation reduction in response to daily azithromycin therapy. Am J Respir Crit Care Med. 2014;189(12):1503-8. [PMID:24779680]

      Comment: Role of azithromycin for prevention in COPD remains controversial.

      Authors here propose that daily use of drug was most helpful in older patients and with GOLD scores of 1 or 2 (milder disease). Use of the drug did seem to prevent flares that required both antibiotic and steroid therapy.

    6. Albert RK, Connett J, Bailey WC, et al. Azithromycin for prevention of exacerbations of COPD. N Engl J Med. 2011;365(8):689-98. [PMID:21864166]

      Comment: This is a randomized controlled trial in 1,142 patients with COPD given placebo vs.

      azithromycin 250 mg/day. azithromycin recipients had a significant reduction in exacerbations (1.5/year vs. 1.8/year; p=< 0.001) and improved lung function.

    7. Pines A, Raafat H, Plucinski K, et al. Antibiotic regimens in severe and acute purulent exacerbations of chronic bronchitis. Br Med J. 1968;2(5607):735-8. [PMID:4872151]

      Comment: One of numerous controlled trials of tetracycline vs. placebo in 149 patients hospitalized for AECB.

      What is bronchitis allergy

      There was SIGNIFICANT BENEFIT FOR TETRACYCLINE TREATMENT in terms of symptom scores and peak expiratory flow rate.

    8. Fernaays MM, Lesse AJ, Sethi S, et al. Differential genome contents of nontypeable Haemophilus influenzae strains from adults with chronic obstructive pulmonary disease. Infect Immun. 2006;74(6):3366-74. [PMID:16714566]

      Comment: The authors, noted authorities on COPD, examined genetic differences between 59 H.

      influenza strains implicated in exacerbations of COPD and 73 that merely colonized the lower airway in these patients. They noted gene patterns that were associated with exacerbations supporting the thesis that these strains own greater pathogenic potential.
      Rating: Important

    9. [Note: Steroid hepatopathy has been reported in dogs but there are no published reports of this in rabbits.]
    10. Bjerkestrand G, Digranes A, Schreiner A. Bacteriological findings in transtracheal aspirates from patients with chronic bronchitis and bronchiectasis: a preliminary report.

      Scand J Respir Dis. 1975;56(4):201-7. [PMID:1198085]

      Comment: The tracheobronchial tree under the larynx is normally sterile. This study using transtracheal aspirations shows that about one-third of patients with chronic bronchitis own COLONIZATION OF THE LOWER AIRWAYS by the same bacteria implicated as the major causes of AECB—H influenzae and S. pneumoniae. This presumably accounts for the common observation that sputum cultures show the same bacteria during stability and during exacerbations.

    11. Snow V, Lascher S, Mottur-Pilson C, et al. Evidence base for management of acute exacerbations of chronic obstructive pulmonary disease.

      Ann Intern Med. 2001;134(7):595-9. [PMID:11281744]

      Comment: Position paper of ACP for managing exacerbations of chronic bronchitis. Indications to Rx: Increased dyspnea, increased cough AND increased sputum purulence. Agents recommended: Amoxicillin, doxycycline, TMP-SMX.

    12. Sethi S, Wrona C, Grant BJ, et al. Strain-specific immune response to Haemophilus influenzae in chronic obstructive pulmonary disease. Am J Respir Crit Care Med.

      2004;169(4):448-53. [PMID:14597486]

      Comment: Longitudinal study of patients with COPD showing some exacerbations are associated with an immune response to a newly acquired strain of H. influenzae. (This supports the role of H. flu as a pathogen in exacerbations).

    13. Murphy TF, Brauer AL, Schiffmacher AT, et al. Persistent colonization by Haemophilus influenzae in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;170(3):266-72. [PMID:15117742]

      Comment: Analysis of sequential (monthly) samples of sputum from patients with COPD defined a group with a less than six month lapse with negative cultures for H flu.

      The subsequently recovered strain was identical to the initial isolate suggesting it was always there and that sputa culture are unreliable sources of this agent.

    14. Vollenweider DJ, Jarrett H, Steurer-Stey CA, et al. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2012;12:CD010257. [PMID:23235687]

      Comment: Review of trials of abx v. placebo RCTs only (2068 pts), found benefit in patient in ICU while those on non-ICU hospitalizations and outpatients were not consistent.

      Of note, these trials ranged in years from 1957 to 2012. There was no apparent impact on mortality or LOS in hospital for those patients.

    15. Wedzicha JA. Role of viruses in exacerbations of chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2004;1(2):115-20. [PMID:16113423]

      Comment: Viruses implicated in 168 cases in 83 patients are: Every viruses — 66 (40%), Rhinovirus — 59% (of the 66), RSV — 29%, Coronavirus -11%, influenza — 16%.

    16. Sethi S. Bacteria in exacerbations of chronic obstructive pulmonary disease: phenomenon or epiphenomenon?

      Proc Am Thorac Soc. 2004;1(2):109-14. [PMID:16113422]

      Comment: The author reviews methods and conclusions of studies to determine exacerbations of COPD with 2 categories: 1) Conventional: sputum culture, serology & placebo-controlled trial; 2) New: Bronchoscopic sampling, molecular epi of sputum isolates, immune response & markers of airway inflammation. Most exciting are the new methods which include studies showing a new strain of H. influenzae is associated w/some exacerbations & there is an immune response that is strain specific to support its potential role.

    17. Emerman CL, Lukens TW, Effron D. Physician estimation of FEV1 in acute exacerbation of COPD. Chest. 1994;105(6):1709-12. [PMID:7911418]

      Comment: The authors show PHYSICIAN ESTIMATES OF THE SEVERITY OF AIRWAY OBSTRUCTION in exacerbations of COPD correlate poorly with FEV-1 measurements

    18. Emerman CL, Cydulka RK. Use of peak expiratory flow rate in emergency department evaluation of acute exacerbation of chronic obstructive pulmonary disease.

      Ann Emerg Med. 1996;27(2):159-63. [PMID:8629745]

      Comment: The authors show the ADVANTAGES OF MEASURING FEV-1 AND/OR PEFR for baseline evaluation and response to treatment. Both require patient effort

    19. Mensa J, Trilla A. Should patients with acute exacerbation of chronic bronchitis be treated with antibiotics? Advantages of the use of fluoroquinolones. Clin Microbiol Infect. 2006;12 Suppl 3:42-54. [PMID:16669928]

      Comment: The authors make a case for fluoroquinolones as preferred antibiotics for exacerbation of COPD because: Purulent sputum is a excellent indicator of large bacterial load.

      Fluoroquinolones penetrate mucous well, they are bactericidal and they reduce bacterial load better than beta-lactams or macrolides. (Nevertheless, clinical trials don’t show these advantages).

    20. Anthonisen NR, Manfreda J, Warren CP, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med. 1987;106(2):196-204. [PMID:3492164]

      Comment: There are numerous trials of antibiotics, but this is THE BEST AND MOST QUOTED TRIAL.

      Anthonisen et al, studied 362 exacerbations and showed that antibiotics own a significant benefit, but only when the exacerbation is relatively severe with at least 2 of the major 3 symptoms—increased cough, sputum, and sputum purulence. Clinical success was noted in this group for 75% of antibiotic recipients vs. 63% of placebo recipients. This is shut, but the number of patients was sufficiently high to shove it over the p=0.05 threshold for statistical significance.

      Rating: Important

    21. Long-term use of corticosteroids might trigger latent Pasteurella or other bacterial infection. (J60.6.w1, P3.2000b.w2)
    22. Wiedemann HP, McCarthy K. Noninvasive monitoring of oxygen and carbon dioxide. Clin Chest Med. 1989;10(2):239-54.

      What is bronchitis allergy

      [PMID:2661121]

      Comment: The data support use OF PULSE OXIMETRY to assess oxygenation except when O2 saturation is < 70%

    23. Albertson TE, Louie S, Chan AL. The diagnosis and treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease and chronic bronchitis. J Am Geriatr Soc. 2010;58(3):570-9. [PMID:20398122]

      Comment: Recommended antibiotics for exacerbations of COLD: amoxicillin, ampicillin, pivampicillin, trimethoprim/sulfamethoxazole and doxycycline. «Second line agents:» amoxicillin/clavulanic acid, second and third generation cephalosporins and fluoroquinolones.

      The latter are described as better versus resistant bacteria but risk driving resistance.

    24. Gump DW, Phillips CA, Forsyth BR, et al. Role of infection in chronic bronchitis. Am Rev Respir Dis. 1976;113(4):465-74. [PMID:1267252]

      Comment: One of the MOST COMPREHENSIVE STUDIES EVER DONE. Authors followed a group of pts with chronic bronchitis & obtained quantitative bacterial cultures of sputum & viral cx at 2-week intervals.

      They showed that exacerbations of bronchitis were often due to viral infection (positive cultures in 32% of exacerbations vs. <1% in periods of stability), sputum bacterial culture showed no significant changes in either frequency of recovery or counts of the large 2—H. flu & S. pneumo). S. pneumo was recovered in 37% of exacerbations & in 33% of control periods; for H. flu, it was 57% & 60%, respectively

    25. Nouira S, Marghli S, Belghith M, et al. Once daily oral ofloxacin in chronic obstructive pulmonary disease exacerbation requiring mechanical ventilation: a randomised placebo-controlled trial. Lancet.

      2001;358(9298):2020-5. [PMID:11755608]

      Comment: Results showed a benefit of ofloxacin with mortality decrease (4% vs 22%) & reduced duration hospitalization & mechanical ventilation. The study raised concerns about ethics of a placebo control with such seriously ill pts, but the accompanying editorial notes that the benefit of antibiotics had never been clearly shown.
      Rating: Important

    26. Jørgensen AF, Coolidge J, Pedersen PA, et al. Amoxicillin in treatment of acute uncomplicated exacerbations of chronic bronchitis.

      A double-blind, placebo-controlled multicentre study in general practice. Scand J Prim Health Care. 1992;10(1):7-11. [PMID:1589668]

      Comment: One of numerous controlled trials of amoxicillin vs. placebo, this one with 262 outpatients with AECB. Analysis by symptom score and peak expiratory flow rate showed NO ADVANTAGE FOR ANTIBIOTICS.

    27. Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA. 1997;278(11):901-4. [PMID:9302241]

      Comment: This review of antibiotic prescribing patterns shows that exacerbations of chronic bronchitis account for 5-10% OF Every ANTIBIOTIC SCRIPTS in the U.S.

      This is a large market.

    28. Seemungal T, Harper-Owen R, Bhowmik A, et al. Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;164(9):1618-23. [PMID:11719299]

      Comment: Study of 168 exacerbations — viruses found in 67 (40%) — most common were rhinovirus and RSV.

    29. Saint S, Bent S, Vittinghoff E, et al. Antibiotics in chronic obstructive pulmonary disease exacerbations.

      A meta-analysis. JAMA. 1995;273(12):957-60. [PMID:7884956]

      Comment: A META-ANALYSIS OF ANTIBIOTIC TRIALS, which shows a slight advantage to these drugs compared to placebo. The benefit was measured in duration of symptoms and in peak expiratory flow rates, but the advantage of antibiotics was tiny and was statistically significant only because the numbers were large.
      Rating: Important

  • Associated Techniques
    Host taxa groups /species
    Disease Author Debra Bourne MA VetMB PhD MRCVS (V.w5)
    Referees Brigitte Reusch BVet Med (Hons) CertZooMed MRCVS (V.w127)

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    How to Treat and Get Rid of Bronchitis With Antibiotics and Other Medicines

    Most of the Time, Bronchitis Will Clear on Its Own

    If a bacterial infection is ruled out and a virus is suspected to be the cause, the bronchitis will typically clear up on its own without treatment.

    The cough may persist for some weeks afterward though.

    Because the illness generally resolves on its own, Picone advocates taking a minimalist approach when you first notice symptoms. Hold hydrated, particularly when you own a fever, and avoid medication, unless you own an underlying complication love asthma.

    If you notice yellow or green mucus along with your cough, don’t be too concerned, says Enrique Machare-Delgado, MD, a pulmonary physician at the Mayo Clinic in La Crosse, Wisconsin.

    Such mucus is an indication of inflammation rather than infection, and it should resolve on its own.

    So when should you see a doctor? If the mucus stays yellow or green for more than two or three days, Dr. Machare-Delgado recommends visiting a doctor. Over that time it should start to turn white or transparent to indicate you’re healing.

    Antibiotics: When They Work for Bronchitis and When They Don’t

    When bronchitis is caused by a virus, which is the case for most incidences of bronchitis, antibiotics won’t clear up the infection, since antibiotics only assist fight bacterial infections.

    Your doctor may order sputum tests from a laboratory to law out the possibility of a bacterial or fungal infection. And if a bacterial infection is found to be the cause, antibiotics may be prescribed.

    It’s worth noting, however, an October 2015 study in the American Journal of Managed Care shows that numerous doctors continue to prescribe antibiotics for acute bronchitis despite public health campaigns to stop the practice. (The overprescription of antibiotics can contribute to making certain forms of pneumonia, tuberculosis, and other diseases harder to treat globally.) (7)

    According to Picone: “Doctors face a lot of pressure from patients to prescribe antibiotics, but generally [for bronchits] the drugs are unnecessary because they won’t combat viruses.”

    Treatments

    Although it can be a progressive disease, patients that are diagnosed before much bronchial damage occurs often own a excellent prognosis.

    Untreated chronic bronchitis can be extremely serious, and people with chronic bronchitis own an increased risk of developing other illnesses, such as colds or pneumonia.

    The main way to treat chronic bronchitis is to avoid the irritant. For allergy-induced bronchitis, this means removing the allergens from the home or work environment. For smokers, this means quitting smoking.

    If chronic bronchitis is caused by allergens, we may treat it with antihistamine medications to reduce the allergic reaction. You may also be prescribed other medications. Bronchodilators can assist to open the airways, and steroids can assist to reduce the inflammation.

    For severe or extremely long-term cases, your doctor may prescribe oxygen therapy.

    What About Over-the-Counter Medications?

    Doctors may prescribe over-the-counter medications such as pain relievers (analgesics), cough expectorants (such as guaifenesin, hydrocodone, or pseudoephedrine), decongestants, bronchodilators, or corticosteroids to treat symptoms.

    But over-the-counter medications love cough expectorants and decongestants own not been proven to be effective, says Picone. He suggests avoiding decongestants and medications with codeine. While codeine may assist suppress a cough, it is also a powerful narcotic, and it won’t necessarily treat the cause of the symptoms or quicken your recovery. (8)

    Machare-Delgado is equally critical of the numerous over-the-counter medications, which he says are not supported by evidence. He adds that because they generally contain numerous diverse ingredients, it’s not possible to establish what works or doesn’t work.

    Learn More About How to Treat Acute Bronchitis

  • Han MK, Tayob N, Murray S, et al.

    Predictors of chronic obstructive pulmonary disease exacerbation reduction in response to daily azithromycin therapy. Am J Respir Crit Care Med. 2014;189(12):1503-8. [PMID:24779680]

    Comment: Role of azithromycin for prevention in COPD remains controversial. Authors here propose that daily use of drug was most helpful in older patients and with GOLD scores of 1 or 2 (milder disease). Use of the drug did seem to prevent flares that required both antibiotic and steroid therapy.

  • Vollenweider DJ, Jarrett H, Steurer-Stey CA, et al. Antibiotics for exacerbations of chronic obstructive pulmonary disease.

    Cochrane Database Syst Rev. 2012;12:CD010257. [PMID:23235687]

    Comment: Review of trials of abx v. placebo RCTs only (2068 pts), found benefit in patient in ICU while those on non-ICU hospitalizations and outpatients were not consistent. Of note, these trials ranged in years from 1957 to 2012. There was no apparent impact on mortality or LOS in hospital for those patients.

  • Albert RK, Connett J, Bailey WC, et al.

    Azithromycin for prevention of exacerbations of COPD. N Engl J Med. 2011;365(8):689-98. [PMID:21864166]

    Comment: This is a randomized controlled trial in 1,142 patients with COPD given placebo vs. azithromycin 250 mg/day. azithromycin recipients had a significant reduction in exacerbations (1.5/year vs. 1.8/year; p=< 0.001) and improved lung function.

  • Albertson TE, Louie S, Chan AL. The diagnosis and treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease and chronic bronchitis.

    J Am Geriatr Soc. 2010;58(3):570-9. [PMID:20398122]

    Comment: Recommended antibiotics for exacerbations of COLD: amoxicillin, ampicillin, pivampicillin, trimethoprim/sulfamethoxazole and doxycycline. «Second line agents:» amoxicillin/clavulanic acid, second and third generation cephalosporins and fluoroquinolones. The latter are described as better versus resistant bacteria but risk driving resistance.

  • Dimopoulos G, Siempos II, Korbila IP, et al. Comparison of first-line with second-line antibiotics for acute exacerbations of chronic bronchitis: a metaanalysis of randomized controlled trials. Chest. 2007;132(2):447-55.

    [PMID:17573508]

    Comment: First line agents (ampicillin, TMP-SMX and doxycycline) vs. 2nd line (amox-CA, macrolides, quinolines and 3d gen cephalosporins). First line agents were inferior (RR 0.5).

  • Mensa J, Trilla A. Should patients with acute exacerbation of chronic bronchitis be treated with antibiotics? Advantages of the use of fluoroquinolones. Clin Microbiol Infect. 2006;12 Suppl 3:42-54. [PMID:16669928]

    Comment: The authors make a case for fluoroquinolones as preferred antibiotics for exacerbation of COPD because: Purulent sputum is a excellent indicator of large bacterial load.

    Fluoroquinolones penetrate mucous well, they are bactericidal and they reduce bacterial load better than beta-lactams or macrolides. (Nevertheless, clinical trials don’t show these advantages).

  • Fernaays MM, Lesse AJ, Sethi S, et al. Differential genome contents of nontypeable Haemophilus influenzae strains from adults with chronic obstructive pulmonary disease. Infect Immun. 2006;74(6):3366-74. [PMID:16714566]

    Comment: The authors, noted authorities on COPD, examined genetic differences between 59 H.

    influenza strains implicated in exacerbations of COPD and 73 that merely colonized the lower airway in these patients. They noted gene patterns that were associated with exacerbations supporting the thesis that these strains own greater pathogenic potential.
    Rating: Important

  • Wilson R, Jones P, Schaberg T, et al. Antibiotic treatment and factors influencing short and endless term outcomes of acute exacerbations of chronic bronchitis. Thorax. 2006;61(4):337-42.

    [PMID:16449273]

    Comment: Patients with AECB were randomized to treatment with moxifloxacin or placebo. Clinical cure was significantly associated with antibiotic treatment (OR 1.5) and negatively associated with age >65, and bronchodilator use. The conclusion was that the benefit of moxifloxacin was seen primarily in those >65 yrs.

  • Chodosh S. Clinical significance of the infection-free interval in the management of acute bacterial exacerbations of chronic bronchitis.

    Chest. 2005;127(6):2231-6. [PMID:15947342]

    Comment: Author discusses a new goal with antibiotics for AECB: delay in the time to the next exacerbation or the infection — free — interval (IFI).

  • Murphy TF, Brauer AL, Grant BJ, et al. Moraxella catarrhalis in chronic obstructive pulmonary disease: burden of disease and immune response. Am J Respir Crit Care Med. 2005;172(2):195-9. [PMID:15805178]

    Comment: The Buffalo group has studied this cohort of 104 pts with COPD for 10 years with monthly sputum cultures.

    In this study they showed M. catarrhalis was newly detected in 57 of 560 exacerbations. This was accompanied by a serologic response and clearance. They conclude M. catarrhalis causes 10% of exacerbations.

  • Sethi S, Wrona C, Grant BJ, et al. Strain-specific immune response to Haemophilus influenzae in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;169(4):448-53. [PMID:14597486]

    Comment: Longitudinal study of patients with COPD showing some exacerbations are associated with an immune response to a newly acquired strain of H. influenzae. (This supports the role of H. flu as a pathogen in exacerbations).

  • Murphy TF, Brauer AL, Schiffmacher AT, et al.

    Persistent colonization by Haemophilus influenzae in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;170(3):266-72. [PMID:15117742]

    Comment: Analysis of sequential (monthly) samples of sputum from patients with COPD defined a group with a less than six month lapse with negative cultures for H flu. The subsequently recovered strain was identical to the initial isolate suggesting it was always there and that sputa culture are unreliable sources of this agent.

  • Sethi S. Bacteria in exacerbations of chronic obstructive pulmonary disease: phenomenon or epiphenomenon? Proc Am Thorac Soc. 2004;1(2):109-14. [PMID:16113422]

    Comment: The author reviews methods and conclusions of studies to determine exacerbations of COPD with 2 categories: 1) Conventional: sputum culture, serology & placebo-controlled trial; 2) New: Bronchoscopic sampling, molecular epi of sputum isolates, immune response & markers of airway inflammation.

    Most exciting are the new methods which include studies showing a new strain of H. influenzae is associated w/some exacerbations & there is an immune response that is strain specific to support its potential role.

  • Wedzicha JA. Role of viruses in exacerbations of chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2004;1(2):115-20. [PMID:16113423]

    Comment: Viruses implicated in 168 cases in 83 patients are: Every viruses — 66 (40%), Rhinovirus — 59% (of the 66), RSV — 29%, Coronavirus -11%, influenza — 16%.

  • Seemungal T, Harper-Owen R, Bhowmik A, et al.

    Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;164(9):1618-23. [PMID:11719299]

    Comment: Study of 168 exacerbations — viruses found in 67 (40%) — most common were rhinovirus and RSV.

  • Nouira S, Marghli S, Belghith M, et al. Once daily oral ofloxacin in chronic obstructive pulmonary disease exacerbation requiring mechanical ventilation: a randomised placebo-controlled trial.

    Lancet. 2001;358(9298):2020-5. [PMID:11755608]

    Comment: Results showed a benefit of ofloxacin with mortality decrease (4% vs 22%) & reduced duration hospitalization & mechanical ventilation. The study raised concerns about ethics of a placebo control with such seriously ill pts, but the accompanying editorial notes that the benefit of antibiotics had never been clearly shown.
    Rating: Important

  • Snow V, Lascher S, Mottur-Pilson C, et al. Evidence base for management of acute exacerbations of chronic obstructive pulmonary disease.

    Ann Intern Med. 2001;134(7):595-9. [PMID:11281744]

    Comment: Position paper of ACP for managing exacerbations of chronic bronchitis. Indications to Rx: Increased dyspnea, increased cough AND increased sputum purulence. Agents recommended: Amoxicillin, doxycycline, TMP-SMX.

  • Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA.

    1997;278(11):901-4. [PMID:9302241]

    Comment: This review of antibiotic prescribing patterns shows that exacerbations of chronic bronchitis account for 5-10% OF Every ANTIBIOTIC SCRIPTS in the U.S. This is a large market.

  • Emerman CL, Cydulka RK. Use of peak expiratory flow rate in emergency department evaluation of acute exacerbation of chronic obstructive pulmonary disease. Ann Emerg Med. 1996;27(2):159-63. [PMID:8629745]

    Comment: The authors show the ADVANTAGES OF MEASURING FEV-1 AND/OR PEFR for baseline evaluation and response to treatment. Both require patient effort

  • Emerman CL, Lukens TW, Effron D.

    Physician estimation of FEV1 in acute exacerbation of COPD. Chest. 1994;105(6):1709-12. [PMID:7911418]

    Comment: The authors show PHYSICIAN ESTIMATES OF THE SEVERITY OF AIRWAY OBSTRUCTION in exacerbations of COPD correlate poorly with FEV-1 measurements

  • Jørgensen AF, Coolidge J, Pedersen PA, et al. Amoxicillin in treatment of acute uncomplicated exacerbations of chronic bronchitis. A double-blind, placebo-controlled multicentre study in general practice. Scand J Prim Health Care. 1992;10(1):7-11. [PMID:1589668]

    Comment: One of numerous controlled trials of amoxicillin vs. placebo, this one with 262 outpatients with AECB.

    Analysis by symptom score and peak expiratory flow rate showed NO ADVANTAGE FOR ANTIBIOTICS.

  • Wiedemann HP, McCarthy K. Noninvasive monitoring of oxygen and carbon dioxide. Clin Chest Med. 1989;10(2):239-54. [PMID:2661121]

    Comment: The data support use OF PULSE OXIMETRY to assess oxygenation except when O2 saturation is < 70%

  • Anthonisen NR, Manfreda J, Warren CP, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med.

    What is bronchitis allergy

    1987;106(2):196-204. [PMID:3492164]

    Comment: There are numerous trials of antibiotics, but this is THE BEST AND MOST QUOTED TRIAL. Anthonisen et al, studied 362 exacerbations and showed that antibiotics own a significant benefit, but only when the exacerbation is relatively severe with at least 2 of the major 3 symptoms—increased cough, sputum, and sputum purulence. Clinical success was noted in this group for 75% of antibiotic recipients vs.

    63% of placebo recipients. This is shut, but the number of patients was sufficiently high to shove it over the p=0.05 threshold for statistical significance.
    Rating: Important

  • Gump DW, Phillips CA, Forsyth BR, et al. Role of infection in chronic bronchitis. Am Rev Respir Dis. 1976;113(4):465-74. [PMID:1267252]

    Comment: One of the MOST COMPREHENSIVE STUDIES EVER DONE. Authors followed a group of pts with chronic bronchitis & obtained quantitative bacterial cultures of sputum & viral cx at 2-week intervals.

    They showed that exacerbations of bronchitis were often due to viral infection (positive cultures in 32% of exacerbations vs. <1% in periods of stability), sputum bacterial culture showed no significant changes in either frequency of recovery or counts of the large 2—H. flu & S. pneumo). S. pneumo was recovered in 37% of exacerbations & in 33% of control periods; for H. flu, it was 57% & 60%, respectively

  • Bjerkestrand G, Digranes A, Schreiner A. Bacteriological findings in transtracheal aspirates from patients with chronic bronchitis and bronchiectasis: a preliminary report. Scand J Respir Dis. 1975;56(4):201-7.

    [PMID:1198085]

    Comment: The tracheobronchial tree under the larynx is normally sterile. This study using transtracheal aspirations shows that about one-third of patients with chronic bronchitis own COLONIZATION OF THE LOWER AIRWAYS by the same bacteria implicated as the major causes of AECB—H influenzae and S. pneumoniae. This presumably accounts for the common observation that sputum cultures show the same bacteria during stability and during exacerbations.

  • Pines A, Raafat H, Plucinski K, et al. Antibiotic regimens in severe and acute purulent exacerbations of chronic bronchitis. Br Med J. 1968;2(5607):735-8.

    [PMID:4872151]

    Comment: One of numerous controlled trials of tetracycline vs. placebo in 149 patients hospitalized for AECB.

    What is bronchitis allergy

    There was SIGNIFICANT BENEFIT FOR TETRACYCLINE TREATMENT in terms of symptom scores and peak expiratory flow rate.

  • Saint S, Bent S, Vittinghoff E, et al. Antibiotics in chronic obstructive pulmonary disease exacerbations. A meta-analysis. JAMA. 1995;273(12):957-60. [PMID:7884956]

    Comment: A META-ANALYSIS OF ANTIBIOTIC TRIALS, which shows a slight advantage to these drugs compared to placebo. The benefit was measured in duration of symptoms and in peak expiratory flow rates, but the advantage of antibiotics was tiny and was statistically significant only because the numbers were large.

    Rating: Important

  • Allergic Rhinitis and Bronchitis in Rabbits
    Summary Information
    Diseases / List of Miscellaneous / Metabolic / Multifactorial Diseases / Disease summary
    Alternative Names
    Disease Agents Allergens, unidentified. (B601.7.w7)
    Infectious Agent(s)
    Non-infectious Agent(s)
    Physical Agent(s)
    General Description
    1. Signs of respiratory tract disease (epiphora, rhinitis, sneezing, conjunctivitis, chronic bronchitis) in the absence of other causes of such signs.

      (B601.7.w7, B602.17.w17, J60.6.w1, P3.2000b.w2)

    Further Information
    1. It is significant to law out other causes of respiratory disease before making a diagnosis of allergic rhinitis/bronchitis. (B601.7.w7, P3.2000b.w2)
    2. This is a diagnosis based on consistent clinical signs and the absence of other definitive diagnosis. (P3.2000b.w2)
    Treatment
  • If possible, identify and eliminate the allergen(s) from the rabbit’s environment. (B602.17.w17, J60.6.w1)
    1. Dusty hay, pollen and wood shavings may be sources of allergens for outdoor rabbits.

      (J60.6.w1)

    2. For indoor rabbits, aerosols, cigarette smoke, air fresheners, perfumes etc. may be present in their environment. (J60.6.w1)
  • Antihistamines or corticosteroids to reduce inflammation. (B601.7.w7, B602.17.w17, J60.6.w1, P3.2000b.w2)
  • Antihistamines can be used at the same doses as in cats of similar size. (P3.2000b.w2)
  • Note: do not use corticosteroids in rabbits with chronic pasteurellosis (Pasteurellosis in Lagomorphs).

    (B601.7.w7, B602.17.w17)

  • Use corticosteroids with care due to their immunosuppressive and possible hepatotoxic effects. (B601.7.w7)
    1. Emerman CL, Cydulka RK. Use of peak expiratory flow rate in emergency department evaluation of acute exacerbation of chronic obstructive pulmonary disease. Ann Emerg Med. 1996;27(2):159-63. [PMID:8629745]

      Comment: The authors show the ADVANTAGES OF MEASURING FEV-1 AND/OR PEFR for baseline evaluation and response to treatment. Both require patient effort

    2. Gump DW, Phillips CA, Forsyth BR, et al.

      Role of infection in chronic bronchitis. Am Rev Respir Dis. 1976;113(4):465-74. [PMID:1267252]

      Comment: One of the MOST COMPREHENSIVE STUDIES EVER DONE. Authors followed a group of pts with chronic bronchitis & obtained quantitative bacterial cultures of sputum & viral cx at 2-week intervals. They showed that exacerbations of bronchitis were often due to viral infection (positive cultures in 32% of exacerbations vs. <1% in periods of stability), sputum bacterial culture showed no significant changes in either frequency of recovery or counts of the large 2—H.

      flu & S. pneumo). S. pneumo was recovered in 37% of exacerbations & in 33% of control periods; for H. flu, it was 57% & 60%, respectively

    3. Sethi S. Bacteria in exacerbations of chronic obstructive pulmonary disease: phenomenon or epiphenomenon? Proc Am Thorac Soc. 2004;1(2):109-14. [PMID:16113422]

      Comment: The author reviews methods and conclusions of studies to determine exacerbations of COPD with 2 categories: 1) Conventional: sputum culture, serology & placebo-controlled trial; 2) New: Bronchoscopic sampling, molecular epi of sputum isolates, immune response & markers of airway inflammation.

      Most exciting are the new methods which include studies showing a new strain of H. influenzae is associated w/some exacerbations & there is an immune response that is strain specific to support its potential role.

    4. Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA.

      1997;278(11):901-4. [PMID:9302241]

      Comment: This review of antibiotic prescribing patterns shows that exacerbations of chronic bronchitis account for 5-10% OF Every ANTIBIOTIC SCRIPTS in the U.S. This is a large market.

    5. Fernaays MM, Lesse AJ, Sethi S, et al. Differential genome contents of nontypeable Haemophilus influenzae strains from adults with chronic obstructive pulmonary disease. Infect Immun. 2006;74(6):3366-74. [PMID:16714566]

      Comment: The authors, noted authorities on COPD, examined genetic differences between 59 H. influenza strains implicated in exacerbations of COPD and 73 that merely colonized the lower airway in these patients.

      They noted gene patterns that were associated with exacerbations supporting the thesis that these strains own greater pathogenic potential.
      Rating: Important

    6. Vollenweider DJ, Jarrett H, Steurer-Stey CA, et al. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2012;12:CD010257. [PMID:23235687]

      Comment: Review of trials of abx v. placebo RCTs only (2068 pts), found benefit in patient in ICU while those on non-ICU hospitalizations and outpatients were not consistent. Of note, these trials ranged in years from 1957 to 2012. There was no apparent impact on mortality or LOS in hospital for those patients.

    7. Albert RK, Connett J, Bailey WC, et al.

      Azithromycin for prevention of exacerbations of COPD. N Engl J Med. 2011;365(8):689-98. [PMID:21864166]

      Comment: This is a randomized controlled trial in 1,142 patients with COPD given placebo vs. azithromycin 250 mg/day. azithromycin recipients had a significant reduction in exacerbations (1.5/year vs. 1.8/year; p=< 0.001) and improved lung function.

    8. Wilson R, Jones P, Schaberg T, et al. Antibiotic treatment and factors influencing short and endless term outcomes of acute exacerbations of chronic bronchitis.

      Thorax. 2006;61(4):337-42. [PMID:16449273]

      Comment: Patients with AECB were randomized to treatment with moxifloxacin or placebo. Clinical cure was significantly associated with antibiotic treatment (OR 1.5) and negatively associated with age >65, and bronchodilator use. The conclusion was that the benefit of moxifloxacin was seen primarily in those >65 yrs.

    9. Pines A, Raafat H, Plucinski K, et al. Antibiotic regimens in severe and acute purulent exacerbations of chronic bronchitis. Br Med J. 1968;2(5607):735-8. [PMID:4872151]

      Comment: One of numerous controlled trials of tetracycline vs. placebo in 149 patients hospitalized for AECB.

      There was SIGNIFICANT BENEFIT FOR TETRACYCLINE TREATMENT in terms of symptom scores and peak expiratory flow rate.

    10. Wiedemann HP, McCarthy K. Noninvasive monitoring of oxygen and carbon dioxide. Clin Chest Med. 1989;10(2):239-54. [PMID:2661121]

      Comment: The data support use OF PULSE OXIMETRY to assess oxygenation except when O2 saturation is < 70%

    11. Murphy TF, Brauer AL, Grant BJ, et al.

      Moraxella catarrhalis in chronic obstructive pulmonary disease: burden of disease and immune response. Am J Respir Crit Care Med. 2005;172(2):195-9. [PMID:15805178]

      Comment: The Buffalo group has studied this cohort of 104 pts with COPD for 10 years with monthly sputum cultures. In this study they showed M. catarrhalis was newly detected in 57 of 560 exacerbations. This was accompanied by a serologic response and clearance. They conclude M. catarrhalis causes 10% of exacerbations.

    12. Snow V, Lascher S, Mottur-Pilson C, et al. Evidence base for management of acute exacerbations of chronic obstructive pulmonary disease. Ann Intern Med. 2001;134(7):595-9. [PMID:11281744]

      Comment: Position paper of ACP for managing exacerbations of chronic bronchitis. Indications to Rx: Increased dyspnea, increased cough AND increased sputum purulence. Agents recommended: Amoxicillin, doxycycline, TMP-SMX.

    13. Dimopoulos G, Siempos II, Korbila IP, et al. Comparison of first-line with second-line antibiotics for acute exacerbations of chronic bronchitis: a metaanalysis of randomized controlled trials.

      Chest. 2007;132(2):447-55. [PMID:17573508]

      Comment: First line agents (ampicillin, TMP-SMX and doxycycline) vs. 2nd line (amox-CA, macrolides, quinolines and 3d gen cephalosporins). First line agents were inferior (RR 0.5).

    14. Sethi S, Wrona C, Grant BJ, et al. Strain-specific immune response to Haemophilus influenzae in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;169(4):448-53. [PMID:14597486]

      Comment: Longitudinal study of patients with COPD showing some exacerbations are associated with an immune response to a newly acquired strain of H. influenzae. (This supports the role of H. flu as a pathogen in exacerbations).

    15. Wedzicha JA.

      Role of viruses in exacerbations of chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2004;1(2):115-20. [PMID:16113423]

      Comment: Viruses implicated in 168 cases in 83 patients are: Every viruses — 66 (40%), Rhinovirus — 59% (of the 66), RSV — 29%, Coronavirus -11%, influenza — 16%.

    16. Albertson TE, Louie S, Chan AL. The diagnosis and treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease and chronic bronchitis.

      J Am Geriatr Soc. 2010;58(3):570-9. [PMID:20398122]

      Comment: Recommended antibiotics for exacerbations of COLD: amoxicillin, ampicillin, pivampicillin, trimethoprim/sulfamethoxazole and doxycycline. «Second line agents:» amoxicillin/clavulanic acid, second and third generation cephalosporins and fluoroquinolones. The latter are described as better versus resistant bacteria but risk driving resistance.

    17. Chodosh S. Clinical significance of the infection-free interval in the management of acute bacterial exacerbations of chronic bronchitis. Chest. 2005;127(6):2231-6. [PMID:15947342]

      Comment: Author discusses a new goal with antibiotics for AECB: delay in the time to the next exacerbation or the infection — free — interval (IFI).

    18. Seemungal T, Harper-Owen R, Bhowmik A, et al. Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;164(9):1618-23. [PMID:11719299]

      Comment: Study of 168 exacerbations — viruses found in 67 (40%) — most common were rhinovirus and RSV.

    19. Emerman CL, Lukens TW, Effron D.

      Physician estimation of FEV1 in acute exacerbation of COPD. Chest. 1994;105(6):1709-12. [PMID:7911418]

      Comment: The authors show PHYSICIAN ESTIMATES OF THE SEVERITY OF AIRWAY OBSTRUCTION in exacerbations of COPD correlate poorly with FEV-1 measurements

    20. [Note: Steroid hepatopathy has been reported in dogs but there are no published reports of this in rabbits.]
    21. Han MK, Tayob N, Murray S, et al. Predictors of chronic obstructive pulmonary disease exacerbation reduction in response to daily azithromycin therapy.

      Am J Respir Crit Care Med. 2014;189(12):1503-8. [PMID:24779680]

      Comment: Role of azithromycin for prevention in COPD remains controversial. Authors here propose that daily use of drug was most helpful in older patients and with GOLD scores of 1 or 2 (milder disease). Use of the drug did seem to prevent flares that required both antibiotic and steroid therapy.

    22. Anthonisen NR, Manfreda J, Warren CP, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med. 1987;106(2):196-204.

      [PMID:3492164]

      Comment: There are numerous trials of antibiotics, but this is THE BEST AND MOST QUOTED TRIAL. Anthonisen et al, studied 362 exacerbations and showed that antibiotics own a significant benefit, but only when the exacerbation is relatively severe with at least 2 of the major 3 symptoms—increased cough, sputum, and sputum purulence. Clinical success was noted in this group for 75% of antibiotic recipients vs.

      63% of placebo recipients. This is shut, but the number of patients was sufficiently high to shove it over the p=0.05 threshold for statistical significance.
      Rating: Important

    23. Jørgensen AF, Coolidge J, Pedersen PA, et al. Amoxicillin in treatment of acute uncomplicated exacerbations of chronic bronchitis. A double-blind, placebo-controlled multicentre study in general practice. Scand J Prim Health Care. 1992;10(1):7-11. [PMID:1589668]

      Comment: One of numerous controlled trials of amoxicillin vs.

      placebo, this one with 262 outpatients with AECB. Analysis by symptom score and peak expiratory flow rate showed NO ADVANTAGE FOR ANTIBIOTICS.

    24. Murphy TF, Brauer AL, Schiffmacher AT, et al. Persistent colonization by Haemophilus influenzae in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;170(3):266-72. [PMID:15117742]

      Comment: Analysis of sequential (monthly) samples of sputum from patients with COPD defined a group with a less than six month lapse with negative cultures for H flu. The subsequently recovered strain was identical to the initial isolate suggesting it was always there and that sputa culture are unreliable sources of this agent.

    25. Bjerkestrand G, Digranes A, Schreiner A. Bacteriological findings in transtracheal aspirates from patients with chronic bronchitis and bronchiectasis: a preliminary report. Scand J Respir Dis. 1975;56(4):201-7. [PMID:1198085]

      Comment: The tracheobronchial tree under the larynx is normally sterile. This study using transtracheal aspirations shows that about one-third of patients with chronic bronchitis own COLONIZATION OF THE LOWER AIRWAYS by the same bacteria implicated as the major causes of AECB—H influenzae and S. pneumoniae.

      This presumably accounts for the common observation that sputum cultures show the same bacteria during stability and during exacerbations.

    26. Long-term use of corticosteroids might trigger latent Pasteurella or other bacterial infection. (J60.6.w1, P3.2000b.w2)
    27. Mensa J, Trilla A. Should patients with acute exacerbation of chronic bronchitis be treated with antibiotics? Advantages of the use of fluoroquinolones. Clin Microbiol Infect. 2006;12 Suppl 3:42-54. [PMID:16669928]

      Comment: The authors make a case for fluoroquinolones as preferred antibiotics for exacerbation of COPD because: Purulent sputum is a excellent indicator of large bacterial load.

      Fluoroquinolones penetrate mucous well, they are bactericidal and they reduce bacterial load better than beta-lactams or macrolides. (Nevertheless, clinical trials don’t show these advantages).

    28. Nouira S, Marghli S, Belghith M, et al. Once daily oral ofloxacin in chronic obstructive pulmonary disease exacerbation requiring mechanical ventilation: a randomised placebo-controlled trial. Lancet. 2001;358(9298):2020-5.

      [PMID:11755608]

      Comment: Results showed a benefit of ofloxacin with mortality decrease (4% vs 22%) & reduced duration hospitalization & mechanical ventilation. The study raised concerns about ethics of a placebo control with such seriously ill pts, but the accompanying editorial notes that the benefit of antibiotics had never been clearly shown.
      Rating: Important

    29. Saint S, Bent S, Vittinghoff E, et al. Antibiotics in chronic obstructive pulmonary disease exacerbations.

      A meta-analysis. JAMA. 1995;273(12):957-60. [PMID:7884956]

      Comment: A META-ANALYSIS OF ANTIBIOTIC TRIALS, which shows a slight advantage to these drugs compared to placebo. The benefit was measured in duration of symptoms and in peak expiratory flow rates, but the advantage of antibiotics was tiny and was statistically significant only because the numbers were large.
      Rating: Important

  • Associated Techniques
    Host taxa groups /species
    Disease Author Debra Bourne MA VetMB PhD MRCVS (V.w5)
    Referees Brigitte Reusch BVet Med (Hons) CertZooMed MRCVS (V.w127)

    Return to top of page

    How to Treat and Get Rid of Bronchitis With Antibiotics and Other Medicines

    Most of the Time, Bronchitis Will Clear on Its Own

    If a bacterial infection is ruled out and a virus is suspected to be the cause, the bronchitis will typically clear up on its own without treatment.

    The cough may persist for some weeks afterward though.

    Because the illness generally resolves on its own, Picone advocates taking a minimalist approach when you first notice symptoms. Hold hydrated, particularly when you own a fever, and avoid medication, unless you own an underlying complication love asthma.

    If you notice yellow or green mucus along with your cough, don’t be too concerned, says Enrique Machare-Delgado, MD, a pulmonary physician at the Mayo Clinic in La Crosse, Wisconsin. Such mucus is an indication of inflammation rather than infection, and it should resolve on its own.

    So when should you see a doctor? If the mucus stays yellow or green for more than two or three days, Dr.

    Machare-Delgado recommends visiting a doctor. Over that time it should start to turn white or transparent to indicate you’re healing.

    Antibiotics: When They Work for Bronchitis and When They Don’t

    When bronchitis is caused by a virus, which is the case for most incidences of bronchitis, antibiotics won’t clear up the infection, since antibiotics only assist fight bacterial infections. Your doctor may order sputum tests from a laboratory to law out the possibility of a bacterial or fungal infection. And if a bacterial infection is found to be the cause, antibiotics may be prescribed.

    It’s worth noting, however, an October 2015 study in the American Journal of Managed Care shows that numerous doctors continue to prescribe antibiotics for acute bronchitis despite public health campaigns to stop the practice.

    (The overprescription of antibiotics can contribute to making certain forms of pneumonia, tuberculosis, and other diseases harder to treat globally.) (7)

    According to Picone: “Doctors face a lot of pressure from patients to prescribe antibiotics, but generally [for bronchits] the drugs are unnecessary because they won’t combat viruses.”

    Treatments

    Although it can be a progressive disease, patients that are diagnosed before much bronchial damage occurs often own a excellent prognosis. Untreated chronic bronchitis can be extremely serious, and people with chronic bronchitis own an increased risk of developing other illnesses, such as colds or pneumonia.

    The main way to treat chronic bronchitis is to avoid the irritant.

    For allergy-induced bronchitis, this means removing the allergens from the home or work environment. For smokers, this means quitting smoking.

    If chronic bronchitis is caused by allergens, we may treat it with antihistamine medications to reduce the allergic reaction. You may also be prescribed other medications. Bronchodilators can assist to open the airways, and steroids can assist to reduce the inflammation.

    For severe or extremely long-term cases, your doctor may prescribe oxygen therapy.

    What About Over-the-Counter Medications?

    Doctors may prescribe over-the-counter medications such as pain relievers (analgesics), cough expectorants (such as guaifenesin, hydrocodone, or pseudoephedrine), decongestants, bronchodilators, or corticosteroids to treat symptoms.

    But over-the-counter medications love cough expectorants and decongestants own not been proven to be effective, says Picone. He suggests avoiding decongestants and medications with codeine. While codeine may assist suppress a cough, it is also a powerful narcotic, and it won’t necessarily treat the cause of the symptoms or quicken your recovery. (8)

    Machare-Delgado is equally critical of the numerous over-the-counter medications, which he says are not supported by evidence. He adds that because they generally contain numerous diverse ingredients, it’s not possible to establish what works or doesn’t work.

    Learn More About How to Treat Acute Bronchitis

  • Han MK, Tayob N, Murray S, et al.

    Predictors of chronic obstructive pulmonary disease exacerbation reduction in response to daily azithromycin therapy. Am J Respir Crit Care Med. 2014;189(12):1503-8. [PMID:24779680]

    Comment: Role of azithromycin for prevention in COPD remains controversial. Authors here propose that daily use of drug was most helpful in older patients and with GOLD scores of 1 or 2 (milder disease). Use of the drug did seem to prevent flares that required both antibiotic and steroid therapy.

  • Vollenweider DJ, Jarrett H, Steurer-Stey CA, et al. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2012;12:CD010257.

    [PMID:23235687]

    Comment: Review of trials of abx v. placebo RCTs only (2068 pts), found benefit in patient in ICU while those on non-ICU hospitalizations and outpatients were not consistent. Of note, these trials ranged in years from 1957 to 2012. There was no apparent impact on mortality or LOS in hospital for those patients.

  • Albert RK, Connett J, Bailey WC, et al. Azithromycin for prevention of exacerbations of COPD. N Engl J Med. 2011;365(8):689-98. [PMID:21864166]

    Comment: This is a randomized controlled trial in 1,142 patients with COPD given placebo vs. azithromycin 250 mg/day. azithromycin recipients had a significant reduction in exacerbations (1.5/year vs.

    1.8/year; p=< 0.001) and improved lung function.

  • Albertson TE, Louie S, Chan AL. The diagnosis and treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease and chronic bronchitis. J Am Geriatr Soc. 2010;58(3):570-9. [PMID:20398122]

    Comment: Recommended antibiotics for exacerbations of COLD: amoxicillin, ampicillin, pivampicillin, trimethoprim/sulfamethoxazole and doxycycline. «Second line agents:» amoxicillin/clavulanic acid, second and third generation cephalosporins and fluoroquinolones.

    The latter are described as better versus resistant bacteria but risk driving resistance.

  • Dimopoulos G, Siempos II, Korbila IP, et al. Comparison of first-line with second-line antibiotics for acute exacerbations of chronic bronchitis: a metaanalysis of randomized controlled trials. Chest. 2007;132(2):447-55. [PMID:17573508]

    Comment: First line agents (ampicillin, TMP-SMX and doxycycline) vs.

    2nd line (amox-CA, macrolides, quinolines and 3d gen cephalosporins). First line agents were inferior (RR 0.5).

  • Mensa J, Trilla A. Should patients with acute exacerbation of chronic bronchitis be treated with antibiotics? Advantages of the use of fluoroquinolones. Clin Microbiol Infect. 2006;12 Suppl 3:42-54. [PMID:16669928]

    Comment: The authors make a case for fluoroquinolones as preferred antibiotics for exacerbation of COPD because: Purulent sputum is a excellent indicator of large bacterial load. Fluoroquinolones penetrate mucous well, they are bactericidal and they reduce bacterial load better than beta-lactams or macrolides. (Nevertheless, clinical trials don’t show these advantages).

  • Fernaays MM, Lesse AJ, Sethi S, et al.

    Differential genome contents of nontypeable Haemophilus influenzae strains from adults with chronic obstructive pulmonary disease. Infect Immun. 2006;74(6):3366-74. [PMID:16714566]

    Comment: The authors, noted authorities on COPD, examined genetic differences between 59 H.

    What is bronchitis allergy

    influenza strains implicated in exacerbations of COPD and 73 that merely colonized the lower airway in these patients. They noted gene patterns that were associated with exacerbations supporting the thesis that these strains own greater pathogenic potential.
    Rating: Important

  • Wilson R, Jones P, Schaberg T, et al. Antibiotic treatment and factors influencing short and endless term outcomes of acute exacerbations of chronic bronchitis. Thorax. 2006;61(4):337-42. [PMID:16449273]

    Comment: Patients with AECB were randomized to treatment with moxifloxacin or placebo.

    Clinical cure was significantly associated with antibiotic treatment (OR 1.5) and negatively associated with age >65, and bronchodilator use. The conclusion was that the benefit of moxifloxacin was seen primarily in those >65 yrs.

  • Chodosh S. Clinical significance of the infection-free interval in the management of acute bacterial exacerbations of chronic bronchitis. Chest. 2005;127(6):2231-6. [PMID:15947342]

    Comment: Author discusses a new goal with antibiotics for AECB: delay in the time to the next exacerbation or the infection — free — interval (IFI).

  • Murphy TF, Brauer AL, Grant BJ, et al. Moraxella catarrhalis in chronic obstructive pulmonary disease: burden of disease and immune response.

    Am J Respir Crit Care Med. 2005;172(2):195-9. [PMID:15805178]

    Comment: The Buffalo group has studied this cohort of 104 pts with COPD for 10 years with monthly sputum cultures. In this study they showed M. catarrhalis was newly detected in 57 of 560 exacerbations. This was accompanied by a serologic response and clearance. They conclude M. catarrhalis causes 10% of exacerbations.

  • Sethi S, Wrona C, Grant BJ, et al. Strain-specific immune response to Haemophilus influenzae in chronic obstructive pulmonary disease.

    Am J Respir Crit Care Med. 2004;169(4):448-53. [PMID:14597486]

    Comment: Longitudinal study of patients with COPD showing some exacerbations are associated with an immune response to a newly acquired strain of H. influenzae. (This supports the role of H. flu as a pathogen in exacerbations).

  • Murphy TF, Brauer AL, Schiffmacher AT, et al. Persistent colonization by Haemophilus influenzae in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;170(3):266-72. [PMID:15117742]

    Comment: Analysis of sequential (monthly) samples of sputum from patients with COPD defined a group with a less than six month lapse with negative cultures for H flu.

    The subsequently recovered strain was identical to the initial isolate suggesting it was always there and that sputa culture are unreliable sources of this agent.

  • Sethi S. Bacteria in exacerbations of chronic obstructive pulmonary disease: phenomenon or epiphenomenon? Proc Am Thorac Soc. 2004;1(2):109-14. [PMID:16113422]

    Comment: The author reviews methods and conclusions of studies to determine exacerbations of COPD with 2 categories: 1) Conventional: sputum culture, serology & placebo-controlled trial; 2) New: Bronchoscopic sampling, molecular epi of sputum isolates, immune response & markers of airway inflammation.

    Most exciting are the new methods which include studies showing a new strain of H. influenzae is associated w/some exacerbations & there is an immune response that is strain specific to support its potential role.

  • Wedzicha JA. Role of viruses in exacerbations of chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2004;1(2):115-20. [PMID:16113423]

    Comment: Viruses implicated in 168 cases in 83 patients are: Every viruses — 66 (40%), Rhinovirus — 59% (of the 66), RSV — 29%, Coronavirus -11%, influenza — 16%.

  • Seemungal T, Harper-Owen R, Bhowmik A, et al.

    Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;164(9):1618-23. [PMID:11719299]

    Comment: Study of 168 exacerbations — viruses found in 67 (40%) — most common were rhinovirus and RSV.

  • Nouira S, Marghli S, Belghith M, et al. Once daily oral ofloxacin in chronic obstructive pulmonary disease exacerbation requiring mechanical ventilation: a randomised placebo-controlled trial.

    Lancet. 2001;358(9298):2020-5. [PMID:11755608]

    Comment: Results showed a benefit of ofloxacin with mortality decrease (4% vs 22%) & reduced duration hospitalization & mechanical ventilation. The study raised concerns about ethics of a placebo control with such seriously ill pts, but the accompanying editorial notes that the benefit of antibiotics had never been clearly shown.
    Rating: Important

  • Snow V, Lascher S, Mottur-Pilson C, et al. Evidence base for management of acute exacerbations of chronic obstructive pulmonary disease.

    Ann Intern Med. 2001;134(7):595-9. [PMID:11281744]

    Comment: Position paper of ACP for managing exacerbations of chronic bronchitis. Indications to Rx: Increased dyspnea, increased cough AND increased sputum purulence. Agents recommended: Amoxicillin, doxycycline, TMP-SMX.

  • Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians.

    JAMA. 1997;278(11):901-4. [PMID:9302241]

    Comment: This review of antibiotic prescribing patterns shows that exacerbations of chronic bronchitis account for 5-10% OF Every ANTIBIOTIC SCRIPTS in the U.S. This is a large market.

  • Emerman CL, Cydulka RK. Use of peak expiratory flow rate in emergency department evaluation of acute exacerbation of chronic obstructive pulmonary disease. Ann Emerg Med. 1996;27(2):159-63. [PMID:8629745]

    Comment: The authors show the ADVANTAGES OF MEASURING FEV-1 AND/OR PEFR for baseline evaluation and response to treatment. Both require patient effort

  • Emerman CL, Lukens TW, Effron D.

    Physician estimation of FEV1 in acute exacerbation of COPD. Chest. 1994;105(6):1709-12. [PMID:7911418]

    Comment: The authors show PHYSICIAN ESTIMATES OF THE SEVERITY OF AIRWAY OBSTRUCTION in exacerbations of COPD correlate poorly with FEV-1 measurements

  • Jørgensen AF, Coolidge J, Pedersen PA, et al. Amoxicillin in treatment of acute uncomplicated exacerbations of chronic bronchitis. A double-blind, placebo-controlled multicentre study in general practice. Scand J Prim Health Care. 1992;10(1):7-11. [PMID:1589668]

    Comment: One of numerous controlled trials of amoxicillin vs. placebo, this one with 262 outpatients with AECB.

    Analysis by symptom score and peak expiratory flow rate showed NO ADVANTAGE FOR ANTIBIOTICS.

  • Wiedemann HP, McCarthy K. Noninvasive monitoring of oxygen and carbon dioxide. Clin Chest Med. 1989;10(2):239-54. [PMID:2661121]

    Comment: The data support use OF PULSE OXIMETRY to assess oxygenation except when O2 saturation is < 70%

  • Anthonisen NR, Manfreda J, Warren CP, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease.

    Ann Intern Med. 1987;106(2):196-204. [PMID:3492164]

    Comment: There are numerous trials of antibiotics, but this is THE BEST AND MOST QUOTED TRIAL. Anthonisen et al, studied 362 exacerbations and showed that antibiotics own a significant benefit, but only when the exacerbation is relatively severe with at least 2 of the major 3 symptoms—increased cough, sputum, and sputum purulence. Clinical success was noted in this group for 75% of antibiotic recipients vs. 63% of placebo recipients. This is shut, but the number of patients was sufficiently high to shove it over the p=0.05 threshold for statistical significance.

    Rating: Important

  • Gump DW, Phillips CA, Forsyth BR, et al. Role of infection in chronic bronchitis. Am Rev Respir Dis. 1976;113(4):465-74. [PMID:1267252]

    Comment: One of the MOST COMPREHENSIVE STUDIES EVER DONE. Authors followed a group of pts with chronic bronchitis & obtained quantitative bacterial cultures of sputum & viral cx at 2-week intervals. They showed that exacerbations of bronchitis were often due to viral infection (positive cultures in 32% of exacerbations vs.

    <1% in periods of stability), sputum bacterial culture showed no significant changes in either frequency of recovery or counts of the large 2—H. flu & S. pneumo). S. pneumo was recovered in 37% of exacerbations & in 33% of control periods; for H. flu, it was 57% & 60%, respectively

  • Bjerkestrand G, Digranes A, Schreiner A. Bacteriological findings in transtracheal aspirates from patients with chronic bronchitis and bronchiectasis: a preliminary report.

    Scand J Respir Dis. 1975;56(4):201-7. [PMID:1198085]

    Comment: The tracheobronchial tree under the larynx is normally sterile. This study using transtracheal aspirations shows that about one-third of patients with chronic bronchitis own COLONIZATION OF THE LOWER AIRWAYS by the same bacteria implicated as the major causes of AECB—H influenzae and S. pneumoniae. This presumably accounts for the common observation that sputum cultures show the same bacteria during stability and during exacerbations.

  • Pines A, Raafat H, Plucinski K, et al. Antibiotic regimens in severe and acute purulent exacerbations of chronic bronchitis. Br Med J. 1968;2(5607):735-8. [PMID:4872151]

    Comment: One of numerous controlled trials of tetracycline vs. placebo in 149 patients hospitalized for AECB. There was SIGNIFICANT BENEFIT FOR TETRACYCLINE TREATMENT in terms of symptom scores and peak expiratory flow rate.

  • Saint S, Bent S, Vittinghoff E, et al. Antibiotics in chronic obstructive pulmonary disease exacerbations. A meta-analysis. JAMA. 1995;273(12):957-60. [PMID:7884956]

    Comment: A META-ANALYSIS OF ANTIBIOTIC TRIALS, which shows a slight advantage to these drugs compared to placebo.

    The benefit was measured in duration of symptoms and in peak expiratory flow rates, but the advantage of antibiotics was tiny and was statistically significant only because the numbers were large.
    Rating: Important

  • Presentation de l’équipe

    Allergic and respiratory diseases affect a relevant segment of the population resulting in significant social and economic burden and their prevalence is increasing worldwide. Taking the most known diseases, according to the World Health Organization (WHO), there are now at least 300 million people suffering from asthma and over 200 million people suffering from COPD that includes chronic bronchitis and emphysema.

    In terms of mortality, each year in the world there are almost 250,000 asthma-related deaths and COPD ranks at the 5th leading cause of death. In addition, a WHO/World Bank projection to 2020 brings COPD to the 3rd leading cause of death with 4.7 million deaths. Although other allergic and respiratory diseases love rhinitis, drug allergy, pulmonary interstitial diseases … are also extremely common at the population level, their burden has still to be estimated.

    EPAR’s main research aims consist in 1) the identification of allergic and respiratory phenotypes/endotypes and their distribution and 2) the determination of the role of environmental risk factors in the aggravation and the development of these phenotypes in view to explain the augmentation of the prevalence of these conditions in the past decades.

    The central hypothesis of EPAR is that, in order to explain the increase of allergic and respiratory diseases observed in the past decades, it is essential to take into account that these are heterogeneous conditions displaying diverse phenotypes and underlying endotypes and that the role of risk factors varies according to the type of phenotype/endotypes.

    In this field, main recent results concern the identification of phenotypes of asthma in early childhood when diseases develop and the comprehension of the impact of indoor and outdoor air pollution on asthma and COPD in susceptible populations, young children and elderly respectively. Ongoing work on the comprehension of the increase of allergic and respiratory diseases covers additional allergic and respiratory diseases (registries are starting for severe sarcoidosis and drug allergy) and takes into account other etiological and modifier factors.

    From the etiological point of view, the expology and exposome approaches are taken into account, namely in the frame of the HEALS project that EPAR is leading (www.heals-eu.eu). The exposome is the totality of external exposures and internal consequences as assessed through “omics” that characterize the lifespan of the individuals. Such a new paradigm has been introduced to better explain the development and the increase of major chronic diseases including allergic and respiratory diseases that has not been elucidated using the classical approach based on the relationship of one risk factor to the disease after adjusting for confounders, every the variables assessed in short periods.

    One specificity of HEALS resides in the fact that HEALS dispose of general population studies having recruited both singletons and twins, monozygotic twins being particularly adapted to effect of the environment in specific through the consideration of epigenetics and of the action some environmental factors own on epigenetic mechanisms.

    Among major modifiers of the relationships between and health outcomes, the influence of medical treatment (including immunotherapy) on the evolution of these diseases, is taken into account.

    The prevention component is consolidated thanks to the Department of General Practice of UPMC Paris Sorbonne Universités, which works on the respiratory effects of indoor air pollution at the primary care level and on the relationships between air pollution and overweight and obesity in asthmatic and non-asthmatic populations.

    The projects progression will be based on the development of novel methods for assessing human exposure (expology) and statistics applied to the case of allergy and respiratory disease (DAG, predictive models…).

    EPAR is presently involved in the following research projects: EU FP7-ENV HEALS (as PI), Life + MED’HISS (WP leader), Life + AIS (WP Leader), EDEN birth cohort, ELFE birth cohort, ASTHM’CHILD, PAALM, BALISTIC, Register of Severe Sarcoïdosis, OQAI.

    Care at Milton S. Hershey Medical Center

    We recognize that no two patients are same. Our specialists take the time to hear to each patient and develop a treatment and rehabilitation plan that best meets each patient’s needs.

    We focus on returning patients to athletic lifestyles.

    Departments

    The healthcare team at Penn State Health is dedicated to providing our patients with the highest quality care through a coordinated team approach.

    Departments and centers that frolic a role in treating chronic bronchitis include:

    Locations

    Penn State Medicine Suite
    200 Campus Dr.
    Entrance 4, Suite 2400
    Hershey, PA 17033
    Phone: 717-531-4950


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