MANAGEMENT OF EPISODES OF BRONCHIAL INFEC TIONS IN GENERAL MEDICINE

Background. Acute bronchitis and chronic obstructive pulmonary disease exacerbations are frequent reasons for consultation with a general pr actitioner (GP). Since no consensus exists about the use of antibiotic s in such indications and little is known about the use of pulmonary f unction tests in general practice, our objective was to describe GP's attitudes and prescription habits when faced with patients suffering f rom acute bronchitis (AB) or chronic bronchitis (CB) exacerbation. Met hods. The GPs participating in public health surveillance through the <<reseau Sentinelles>> (French Communicable Diseases Network) in March 1993 answered a postal questionnaire. This questionnaire collected th eir clinical attitude and prescriptions for 7 clinical cases of varyin g severity. Results. 430 (94.7%) of the GPs answered the questionnaire . Of these more than 95% prescribed antibiotics in all the clinical ca ses, including for common acute bronchitis. Wide spectrum penicillins and macrolides were prescribed significantly less often as the past hi story increased in severity, whereas tetracyclins and oral cephalospor ins were prescribed significantly more often in severe cases. Fluoroqu inolones were nearly exclusively reserved for the treatment of advance d CB. Smoking cessation was systematically advised by the GPs. Faced w ith AB and a smoking history, 44.2% of the GPs prescribed a chest x-ra y. In the case of repeat episodes of winter bronchitis, more than 70% of them evoked the diagnosis of CB. 98.% of the GPs had easy access to pulmonary function tests (PFTs) which 69.2% of the GPs prescribed as soon as CB was suspected. Conclusion. In the absence of a therapeutica l consensus regarding bronchitis, antibiotics were prescribed virtuall y systematically. PFTs were not yet a routing gesture in general pract ice even though they were widely available and prescribed.