ACUTE INFECTIVE EXACERBATIONS OF CHRONIC-BRONCHITIS

Patients with an acute infective exacerbation of chronic bronchitis (A ECB) (n=471) were enrolled into a computer-based general-practice stud y to determine whether features of past history, presenting symptoms, or findings on examination were predicitive of failure to recover. The median age was 68, 56.3% were male, and 82% were current or ex-smoker s. All had daily sputum production and 57.5% had moderate or severe ai rflow obstruction. During the AECB 11.5% were pyrexial, and 80.7% had abnormal auscultatory findings; about half had moderate to severe incr eases in dyspnoea and airflow obstruction, and the majority had increa ses in sputum volume and/or purulence. The median number of AECBs in t he previous year was three, and one-third of patients had cardiopulmon ary disease. The only factors significantly (p<0.05) predicting failur e to recover from an AECB were historical. Neither clinical features a t presentation nor antibiotic treatment affected recovery. Coexistent cardiopulmonary disease was a risk factor for returning with a chest p roblem and for being referred to hospital, The number of chest infecti ons in the previous 12 months was a risk factor for returning with a c hest problem. The higher the number of chest infections, the higher th e odds of returning with a chest problem. The best combination predict ing return with a chest problem was history of cardiopulmonary disease and more than four previous AECBs in the last 12 months. The sensitiv ity was 75% and specificity 47%.