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

Background - Bacterial infections of the lower airways during an exace rbation in patients with asthma or chronic obstructive pulmonary disea se (COPD) may be the cause of an exacerbation or the consequence of a viral infection or an increase in airways limitation. To determine whe ther bacterial infection is an important component in the pathogenesis of an exacerbation, the effects of antimicrobial treatment must be st udied. Methods - Patients with asthma or COPD seen in general practice were studied in a double blind randomised manner to investigate wheth er the antimicrobial drugs amoxicillin (500 mg three times daily), cot rimoxazole (960 mg twice daily), or a placebo, each when added to a sh ort course of oral corticosteroids, can accelerate recovery from exace rbations. Patients were instructed to contact their own physician earl y in the morning when complaints of increased shortness of breath, whe ezing, or exacerbations of cough with or without sputum production occ urred. Treatment effects were evaluated over the next 14 days by study ing symptom scores (wheeze, dyspnoea, cough with and without mucus pro duction, and awakening with dyspnoea), peak expiratory flow values (PE F, expressed as % predicted), and sublingual temperature. Bacteriologi cal study of the sputum was made at the onset of an exacerbation and 7 , 21 and 35 days afterwards. Results - Of 195 patients enrolled 71 (36 %) contacted their physician for symptoms of an exacerbation. Symptoms improved in all three groups, improvements ranging from 0.54 to 0.75 points per day on a four point scale. PEF % predicted showed improveme nts in the three groups after the exacerbation, ranging from 0.34% to 0.78% predicted per day, finally returning to baseline values. Subling ual temperature did not change. Six of 71 patients consulted their phy sician because of a relapse between four and 24 days after the start o f treatment. In only two of the 50 sputum samples, collected during an exacerbation, and which contained equal to or greater than 10(5) bact eria in culture sensitive to the chosen antibiotic given, did any bene fit from antimicrobial treatment occur. During the recovery period spu tum purulence improved irrespective of antibiotic treatment. Conclusio ns - Antibiotics given with a short course of oral prednisolone during an exacerbation do not accelerate recovery as measured by changes in peak flow and symptom scores in ambulatory patients with mild to moder ate asthma or COPD when treated by their general practitioners. Moreov er, antibiotics do not reduce the number of relapses after treating an exacerbation.