Hayes Don, Meyer Keith C
Department of Pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky, USA.
Drugs Aging. 2007;24(7):555-72. doi: 10.2165/00002512-200724070-00004.
Chronic bronchitis (CB) is a disorder that is characterised by chronic mucus production. This disorder is called chronic obstructive pulmonary disease (COPD) when airflow obstruction is present. The majority of patients with COPD, which often goes undiagnosed or inadequately treated in the elderly, have symptoms consistent with CB. The clinical course of CB is usually punctuated by periodic acute exacerbations linked to infections caused by viral and typical or atypical bacterial pathogens. Acute exacerbations of chronic bronchitis (AECB) often lead to a decline in lung function and poor quality of life in association with increased risk of mortality and a significant economic impact on the healthcare system and society because of the direct costs of hospitalisations. In elderly individuals with COPD, co-morbidities play a vital role as determinants of health status and prognosis. Failure to eradicate infecting pathogens contributes to persistence of infection and inflammation that requires repeated courses of therapy and hospitalisation. Stratifying patients with AECB according to symptoms, degree of pulmonary function impairment and risk factors for poor outcome can help clinicians choose empirical antimicrobial chemotherapy regimens that are most likely to result in treatment success. Failure to cover likely pathogens associated with episodes of AECB can lead to lengthy hospital admissions and significant declines in functional status for elderly patients. Fluoroquinolones may provide the best therapeutic option for elderly patients with COPD who have complicated underlying CB but who are sufficiently stable to be treated in the outpatient setting. Optimised treatment for stable outpatients with CB may diminish the frequency of AECB, and effective antimicrobial therapy for AECB episodes can significantly diminish healthcare costs and maintain quality of life in the elderly patient.
慢性支气管炎（CB）是一种以长期产生黏液为特征的疾病。当存在气流阻塞时，这种疾病被称为慢性阻塞性肺疾病（COPD）。大多数COPD患者在老年人中常未被诊断或治疗不充分，其症状与CB相符。CB的临床病程通常以与病毒及典型或非典型细菌病原体引起的感染相关的周期性急性加重为特征。慢性支气管炎急性加重（AECB）常导致肺功能下降和生活质量降低，同时伴有死亡风险增加，并且由于住院的直接费用，对医疗系统和社会产生重大经济影响。在患有COPD的老年人中，合并症作为健康状况和预后的决定因素起着至关重要的作用。未能根除感染病原体导致感染和炎症持续存在，需要反复治疗和住院。根据症状、肺功能损害程度和不良预后风险因素对AECB患者进行分层，有助于临床医生选择最有可能取得治疗成功的经验性抗菌化疗方案。未能覆盖与AECB发作相关的可能病原体可能导致老年患者住院时间延长和功能状态显著下降。氟喹诺酮类药物可能为患有复杂基础CB但病情足够稳定可在门诊治疗的老年COPD患者提供最佳治疗选择。对稳定的CB门诊患者进行优化治疗可能会减少AECB的发生频率，而对AECB发作进行有效的抗菌治疗可显著降低医疗成本并维持老年患者的生活质量。
