Professor and Chief, Division of Pulmonary and Critical Care Medicine, UCDHS and VA Northern California Health Care System, 4150 V Street, Suite 3400, Sacramento, CA 95817, USA.
Expert Rev Respir Med. 2009 Oct;3(5):539-48. doi: 10.1586/ers.09.37.
Chronic bronchitis (CB) is a critical component of chronic obstructive pulmonary disease (COPD). Emphysema, reversible airway disease and bronchiectasis also contribute to COPD. Elderly patients are at increased risk for COPD and its components - emphysema, CB and bronchiectasis. In addition, older patients are at increased risk for resistant organisms during episodes of acute exacerbation of CB (AECB). These organisms include the more common bacteria implicated in AECB, such as Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae, and less common nonenteric, Gram-negative organisms such as Pseudomonas aeruginosa. Risk-stratified antibiotic treatment guidelines for AECB appear to be useful, although they have not been prospectively validated for the general CB population, and especially not in the elderly CB population. Many of the AECB treatment guidelines that are stratified based on risk factors have recommended that the oral respiratory fluoroquinolone antibiotics (gemifloxacin, levofloxacin and moxifloxacin) play a second-line but pivotal role, particularly in patients who have failed initial antibiotic treatment for simple CB or as initial treatment for complicated CB.
慢性支气管炎（CB）是慢性阻塞性肺疾病（COPD）的重要组成部分。肺气肿、可逆转的气道疾病和支气管扩张症也会导致 COPD。老年患者患 COPD 及其各组成部分（肺气肿、CB 和支气管扩张症）的风险增加。此外，在 CB 急性加重期（AECB）发作期间，老年患者更容易出现耐药菌。这些病原体包括更常见的与 AECB 相关的细菌，如流感嗜血杆菌、卡他莫拉菌和肺炎链球菌，以及不太常见的非肠道、革兰氏阴性菌，如铜绿假单胞菌。针对 AECB 的风险分层抗生素治疗指南似乎是有用的，尽管它们尚未针对一般的 CB 人群进行前瞻性验证，特别是在老年 CB 人群中。许多基于危险因素分层的 AECB 治疗指南建议口服呼吸氟喹诺酮类抗生素（加替沙星、左氧氟沙星和莫西沙星）发挥二线但关键作用，特别是在最初简单 CB 抗生素治疗失败或作为复杂 CB 的初始治疗的患者中。
