Our understanding of chronic bronchitis has been hampered by the fact that the diagnosis is based upon historical evidence of recurrent cough and sputum without any requirement that certain physiologic or microscopic criteria be met. Despite the fact that epidemiological studies have implicated viruses, bacteria, and Mycoplasma pneumoniae in a varying percentage of exacerbations, in an individual case it is often difficult to establish a causal role for any agent. Antibiotics seem to reduce the morbidity of an infective exacerbation, but the widespread use of prophylactic antibiotics cannot be justified on the basis of the studies currently available. It would seem that the most sensible approach in the treatment of patients with chronic bronchitis would be to treat them on an individual basis, avoiding the indiscriminate use of antibiotics, but employing them on a trial basis in patients with a demonstrated proclivity for seasonal exacerbations. It is hoped that future clinical trials incorporating only patients meeting the classic criteria for chronic bronchitis and its exacerbations will develop treatments for this significant disease which are more successful than those currently available.
