Sachs A P, Koëter G H, Groenier K H, van der Waaij D, Schiphuis J, Meyboom-de Jong B
Department of Family Practice, University of Groningen, The Netherlands.
Thorax. 1995 Jul;50(7):758-63. doi: 10.1136/thx.50.7.758.
Bacterial infections of the lower airways during an exacerbation in patients with asthma or chronic obstructive pulmonary disease (COPD) may be the cause of an exacerbation or the consequence of a viral infection or an increase in airways limitation. To determine whether bacterial infection is an important component in the pathogenesis of an exacerbation, the effects of antimicrobial treatment must be studied.
Patients with asthma or COPD seen in general practice were studied in a double blind randomised manner to investigate whether the antimicrobial drugs amoxicillin (500 mg three times daily), cotrimoxazole (960 mg twice daily), or a placebo, each when added to a short course of oral corticosteroids, can accelerate recovery from exacerbations. Patients were instructed to contact their own physician early in the morning when complaints of increased shortness of breath, wheezing, or exacerbations of cough with or without sputum production occurred. Treatment effects were evaluated over the next 14 days by studying symptom scores (wheeze, dyspnoea, cough with and without mucus production, and awakening with dyspnoea), peak expiratory flow values (PEF, expressed as % predicted), and sublingual temperature. Bacteriological study of the sputum was made at the onset of an exacerbation and 7, 21 and 35 days afterwards.
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 improvements in the three groups after the exacerbation, ranging from 0.34% to 0.78% predicted per day, finally returning to baseline values. Sublingual temperature did not change. Six of 71 patients consulted their physician because of a relapse between four and 24 days after the start of treatment. In only two of the 50 sputum samples, collected during an exacerbation, and which contained > or = 10(5) bacteria in culture sensitive to the chosen antibiotic given, did any benefit from antimicrobial treatment occur. During the recovery period sputum purulence improved irrespective of antibiotic treatment.
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 moderate asthma or COPD when treated by their general practitioners. Moreover, antibiotics do not reduce the number of relapses after treating an exacerbation.
哮喘或慢性阻塞性肺疾病（COPD）患者病情加重时，下呼吸道细菌感染可能是病情加重的原因，也可能是病毒感染或气道受限加重的结果。为确定细菌感染是否为病情加重发病机制中的重要因素，必须研究抗菌治疗的效果。
以双盲随机方式对全科医疗中诊治的哮喘或COPD患者进行研究，以调查抗菌药物阿莫西林（每日三次，每次500毫克）、复方新诺明（每日两次，每次960毫克）或安慰剂，在加用短期口服糖皮质激素时，是否能加速病情加重后的恢复。患者被告知，当出现呼吸急促加重、喘息或咳嗽加重（无论有无咳痰）的症状时，应在清晨联系自己的医生。在接下来的14天内，通过研究症状评分（喘息、呼吸困难、有无黏液咳出的咳嗽以及因呼吸困难而醒来）、呼气峰值流速值（PEF，以预测值的百分比表示）和舌下温度来评估治疗效果。在病情加重开始时以及之后的第7、21和35天对痰液进行细菌学研究。
195名入组患者中，71名（36%）因病情加重症状联系了医生。三组患者的症状均有改善，在四分制量表上，改善幅度为每天0.54至0.75分。预计PEF%在病情加重后三组均有改善，每天改善幅度为预计值的0.34%至0.78%，最终恢复到基线值。舌下温度未变化。71名患者中有6名在治疗开始后4至24天因病情复发咨询了医生。在病情加重期间采集的50份痰液样本中，只有2份培养出对所用抗生素敏感且细菌数≥10⁵的样本，抗菌治疗有获益。在恢复期间，无论是否使用抗生素，痰液脓性均有所改善。
对于由全科医生治疗的轻至中度哮喘或COPD门诊患者，在病情加重期间给予短期口服泼尼松龙时加用抗生素，根据峰值流速和症状评分的变化衡量，并不会加速恢复。此外，抗生素并不能减少病情加重治疗后的复发次数。
