Changing strategies for treatment of chronic bronchitis.

There has been a recent re-examination of the therapeutic approach to chronic bronchitis, with or without airflow obstruction, partly as a result of intense interest in asthma therapy. Although the mainstay of therapy in chronic bronchitis is still smoking cessation, there has been a shift in importance and use of therapeutic interventions based on pathophysiological considerations. The presence of airway inflammation and bronchial hyperreactivity in chronic bronchitis, analogous to asthma, has spurred interest in the use of anti-inflammatory agents such as inhaled steroids, with the hope that these drugs will have the same favorable effects on airflow obstruction as in asthma. Recognition of the relative importance of cholinergic stimulation in airflow obstruction associated with chronic bronchitis has elevated the role of anticholinergic agents to primary therapy. And lastly, evolving understanding of the role of infectious agents in exacerbations of chronic bronchitis is having an impact on the perceived importance of antibiotics in this setting. This article will discuss the rationale, evidence of efficacy, and current role for each of these treatment modalities in chronic bronchitis.