The Diagnosis and Treatment of Elderly Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Chronic Bronchitis

Abstract

The syndrome of chronic obstructive pulmonary disease (COPD) consists of chronic bronchitis (CB), bronchiectasis, emphysema, and reversible airway disease that combine uniquely in an individual patient. Older patients are at risk for COPD and its components--emphysema, CB, and bronchiectasis. Bacterial and viral infections play a role in acute exacerbations of COPD (AECOPD) and in acute exacerbations of CB (AECB) without features of COPD. Older patients are at risk for resistant bacterial organisms during their episodes of AECOPD and AECB. Organisms include the more-common bacteria implicated in AECOPD/AECB such as Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae. Less-common nonenteric, gram-negative organisms including Pseudomonas aeruginosa, gram-positive organisms including Staphylococcus aureus, and strains of nontuberculosis Mycobacteria are more often seen in AECOPD/AECB episodes involving elderly patients with frequent episodes of CB or those with bronchiectasis. Risk-stratified antibiotic treatment guidelines appear useful for purulent episodes of AECOPD and episodes of AECB. These guidelines have not been prospectively validated for the general population and especially not for the elderly population. Using a risk-stratification approach for elderly patients, first-line antibiotics (e.g., amoxicillin, ampicillin, pivampicillin, trimethoprim/sulfamethoxazole, and doxycycline), with a more-limited spectrum of antibacterial coverage, are used in patients who are likely to have a low probability of resistant organisms during AECOPD/AECB. Second-line antibiotics (e.g., amoxicillin/clavulanic acid, second- or third-generation cephalosporins, and respiratory fluoroquinolones) with a broader spectrum of coverage are reserved for patients with significant risk factors for resistant organisms and those who have failed initial antibiotic treatment.

Burden of Exacerbations in Patients with Moderate to Very Severe COPD in the Netherlands: A Real-life Study

“…As hospitalization records in the Dutch Medical Registry include a single mandatory primary diagnosis code and may include one or more optional secondary diagnosis codes, an infective AECOPD (with a Gram-negative agent) could have been missed and the proportion and recurrence rate may have been underestimated. However, the proportion of infective AECOPDs as found in the present study is not lower than the proportion as described in the literature (7,24).…”

Spatial and temporal variability of idiopathic pulmonary fibrosis cases in Silesian Voivodeship in years 2006–2010

“…Our observations are consistent with the results of other authors [1,2,7]. It is well known that physiological changes in lungs related to the lung parenchyma loss of elasticity are significant in the case of elderly people [22][23][24]. The age is also a significant factor stimulating other diseases.…”

High Incidence of Community-Acquired Pneumonia among Rapidly Aging Population in Japan: A Prospective Hospital-Based Surveillance

“…H. influenzae is commonly involved in acute exacerbation of chronic bronchitis and chronic obstructive pulmonary disease (23). In fact, the present study revealed that such chronic respiratory diseases were more common among elderly people and were associated with H. influenzae but not S. pneumoniae positivity (results not shown).…”