Symptom resolution assessed using a patient directed diary cardduring treatment of acute exacerbations of chronic bronchitis

摘要

BACKGROUND—Acute exacerbations of chronic bronchitis are common and the presenting symptoms vary, although it is not clear how this should influence management. From a health care perspective, an understanding of the speed of symptom resolution is of importance to determine the success of treatment or when a change is indicated because of treatment failure.
METHODS—The response of 63 patients treated at home for exacerbations of chronic bronchitis was assessed using a patient directed diary card incorporating sputum characteristics and symptoms. Treatment was given according to the nature of the sputum at presentation; patients with purulent sputum received an antibiotic for 5 or 10 days (randomised, double blind) whereas patients with mucoid sputum received high dose inhaled steroid or placebo for 14 days (randomised, double blind).
RESULTS—The mean (SE) total diary card score at presentation was significantly higher in the purulent group than in the mucoid group (19.7 (0.9) v 16.3 (0.9); mean difference -3.4 (95% CI -6.1 to -0.7), p<0.05). In the purulent group sputum colour andvolume improved rapidly and in both groups the mean (SE) total diary card score had improved by the fifth day of treatment to 13.0(0.7) inthe purulent group (mean difference -6.6 (95% CI -8.8 to -4.4),p<0.001) and 14.6 (0.8) in the mucoid group (mean difference -1.7(95% CI -4.0 to 0.8), p<0.05), which was no longer significantly different from the stable state. Diary card scores did not differ significantly between patients who received antibiotics for 5or 10 days in the purulent group or between patients who received inhaledfluticasone or placebo in the mucoid group.
CONCLUSIONS—Exacerbationsof chronic bronchitis associated with purulent sputum havesignificantly worse symptoms at presentation than those with mucoidsputum. In both groups these symptoms resolve rapidly so that by thefifth day of treatment they are no different from the stable state. Nosignificant effect was found on symptom resolution of antibioticduration (5 v 10 days) in the purulent groupor of inhaled fluticasone in the mucoid group, which resolved withoutantibiotics. Larger numbers may be required to demonstrate astatistically (if not clinically) significant difference.