Is co-morbidity taken into account in the antibiotic management of elderly patients with acute bronchitis and COPD exacerbations?

1. 2. 3. 4. 5. Jettie Bont, Eelko Hak, Christine E Birkhoff, Arno W Hoes and Theo JM Verheij

+ Author Affiliations 1. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
1. Correspondence to: J. Bont, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85060, 3508 AB Utrecht, The Netherlands. Email: j.bont@umcutrecht.nl

Received November 6, 2006. Revision received March 23, 2007. Accepted April 25, 2007.

Abstract
Background. Guidelines on acute lower respiratory tract infections recommend restrictive use of antibiotics, however, in patients with relevant co-morbid conditions treatment with antibiotics should be considered. Presently, it is unknown whether GPs adhere to these guidelines and target antibiotic treatment more often at patients with risk-elevating conditions. Objectives. We assessed whether in elderly primary care patients with acute bronchitis or exacerbations of chronic pulmonary disease (COPD), antibiotics are more often prescribed to patients with risk-elevating co-morbid conditions. Methods. Using the Utrecht GP research database, we analysed 2643 episodes in patients of 65 years of age or older with a GP-diagnosed acute bronchitis or exacerbation of COPD. Multivariable logistic regression analysis was applied to determine independent determinants of antibiotic use. Results. Antibiotic prescribing rates were high in both acute bronchitis (84%) and in exacerbations of COPD (53%). In acute bronchitis, only age was an independent determinant of antibiotic use [odds ratio (OR) 1.03, 95% confidence interval (CI) 1.0031.048], whereas in exacerbations of COPD antibiotics were more often prescribed to male patients (OR 1.3, 95% CI 1.01.5), patients with diabetes (OR 1.7, 95% CI 1.12.4) and heart failure (OR 1.3, 95% CI 1.0 1.7).

Conclusion. Dutch GPs prescribe antibiotics in the majority of elderly patients with acute bronchitis and in half of the episodes of exacerbations of COPD. Tailoring their antibiotic treatment according to the presence or absence of high-risk co-morbid conditions could help GPs in improving antibiotic use in patients with respiratory tract infections in primary care.
http://fampra.oxfordjournals.org/content/24/4/317.abstract

Domestic biomass fuel combustion and chronic bronchitis in two rural Bolivian villages.
Albalak R, Frisancho AR, Keeler GJ. Source

Department of International Health, Rollins School of Public Health of Emory University, Atlanta, Georgia 30322, USA.
Abstract BACKGROUND:

Chronic bronchitis is an important public health problem worldwide. A study was undertaken to examine the association between exposure to air pollution from domestic biomass fuel combustion and chronic bronchitis in two rural Bolivian highland villages: a village in which cooking is done exclusively indoors and a village in which cooking is done primarily outdoors. Apart from this difference, the villages were virtually identical in terms of socioeconomic status, climate, altitude, access to health care, and other potential confounders.
METHODS:

Pollution exposure was assessed by combining information on concentrations of particulate matter of <10 microm diameter (PM(10)) in 12 randomly selected households in each village in all potential microenvironments of exposure with time allocation information. The prevalence of chronic bronchitis was assessed using the British Medical Research Council's questionnaire on individuals >20 years of age in both villages (n = 241).
RESULTS:

Daily pollution exposure was significantly higher in the indoor cooking village (range for adults: 9840-15 120 microg-h/m(3)) than in the outdoor cooking village (range for adults: 5520-6240 microg-h/m(3)) for both seasons and for men and women. The overall prevalence of chronic bronchitis was 22% and 13% for the indoor and outdoor cooking villages, respectively. Logistic

regression analysis, which excluded the few smokers present in the population, showed a 60% reduced risk of chronic bronchitis in the outdoor cooking village compared with the indoor cooking village (OR 0.4; 95% CI 0.2 to 0.8; p = 0.0102) after adjusting for age and sex. Individuals aged >40 years were 4.3 times more likely to have chronic bronchitis than the younger age group (OR = 4.3; 95% CI 2.0 to 9.3; p = 0.0002). There was no significant difference in the prevalence of chronic bronchitis in men and women.
CONCLUSIONS:

The results of this study suggest an association between chronic bronchitis and exposure to domestic biomass fuel combustion, but further large scale studies from other areas of the developing world are needed to confirm the association. Results from this and other studies will assist the development of culturally acceptable and feasible alternatives to the high exposure cooking stoves currently being used by most people worldwide.
http://www.ncbi.nlm.nih.gov/pubmed/10525559

Wheezing bronchitis reinvestigated at the age of 10 years. (PMID:9174218)

Abstract Citations BioEntities Related Articles

Wennergren G, Amark M, Amark K, Oskarsdttir S, Sten G, Redfors S Department of Paediatrics, Ostra University Hospital, Gteborg, Sweden. Acta Paediatrica (Oslo, Norway : 1992) [1997, 86(4):351-5] Type: Journal Article, Research Support, Non-U.S. Gov't DOI: 10.1111/j.1651-2227.1997.tb09021.x Abstract Highlight Terms

Diseases(1) Species(1) Chemicals(1) We have reinvestigated 92/101 children aged 10, who before the age of 2 years were admitted to a paediatric ward due to wheezing bronchitis. At the present time, 70% are symptom-free without medication, 20% have mild asthma, 8% moderate and 2% severe asthma. Persistent asthma correlated significantly to the presence of some other atopic disease in recent years, to early start of wheezing during infancy and to intense obstructive disease as a young child, while initial respiratory syncytial virus infection did not. A clear-cut relationship between smoking in the home in

infancy and persistent asthma emerged (not visible at a preschool follow-up). The histamine challenge results correlated to the clinical picture. A normal histamine challenge was seen in 63%, mild hyperresponsiveness in 19%, moderate in 12% and pronounced hyperresponsiveness in 6%. The figures for persistent asthma and bronchial hyperresponsiveness are high compared with the prevalence of asthma in the overall population of schoolchildren.

http://ukpmc.ac.uk/abstract/MED/9174218