Chronic bronchitis: when and how to treat

Chronic bronchitis, as defined by the magnitude and duration of sputum production, is a diagnosis that encompasses a variety of patients with physiological abnormalities ranging from mild to severe. The first element of therapy is the cessation of smoking, the single most frequent cause of chronic bronchitis. In assisting patients to stop cigarette abuse, nicotine-containing gum has been useful. Therapy directed at airway narrowing continues to be the most widely prescribed. The use of metered dose inhalers containing either beta-adrenergic stimulants or, more recently, ipratropium bromide, an atropine-like agent, continues to be the mainstream of therapy. Theophylline remains a widely prescribed bronchodilator. The use of corticosteroids remains controversial in the stable patient, but appears to be indicated clearly in the patient with an acute exacerbation. The usefulness of antibiotics in acute exacerbations is still uncertain; further studies are needed. Augmentation of survival by the use of chronic supplemental O2 is now certain; more efficient ways to administer O2 are now available. Finally, pulmonary rehabilitation provides a means of improving quality of life in severely disabled patients.