Exacerbation of chronic bronchitis

Case report:

A 73 years old patient with a known for a long time with heart failure myocardial infarction expired a few years ago as well as a long-term use of cigarettes with more than 40 pack years complains of increasing shortness of breath, increased, especially morning sputum and also a significant yellowing this ejection. There are no temperatures but the breathlessness has increased considerably. It started the symptoms three days ago, after the patient had been infected with the grandchildren with a febrile viral respiratory infection. Physical examination shows a significant cyanosis, on lung ubiquitous dry bronchitic sounds with prolonged expiratory phase are audible, beyond is the diaphragm by percussion let down, not very mobile and percussion hyper sonorous. Evidence of pneumonia do not arise in the auscultation. The arterial blood gas analysis shows a significant hypoxia with PaO2 of 55 mm Hg and the "peak flow" that the patient regularly measures itself, has dropped to below 150 l / min. The peripheral edema on the lower legs are more pronounced than in the previous investigation.

Diagnosis and Etiology:

This patient suffers as a result of their strong nicotine for many years from a chronic mucopurulent and obstructive bronchitis, the now obvious, starting with a viral infection, is exacerbated by bacteria. The patient falls ill about three to four times a year, especially in the winter months, to such exacerbations and has been a significant reduction in their advanced respiratory function. With such frequent exacerbations and the image of an advanced chronic obstructive pulmonary disease (Pneumococcal Haemophilus influenzae,) must beside the usual pathogens of purulent bronchitis are also thought of Moraxella catarrhalis, Klebsiella species, Proteus species and Enterobacter species. In principle, an adequate microbiological examination of sputum is carried out in these patients; on the result of this analysis, however, in acute cases, in particular in order to avoid hospitalization, can not be serviced.

Therapy:

In the microbiological etiology necessarily have to be thought of the called gram-negative bacteria and an appropriate empirical antibiotic therapy can be chosen. We recommend Aminobenzylpenicilline together with beta-lactamase inhibitors [ampicillin plus sulbactam (UNACID), amoxicillin plus clavulanic acid (Augmentin)]. Other alternatives are oral cephalosporin [eg Cefuroxime (ELOBACT et al) undLoracarbef (LORAFEM)]. Even fluoroquinolones wieLevofloxacin (Tavanic) or moxifloxacin (Avelox) and Pseudomonas aeruginosa also ciprofloxacin (Cipro, among others) are also therapeutic alternatives. In addition, an anti-obstructive and secretolytic therapy should be carried out in this patient, beyond the initiation of a long-term oxygen therapy must be checked. The antibiotic treatment is carried out to three days on the discoloration of the sputum beyond what means approximately eight to 14 days as a time frame in the rule.