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Antibiotics No Help for Most Emphysema, Chronic Bronchitis

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April 2, 2001 -- New guidelines for treating emphysema and chronic bronchitis show that several popular treatments aren't needed -- but they come up short on alternatives.

The guidelines, published in the April 3 issue of the Annals of Internal Medicine and the April issue of CHEST, for the first time give doctors a list of what works -- and what doesn't -- for these devastating conditions.

Emphysema and chronic bronchitis -- known to doctors as chronic obstructive pulmonary disease or COPD -- make it very hard for a person to exhale. COPD usually begins with a morning cough and shortness of breath, and gradually gets worse -- much worse. It is the fourth-leading cause of death in the U.S. As many as nine out of 10 patients get COPD by smoking cigarettes.

COPD patients have recurring bouts of blocked air passages, extreme shortness of breath, coughing spells, and/or lung congestion with thick mucus. Doctors call these recurring bouts "exacerbations." Each bout takes its toll, significantly reducing a patient's life span and quality of life.

But doctors still don't know exactly what to tell patients who ask the big questions: What symptoms can I expect? What will my life be like? How long do I have before I have another relapse? How long do I have to live?

Vincenza T. Snow, MD, is senior medical associate for the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), which developed the treatment guidelines together with the American College of Chest Physicians (ACCP). She is the lead author of the new guidelines.

"Our hope is that these guidelines will be widely read and that they will light a fire under researchers," Snow tells WebMD. "We support more studies that provide information patients can use."

Because the guidelines are based on existing research, they mostly apply to patients who are in the hospital -- even though 80% of COPD patients are treated in doctors' offices. Nevertheless, they make official several radical changes in treatment.

"I thing the biggest surprise is going to be the use of antibiotics," says Snow, who teaches at the Medical College of Pennsylvania in Philadelphia. "It was previously our impression that all acute exacerbations of COPD had to be treated with antibiotics. But the evidence shows that bacteria in the respiratory tract aren't playing much of a role, if any at all. The only time you see any benefit -- and it is a small one -- is in the most severe exacerbations. Hopefully, this means we won't give rise to antibiotic-resistant bugs in these patients who are treated over and over again."

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