Chest
Clinical InvestigationsCOPDRelationship of Sputum Color to Nature and Outpatient Management of Acute Exacerbations of COPD
Section snippets
Materials and Methods
Patients presenting to their primary-care physicians with acute exacerbations associated with sputum production and underlying diagnoses of COPD were considered for the study. All had a history of chronic bronchitis (daily sputum production for at least 3 months of 2 consecutive years) and the development of new symptoms with sputum production that led to a consultation with their general practitioner. These new symptoms included increased dyspnea, cough, sputum volume, sputum purulence,
Results
Of the 148 patients referred during the 15 months of the study, 1 patient was not entered in to the study because clinical review indicated the presence of pneumonia. Three patients were withdrawn within 7 days because of noncompliance, 3 refused entry, 6 were unable to provide a suitable sputum sample for analysis, and 14 were not entered because it was believed that they would be unable to comply with the study or had received recent (in the previous 4 weeks) changes in therapy. The
Discussion
The verification of a bacterial cause of an acute exacerbation of COPD is difficult. Undoubtedly, bacteria play a role, although it requires large studies or meta-analysis to demonstrate that antibiotics influence outcome.19 This is hardly surprising, because many exacerbations will not have a bacterial origin, and even when they do, spontaneous resolution can occur.
Previous authors have suggested that the presence of > 25 neutrophils/low-power field20 or a positive Gram's stain21 indicates a
Conclusions
In summary, we believe that acute exacerbations of COPD are heterogeneous as described in the extensive study by Macfarlane and colleagues28 and the review by Madison and Irwin.12 Subdivision of the exacerbations by sputum color identifies a group in whom recovery occurs without antibiotic therapy. The presence of mucoid sputum should be confirmed, however, as 15 of the patients (40%) subjectively reported that the color had changed. Comparison with a color chart indicated that this was to
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