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Health-Status Changes After Acute Exacerbation of Chronic Bronchitis Predict Future Exacerbations: Presented at ATS

By Charlene Laino

ORLANDO, FL -- May 27, 2004 -- The magnitude of recovery from an acute exacerbation of chronic bronchitis (AECB) after antibiotic treatment is an independent predictor of future exacerbations, researchers report for the first time.

The findings come from a new analysis of data by the landmark MOSAIC study, which pitted moxifloxacin against standard therapy for the treatment of AECB.

Paul W. Jones, PhD, professor of respiratory medicine, St. George's Hospital Medical School, London, United Kingdom, presented the results May 26th at the 100th International Conference of the American Thoracic Society.

The MOSAIC study enrolled 1,935 patients with chronic bronchitis and a history of smoking. During a 12-month monitoring period, 730 patients had an AECB and were randomized to receive 5 days of moxifloxacin or 7 days of 500 mg of amoxicillin twice a day; 500 mg of clarithromycin twice a day; or 250 mg of cefuroxime axetil twice a day.

Patients had a mean age of 63 years and about two thirds of them were male. About one fourth had 4 or more acute exacerbations in the year prior to study entry.

All patients were administered the St. George's Respiratory Questionnaire -- a validated measure of health status. At baseline, the average score on the 100-point scale was 56.3 points in the moxifloxacin arm and 56.6 points in the usual treatment group, Dr. Jones said.

Nine months later, the score fell by 11.4 points in patients who did not have a second AECB episode, compared with 6.6 points in the group of patients that did have a repeat episode (P <.0001).

Logistic regression analysis showed that a 4-point decrease on the questionnaire scale after the end of antibiotic treatment was associated with a 12.8% deceased risk of re-exacerbation within the following 9 months, Dr. Jones said.

Use of inhaled corticosteroids and long-acting beta2-agonists emerged as independent predictors of an increased likelihood of exacerbation during the 9-month period, Dr. Jones said, adding that these associations are unlikely to be causal.

"The size of the symptomatic improvement following treatment with an acute infective exacerbation of chronic obstructive pulmonary disease predicts the time to the next exacerbation," Dr. Jones said in an interview. "The nature of the link between the degree of recovery following an effectively treated exacerbation and the likelihood of having a further exacerbation is yet to be established."

The study was funded by Bayer Pharmaceuticals.


[Presentation title: "Health Status Changes Following Antibiotic Treatment of an Acute Exacerbation of Chronic Bronchitis (AECB) Reduce the Risk of AECB Recurrence in COPD -- the Mosaic Study." Poster #511]

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