Exacerbations of chronic obstructive pulmonary disease (COPD) are one of the most common causes of impaired health status and hospital admissions in the US. Current data reveals that therapy for an acute exacerbation is usually a course of antibiotics and oral corticosteroids. However, there is no evidence that this changes the rate of readmissions. It is well know that over 7% of patients hospitalized for an exacerbation are not back to their lung function base line in over 90 days.
Antibiotics called macrolides, which are commonly used for exacerbations, have also been shown to prevent exacerbations. However, there has been some concern that long term use leads to antibiotic resistance, cardiac toxicity and ototoxicity (problems with the ear and hearing). I have personally used weekly courses of macrolides (i.e. daily for the first 7 days of each month) for selected patients who have had frequent exacerbations. A recent study showed that the use of a macrolide daily for 3 months following a hospitalization for an exacerbation significantly improved the readmission risk and improved lung function on pulmonary function testing. Patients are at greatest risk for readmission for an exacerbation in the first 3 months following hospital discharge and may benefit substantially from this regimen. Studies still need to be done to see if this is a reasonable protocol for all patients, and the concerns over cardiac and ototoxicity remain. Interestingly, exacerbation prevention was increased over the next six months after therapy in the macrolide treatment group.