Antibiotic prevention of acute exacerbations of COPD.

Foreword This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the authors’ clinical recommendations. Stage A 55-year-old man presents with a history of recurrent exacerbations of chronic obstructive pulmonary disease (COPD) during the past year. These episodes were characterized by increased shortness of breath, cough, and sputum production. The diagnosis of COPD was made 2 years previously. Pulmonary-function testing then revealed a forced expiratory volume in 1 second (FEV1) of 50% of the predicted value after bronchodilator inhalation, with a ratio of FEV1 to forced vital capacity (FVC) of 60%. The patient had a 30-pack-year smoking history but stopped smoking after chronic lung disease was diagnosed. On the current visit, he . . .