The question is: Should patients with COPD be given antibiotics to keep on-hand to use at their discretion?.
I believe that only certain patients with COPD should be given antibiotics so they can self-medicate in case of an infectious exacerbation of their COPD.
The goals of patient initiated antibiotic therapy include shortening the time between diagnosis and treatment, providing treatment as conveniently as possible and minimizing the obstacles to the delivery of urgently required care.
ProsAlthough in the past it was a controversial subject, a consensus has been recently built in support of the use of broad spectrum antibiotics for the treatment of exacerbations of COPD believed to be infectious. An infectious exacerbation of COPD is defined as a sudden flare up in respiratory symptoms that include increased cough and mucus volume.
These diagnostic guidelines must be differentiated from the more severe problem of pneumonia. A recent review published by The Cochrane Collaboration concluded in favor of antibiotic use in the treatment of exacerbations, saying that antibiotic therapy in this particular setting helps patients recover from COPD exacerbations.
ConsI do not think every patient with COPD is able to self-diagnose and self-treat with antibiotics. It takes insight, motivation and decisiveness to be able to properly start a course of antibiotics. A patient should have successfully overcome at least one infectious exacerbation in collaboration with their physician prior to being a candidate for "patient controlled antibiotic therapy." Those patients who have demonstrated an ability to correctly recognize an exacerbation and differentiate an exacerbation from other problems should be considered potential candidates.
Patients who suffer from COPD plus other active medical problems or “co-morbidities” are not ideal candidates to be given the responsibility to start an antibiotic course. These patients will have more trouble determining if their increased respiratory symptoms are due to an exacerbation of COPD or one of their other ailments.
The Next Steps
After a sound relationship has been established between a patient with COPD and physician, it is appropriate to empower some patients so they can treat themselves with an antibiotic when necessary. A candidate patient needs to be counseled and educated about the risks and benefits of the self-initiated treatment prior to the antibiotic prescription.
The patient and physician must agree on a set of symptoms and signs that should lead the patient to initiate use of the antibiotic. In addition, an explicit agreement should be reached to ensure the patient will seek additional help if symptoms fall out of the range of what is considered an accepted exacerbation of COPD.
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