Physiologic and Antibiotic (Penicillin) Therapy in Chronic Hypertrophic Pulmonary Emphysema

¹ The Department of Medicine, College of Physicians and Surgeons, Columbia University and the Presbyterian Hospital, New York City.

A report is presented of the results of physiologic therapy and antibiotic (penicillin) treatment in patients with pulmonary emphysema. In this group of cases the associated diagnosis was more commonly bronchial asthma, less frequently pulmonary fibrosis, bronchiectasis, sinusitis and chronic bronchitis.

The results of treatment may be summarized as follows: Of 86 courses of treatment in 51 patients clinical improvement attributable chiefly to penicillin therapy was marked in 20, moderate in 19, slight in 25; in 22 no improvement took place. The results of physiologically directed therapy in the same group were marked improvement in 9, moderate in 36, slight in 23 and none in 18. Of a total of 86 courses, 66 cases manifested moderate or marked improvement. In analyzing the role played by each therapeutic factor as well as could be determined, 31 of the 66 improved cases appeared to be more influenced by physiologic therapy, 27 by penicillin treatment, with an equal effectiveness in 8 cases. In some of the cases treated in this series previous exposure to physiologic therapy had resulted in a baseline of improvement, which gave the appearance of less striking effect from this type of therapy than might have been anticipated in patients who had not been treated by the procedures used in bronchial relaxation and inhalational therapy. The study of the sputum culture before and after treatment revealed the characteristic disappearance of gram positive organisms in the majority of cases with replacement by gram negative bacteria.

In most cases penicillin was administered as an aerosol but favorable results were also obtained with systemic administration. The response to varying modes of treatment of the individual case is presented in tabular form.