Exacerbations of chronic obstructive pulmonary disease: when are bacteria important?

Abstract

The progressive course of chronic obstructive pulmonary disease (COPD) is often aggravated by exacerbations, the majority of them produced by bronchial infection. Frequent exacerbations have been demonstrated to have a negative impact on quality of life and pulmonary function in patients with COPD, particularly in active smokers. Furthermore, acute exacerbations are the most frequent cause of medical visits, hospital admissions and death among patients with chronic lung disease.Evidence indicates that the number of patients with pathogenic bacteria in respiratory secretions and the bronchial bacterial load increase during exacerbations. Furthermore, the local inflammatory response of the host parallels the increase in bacterial load. From these observations, it can be speculated that, for symptoms of acute exacerbation to appear, there must be a minimum bacterial load in the airways, i.e. a threshold above which the inflammatory reaction is severe enough to elicit clinical symptoms of exacerbation. This threshold may vary from patient to patient owing to different modifying factors. Some of these factors may be the recognised risk factors for relapse, such as increasing age, impairment of lung function, comorbid conditions or frequent exacerbations in the past.Relapse rates after ambulatory treatment of acute exacerbation of COPD may be as high as 20-25% of cases. Relapses are associated with significant mordibity and increased costs.A number of unanswered questions remain regarding exacerbations of chronic obstructive pulmonary disease. These include the role of viral infection, the importance of residual bacterial colonisation and the impact of new antibiotics on the treatment of exacerbations. Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases in developed countries. Furthermore, the number of individuals affected has grown since the 1980s [1]. In Spain, the prevalence of COPD is 9% in adults aged 40-70 yrs, although only 22% of these are diagnosed [2]. Tobacco smoking is the main aetiological factor for COPD. In a population-based study in Spain, 25% of the population aged 40-70 yrs were smokers and another 25% former smokers [3]. Only 15-20% of smokers will develop COPD, and smokers with COPD exhibit higher tobacco consumption and greater dependence on nicotine than smokers who do not have COPD, and more than one-third have never tried to stop smoking [3]. These figures indicate that the problem of COPD in most developed countries will continue to increase in the near future.The chronic and progressive course of COPD is often aggravated by short periods of increasing symptoms, particularly increasing cough, dyspnoea and production of sputum which can become purulent.

Efficacy of moxifloxacin in the treatment of bronchial colonisation in COPD

“…Instead, the rationale for the use of the fluoroquinolone moxifloxacin for the treatment of stable COPD is based on its antibacterial efficacy. Bacterial eradication reduces the inflammatory burden of the airways [6,36] and may eventually prevent the development of exacerbations [11,14,37,38]. Treatment with moxifloxacin has been efficacious in eradicating bacteria from the airways but has neither prevented the occurrence of exacerbations nor prolonged the time to the first exacerbation in our population.…”

“…Understanding the role of bacterial colonisation in COPD is crucial for the development of strategies aimed at eliminating the PPMs from the lower airways [11]. The new, more active antibiotics may allow short courses of treatment to be administered with the objective of eradicating bacteria in the airways.…”

Human Rhinovirus Association with Influenza-Like Illness and Symptomatic Treatment for Acute Respiratory Infection in a Brazilian Southern City

“…Pulmonary diseases (PD) are a major risk factor for severe and occasionally life threatening complications arising from an ARI, regardless of the causative agent (MIRAVITLLES, 2002;SAPEY e STOCKLEY, 2006;WALSH, FALSEY e HENNESSEY, 1999). Influenza vaccination is highly recommended in these patients.…”

Особливості Мікробіоти Ротоглотки Дітей, Хворих На Бронхіальну Астму Та Гостру Респіраторну Інфекцію

“…Роль інфекційних агентів у виникненні та персис-туванні запального процесу у хворих із бронхіальною астмою постійно викликає інтерес і неоднозначно трактується клініцистами, мікробіологами та пато-морфологами [8,5,14]. Невирішеними залишаються питання про первинну або вторинну роль патогенної мікрофлори у виникненні загострень та зниженні ефек-тивності проведеного лікування, що слід враховувати при застосуванні препаратів (кортикотропні гормони, антибіотики тощо), які, у свою чергу, як побічний ефект мають порушення місцевого мікробного балансу [8].…”