HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Miravitlles, M. Search for Related Content PubMed PubMed Citation Articles by Miravitlles, M.

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

CORRESPONDENCE: M. Miravitlles, Servei de Pneumologia, Institut Clínic de Pneumologia i, Cirurgia Toràcica (IDBAPS)Hospital Clínic i Provincial, Barcelona, Spain. Fax: 34 932275454. E-mail: marcm@separ.es

Keywords: bronchial colonisation, bronchial infection, chronic obstructive pulmonary disease, exacerbation

Received: January 28, 2002
Accepted February 6, 2002

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.

This article has been cited by other articles:

				M. I. Restrepo and A. Anzueto Guidelines for the diagnoses and treatment of adult lower respiratory tract infections: a true "European cooperative effort" Eur. Respir. J., December 1, 2005; 26(6): 979 - 981. [Full Text] [PDF]