Abstract
Chronic infections are associated with exacerbation in patients with chronic obstructive pulmonary disease (COPD). The major objective of the management of these patients is the prevention and effective treatment of exacerbations. Patients that have increased sputum production, associated with purulence and worsening shortness of breath, are the ones that will benefit from antibiotic therapy. It is important to give the appropriate antibiotic therapy to prevent treatment failure, relapse, and the emergence of resistant pathogens. In some patients, systemic corticosteroids are also indicated to improve symptoms. In order to identify which patients are more likely to benefit from these therapies, clinical guidelines recommend stratifying patients based on their risk factor associated with poor outcome or recurrence. It has been identified that patients with more severe disease, recurrent infection and presence of purulent sputum are the ones that will be more likely to benefit from this therapy. Another approach related to disease prevention could be the use of prophylactic antibiotics during steady state condition. Some studies have evaluated the continuous or the intermittent use of antibiotics in order to prevent exacerbations. Due to increased bacterial resistance to antibiotics and the presence of side effects, several antibiotics have been developed to be nebulized for both treatment and prevention of acute exacerbations. There is a need to design long-term studies to evaluate these interventions in the natural history of the disease. The purpose of this publication is to review our understanding of the role of bacterial infection in patients with COPD exacerbation, the role of antibiotics, and future interventions.
Highlights
It is important to determine the role of bacteria and other pathogens in chronic obstructive pulmonary disease (COPD) patients with stable disease and during exacerbations
The number of studies examining the microbiome of the lower airways is limited and there is some overlap between bacteria seen in COPD and healthy individuals [7]; a recent study has reported a significantly different bacterial community in patients with very severe COPD compared with nonsmokers, smokers and patients with cystic fibrosis [8]
Studies are clearly needed to understand the role of these microbiomes in healthy individuals and COPD patients and how to recognize that an “acute infection” is present; we need to understand the impact of antibiotics—given for either acute exacerbations, or chronic long-term administration—on these bacterial communities
Summary
It is important to determine the role of bacteria and other pathogens in chronic obstructive pulmonary disease (COPD) patients with stable disease and during exacerbations. It has been suggested that the term chronic bronchial infection would be more appropriate when addressing the presence of significant concentrations of PPMs in the lower airways of stable COPD patients [2,5]. Studies are clearly needed to understand the role of these microbiomes in healthy individuals and COPD patients and how to recognize that an “acute infection” is present; we need to understand the impact of antibiotics—given for either acute exacerbations, or chronic long-term administration—on these bacterial communities. The problem with these studies was that, at the time, we did not have an adequate definition of COPD; we had a small number of patients; we used narrow-spectrum antibiotics, and not well-defined end-points After completion of these studies, there was increased concern regarding the development of bacterial resistance; no new studies were conducted for several years [9]. The purpose of this publication is to review the role of bacterial infection in patients with COPD both in stable conditions and exacerbation, as well as the role of antibiotics, and what other interventions can impact patients
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