Abstract
Currently, chronic obstructive pulmonary disease (COPD) patients and their physicians face a number of significant clinical challenges, one of which is the high degree of uncertainty related to chronic bronchial infection (CBI). By reviewing the current literature, several challenges can be identified, which should be considered as goals for research. One of these is to establish the bases for identifying the biological and clinical implications of the presence of potentially pathogenic microorganisms in the airways that should be more clearly elucidated according to the COPD phenotype. Another urgent area of research is the role of long-term preventive antibiotics. Clinical trials need to be carried out with inhaled antibiotic therapy to help clarify the profile of those antibiotics. The role of inhaled corticosteroids in patients with COPD and CBI needs to be studied to instruct the clinical management of these patients. Finally, it should be explored and confirmed whether a suitable antimicrobial treatment during exacerbations may contribute to breaking the vicious circle of CBI in COPD. The present review addresses the current state of the art in these areas to provide evidence which will enable us to progressively plan better healthcare for these patients.
Highlights
One of the situations with a major potentially negative impact on patients with chronic obstructive pulmonary disease (COPD) and which generates considerable uncertainty in clinical practice is the presence of a chronic bronchial infection (CBI)
This clinical situation has been associated with the presence of bronchiectasis; there is accumulating evidence to indicate that COPD patients may have a CBI that causes a major clinical impact and which affects the progression of the disease without the presence of bronchiectasis being necessary [1]
The presence of CBI by the usual potentially pathogenic microorganisms (PPM) is a risk factor for frequent and more severe bacterial exacerbations [22], establishing a vicious circle of CBI and bacterial exacerbations, modulated by the host’s defense mechanisms and the antibiotic treatment, either during exacerbations or in the stable phase
Summary
One of the situations with a major potentially negative impact on patients with chronic obstructive pulmonary disease (COPD) and which generates considerable uncertainty in clinical practice is the presence of a chronic bronchial infection (CBI). No management strategies have been developed and tested for the treatment of CBI; instead, research has been conducted into treatments to prevent exacerbations in patients with CBI [3,4] This clinical context represents a significant challenge for the clinician and generates numerous research questions that require a solution before the clinical questions posed may be answered. We will start by addressing a number of relevant but controversial issues
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