Chronic obstructive pulmonary disease, neutrophils and bacteria: from science to integrated care pathways

The incidence of chronic obstructive pulmonary disease (COPD) and its effect on morbidity and mortality is rising. Extensive research implicates the role of inflammation and particularly the effect of neutrophil proteinases in generating many of the pathological features seen as part of the COPD syndrome. Exacerbations of COPD are an important cause of morbidity, mortality and progressive deterioration in lung function. These episodes are poorly defined but bacteria in the airways drives neutrophilic inflammation and proteinase release and hence may play a key role. The differentiation between benign colonisation and heightened neutrophilic inflammation can be determined by observation of sputum purulence. This reflects the likelihood of bacteria being present and particularly the number of bacteria. This simple clinical observation enables decision making about the need for antibiotic therapy to be as much a part of patient self-management as physician directed management in the integrated care pathway for COPD.