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Role of infection in exacerbations of chronic obstructive pulmonary disease
Marc Miravitlles1, Antonio Anzueto
1aPneumology Department, Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain bDepartment of Medicine, Division of Pulmonary Diseases/Critical Care Medicine, The University of Texas Health Science Center at San Antonio and The South Texas Veterans Healthcare System, Audie L, Murphy Memorial Veterans Hospital Division, San Antonio, Texas, USA.
Purpose Of Review:
In this review, we present the latest findings on the cause, pathogenesis and management of patients with chronic obstructive pulmonary disease (COPD) and an infective phenotype.
Recent Findings:
More than half of COPD exacerbations are infective. Bacteria are isolated in 70% of them, but viruses also play an important role, both alone and in combination with bacteria. Furthermore, in many cases, viral infection can be followed by bacterial infection in patients with COPD but not in individuals with normal lung function. Viral infection may produce changes in the lung microbiome that may precipitate subsequent bacterial infection. Research on the lung microbiome is providing new insight into the pathogenesis of infection in healthy and diseased lungs.
Summary:
COPD patients have alterations in their lung microbiome that may result in chronic infection with potentially pathogenic microorganisms (PPMs) even in periods of clinical stability and associated with a higher frequency of bacterial exacerbations. Patients with this infective phenotype may require a personalized approach to therapy with the use of short-term or long-term antibiotic treatment in addition to the usual treatment for COPD.
Insights
Chronic obstructive pulmonary disease (COPD) patients with an infective phenotype show altered lung microbiomes, leading to chronic infections and more frequent bacterial exacerbations. Personalized antibiotic therapy may be required for these patients.
Area of Science:
- Pulmonary Medicine
- Microbiology
- Infectious Diseases
Background:
- Chronic obstructive pulmonary disease (COPD) is a major global health issue.
- Infective exacerbations significantly contribute to COPD progression and mortality.
- Understanding the role of the lung microbiome in COPD pathogenesis is crucial.
Purpose of the Study:
- To review the latest findings on the cause, pathogenesis, and management of COPD with an infective phenotype.
- To explore the role of the lung microbiome in COPD-related infections.
- To discuss personalized therapeutic approaches for COPD patients with an infective phenotype.
Main Methods:
- Literature review of recent studies on COPD, infective exacerbations, and lung microbiome.
- Analysis of bacterial and viral roles in COPD exacerbations.
- Investigation of microbiome alterations in COPD patients.
Main Results:
- Over half of COPD exacerbations are infective, with bacteria isolated in 70%.
- Viruses play a significant role, alone or with bacteria, and can precede bacterial infections in COPD.
- COPD patients exhibit lung microbiome alterations, leading to chronic infections and increased bacterial exacerbations.
Conclusions:
- Altered lung microbiomes in COPD patients can lead to chronic infections with potentially pathogenic microorganisms (PPMs).
- This infective phenotype is associated with a higher frequency of bacterial exacerbations.
- Personalized therapy, potentially including short- or long-term antibiotics, may be necessary for these patients.
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