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© 2004 The American Thoracic Society
Bacteria in Exacerbations of Chronic Obstructive Pulmonary Disease
Phenomenon or Epiphenomenon?
Department of Medicine, University of Buffalo SUNY, and VA WNY Healthcare System, Buffalo, New York
Correspondence and requests for reprints should be addressed to Sanjay Sethi, M.D., VA WNY Healthcare System, Medical Research 151, 3495 Bailey Avenue, Buffalo, NY 14215. E-mail: ssethi{at}buffalo.edu
Our understanding of the pathogenesis and consequences of acute exacerbations of chronic obstructive pulmonary disease (COPD) has increased considerably in the past decade. Several new lines of evidence support bacterial causation of approximately half of the exacerbations in COPD. Acquisition of new strains of bacterial pathogens in patients with COPD is associated with a substantial increase in risk of exacerbation. Bacterial pathogens are isolated in significant concentrations from bronchoscopic samples obtained during acute exacerbation. Neutrophilic airway inflammation is associated with isolation of bacterial pathogens from sputum. A specific immune response to the infecting strains of bacterial pathogens isolated from sputum during exacerbations has been demonstrated. Future work should strive to understand better the host–pathogen interaction that leads to an exacerbation and to develop novel therapeutic and preventive measures.
Key Words: chronic obstructive pulmonary disease • exacerbation • bacteria • surface antigen • infection
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