Chest
Infectious Etiology of Acute Exacerbations of Chronic Bronchitis
Section snippets
Definition and Diagnosis
The most commonly used definition of an acute exacerbation of chronic bronchitis is a subjective increase from baseline of one or more chronic symptoms. These symptoms include shortness of breath, cough, sputum production, sputum purulence, and sputum tenacity. Several other disorders can cause such an increase in symptoms and need to be excluded with reasonable certainty by the evaluating clinician. Differential diagnoses include pneumonia, congestive heart failure, myocardial ischemia, upper
Model of Recurrent NTHI Infection in COPD
Patients with COPD have recurrent infections with NTHI, which clinically manifest as associated with increasing symptoms (exacerbation), or without an acute change in symptoms (colonization). Based on emerging evidence that NTHI infection in COPD is a dynamic process and the immune response to infecting strains is predominantly strain specific, we can hypothesize a model to explain recurrent NTHI infections in patients with COPD (Fig 3). The factors that determine the clinical manifestations of
Conclusion
When strictly defined as suggested above, it is likely that 80% of AECB are infectious in origin, with 40 to 50% caused by bacteria, 30% by viruses, and 5 to 10% by atypical bacteria. Concomitant infections by more than one infectious pathogen appear to occur in 10 to 20% of patients. Several lines of evidence demonstrate bacterial infection to be a cause of AECB. Tracheobronchial airway infection in COPD is a complex dynamic process. Understanding this process and the host immune response to
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Supported by VA Merit Review.