Chest
Volume 117, Issue 5, Supplement 2, May 2000, Pages 380S-385S
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Infectious Etiology of Acute Exacerbations of Chronic Bronchitis

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Infectious agents are a major cause of acute exacerbations of chronic bronchitis (AECB) and COPD. Several respiratory viruses are associated with 30% of exacerbations, with or without a superimposed bacterial infection. Atypical bacteria, mostly Chlamydia pneumoniae, have been implicated in < 10% of AECB. The role of bacterial pathogens when isolated from the respiratory tract during AECB has become better defined by application of several newer investigative techniques. Bacterial pathogens can be isolated in significant concentrations from distal airways in 50% of AECB. Specific immune responses to surface exposed antigens of the infecting pathogen have been shown to develop after an exacerbation. Emerging evidence from molecular epidemiology and measurement of airway inflammation further support the role of bacteria in AECB. When properly defined, 80% of AECB are likely to be infectious in origin.

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.

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