Chest
Debate in PrintDo Bacteria Cause Exacerbations of COPD?
Section snippets
Microbiological Studies
Protected brush samples obtained from the lower respiratory tract by bronchoscopy in both hospitalized and ambulatory patients with exacerbations yield significant growth of potential bacterial pathogens in only about 50% of specimens.7, 20, 21 In these studies S pneumoniae and H influenzae, alone or together, constitute a large proportion of the isolates, being present in about 30 to 40% of all the patients. Most investigations using cultures of expectorated sputum have also identified these
Serologic Studies
Several studies have examined the immunologic response associated with exacerbations. One investigation employed a RBC agglutination technique with an antigen obtained from a fresh isolate of H influenzae.36 Antibody titers did not rise during exacerbations, even when H influenzae grew from the sputum. Another study employed a complement fixation test using a soluble antigen prepared from a single strain of unencapsulated H influenzae.37 In a small group of patients with COPD studied during
Placebo-Controlled Studies
An ideal study of antibiotic efficacy in exacerbations should be prospective, randomized, double-blind, and placebo-controlled. It should enroll numerous patients to ensure a representative population sample and to avoid missing an effect because of inadequate numbers of participants. Using chest radiographs, it should exempt patients with parenchymal opacities consistent with pneumonia, since the inclusion of participants with that infection would, of course, favor antibiotics. The trial
Conclusion
Assessing the available studies with the criteria delineated earlier fails to provide compelling evidence that bacteria cause COPD exacerbations:
References (80)
- et al.
Chronic obstructive pulmonary disease.
Lancet
(1998) - American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease....
- et al.
Infections with viruses and Mycoplasma pneumoniae during exacerbations of chronic bronchitis.
J Infect Dis
(1978) - et al.
Role of infection in chronic bronchitis.
Am Rev Respir Dis
(1976) - et al.
A study of infective and other factors in exacerbations of chronic bronchitis.
Br J Dis Chest
(1980) - et al.
Association of viral and Mycoplasma pneumoniae infections with acute respiratory illness in patients with chronic obstructive pulmonary disease.
Am Rev Respir Dis
(1980) - et al.
Bronchial microbial patterns in severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation.
Am J Respir Crit Care Med
(1998) - et al.
Chlamydia pneumoniae, strain TWAR, infection in patients with chronic obstructive pulmonary disease.
Am Rev Respir Dis
(1991) - et al.
Chlamydia pneumoniae infection in acute exacerbations of COPD.
Eur Respir J
(1993) - et al.
Acute purulent exacerbations of chronic obstructive pulmonary disease and Chlamydia pneumoniae infection.
Am J Respir Crit Care Med
(1999)