title: Role of infection and antimicrobial therapy in acute exacerbations of chronic obstructive pulmonary disease.
abstract: Over the past several years, the significance of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in patients with chronic airflow obstruction has become increasingly apparent due to the impact these episodes have on the natural history of disease. It is now known that frequent AECOPD can adversely affect a patient's health-related quality of life and short- and long-term pulmonary function. The economic burden of these episodes is also substantial. AECOPDs represent a local and systemic inflammatory response to both infectious and noninfectious stimuli, but the majority of episodes are likely related to bacterial or viral pathogens. Patients with purulent sputum and multiple symptoms are the most likely to benefit from treatment with antibiotics. Antibiotic choice should be tailored to the individual patient, taking into account the severity of the episode and host factors which might increase the likelihood of treatment failure. Current evidence suggests that therapeutic goals not only include resolution of the acute episode, but also prolonging the time to the next event. In the future, preventing exacerbations will likely become increasingly accepted as an additional therapeutic goal in chronic obstructive pulmonary disease patients.
authors.affiliation: The University of Michigan Health System, 1500 East Medical Center Drive, 3916 Taubman Center, Box 0360, Ann Arbor, MI 48109, USA. fmartine@umich.edu
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: Martinez
authors.forename: MeiLan K
authors.initials: MK
authors.lastname: Han
authors.forename: Kevin
authors.initials: K
authors.lastname: Flaherty
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Curtis
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D002986:Clinical Trials as Topic; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*; D014777:Virus Diseases / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000890:Anti-Infective Agents