title: Role of infection in exacerbations of chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  In this review, we present the latest findings on the cause, pathogenesis and management of patients with chronic obstructive pulmonary disease (COPD) and an infective phenotype.
  
  
  RESULTS
  More than half of COPD exacerbations are infective. Bacteria are isolated in 70% of them, but viruses also play an important role, both alone and in combination with bacteria. Furthermore, in many cases, viral infection can be followed by bacterial infection in patients with COPD but not in individuals with normal lung function. Viral infection may produce changes in the lung microbiome that may precipitate subsequent bacterial infection. Research on the lung microbiome is providing new insight into the pathogenesis of infection in healthy and diseased lungs.
  
  
  CONCLUSIONS
  COPD patients have alterations in their lung microbiome that may result in chronic infection with potentially pathogenic microorganisms (PPMs) even in periods of clinical stability and associated with a higher frequency of bacterial exacerbations. Patients with this infective phenotype may require a personalized approach to therapy with the use of short-term or long-term antibiotic treatment in addition to the usual treatment for COPD.
authors.affiliation: aPneumology Department, Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain bDepartment of Medicine, Division of Pulmonary Diseases/Critical Care Medicine, The University of Texas Health Science Center at San Antonio and The South Texas Veterans Healthcare System, Audie L, Murphy Memorial Veterans Hospital Division, San Antonio, Texas, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Miravitlles
authors.forename: Antonio
authors.initials: A
authors.lastname: Anzueto
mesh_terms: D006801:Humans; D008168:Lung / Q000382:microbiology / Q000503:physiopathology; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000382:microbiology* / Q000503:physiopathology / Q000821:virology