title: Treatment of patients with COPD and recurrent exacerbations: the role of infection and inflammation.
abstract: Exacerbations of COPD represent an important medical and health care problem. Certain susceptible patients suffer recurrent exacerbations and as a consequence have a poorer prognosis. The effects of bronchial infection, either acute or chronic, and of the inflammation characteristic of the disease itself raise the question of the possible role of antibiotics and anti-inflammatory agents in modulating the course of the disease. However, clinical guidelines base their recommendations on clinical trials that usually exclude more severe patients and patients with more comorbidities, and thus often fail to reflect the reality of clinicians attending more severe patients. In order to discuss aspects of clinical practice of relevance to pulmonologists in the treatment and prevention of recurrent exacerbations in patients with severe COPD, a panel discussion was organized involving expert pulmonologists who devote most of their professional activity to day hospital care. This article summarizes the scientific evidence currently available and the debate generated in relation to the following aspects: bacterial and viral infections, chronic bronchial infection and its treatment with cyclic oral or inhaled antibiotics, inflammatory mechanisms and their treatment, and the role of computerized tomography as a diagnostic tool in patients with severe COPD and frequent exacerbations.
authors.affiliation: Pneumology Department, Hospital Universitari de Bellvitge, Universidad de Barcelona, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
authors.forename: Salud
authors.initials: S
authors.lastname: Santos
authors.affiliation: Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Pneumology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Marin
authors.affiliation: Pneumology Department, Hospital Universitari de Vic, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Serra-Batlles
authors.affiliation: Pneumology Unit, Hospital Plató, Universidad Autónoma, Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: de la Rosa
authors.affiliation: Pneumology Department, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma, Barcelona, Spain.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Solanes
authors.affiliation: Pneumology Department, Hospital Universitari Parc Taulí, Sabadell, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Pomares
authors.affiliation: Pneumology Department, Hospital Universitari de Bellvitge, Universidad de Barcelona, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: López-Sánchez
authors.affiliation: Pneumology Department, Hospital Universitari de Bellvitge, Universidad de Barcelona, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Mariana
authors.initials: M
authors.lastname: Muñoz-Esquerre
authors.affiliation: Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Pneumology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Marc
authors.initials: M
authors.lastname: Miravitlles
mesh_terms: D001424:Bacterial Infections / Q000150:complications / Q000276:immunology / Q000517:prevention & control; D000066491:Clinical Decision-Making; D002986:Clinical Trials as Topic; D019468:Disease Management; D018450:Disease Progression; D006801:Humans; D007249:Inflammation / Q000276:immunology*; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D012720:Severity of Illness Index; D000067251:Symptom Flare Up; D014777:Virus Diseases / Q000150:complications / Q000517:prevention & control
keywords: COPD exacerbation; anti-inflammatory treatment; antibiotics; bronchial infection; treatment