Role of infection in exacerbations of chronic obstructive pulmonary disease

Purpose of review 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. Recent findings 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. Summary 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.