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Review
. 2020 May 28;9(6):1639.
doi: 10.3390/jcm9061639.

Current Challenges in Chronic Bronchial Infection in Patients with Chronic Obstructive Pulmonary Disease

José Luis Lopez-Campos  1   2 , Marc Miravitlles  2   3 , David de la Rosa Carrillo  4 , Rafael Cantón  5 , Juan Jose Soler-Cataluña  6 , Miguel Angel Martinez-Garcia  2   7
Affiliations
Review

Current Challenges in Chronic Bronchial Infection in Patients with Chronic Obstructive Pulmonary Disease

José Luis Lopez-Campos et al. J Clin Med. .

Abstract

Currently, chronic obstructive pulmonary disease (COPD) patients and their physicians face a number of significant clinical challenges, one of which is the high degree of uncertainty related to chronic bronchial infection (CBI). By reviewing the current literature, several challenges can be identified, which should be considered as goals for research. One of these is to establish the bases for identifying the biological and clinical implications of the presence of potentially pathogenic microorganisms in the airways that should be more clearly elucidated according to the COPD phenotype. Another urgent area of research is the role of long-term preventive antibiotics. Clinical trials need to be carried out with inhaled antibiotic therapy to help clarify the profile of those antibiotics. The role of inhaled corticosteroids in patients with COPD and CBI needs to be studied to instruct the clinical management of these patients. Finally, it should be explored and confirmed whether a suitable antimicrobial treatment during exacerbations may contribute to breaking the vicious circle of CBI in COPD. The present review addresses the current state of the art in these areas to provide evidence which will enable us to progressively plan better healthcare for these patients.

Keywords: COPD; chronic bronchial infection; potentially pathogenic microorganism.

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Conflict of interest statement

J.L.L.-C. has received honoraria for lecturing, scientific advice, participation in clinical studies, or writing for publications for the last three years from (in alphabetical order) AstraZeneca, Boehringer Ingelheim, Chiesi, CSL Behring, Esteve, Ferrer, Gebro, GlaxoSmithKline, Grifols, Menarini, Novartis, Rovi, and Teva. M.M. has received speaker fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, Menarini, Rovi, Bial, Sandoz, Zambon, CSL Behring, Grifols, and Novartis; consulting fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Bial, Gebro Pharma, Kamada, CSL Behring, Laboratorios Esteve, Ferrer, Mereo Biopharma, Verona Pharma, TEVA, Spin Therapeutics, pH Pharma, Novartis, Sanofi, and Grifols; and research grants from GlaxoSmithKline and Grifols. D.d.l.R.C. has received fees as speaker from Teva and Zambon. R.C. has received fees as speaker from Chiesi and Zambon. J.J.S.-C. has received speaker fees from AstraZeneca, Bial, Boehringer Ingelheim, Chiesi, Esteve, Ferrer, GSK, Menarini, Mundipharma, Novartis, and Rovi and consulting fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Mundipharma, and Novartis. M.A.M.-G. has received grants from Vitalaire, Philips and Teva, as well as fees from GSK, Astra, Esteve, Chiesi, Vitalaire, Philips, Menarini, TEVA, and Zambón.

Figures

Figure 1
Figure 1
Areas of controversy about long-term antibiotic therapy in COPD. AE: Acute exacerbation, AB: antibiotic therapy (Continuous line: AB1; short dotted line: AB2; long dotted line: AB3); C: cure; Horizontal dotted/dashed line: clinical threshold within certain limits of variability according to modifying factors (horizontal continuous lines). Under AB therapy, the concentration of PPM decreases, and when the threshold is crossed again, the clinical symptoms disappear (cure). When the intensity and speed of the bactericidal activity of the AB is increased, recovery occurs more rapidly, and the time to the next exacerbation (horizontal arrow) is lengthened. AB activity produces a “fall” in bacterial concentrations, which, if not completely eradicated after the pressure of the antimicrobial agent is removed, “rise” again. Reproduced with permission of the © ERS 2020. European Respiratory Journal 20 (36 suppl) 9s–19s; DOI: 10.1183/09031936.02.00400302 Published 1 July 2002.
Figure 2
Figure 2
Areas of controversy about long-term antibiotic therapy in COPD.
See this image and copyright information in PMC

References

    1. Matkovic Z., Miravitlles M. Chronic bronchial infection in copd. Is there an infective phenotype? Respir. Med. 2013;107:10–22. - PMC - PubMed
    1. Martinez-Garcia M.A., Miravitlles M. Bronchiectasis in copd patients: More than a comorbidity? Int. J. Chronic Obstr. Pulm. Dis. 2017;12:1401–1411. - PMC - PubMed
    1. Miravitlles M., Anzueto A. Antibiotics for acute and chronic respiratory infection in patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2013;188:1052–1057. doi: 10.1164/rccm.201302-0289PP. - DOI - PubMed
    1. Santos S., Marin A., Serra-Batlles J., de la Rosa D., Solanes I., Pomares X., Lopez-Sanchez M., Munoz-Esquerre M., Miravitlles M. Treatment of patients with copd and recurrent exacerbations: The role of infection and inflammation. Int. J. Chronic Obstr. Pulm. Dis. 2016;11:515–525. - PMC - PubMed
    1. Man W.H., de Steenhuijsen Piters W.A., Bogaert D. The microbiota of the respiratory tract: Gatekeeper to respiratory health. Nat. Rev. Microbiol. 2017;15:259–270. doi: 10.1038/nrmicro.2017.14. - DOI - PMC - PubMed