Treatment of COPD exacerbations: antibiotics

The debate about the importance of bacterial infection in chronic obstructive pulmonary disease will continue. About half of exacerbations yield positive sputum bacteriology, and the isolation rate can be increased by selection of purulent samples. However, bacteria are also isolated in the stable state. The presence of bacteria in sputum alone during an exacerbation does not prove causation. Bacteria have been associated with airway inflammation both in the stable state, when the level of inflammation is related to the size of the bacterial load, and during exacerbations, when resolution of the inflammation is related to bacterial eradication. New evidence has been obtained from epidemiological, immunological and antibiotic studies that supports a role for bacterial infection in causing neutrophilic airway inflammation in chronic obstructive pulmonary disease, and if accepted should lead to new research in the use of