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dc.contributorVall d'Hebron Barcelona Hospital Campus
dc.contributor.authorMartinez-Garcia, Miguel Angel
dc.contributor.authorMiravitlles Fernández, Marc
dc.date.accessioned2022-08-17T11:30:16Z
dc.date.available2022-08-17T11:30:16Z
dc.date.issued2022-03-23
dc.identifier.citationMartinez-Garcia MA, Miravitlles M. The Impact of Chronic Bronchial Infection in COPD: A Proposal for Management. Int J Chron Obstruct Pulmon Dis. 2022 Mar 23;17:621–30.
dc.identifier.issn1178-2005
dc.identifier.urihttp://hdl.handle.net/11351/8007
dc.descriptionBronchial infection; Exacerbation; Pathogenic microorganisms
dc.description.abstractUp to 50% of patients with chronic obstructive pulmonary disease (COPD) in stable state may carry potentially pathogenic microorganisms (PPMs) in their airways. The presence of PPMs has been associated with increased symptoms, increased risk and severity of exacerbations, a faster decline in lung function and impairment in quality of life. Although some clinical trials have demonstrated a reduction in exacerbations in patients chronically treated with systemic antibiotics, particularly macrolides, the selection of patients was based on the previous frequency of exacerbations and not on the presence of PPMs in their airways. Therefore, unlike in bronchiectasis, there is a lack of evidence-based recommendations for assessment and treatment of the presence of PPMs in either single or repeated isolations in COPD. In this article, we propose that chronic bronchial infection (CBI) in COPD be defined as the isolation of the same PPM in at least three sputum samples separated by more than one month; we review the impact of CBI on the natural course of COPD and suggest a course of action in patients with a single isolation of a PPM or suspected CBI. Antibiotic treatment in stable COPD should be recommended based on four main criteria: a) the presence of comorbid bronchiectasis, b) the demonstration of a single or multiple isolation of the same PPM, c) the clinical impact of CBI on the patients, and d) the type of PPM, either Pseudomonas aeruginosa or non-pseudomonal PPM. These recommendations are derived from evidence generated in patients with bronchiectasis and, until new evidence specifically obtained in COPD is available, they may help in the management of these challenging patients with COPD. Existing evidence suggests that inhaled therapy is insufficient to manage patients with moderate-to-severe COPD, frequent exacerbations, and CBI. New studies must be conducted in this particularly demanding population.
dc.language.isoeng
dc.publisherDove Press
dc.relation.ispartofseriesInternational Journal of Chronic Obstructive Pulmonary Disease;17
dc.rightsAttribution-NonCommercial 4.0 International
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/
dc.sourceScientia
dc.subjectPulmons - Malalties obstructives - Tractament
dc.subjectBronquitis
dc.subject.meshPulmonary Disease, Chronic Obstructive
dc.subject.mesh/drug therapy
dc.subject.meshBronchitis, Chronic
dc.titleThe Impact of Chronic Bronchial Infection in COPD: A Proposal for Management
dc.typeinfo:eu-repo/semantics/article
dc.identifier.doi10.2147/COPD.S357491
dc.subject.decsenfermedad pulmonar obstructiva crónica
dc.subject.decs/farmacoterapia
dc.subject.decsbronquitis crónica
dc.relation.publishversionhttps://doi.org/10.2147/COPD.S357491
dc.type.versioninfo:eu-repo/semantics/publishedVersion
dc.audienceProfessionals
dc.contributor.organismesInstitut Català de la Salut
dc.contributor.authoraffiliation[Martinez-Garcia MA] Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain. CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. [Miravitlles M] CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. Servei de Pneumologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
dc.identifier.pmid35355582
dc.identifier.wos000777384000001
dc.rights.accessrightsinfo:eu-repo/semantics/openAccess


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