Hippokratia 1998, 2(2):72-78
The role of bacterial infection in aetiopathogenesis of stable and exacerbated COPD, has been under discussion in recent years. In this study has been reviewed the literature from the least 30 years about aetiopathogenesis of COPD in exacerbation. It has been found that a spectrum of infectious agents (viruses, mycoplasma, bacterial) and poorly understood noninfectious factors are involved in pathogenesis of exacerbation. The most commonly found bacteria were H. Influenzae, S. Pneumoniae and B. Catarrhalis. Sputum culture does not differentiate between colonization and infection. The strategy of antibiotics administration should be considered only in those patients with COPD who experience 4 or more exacerbations per year. The choice of antibiotic should be guided by the likely etiology of the exacerbation and the lower price. Over the next several years investigation in needed in the following areas: 1) the molecular and cellular basis of colonization and adherence of bacteria to respiratory epithelium needs to be elucidated, 2) analysis of bacteria antigenic structure in patients with COPD, 3) studies of the mucosal antibody response to the three bacteria which are important pathogen in COPD. All these future directions will elucidate the pathogenesis of exacerbation of COPD, and they will also determine new approaches in the therapy of COPD.