The role of infection in exacerbations of COPD remains
controversial and incompletely understood. Although some investigators
believe that bacteria are not important for patients with exacerbation,
we disagree and believe that patients with at least two of the three
cardinal symptoms of exacerbation should receive antibiotic therapy.
With an open-minded view of the area, we review the data, showing that
bacteriologic studies, pathologic investigations, and clinical trials
all support roles for bacteria and antibiotic therapy in this disease.
Still, many questions remain, and future studies will be needed to
better define the mechanisms of bacterial invasion in the bronchitic
patient and to develop effective vaccines to prevent exacerbations. In
the meantime, we must rely on antibiotic therapy, and we will need
prospective studies to corroborate preliminary findings showing that
different patients may require different therapies; thus, patient
subsetting may be vital in the selection of antibiotic therapy for
exacerbations of COPD.