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Coinfection in Exacerbations of COPD : A New Frontier

Sanjay Sethi, MD
Author and Funding Information

Affiliations: Buffalo, NY
 ,  Dr. Sethi is an Associate Professor, Department of Medicine, Division of Pulmonary and Critical Care and Sleep Medicine, University at Buffalo SUNY, and Department of Veterans Affairs Western New York Healthcare System.

Correspondence to: Sanjay Sethi, MD, Veterans Affairs Western New York Healthcare System (151), 3495 Bailey Ave, Buffalo NY 14215; e-mail: ssethi@buffalo.edu



Chest. 2006;129(2):223-224. doi:10.1378/chest.129.2.223
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Investigations with modern investigative techniques have clarified considerably the role of bacteria and viruses in the pathogenesis of exacerbations of COPD. Application of polymerase chain reaction-based methods for detection has shown that viral nucleic acids are present in respiratory secretions in 30 to 50% of exacerbations.12 Furthermore, these studies used sputum samples, rather than nasopharyngeal samples, as was done in previous studies, providing us with confidence that direct viral infection of the tracheobronchial tree is responsible for the exacerbation. Application of molecular epidemiology has demonstrated that acquisition of new strains of bacteria is critical to the pathogenesis of bacterial exacerbations.3 Other investigations45 have shown that specific immune responses and a neutrophilic inflammatory process accompany bacterial exacerbations. Typical and atypical bacterial pathogens are now implicated in up to 50% of exacerbations.

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