The role of infection in acute exacerbations of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States and the second leading cause of work disability. Extensive data indicate that bacterial infection has an important role in acute exacerbations of COPD. Antibiotic therapy has been shown to benefit patients with exacerbations of COPD by improving clinical outcomes and hastening clinical and physiologic recovery. Antibiotics also provide long-term benefits such as preventing the progression of disease, minimizing secondary colonization with resistant organisms, and prolonging the time between exacerbations. Classifying an episode of COPD as uncomplicated, complicated, or at risk for Pseudomonas is useful in determining antibiotic therapy for patients with an acute exacerbation. Although patients with less severe uncomplicated disease can be treated with older antimicrobial agents, those with serious comorbid conditions or advanced structural lung disease require treatment with new more potent agents. Knowing the patterns of antimicrobial resistance in the respiratory pathogens, antibiotic pharmacokinetics, and factors influencing patient compliance is necessary to prevent treatment failures.