Martinez Fernando J
Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, 1500 East Medical Center Drive, SPC 5360, Ann Arbor, MI 48109-5360, USA.
Proc Am Thorac Soc. 2007 Dec;4(8):647-58. doi: 10.1513/pats.200707-097TH.
Acute exacerbations of chronic obstructive pulmonary disease (COPD) are important events in the natural history of this chronic lung disorder. These events can be caused by a large number of infectious and noninfectious agents and are associated with an increased local and systemic inflammatory response. Their frequency and severity have been linked to progressive deterioration in lung function and health status. Infectious pathogens ranging from viral to atypical and typical bacteria have been implicated in the majority of episodes. Most therapeutic regimens to date have emphasized broad, nonspecific approaches to bronchoconstriction and pulmonary inflammation. Increasingly, therapy that targets specific etiologic pathogens has been advocated. These include clinical and laboratory-based methods to identify bacterial infections. Further additional investigation has suggested specific pathogens within this broad class. As specific antiviral therapies become available, better diagnostic approaches to identify specific pathogens will be required. Furthermore, prophylactic therapy for at-risk individuals during high-risk times may become a standard therapeutic approach. As such, the future will likely include aggressive diagnostic algorithms based on the combination of clinical syndromes and rapid laboratory modalities to identify specific causative bacteria or viruses.
慢性阻塞性肺疾病（COPD）急性加重是这种慢性肺部疾病自然史中的重要事件。这些事件可由大量感染性和非感染性因素引起，并与局部和全身炎症反应增加有关。其发作频率和严重程度与肺功能和健康状况的进行性恶化相关。从病毒到非典型和典型细菌的感染性病原体与大多数发作有关。迄今为止，大多数治疗方案都强调针对支气管收缩和肺部炎症的广泛、非特异性方法。越来越多的人主张针对特定病因病原体的治疗。这些方法包括基于临床和实验室的细菌感染识别方法。进一步的研究表明了这一广泛类别中的特定病原体。随着特定抗病毒疗法的出现，将需要更好的诊断方法来识别特定病原体。此外，在高危时期对高危个体进行预防性治疗可能会成为一种标准治疗方法。因此，未来可能会包括基于临床综合征和快速实验室检测方法相结合的积极诊断算法，以识别特定的致病细菌或病毒。
