Academic Unit of Respiratory Medicine, Royal Free Campus, UCL Medical School, London, UK.
Med Clin North Am. 2012 Jul;96(4):789-809. doi: 10.1016/j.mcna.2012.02.008. Epub 2012 Mar 16.
The mechanisms of COPD exacerbation are complex. Respiratory viruses (in particular rhinovirus) and bacteria play a major role in the causative etiology of COPD exacerbations. In some patients, noninfective environmental factors may also be important. Data recently published from a large observational study identified a phenotype of patients more susceptible to frequent exacerbations. Many current therapeutic strategies can reduce exacerbation frequency. Future studies may target the frequent exacerbator phenotype, or those patients colonized with potential bacterial pathogens, for such therapies as long-term antibiotics, thus preventing exacerbations by decreasing bacterial load or preventing new strain acquisition in the stable state. Respiratory viral infections are also an important therapeutic target for COPD. Further work is required to develop new anti-inflammatory agents for exacerbation prevention, and novel acute treatments to improve outcomes at exacerbation.
COPD 加重的机制较为复杂。呼吸道病毒（尤其是鼻病毒）和细菌在 COPD 加重的病因学中起着主要作用。在某些患者中，非感染性环境因素也可能很重要。最近发表的一项大型观察性研究的数据确定了一种对频繁加重更敏感的患者表型。许多目前的治疗策略可降低加重频率。未来的研究可能针对频繁加重表型或那些定植有潜在细菌病原体的患者，应用长期抗生素等疗法，通过降低细菌负荷或在稳定期预防新菌株获得，从而预防加重。呼吸道病毒感染也是 COPD 的一个重要治疗靶点。需要进一步研究以开发用于预防加重的新型抗炎药物，以及改善加重时结局的新型急性治疗方法。
