Lopez-Campos José Luis, Miravitlles Marc, de la Rosa Carrillo David, Cantón Rafael, Soler-Cataluña Juan Jose, Martinez-Garcia Miguel Angel
Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, 41013 Seville, Spain.
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain.
J Clin Med. 2020 May 28;9(6):1639. doi: 10.3390/jcm9061639.
Currently, chronic obstructive pulmonary disease (COPD) patients and their physicians face a number of significant clinical challenges, one of which is the high degree of uncertainty related to chronic bronchial infection (CBI). By reviewing the current literature, several challenges can be identified, which should be considered as goals for research. One of these is to establish the bases for identifying the biological and clinical implications of the presence of potentially pathogenic microorganisms in the airways that should be more clearly elucidated according to the COPD phenotype. Another urgent area of research is the role of long-term preventive antibiotics. Clinical trials need to be carried out with inhaled antibiotic therapy to help clarify the profile of those antibiotics. The role of inhaled corticosteroids in patients with COPD and CBI needs to be studied to instruct the clinical management of these patients. Finally, it should be explored and confirmed whether a suitable antimicrobial treatment during exacerbations may contribute to breaking the vicious circle of CBI in COPD. The present review addresses the current state of the art in these areas to provide evidence which will enable us to progressively plan better healthcare for these patients.
目前，慢性阻塞性肺疾病（COPD）患者及其医生面临着一些重大的临床挑战，其中之一是与慢性支气管感染（CBI）相关的高度不确定性。通过回顾当前文献，可以确定几个挑战，这些挑战应被视为研究目标。其中之一是建立识别气道中潜在致病微生物存在的生物学和临床意义的基础，应根据COPD表型更清楚地阐明这些意义。另一个紧迫的研究领域是长期预防性抗生素的作用。需要进行吸入抗生素治疗的临床试验，以帮助明确这些抗生素的情况。需要研究吸入性糖皮质激素在COPD和CBI患者中的作用，以指导这些患者的临床管理。最后，应探索并确认在急性加重期进行适当的抗菌治疗是否有助于打破COPD中CBI的恶性循环。本综述阐述了这些领域的当前技术水平，以提供证据，使我们能够逐步为这些患者规划更好的医疗保健。
