Acute Exacerbations of COPD: Methods and Role of Microbiology

Abstract

Diagnosis of an acute exacerbation of chronic obstructive pulmonary disease (AE/COPD) provides little guidance as to the appropriate therapy for the individual patient presenting with this syndrome. The problem is that the clinical presentation characteristic of acute exacerbation is not distinctive for a specific etiology. In addition, any single patient with COPD may have chronic bronchitis (CB), chronic bronchial asthma (CBA), pulmonary emphysema (CPE), or a combination of these upon which the AE is superimposed. Faced with this dilemma, many clinicians prefer to use COPD and avoid making the specific diagnoses. The occurrence of an AE in this setting now requires another “best guess” as to specific etiology, or to treat to cover the more common etiologies for the AE. The proper assessment of acute exacerbations is not assisted by using COPD as a description of the underlying bronchopulmonary disease. COPD is not a disease with a defined pathologic basis, but rather is a description of a physiologic abnormality common to many pathophysiologically different diseases. Although the three predominant diseases under COPD often co-exist in individual patients, specific therapeutic treatment for the individual patient depends on defining the role each play in the individual patient. A specific diagnosis is particularly important to the patient who only has CB, or CBA, or CPE. Despite the increasing knowledge of the important pathophysiologic differences in bronchial receptors and the inflammatory processes between CB and CBA, the shotgun approach to treatment at the clinical level remains popular.