Severe Acute Exacerbations of COPD: Epidemiology and Antimicrobial Treatment
Severity criteria for exacerbations of chronic obstructive pulmonary disease (COPD) have not yet been defined as they have for pneumonia. Therefore, investigators have usually adopted pragmatic criteria to define their study populations according to the subject of the study. For example, studies addressing modalities of ventilatory support have used acute severe hypoxemia and/or hypercapnic failure as entry criteria [1-5]. Most studies evaluating antimicrobial treatment have characterized the populations studied by the severity of airflow limitation in stable states and/or during exacerbations [6-9]. However, patients with severe airflow limitation (e.g. forced expiratory volume in one second - FEV1 - < 35% predicted) in stable states or during an exacerbation may or may not present with acute respiratory failure and vice versa. On the other hand, a recent study has provided evidence that patients with severe airflow limitation may be more likely to have an infection by gram-negative enterobacteriaceae (GNEB) or Pseudomonas aeruginosa  but it is not known whether the type of pathogen independently predicts severe exacerbations.
KeywordsChronic Obstructive Pulmonary Disease Acute Exacerbation Antimicrobial Treatment Severe Exacerbation Moraxella Catarrhalis
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