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Review
. 2016 Mar 1:11:445-53.
doi: 10.2147/COPD.S93398. eCollection 2016.

Bacterial-viral load and the immune response in stable and exacerbated COPD: significance and therapeutic prospects

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Review

Bacterial-viral load and the immune response in stable and exacerbated COPD: significance and therapeutic prospects

Silvestro Ennio D'Anna et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation and an abnormal inflammatory response of the lung. Bacteria and viruses are a major cause of COPD exacerbations and may contribute to COPD progression by perpetuating the inflammatory response in the airways. Bacterial variety diminishes with increasing COPD severity. Respiratory viruses can colonize the lower respiratory tract in stable COPD, altering the respiratory microbiome and facilitating secondary bacterial infections. In this review, we present the most updated information about the role of bacteria and viruses in stable and exacerbated COPD. In our opinion, to optimize therapeutic strategies, the dynamic events involving bacterial-viral infections and related immune response in COPD phenotypes need to be better clarified. Our paper would address these points that we consider of great importance for the clinical management of COPD.

Keywords: COPD phenotype; biomarkers; exacerbations; microbiome; severity of COPD.

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Figures

Figure 1
Figure 1
Scheme representing the normal airway microbiota and human respiratory pathogens most frequently associated with COPD exacerbations. Abbreviation: COPD, chronic obstructive pulmonary disease.
Figure 2
Figure 2
Representation of the known mechanisms proposed to explain how influenza virus favors bacterial outgrowth. Notes: Bronchial epithelial damage is followed by a decrease of neutrophils recruitment, NK activity, and Th17 numbers and activity. Alveolar epithelial damage could be followed by a decrease of alveolar macrophage numbers and activity. Abbreviation: NK, natural killer.

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