The Spectrum of Bronchial Infection

156 Pages·2013·4.281 MB·English

by  Francesco Blasi, Marc Miravitlles

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EUROPEAN RESPIRATORY monograph fe
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Lower respiratory tract infections are one the most frequent n
causes of medical consultation in primary care. They are
also one of the main causes of emergency visits and hospital
admissions. The majority of these infections occur in the
bronchial tree and include a large spectrum of aetiologies and
clinical manifestations, from mild acute bronchitis to severe
bronchiectasis and exacerbations of chronic obstructive
pulmonary disease. In this Monograph, a series of prestigious
researchers and clinicians provide an overview of the advances The Spectrum of
in the pathogenesis, manifestations and new approaches to
treatment of bronchial infection in a wide variety of clinical
scenarios. This book offers the reader the best existing Bronchial Infection
scientific evidence that can be applied to the care of patients
with any kind of bronchial infection.
Edited by Francesco Blasi
and Marc Miravitlles
EUROPEAN
RESPIRATORY
R 60
E Print ISSN 1025-448x
Online ISSN 2075-6674 EUROPEAN RESPIRATORY

Print ISBN 978-1-84984-034-7
S
Online ISBN 978-1-84984-035-4
P
Number 60 June 2013
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European Respiratory Monograph 60, June 2013
The Spectrum of
Bronchial Infection
Published by European Respiratory
Society ©2013
June 2013
Print ISBN: 978-1-84984-034-7
Online ISBN: 978-1-84984-035-4 Edited by
Print ISSN: 1025-448x
Francesco Blasi and Marc Miravitlles
Online ISSN: 2075-6674
Printed by Page Bros Ltd, Norwich, UK

Managing Editor: Rachel White
European Respiratory Society
442 Glossop Road, Sheffi eld,
S10 2PX, UK
Tel: [phone]
E-mail: [email protected]
Editor in Chief
All material is copyright to European Tobias Welte
Respiratory Society. It may not be
reproduced in any way including
electronic means without the express
permission of the company.
Statements in the volume refl ect the
views of the authors, and not necessarily
those of the European Respiratory
Society, editors or publishers.
Th is book is one in a series of European Respiratory Monographs. Each
individual issue provides a comprehensive overview of one specifi c clini-
cal area of respiratory health, communicating information about the
most advanced techniques and systems required for its investigation.
It provides factual and useful scientifi c detail, drawing on specifi c case
studies and looking into the diagnosis and management of individual
patients. Previously published titles in this series are listed at the back of
this Monograph.

Contents
Number 60 June 2013
Preface v
Guest Editors vii

Introduction ix

1. Acute bronchitis: aetiology and treatment 1
Carl Llor
2. Chronic bronchitis: a risk factor for bronchial infection 18
Laia Garcia-Bellmunt, Oriol Sibila, Marcos I. Restrepo and Antonio Anzueto
3. Sputum colour: a marker of bacterial infection 27
Robert A. Stockley
4. Chronic bronchial infection/colonisation: aetiology and mechanisms 34
Sanjay Sethi
5. Impact of chronic bronchial infection on the lungs and beyond 46
Zinka Matkovic, Neven Tudoric and Marc Miravitlles
6. Definition and aetiology of infective exacerbations of COPD 58
Gaetano Caramori, Marco Contoli, Brunilda Marku, Paolo Casolari,
Alessia Pauletti, Giacomo Forini and Alberto Papi
7. The role of viruses in chronic bronchitis and exacerbations of COPD 68
Gernot G.U. Rohde
8. Virus–bacteria interactions in COPD exacerbations 76
Patrick Mallia, Aran Singanayagam and Sebastian L. Johnston
9. Impact of exacerbations in the natural course of COPD 84
Francesco Blasi, Stefano Aliberti and Marco Mantero
10. Antibiotic treatment and prevention of exacerbations of COPD 96
Maria Lerikou, Elias Perros, Urania Anagnostopoulou and George Dimopoulos
11. Definition and aetiology of non-CF bronchiectasis 107
Robert Wilson, David M. Hansell and Michael R. Loebinger
12. The role of inhaled antibiotics in bronchial infection 120
Diana Bilton
13. Prevention and treatment of exacerbations of non-CF bronchiectasis 127
Jessica Rademacher and Felix C. Ringshausen
CME credit application form 137
C O P E COMMITTEE ON PUBLICATION ETHICS
This journal is a member of and subscribes to
the principles of the Committee on Publication
Ethics.
Preface
The 21st century will be described as the century of infectious diseases.
This is not only because of the increasing number of new infections,
suchassevereacuterespiratorysyndrome,theH1N1pandemicorthespread
ofWestNilevirusanddenguefever,butalsobecausetheroleofinfectionin
the pathogenesis of chronic diseases has been recognised and is now better
understood. Chronic bronchial infection plays a role in the progression and
prognosis of many lung diseases but also contributes to a systemic
inflammatory response, which is a predisposition for extrapulmonary
diseases such as arteriosclerosis or diabetes mellitus.
At present, the mechanisms that contribute to chronic pathogenic
colonisation of the lower respiratory tract are not entirely clear. Is there a
defect of the innate or the adaptive immune system of the lung favouring
chronic colonisation? Are there deficits in the innate and/or adaptive
immune system on a local pulmonary level that contribute to the primary
colonisation and secondary tissue damage? What is the role of air pollution
and other environmental factors?
Manyquestionsaboutchronicbronchialinfectionareunclear.Isitpossibleto
preventthis condition by early, adequate treatmentof theunderlying disease
or is it better to stimulate an immuneresponse by vaccination or similar
immunomodulatoryagents?Isitpossibletoinfluencethecourseofthedisease
by treatingchronic pulmonaryinfection? How long should the treatment
period last for? Should the patient receivethesame treatmentstrategy or
should differenttreatmentbe administered at differenttime-points?
This issue of the European Respiratory Monograph (ERM) summarises the
current understanding of chronic bronchopulmonary infections and
addresses future needs.
I would like to congratulate the Guest Editors, Francesco Blasi and Marc
Miravitlles,fortheirtremendousworkinbringingtogetherthiscutting-edge
ERM,whichshouldbeofinterestforgeneralmedicaldoctorsandrespiratory
physicians, as well as infectious diseases specialists. In addition, it will
provideguidanceforfuturebasicandclinicalresearch.Iamsurethatreaders
fromdifferentareasofrespiratorymedicinewillfindthisERMusefulintheir
daily practice.
EurRespirMonogr2013;60:v.CopyrightERS.DOI:10.1183/1025448x.10005813.PrintISBN:978-1-84984-034-7.
OnlineISBN:978-1-84984-035-4.PrintISSN:1025-448x.OnlineISSN:2075-6674.
v

Guest Editors
FrancescoBlasiisProfessorofRespiratoryMedicineandVice-chairmanofthe
DepartmentofPathophysiologyandTransplantationattheUniversityofMilan,
Milan, Italy,aswell asDirectorofRespiratory Diseases attheUnit IRCCS
FondazioneCa` GrandaOspedaleMaggioreMilan.HeiscurrentlyPresidentof
theEuropean Respiratory Society (ERS)(2012–2013).
Professor Blasi haspublished more than180 papersininternational journals.
He isan Associate Editor ontheeditorial boardsof PulmonaryPharmacology
and Therapeutics, RespiratoryResearch, Clinical Respiratory Journal and
Therapeutic Advances in Respiratory Disease. Hisresearch interests include the
effectsofatypicalbacterialinfectiononcellularimmunityinchronicbronchitis,
andtheroleofatypicalbacteriaandviralinfectioninasthmaonset.Heisalso
interested intheroleofantibiotics inthetreatment ofchronic obstructive
Francesco Blasi
pulmonary disease (COPD)exacerbations andasthma. Heis actively working
onpneumoniaandtuberculosisresearchtrials.ProfessorBlasiwasalsoinvolved
in theERS/EuropeanSociety ofClinical Microbiology andInfectious Diseases
(ESCMID)guidelinesonlowerrespiratorytractinfections.Inadditiontobeing
amember of theERS,he isalso amember oftheAmerican Thoracic Society
(ATS) and theItalian Respiratory Medicine Society(SIMeR).
MarcMiravitllesisapulmonologistworkinginclinicalresearchintheHospital
Universitari Valld’Hebron inBarcelona, Spain. Hisprimary research interests
include COPD,chronic bronchitis, a -antitrypsin deficiency, lungdefence
1
mechanisms andrespiratory infections.
Marc Miravitlles serves onvarious medical committees and isamember of
numerousprofessionalsocieties,includingtheSpanishSocietyofPneumology
andThoracicSurgery(SEPAR),whereheservedasSecretary(1999–2003),and
wasresponsible forinternational relationships from 2006 to 2011.Dr
Miravitlles acted astheChairoftheRespiratory Infections Group oftheERS
(2008–2011).Hehasalsoactedasaconsultantforthedevelopmentofdifferent
international guidelines for COPD,suchastheATS/ERSTask Force on
outcomesinCOPD.HewasalsoaconsultantoftheSpanishMinistryofHealth
Marc Miravitlles
forthedevelopmentofthenationalstrategyagainstCOPD(2009onwards)and
isthecoordinatoroftheSpanishnationalguidelinesforCOPD.DrMiravitlles
is EditorinChief ofHot Topicsin Respiratory Medicine,Editor inChiefof
Therapeutic Advances in Respiratory Diseases and servesasan Associate Editor
for Respiration, the InternationalJournal ofCOPD andtheClinical Respiratory
Journal. Dr Miravitlleshas publishedover 200articles inanumberofpeer-
reviewed international medical journals, whichwere largelyrelated toCOPD,
infection inCOPDand a -antitrypsin deficiency.
1
EurRespirMonogr2013;60:vii.
CopyrightERS2013.
DOI:10.1183/1025448x.10005213
PrintISBN:978-1-84984-034-7
OnlineISBN:978-1-84984-035-4
PrintISSN:1025-448x
OnlineISSN:2075-6674
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