Mechanisms and Management of COPD Exacerbations by L. Allegra, F. Blasi

By L. Allegra, F. Blasi

Chronic obstructive pulmonary disorder (COPD) is an more and more vital ailment world-wide. while such a lot different major ailments have proven a decline some time past many years, COPD morbidity and mortality is on a gentle raise. Exacerbations are typically outlined as a rise in cough, a transformation within the color or volume of sputum, and a worsening dyspnea. The function of bacterial infections and the efficacy of antimicrobial treatment in acute exacerbations of power bronchitis (AECD) continues to be debatable. Exacerbations of persistent bronchitis are a standard prevalence in medical perform and are a number one reason for antibiotic prescription between breathing infections. it's nonetheless doubtful no matter if every one new exacerbation may well go to pot the normal heritage of power bronchitis. absolutely, each episode encompasses a transitority worsening in lung functionality and will for that reason pose the specter of respiration failure or dying in additional significantly obstructed patients.

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The chosen therapy is usually based on what type of AE could hurt the patient most if not treated. The ability to establish the correct etiology of an AE in the classic COPD patient can be greatly enhanced by evaluation of the sputum produced as a result of the specific etiologic factors. Table 2 details the important differential characteristics available from sputum evaluation for the main types of AE. The nature of the inflammatory cell response, and the changes of the exfoliated bronchial epithelial cells and of the bacterial population provide key diagnostic Acute Exacerbations of COPD: Methods and Role of Microbiology 41 Table 2.

However, bacteria are probably significant in perpetuating the disease and may be critical in producing the characteristic exacerbations. Cultural methodologies currently used may not exclude oral flora that can contaminate sputum specimens. Pathogenic bacteria can be cultured from the bronchi in up to 82% of cases of chronic bronchitis. Routine sputum specimens from patients with chronic bronchitis commonly contain non-encapsulated H. injluenzae, s. pneumoniae, and other oropharyngeal commensal flora, including Moraxella catarrhalis and H.

Further evaluation of such specimens will not provide useful information. Finding macrophages in the specimen is a strong indicator that an appropriate aliquot has been selected. This aliquot should be used for the definitive examinations. A small part of this aliquot should be placed on another microscope slide and covered with a coverslip. This should be examined under high power to locate cellular areas and then evaluated using the oil immersion objective to identify the types of inflammatory and bronchial epithelial cells.

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