Respiratory infections in COPD patients

Abstract

Respiratory failure in patients with chronic obstructive pulmonary disease (COPD) admitted in the intensive care unit has multiple causes. Among them, almost half are caused by bacterial or viral infections. Pathogens involved in acute exacerbations of COPD are Haemophilus influenzae, Streptococcus pneumoniae and Branhamella catarrhalis for bacteria and Rhinovirus, Influenzae and Coronavirus for viruses.  In patients with severe acute exacerbation of COPD requiring non-invasive ventilation, guidelines recommend the prescription of antibiotics, despite a risk of increasing the selections of resistant bacteria (Pseudomonas aeruginosa and Enterrobacteriaceae). In case of acute respiratory failure, clinical and paraclinical tools are not efficient to discriminate infectious from non-infectious cause. A systematic approach may help to rule out to a non-infectious cause of acute respiratory failure, and hence to spare antibiotic use.