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Bacterial Colonization in Chronic Obstructive Pulmonary Disease: Is It Related to Evolution?

The culture of bronchial secretions obtained through techniques not susceptible to contamination by oropharyngeal flora have shown that 25% to 40% of stable chronic obstructive pulmonary disease (COPD) patients have bronchial colonization by potentially pathogenic microorganisms, with Haemophilus influenzae and Streptococcus pneumoniae being the bacteria most often recovered. Bronchial colonization may be related to persistence of microorganisms after an infection or to recurrent reinfections without macroscopic changes in the sputum and is associated with an inflammatory response in the mucosa, involving mainly neutrophils, that may have an impact on lung function decline. Furthermore, more than 30% of stable COPD patients have detectable antibodies to Chlamydia pneumoniae. This finding suggests a clinically significant role for this microorganism in COPD, although chronic infection by Chlamydia pneumoniae does not seem to have an effect on the natural history of the disease. Bronchial colonization may be more frequent in COPD patients with severe disease, partly due to colonization by Pseudomonas aeruginosa and other enteric Gram-negative bacteria. Current smoking is a well-defined risk factor for the colonization of the bronchial mucosa, independent of lung function.