Chronic obstructive pulmonary disease (COPD) is the most common chronic respiratory condition in adults and is characterized by progressive airflow limitation that is not fully reversible. The main etiological agents linked with COPD are cigarette smoking and biomass exposure but respiratory infection is believed to play a major role in the pathogenesis of both stable COPD and in acute exacerbations. Acute exacerbations are associated with more rapid decline in lung function and impaired quality of life and are the major causes of morbidity and mortality in COPD. Preventing exacerbations is a major therapeutic goal but currently available treatments for exacerbations are not very effective. Historically, bacteria were considered the main infective cause of exacerbations but with the development of new diagnostic techniques, respiratory viruses are also frequently detected in COPD exacerbations. This article aims to provide a state-of-the art review of current knowledge regarding the role of infection in COPD, highlight the areas of ongoing debate and controversy, and outline emerging technologies and therapies that will influence future diagnostic and therapeutic pathways in COPD.

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This study was conducted to assess the adherence and impact of National institute for Health and Clinical excellence (NICE) guidelines on Computer tomography (CT) imaging of head injuries in the emergency department of Wexham Park Hospital in December 2003 and 2008. A data collection sheet was used to collect information on the CT imaging of head injury patients presenting to Wexham Park Hospital Emergency department in December 2003 and then again in December 2008. 37 patients were included in the audit in 2003 and 47 in 2008. As a consequence of the results in 2003 a change was implemented this consisted of distributing copies of the head injury guidelines and locating them in the areas receiving major trauma in the Emergency department. There was also education given to new doctors starting work in the Emergency department about the head injury guidelines. The data collected in 2008 assessed the impact of this change. In 2003, 30% and in 2008, 17% of head injury patients received the appropriate CT imaging according to criteria 1 of the guidelines. 26% of patients in 2003 with head injuries fulfilled one or more of Criteria 1 of the guideline but did not receive CT imaging. In 2008 this had reduced to only 4% of patients requiring a head CT according to criteria, but not receiving one. This indicates a dramatic improvement following the interventions in the emergency department. This indicates that very simple interventions have increased the adherence to national head injuries imaging guidelines. This intervention is simple, cheap, is time effective to set up, and is easily reproducible in other hospitals and with other sets of guidelines within the emergency department.