Chronic Bronchial Infection Is Associated with More Rapid Lung Function Decline in Chronic Obstructive Pulmonary Disease

Closing the Loop on the Vicious Circle in Chronic Obstructive Pulmonary Disease

“…They induce inflammation in models of airway infection and cause acute infections in the respiratory tract. Martínez-García and colleagues ( 1 ) and previous work confirms the sentinel role of these pathogens in driving airway inflammation, which has the potential to cause airway damage and progression of lung disease, with NTHI appearing early and consistently and PA appearing later in some unlucky individuals.…”

“…What was missing was the demonstration that this microbiome-driven inflammation was actually associated with lung damage, the standard measurement of which still remains FEV 1 decline. This study fills the gap and, despite its limitations, closes the vicious circle ( 1 ).…”

“…Yogi Berra said, “You can see a lot by just observing.” When it comes to chronic human diseases that are difficult to replicate in animals and whose clinical courses span decades, for example, chronic obstructive pulmonary disease (COPD), well-planned and well-executed observational studies can yield important observations. Martínez-García and colleagues not only followed patients with COPD in their clinic but made standardized clinical and laboratory observations and then examined their accumulated data ( 1 ). This has already yielded seminal observations about the importance of bronchiectasis in patients with COPD ( 2 ).…”

“…In this issue of AnnalsATS (pp. 1842–1847 ), the authors show that chronic bacterial infection (CBI), which was defined as three or more positive sputum cultures by the same potentially pathogenic microorganisms over 1 year, was associated with faster decline of lung function compared with individuals who did not have CBI ( 1 ). Furthermore, accelerated decline in forced expiratory volume in 1 second (FEV 1 ) was also seen among patients with at least one Pseudomonas aeruginosa (PA) isolation over the study period.…”

Global initiative for chronic obstructive lung disease 2023 report: gold executive summary

“…Severe respiratory infections in childhood have been associated with reduced lung function and increased respiratory symptoms in adulthood [47,49] . In adults, chronic bronchial infection, particularly with Pseudomonas aeruginosa, is associated with accelerated FEV1 decline [50] . In many parts of the world, tuberculosis [51] and HIV infection [52] are also important risk factors for COPD.…”