ABSTRACT
Surprisingly, despite intensive investigation, the role of bacterial tracheobronchitis in the pathogenesis of COPD exacerbations remains unclear. This has resulted largely from the inability of sputum cultures to distinguish between colonization and infection, since potentially pathogenic bacteria are cultured with equal frequency during symptom atic exacerbations and periods of clinical stability. The importance of bacterial infection has been indirectly assessed by a number of randomized, placebo-controlled trials of anti biotic therapy in patients with increased dyspnea, cough, and sputum production. These studies have shown that antibiotics produce little or no clinical benefit even when a statisti cally significant effect can be demonstrated and suggest that bacterial tracheobronchitis is a relatively infrequent cause of respiratory decompensation in patients with COPD.
