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Previous Volume 359:2355-2365 November 27, 2008 Number 22 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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Historical Perspective

In the 1950s and 1960s, according to a theory known as the British hypothesis, repeated airway infection and hypersecretion of mucus were thought to be the causes of chronic obstructive pulmonary disease (COPD). Subsequently, exposure to tobacco smoke was identified as the predominant cause. Researchers were still unable to relate the frequency of exacerbations — acute increases in the respiratory symptoms of COPD that require medical intervention — and hypersecretion of mucus to the progression of airflow obstruction.¹ Instead, the frequency of bacterial isolation from sputum was found to be similar in stable COPD and during exacerbations. On the basis . . . [Full Text of this Article]

Exacerbations

Bacteria as a Cause of Exacerbations

Viruses as a Cause of Exacerbations

Interaction of Viruses and Bacteria

Chronic Infection in COPD

Bacterial Colonization and Inflammation

Other Evidence of Chronic Infection

Other Chronic Infections

Mechanisms of Chronic Infection in COPD

Innate Lung Defense

The Vicious Circle

Antibiotics in COPD

Future Directions

Source Information

From the Divisions of Pulmonary and Critical Medicine (S.S.) and the Division of Infectious Diseases (T.F.M.), Department of Medicine, University at Buffalo, State University of New York, Buffalo; and the Department of Veterans Affairs Western New York Healthcare System, Buffalo (S.S., T.F.M.).

Address reprint requests to Dr. Sethi at Veterans Affairs Western New York Healthcare System (151), 3495 Bailey Ave., Buffalo, NY 14215, or at ssethi@buffalo.edu.

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