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Table 1 Co-factors in acute exacerbations of COPD

From: Antimicrobial therapies for prevention of recurrent acute exacerbations of COPD (AECOPD): beyond the guidelines

Reduced mucociliary clearance

GORD

Airway colonization

Immune deficiency

Aspiration

GOLD D treatment

Direct injury by tobacco smoke

Increased frequency of Hiatus Hernia [4]

and GORD [6] leading to chemical, food and microbial aspiration

H Influenzae

S pneumonia

M catarrhalis

P aeruginosa

Innate immunity impaired- shortening of cilia, squamous cell metaplasia, goblet-cell hyperplasia, loss of tight junction from toxic effects of smoking

Swallowing normally performed in exhalation. In COPD pts swallowing can be immediately before or after inspiration heightening aspiration -risk considerably [12]

•LAMA/LABA

•ICS

•Azithromycin

•Roflumilast

•Influenza Vacc

•Pneumococcal Vacc

•Pulmonary rehabilitation within 6 weeks of hospital discharge for AECOPD

Chronic airway inflammation ± bronchiectasis

 

Adenovirus

Influenza B

Coronovirus

Rhinovirus

Influenza A [6, 7]

Adaptive immunity- fewer CD4 + T central memory cells and CD8 + T effector memory cells [8]

  

Recent exacerbation

  

Primary Immune deficiency disease-hypogammaglobulinaemia, specific antibody deficiency, selective IgA deficiency [9]

  

Airways obstruction

  

Immunosenescence- cellular senescence, stem cell exhaustion, increased oxidative stress, alteration in extracellular matrix, reduction in endogenous anti-ageing molecules [10]

  

Dynamic expiratory collapse

  

Supressed antiviral immune response [11]

  

↑Mucus tenacity

     

Expiratory muscle weakness—sarcopenia, altered pulmonary dynamics

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