Abstract
Classically, the role of pulmonary infection in patients with chronic obstructive pulmonary disease (COPD) has focused on periods of exacerbation. However, in a clinically stable situation, little attention has been paid to the role play by the presence of potentially pathogenic micro-organisms (especially when they are repeatedly isolated, which is known as chronic bronchial infection [CBI]) in the pathogenesis, prognosis and disease treatment. In recent years, however, some evidence has been published on the deleterious effect of CBI in COPD since it has been associated to greater local inflammation, greater disease severity, poorer health-related quality of life, greater number and severity of exacerbations and cardiovascular events, presence of bronchiectasis, rapid decline of lung function, and even higher mortality (especially related to Pseudomonas aeruginosa infection). It is not known, however, what is the role of anti-inflammatory or antibiotic treatments on CBI in stable COPD patients. This review focused on the scientific evidence on this topic that exists up to now, from the very definition of IBC in COPD to the possible treatments that this situation entails, as well as the numerous future challenges it generates, especially the development of knowledge of the pulmonary microbiome, its alterations and its consequences.