Case 7

Acute exacerbations of chronic obstructive pulmonary disease (COPD) are a frequent cause of acute admission to hospital. These may be characterized by increased sputum production or a change in character, from mucoid to purulent, but microbiological analysis of sputum in such patients is usually not rewarding. With the use of molecular diagnostics, viral causes are increasingly recognized such as respiratory synctial virus and meta-pneumovirus. Many patients do not require an antibiotic as part of therapy but where indicated an agent such as co-amoxyclav may be appropriate. Further research on the respiratory microbiome may provide new insights into the dynamics of the normal flora in patients with COPD. Prophylactic antibiotics, such as with a macrolide, is controversial; the immunomodulatory impact may be outweighed by the risk of antibiotic resistance and drug side-effects.