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Pneumologie 2010; 64(8): 504-520
DOI: 10.1055/s-0029-1244200
Symposiumsbericht

© Georg Thieme Verlag KG Stuttgart · New York

COPD und Infektion

Ergebnisse des Expertentreffens Luftschlösser 2009, Geisenheim-Johannisberg, 4. – 5. Dezember 2009 (Sponsor: Boehringer Ingelheim Pharma GmbH & Co KG)COPD and InfectionResults of an Expert Meeting, December 4 – 5, 2009 (Sponsor: Boehringer Ingelheim Pharma GmbH & Co KG)R.  Bals1 , A.  Gillissen2 , J.  Lorenz3 , H.  Morr4 , M.  Pfeifer5 , W.  Randerath6 , G.  Rohde7 , 14 , G.  Schultze-Werninghaus7 , G.  Steinkamp8 , C.  Taube9 , C.  Vogelmeier10 , H.  Watz11 , T.  Welte12 , H.  Worth13
  • 1Klinik für Innere Medizin, Schwerpunkt Pneumologie, Universität Marburg
  • 2Robert Koch-Klinik, Thoraxzentrum des Klinikums St. Georg, Leipzig
  • 3Klinik für Pneumologie und Internistische Intensivmedizin, Klinikum Lüdenscheid
  • 4Pneumologische Klinik Waldhof Elgershausen, Greifenstein/Hessen
  • 5Klinik Donaustauf, Universität Regensburg
  • 6Klinik für Pneumologie und Allergologie, Krankenhaus Bethanien, Solingen
  • 7Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Medizinische Klinik III – Pneumologie, Allergologie, Schlaf- und Beatmungsmedizin, Bochum
  • 8Medizinisch-wissenschaftliches Publizieren, Schwerin
  • 9III. Med. Klinik, Johannes Gutenberg-Universität Mainz
  • 10Klinik für Innere Medizin mit Schwerpunkt Pneumologie, Universitätsklinikum Gießen und Marburg, Standort Marburg
  • 11Pneumologisches Forschungsinstitut GmbH am Krankenhaus Großhansdorf
  • 12Abt. Pneumologie, Medizinische Hochschule Hannover
  • 13Medizinische Klinik I, Klinikum Fürth
  • 14Department of Respiratory Medicine, MUMC, Maastricht NL
Further Information

Publication History

Publication Date:
08 June 2010 (online)

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Zusammenfassung

Infektionen sind häufige und wichtige Ursachen von Exazerbationen der COPD. Diese Übersicht diskutiert Ursachen und Konsequenzen für die Therapie. Zwischen COPD, Komorbiditäten, körperlicher Inaktivität und systemischer Inflammation bestehen komplexe Beziehungen. Die Komponenten des postulierten chronischen inflammatorischen systemischen Syndroms müssen noch genauer beschrieben werden; der kleinste gemeinsame Nenner scheint die körperliche Inaktivität zu sein. Für infektiöse Prozesse spielen die angeborenen und erworbenen Immunmechanismen eine Rolle. Wann der Nachweis von Bakterien als Beweis für Kausalität angesehen werden muss (Besiedlung vs. akute Infektion), ist eine klinisch wichtige Frage. Auch die Bedeutung viraler Infektionen für die Exazerbation der COPD ist weiter zu klären, wobei es auch hier um die Unterscheidung zwischen akuter Infektion und Viruspersistenz geht. Ambulant erworbene Pneumonien sind für COPD-Patienten ein besonderes Risiko. Bei der Indikationsstellung zur Antibiotikatherapie unterstützen klinische Scores und die Bestimmung des Procalcitonins. Antibiotika müssen wahrscheinlich nicht länger als über 5 Tage verabreicht werden, denn bei längerer Behandlung ist die Wirkung nicht besser und die Zahl der Nebenwirkungen nimmt zu. Hospitalisationen wegen Exazerbationen sind bei COPD mit einer signifikant erhöhten Mortalität assoziiert.

Abstract

Infections are frequent and important causes of exacerbations in patients with COPD. This article reviews underlying mechanisms and therapeutic consequences. A complex interaction exists between COPD, co-morbidities, physical inactivity and systemic inflammation. The components of the postulated chronic inflammatory systemic syndrome need to be identified in more detail; physical inactivity seems to be the least common denominator. The patient’s adaptive and innate immune systems play a role for the pathogenesis of infections. When interpreting positive bacterial cultures, it is important to differentiate between colonisation and infection. The impact of viral infections in COPD exacerbation needs further clarification, including the task to distinguish acute infection from viral persistence. Community acquired pneumonias pose a special risk for patients with COPD. Clinical scores and procalcitonin serum concentrations can support decisions on whether or not to start antibiotic treatment. Antibiotics probably do not need to be taken for longer than 5 days, since their efficacy does not increase after longer treatment, while adverse events rise in frequency. Hospitalisations for respiratory exacerbations are associated with increased mortality in COPD.

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Prof. Dr. G. Schultze-Werninghaus

Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH
Medizinische Klinik III – Pneumologie, Allergologie, Schlaf- und Beatmungsmedizin

Bürkle-de-la-Camp-Platz 1
44789 Bochum

Email: gerhard.schultze-werninghaus@bergmannsheil.de

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