Airway bacterial colonization: The missing link between COPD and cardiovascular events?

Salvatore Fuschillo, Michele Martucci, Claudio F. Donner, Giovanni Balzano

Research output: Contribution to journalArticlepeer-review


Background: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide and, according to the World Health Organization, its prevalence will double by 2020. COPD is a chronic inflammatory disease of the lung characterized by poorly reversible airflow limitation and, frequently, by extrapulmonary manifestations. In particular, the cardiovascular manifestations are responsible for high morbidity and mortality. Methods and results: A systematic literature search was performed of studies published in Medline until December 2010, using the key-words: COPD, bacterial colonization, COPD exacerbation, atherosclerosis, systemic inflammation, cardiovascular event and risk factors. In addition to the studies identified in the primary search, reference lists of included articles were analyzed for additional papers related to the topic. The pathogenetic mechanisms underlying atherosclerosis - namely inflammation, oxidative stress and endothelial dysfunction - are in common with COPD. Moreover, they are increased in the presence of COPD, especially in patients who present airway bacterial colonization, increased rate of exacerbations and elevated levels of both airway and systemic inflammation. Conclusion: COPD is associated with an increased burden of atherosclerotic disease. Systemic inflammation and oxidative stress play key roles in this association. COPD patients with airway bacterial colonization, as compared to patients without airway colonization, generally present more frequent exacerbations and higher levels of both airway and systemic inflammation. This COPD subgroup should be considered at particularly increased risk of developing cardiovascular complications and receive more attention concerning diagnosis, treatment, prevention and research.

Original languageEnglish
Pages (from-to)915-923
Number of pages9
JournalRespiratory Medicine
Issue number7
Publication statusPublished - Jul 2012


  • Atherosclerosis
  • Bacterial colonization
  • Chronic obstructive pulmonary disease
  • Endothelial dysfunction
  • Systemic inflammation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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