Current opinion in pulmonary medicine
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Bronchiolar abnormalities are relatively common and occur in a variety of clinical contexts. There have been an increasing number of terms, some of which are redundant, used in referring to various forms of bronchiolar disorders. The purpose of this review is to provide an updated classification scheme to facilitate the clinical approach to patients with suspected bronchiolar disease. ⋯ In the clinical approach to a patient with bronchiolar disease, primary bronchiolar disorders should be distinguished from predominantly parenchymal or large airway processes with bronchiolar involvement. The number of patterns of bronchiolar response to injury is limited and these patterns are generally non-specific in regard to cause. Appropriate diagnosis and management of patients with bronchiolar disorders depend on judicious correlation of clinical, physiologic, and morphologic manifestations.
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Nontypeable Haemophilus influenzae is the most common bacterial pathogen associated with airway infection in chronic obstructive pulmonary disease, both in stable disease and during exacerbations. Past attempts to elucidate its role as a pathogen in this disease yielded confusing and contradictory results, leading to its designation as an 'innocent bystander' with little if any pathogenic role in exacerbations and stable disease. Application of modern understanding of bacterial pathogenesis and of innovative research methodologies, however, has considerably clarified its role. ⋯ Though much has been learnt about nontypeable H. influenzae in chronic obstructive pulmonary disease, new therapeutic and preventive approaches require an even greater understanding of this host-pathogen interaction.