Nontypeable Haemophilus influenzae and chronic obstructive pulmonary disease: a review for clinicians

Abstract

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide. In the lower airways of COPD patients, bacterial infection is a common phenomenon and Haemophilus influenzae is the most commonly identified bacteria. Haemophilus influenzae is divided into typeable and nontypeable (NTHi) strains based on the presence or absence of a polysaccharide capsule. While NTHi is a common commensal in the human nasopharynx, it is associated with considerable inflammation when it is present in the lower airways of COPD patients, resulting in morbidity due to worsening symptoms and increased frequency of COPD exacerbations. Treatment of lower airway NTHi infection with antibiotics, though successful in the short term, does not offer long-term protection against reinfection, nor does it change the course of the disease. Hence, there has been much interest in the development of an effective NTHi vaccine. This review will summarize the current literature concerning the role of NTHi infections in COPD patients and the consequences of using prophylactic antibiotics in patients with COPD. There is particular focus on the rationale, findings of clinical studies and possible future directions of NTHi vaccines in patients with COPD.

KEYWORDS:

• Chronic obstructive pulmonary disease
• exacerbations
• nontypeable Haemophilus influenza; pathogenesis
• treatment

Disclosure statement

KBS and AC have no conflicts of interest.

MPES has received support from GlaxoSmithKline (GSK), Sanofi Pasteur and Pfizer to attend and present at conferences, scientific meetings and advisory boards.

AWC received an educational grant from GSK to develop website on NTHi and the e-journal, Pneumonia. AWC received travel support from GSK to attend a conference on otitis media and other respiratory meetings related to NTHi. AWC has attended an advisory board on pneumococcal disease hosted by Seqirus.

Funding

MPES has received support from GlaxoSmithKline (GSK), Sanofi Pasteur and Pfizer to attend and present at conferences, scientific meetings and advisory boards. AWC received an educational grant from GSK to develop website on NTHi and the ejournal, Pneumonia. AWC received travel support from GSK to attend a conference on otitis media and other respiratory meetings related to NTHi. AWC has attended an advisory board on pneumococcal disease hosted by Seqirus.