COPD Infection Management and Mitigation Strategies: Focusing on Diagnostics and Targeted Treatments

Joe Darrah

September 04, 2025

As the “Swiss Army knife of bacteria,” methicillin-resistant Staphylococcus aureus is quite the problematic organism, said John Osiecki, PhD. Among the diverse group of gram-positive bacteria characterized by thick cellular walls made of peptidoglycan, a complex polymer that provides strength to the cell, the microbe facilitates infection through the secretion of many enzymes and proteins. S aureus can dissolve a bone. It can erode a muscle. It can cause severe infections, especially among those patients who are already immunocompromised with chronic obstructive pulmonary disease (COPD), which totals about 16 million adults in the US, according to the CDC.

Within this population, an estimated 700,000 to one million acute exacerbations of COPD (AECOPD) are said to occur annually in the US, representing nearly 2% of all emergency department (ED) visits, according to the National Library of Medicine, with a growing number of AECOPD cases being caused by the presence of S aureus and other bacteria that have developed antimicrobial resistance (AMR).

“And the resistance is continuing to evolve,” said Osiecki, vice president for North America medical affairs at bioMérieux, a global biotechnology and healthcare company that specializes in the development of in vitro diagnostics and the understanding of trends in antimicrobial resistance. “This is something we’ve been keeping our finger on the pulse of for many years now.”

As those diagnosed with COPD continue to live longer through the help of advanced medical treatments and improved disease management, the threat of AMR is also expected to intensify. Improving the quality of life for these patients will depend on the mitigation of disease flareups, prompt identification of infectious bacteria, and effective use of necessary treatments.

Cures and Consequences

Unfortunately, the correlation between AMR and COPD remains primarily rooted in the use of general broad-spectrum antibiotics, especially when it comes to severe exacerbations. The successful use of antibiotics over time and the subsequent resistance that has developed draws a complicated conclusion: that there are medical tradeoffs when it comes to the management of chronic diseases, said Regina Pillai, MD, a board-certified pulmonary critical care physician at CLS Health, Webster, Texas.

Despite the awareness, there doesn’t seem to be much promise for an end in sight. “This is still an emerging problem not just in COPD but in general for other infectious disease processes that we use antibiotics for,” said Pillai. “This may be the outcome of continued lifespan and the treatment of patients as they live longer.”

Further complicating the matter is the overall threat of infection to this patient population, which Pillai said is a multilayered rationale: 1) architecturally abnormal lung tissue from the inflammatory disease process which makes it more likely for bacteria to invade and replicate in the lungs, 2) the breakdown of lung parenchyma, and 3) the use of chronic steroids for daily maintenance and treatment of flare-ups.

“With COPD, the lung airways allow bacteria to infect them more than normal lungs that have good clearance of mucus and are able to recover,” said Pillai. “These bacteria are more likely able to cause disease, upper and lower respiratory tract infections, and pneumonia in COPD patients. And when you have antibiotic resistance in a patient group that is already susceptible to high infection rates, it becomes a difficult task to manage. The older population and those who have severe disease, because they’re more prone to respiratory failure, being hospitalized, and having severe pneumonia, are those we really want to watch.”

Comorbid conditions are also important to focus on, she said. “Other disease processes, such as obesity, sleep apnea, and congestive heart failure, or being a current smoker, may cause patients to decline faster. These comorbid conditions can worsen their disease process — not from a pneumonia perspective but from a functional and respiratory status perspective.”

Patients with COPD are becoming more likely to experience resistance to antibiotic groups including beta-lactams, penicillins, and macrolides, the latter of which is not always protective against one of the most common causes of bacterial pneumonia, Streptococcus pneumoniae, said Pillai. “But in general, it’s an antibiotic resistance pattern, especially with the penicillin group, the most commonly used medications,” said Pillai. “With COPD patients, when they’re having an active, severe flare-up, it’s difficult to not use an antibiotic when you know they are at risk for hospitalization and severe pneumonia. One way that we’re trying to counteract this is the use of diagnostic approaches and doing symptomatic therapy if it’s viral.”

Strategies for Diagnosis and Treatments

At bioMérieux, an emphasis on reducing the time it takes to identify pathogens is driving diagnostics, said Osiecki. “If you look back historically, the methods we’ve used are very slow, according to today’s standards. Because it took so long to identify the organism, we’ve had empiric therapy to provide what we think would be the best, most broad coverage for patients with respiratory infections.”

One example of this type of molecular diagnostic technology is a blood culture identification panel that can generate results within an hour from the time that the sample is available to the laboratory, according to Osiecki. “We’re providing the opportunity for clinicians to be more informed, to have guided directions to be able to make better choices for which antibiotics to use, or to withhold antibiotics in situations,” he said. “It gives us the opportunity to personalize, to customize, to tailor the treatment pathways and the individual therapeutics that are provided to patients.”

At Clearway Health, a specialty pharmacy services company based in Boston, pharmacist-led initiatives are linking hospitals and health systems across the country with disease-specific programs that are intended to place patient liaisons and clinical pharmacists into existing workflows to collaborate with care teams to help those patients who are prescribed specialty drugs to receive them more quickly.

This past May, a COPD therapy optimization program launched following the approval of dupilumab, a biologic indicated for COPD, in September 2024. The program leverages clinical and pharmacy data to proactively identify high-risk patients and deliver targeted interventions that are aimed at improving outcomes, reducing exacerbations, and enhancing access to appropriate therapies, said Amanuel Kehasse PharmD, PhD, director of Clinical Programs and Drug Information at Clearway.

“Our clinical pharmacists are well positioned to address gaps by optimizing therapy in alignment with Global Initiative for Chronic Obstructive Lung Disease guidelines, educating patients on proper inhaler use, monitoring disease progression, and facilitating coordinated care. As part of the program’s ongoing pipeline monitoring, clinical and financial implications of newly approved therapies or expanded indications for existing medications are routinely evaluated.”

Weekly data feed systems are established to track COPD-related hospitalizations and ED visits to assess adherence and confirm whether patients are receiving optimized therapy. For patients who continue to experience exacerbations despite optimized inhaler therapy, pharmacists assess eosinophilic phenotype, identify candidates for advanced therapy with biologics, and provide therapy optimization recommendations for pulmonologists to consider, explained Kehasse.

“We also utilize pharmacy dispensing data to identify COPD patients who are maintained on long-term high-dose oral corticosteroids,” he said. “For these patients, our goal is to transition them toward steroid-free disease control by tapering off oral steroids and considering newer biologic therapies as appropriate.”

Under a collaborative practice agreement, pharmacists identify eligible patients and perform all necessary pretreatment screenings, thus reducing the administrative and clinical burden on pulmonologists, said Kehasse. By expanding provider capacity, the program seeks to help more patients receive optimized therapy and achieve therapeutic goals, including steroid-free disease control.

“Clinical pharmacists document their assessments, care plans, and therapy optimization recommendations for eligible patients,” said Kehasse. “Once the provider approves the recommendations, the pharmacy team collaborates with patients, insurance, and providers to coordinate medication access, financial assistance, adherence support, disease state, and medication education and conduct ongoing monitoring.”

The Lung Microbiome

A better understanding of AMR and its relationship with COPD could come as more is learned about lung microbiome and whether changes in lung bacteria are a cause or consequence of the disease and its exacerbations. This remains a significant and somewhat controversial topic, however, said Pillai.

“There was some thought in the past that the lungs were sterile, but there’s emerging research that says it’s not totally sterile — that there may be a diverse community of microbes that may be part of the lung tissue,” she said. “Some researchers think it’s not consistent and can be changing over time. The research is not fully out yet on that process.”

For Osiecki and his colleagues, next steps will center around the introduction of more tasks to provide still faster turnaround testing times and point-of-care solutions. “We believe that’s going to be the future of improved rapid diagnostics to really tailor and prevent the spread of antimicrobial resistance to really combat the challenges that we’re facing today that we’re seeing continue to evolve,” he said.

Kehasse, Osiecki, and Pillai reported no relevant financial relationships.

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