—We appreciate the emphasis by Drs Murphy and Sethi on the need to understand and treat or prevent infectious exacerbations of COPD. We agree that better strategies and agents for the prevention of viral and bacterial invasion are needed. In our article we stated, "Many aspects of the natural history of COPD need further study." We also commented on adhesion molecules and the role of leukocyte elastases in the pathogenesis of COPD.We also emphasized "elucidating other risk factors besides smoking" in the pathogenesis of airway inflammation and cited the critical role of antibiotics in another obstructive pulmonary disease, cystic fibrosis, in which bronchial suppuration demands antibiotic treatment, but indicated, "Whether or not such would be the same in other patients remains to be tested." We commented that antibiotics are valuable in some patients with purulent bronchitis and also cited the same important reference,1 as did Murphy and Sethi,
Weinmann G. A National Strategy for Research in Chronic Obstructive Pulmonary Disease-Reply. JAMA. 1997;277(20):1596. doi:10.1001/jama.1997.03540440030028
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