Pharmacological interventions may also reduce the frequency of exacerbation episodes of chronic bronchitis or COPD and include inhaled long-acting β2 receptor agonists, long-acting anticholinergics, inhaled corticosteroids and systemic antibiotics for complicated patients. The role of bacteria in acute sinusitis is not fully understood, Capmatinib order with symptoms overlapping with those occurring in viral common cold [6], potentially leading to inappropriate

antibiotic use. Use of antibiotics should be preserved for those ABRS patients who have purulent nasal discharge and more severe disease with high fever [6]. In chronic rhinosinusitis patients, prophylactic antibiotics are given only to immunosuppressed patients, and the recurrence of infections is prevented with nasal corticosteroids in immunocompetent patients [6]. Vaccination is recommended for immunocompetent people who are at higher risk of an unfavourable outcome from influenza infection or pneumococcal disease [72], although such policies do not prevent further respiratory infections completely. Influenza vaccinations are also currently recommended as part of the management of people with COPD, based largely Rigosertib research buy on evidence from observational

studies since few randomised controlled trials (RCTs) have been reported. Fludarabine concentration It has been reported that inactivated influenza vaccine reduces exacerbations in COPD patients [87]. There is a mild increase in transient local adverse effects with vaccination, but no evidence of an increase in early exacerbations [88]. Data on pneumococcal vaccination are limited although available studies suggest a beneficial effect in COPD and its use is recommended for COPD patients aged

≥65 years and for younger patients with significant co-morbidity [72], [74], [86] and [88]. In addition, pneumococcal vaccination has been shown to reduce the incidence of CAP in COPD patients aged <65 years and in those with severe COPD with an FEV1 (forced expiratory volume in 1 s) <40% predicted [88]. In CAP, S. pneumoniae is the most prevalent pathogen and some aggressive highly virulent forms may cause invasive disease or meningitis. Studies confirmed the positive impact of vaccination on the rate of pneumococcal pneumonia and invasive disease, therefore this vaccination is recommended in all who are elderly or at higher risk of pneumococcal disease [72] and [86]. Immunostimulation with bacterial lysates may also have a role in preventing bacterial respiratory infections [89] and [90]. The correlation between recurrent RTIs and immunological deficiency suggests a rationale for development of immunostimulating preventive treatments for such patients.