Date of Award

January 2013

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Melinda M. Pettigrew


Background: Chronic Obstructive Pulmonary Disease (COPD) exacerbations caused by bacterial infections account for more than 50% of all exacerbation episodes, with Haemophilus influenzae as the most frequently isolated pathogen. The role of antibiotics in treating COPD bacterial exacerbations remains unclear.

Objective: The current analysis evaluates the interaction of H. influenzaes with other pathogens while controlling for the use of antibiotics.

Methods: Data were from a longitudinal study of COPD patients conducted at a VA medical center from 1994-2010. Analysis was restricted to sputum samples collected over the course of one year in a total of 130 patients. Presence of Moraxella catarrhalis, Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, and antibiotic use within the past 21 days were examined to predict the colonization by H. influenzae using repeated measures logistic regression.

Results: The cohort was primarily male (96.9), white (89.9%), with an average age of 66.7 (SD 9.6) years and with moderate to severe airway obstruction. H. influenzae was detected 20% at any given time in the 130 patients. There was a trend for the presence of S. aureus and use of antimicrobial therapy in the past 21 days to be associated with decreasing the likelihood of colonization by H. influenzae.

Conclusion: Future research of the underlying mechanisms of these complex polymicrobial interactions will require further investigation of the environment of the lung microbiome, the host immune response and the impact of the medication on these host-pathogen and pathogen-pathogen interactions. Management of COPD and prevention of exacerbations of COPD would reduce both the rapid decline in lung function associated with bacterial infections, and the associated healthcare costs.


This is an Open Access Thesis.

Open Access

This Article is Open Access