[Correspondence] Targeting pathogen adhesion molecules to improve COPD outcomes

Humans are programmed to follow intellectual fashions. In the field of chronic obstructive pulmonary disease (COPD), the concept that inflammation is the core problem is dominant, whereas other key issues such as parallel chronic infection and airway remodelling have received much less emphasis. In this Correspondence, we explain why specific microbes chronically colonise and infect the airways from a very early stage in COPD pathogenesis and discuss how it might be possible to stop this. These airway pathogens are likely major drivers of innate immune activation and oxidant production, which together with direct effects of cigarette smoke, lead to epithelial stem-cell gene reprogramming.