MxA and CRP-Guided Use of Antimicrobial Agents for AECOPD

Respiratory viral infections are a leading cause of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). However, there is currently a lack of rapid diagnostic methods to differentiate the cause of AECOPD, resulting in insufficient attention to viral-induced exacerbations, with antibiotic treatment remaining the primary treatment.

Myxovirus resistance protein A (MxA) has been identified as a potential biomarker to distinguish respiratory viral infections, while C-reactive protein (CRP) has been confirmed as a useful guide for antibiotic therapy in AECOPD.

This randomized controlled trial aims to investigate the clinical value of MxA and CRP-guided antimicrobial treatment in outpatients with AECOPD, with the goal of reducing antibiotic overuse and improving patient outcomes.

Inclusion criteria

• ≥40 years old；
• Current or former smoker with a minimum smoking history of 10 pack years, clinical diagnosed with mild-to-severe COPD;
• Presenting with an acute exacerbation of COPD
• The severity of AECOPD is mild to moderate.

Exclusion criteria

• Required urgent hospitalization
• Received interferon therapy within 30 days before screening
• Had an active systemic inflammatory condition within 30 days prior to screening, such as cerebral infarction, myocardial infarction, or surgery
• Received vaccine in the past 30 days
• Active tuberculosis
• Immunocompromised
• Presenting with current respiratory failure
• Clinical suspicion of pneumonia or pulmonary edema.
• Coexisting bronchiectasis, cystic fibrosis, or asthma
• Had a concurrent infection at another site, such as urinary tract infections or sinusitis;
• Contraindications to antibiotics and/or antivirals
• Known etiology of the present exacerbation
• Pre-treatment with corticosteroids (cumulative dose of methylprednisolone ≥ 80 mg or equivalent dose) for the present exacerbation.