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influenzae , a frequent coloniser of the upper respiratory tract, which may be due to CS potentiating reduced phosphoinositide 3-kinase signalling, triggered by the gram-negative bacteria.57 Using bioparticles from the gram-negative bacteria Escherichia coli , AM phagocytosis has been shown to be impaired in patients with COPD who were current smokers when compared with patients with COPD who were ex-smokers.40 CS exposure also causes bacteria to become more virulent, with reduced lysis and resistance to macrophage killing such as seen in gram-positive bacteria, Staphylococcus aureus .4 In this study, CS exposure altered surface charge and hydrophobicity of the bacterial cell wall, which confers resistance to killing by antimicrobial peptides, both effecting the pathogenicity as well as host susceptibility by impairment of AM function