Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations.
By A. Papi, C. Bellettato, F. Braccioni, M. Romagnoli, P. Casolari, G. Caramori, L. Fabbri, S. Johnston. American Journal of Respiratory and Critical Care Medicine, 2006
1,094 citations recorded by the source corpus.
RATIONALE Severe exacerbations of chronic obstructive pulmonary disease (COPD) are major causes of health care costs mostly related to hospitalization. The role of infections in COPD exacerbations is controversial. OBJECTIVES We investigated whether COPD exacerbations requiring hospitalization are associated with viral and/or bacterial infection and evaluated relationships among infection, exacerbation severity, assessed by reduction of FEV1, and specific patterns of airway inflammation. METHODS We examined 64 patients with COPD when hospitalized for exacerbations, and when in stable convalescence. We measured lung function, blood gases, and exhaled nitric oxide, and examined sputum for inflammation and for viral and bacterial infection. RESULTS Exacerbations were associated with impaired lung function (p < 0.01) and increased sputum neutrophilia (p < 0.001). Viral and/or bacterial infection was detected in 78% of exacerbations: viruses in 48.4% (6.2% when stable, p < 0.001) and bacteria in 54.7% (37.5% when stable, p = 0.08). Patients with infectious exacerbations (29.7% bacterial, 23.4% viral, 25% viral/bacterial coinfection) had longer hospitalizations (p < 0.02) and greater impairment of several measures of lung function (all p < 0.05) than those with noninfectious exacerbations. Patients with exacerbations with coinfection had more marked lung function impairment (p < 0.02) and longer hospitalizations (p = 0.001). Sputum neutrophils were increased in all exacerbations (p < 0.001) and were related to their severity (p < 0.001), independently of the association with viral or bacterial infections; sputum eosinophils were increased during (p < 0.001) virus-associated exacerbations. CONCLUSIONS Respiratory infections are associated with the majority of COPD exacerbations and their severity, especially those with viral/bacterial coinfection. Airway neutrophilia is related to exacerbation severity regardless of viral and/or bacterial infections. Eosinophilia is a good predictor of viral exacerbations.
Subfields: Emergency Medical Services, Pulmonary and Respiratory Medicine, Sociology and Political Science
View Paper: https://www.semanticscholar.org/paper/3f71b01738c04280014b124045794c0914e55119
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Citations in the corpus
- Blood eosinophils to direct corticosteroid treatment of exacerbations of chronic obstructive pulmonary disease: a randomized placebo-controlled trial. (2012, neutral): “5) CRP, mg/L 3 (2) 24 (67) 3 (7) 3 (5)”
- Guidelines for the management of adult lower respiratory tract infections - Full version (2011, neutral): “[167] Prospective study of diagnostic yield from sputa from patients during and after exacerbations of COPD PCS 3A+”
- How cigarette smoke skews immune responses to promote infection, lung disease and cancer (2009, background): “Similar considerations apply to acute exacerbations of COPD that are due to bacterial and viral infection”
- Prevalence, Severity and Mortality associated with COPD and Smoking in patients with COVID-19: A Rapid Systematic Review and Meta-Analysis (2020, background): “Various factors have been described to contribute to acute worsening of COPD, however, viral infection remains the main trigger, including seasonal coronaviruses (12-14).”