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Relationship between bacterial colonisation and the frequency, character, and severity of COPD exacerbations.
Thorax 2002; 57(9):759-64T

Abstract

BACKGROUND

Patients with chronic obstructive pulmonary disease (COPD) are prone to frequent exacerbations which are a significant cause of morbidity and mortality. Stable COPD patients often have lower airway bacterial colonisation which may be an important stimulus to airway inflammation and thereby modulate exacerbation frequency.

METHODS

Twenty nine patients with COPD (21 men, 16 current smokers) of mean (SD) age 65.9 (7.84) years, forced expiratory volume in 1 second (FEV(1)) 1.06 (0.41) l, FEV(1) % predicted 38.7 (15.2)%, FEV(1)/FVC 43.7 (14.1)%, inhaled steroid dosage 1.20 (0.66) mg/day completed daily diary cards for symptoms and peak flow over 18 months. Exacerbation frequency rates were determined from diary card data. Induced sputum was obtained from patients in the stable state, quantitative bacterial culture was performed, and cytokine levels were measured.

RESULTS

Fifteen of the 29 patients (51.7%) were colonised by a possible pathogen: Haemophilus influenzae (53.3%), Streptococcus pneumoniae (33.3%), Haemophilus parainfluenzae (20%), Branhamella catarrhalis (20%), Pseudomonas aeruginosa (20%). The presence of lower airway bacterial colonisation in the stable state was related to exacerbation frequency (p=0.023). Patients colonised by H influenzae in the stable state reported more symptoms and increased sputum purulence at exacerbation than those not colonised. The median (IQR) symptom count at exacerbation in those colonised by H influenzae was 2.00 (2.00-2.65) compared with 2.00 (1.00-2.00) in those not colonised (p=0.03). The occurrence of increased sputum purulence at exacerbation per patient was 0.92 (0.56-1.00) in those colonised with H influenzae and 0.33 (0.00-0.60) in those not colonised (p=0.02). Sputum interleukin (IL)-8 levels correlated with the total bacterial count (rho=0.459, p=0.02).

CONCLUSION

Lower airway bacterial colonisation in the stable state modulates the character and frequency of COPD exacerbations.

Authors+Show Affiliations

Academic Respiratory Medicine, St Bartholomew's and Royal London School of Medicine and Dentistry, London EC1A 7BE, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12200518

Citation

Patel, I S., et al. "Relationship Between Bacterial Colonisation and the Frequency, Character, and Severity of COPD Exacerbations." Thorax, vol. 57, no. 9, 2002, pp. 759-64.
Patel IS, Seemungal TA, Wilks M, et al. Relationship between bacterial colonisation and the frequency, character, and severity of COPD exacerbations. Thorax. 2002;57(9):759-64.
Patel, I. S., Seemungal, T. A., Wilks, M., Lloyd-Owen, S. J., Donaldson, G. C., & Wedzicha, J. A. (2002). Relationship between bacterial colonisation and the frequency, character, and severity of COPD exacerbations. Thorax, 57(9), pp. 759-64.
Patel IS, et al. Relationship Between Bacterial Colonisation and the Frequency, Character, and Severity of COPD Exacerbations. Thorax. 2002;57(9):759-64. PubMed PMID: 12200518.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relationship between bacterial colonisation and the frequency, character, and severity of COPD exacerbations. AU - Patel,I S, AU - Seemungal,T A R, AU - Wilks,M, AU - Lloyd-Owen,S J, AU - Donaldson,G C, AU - Wedzicha,J A, PY - 2002/8/30/pubmed PY - 2002/10/3/medline PY - 2002/8/30/entrez SP - 759 EP - 64 JF - Thorax JO - Thorax VL - 57 IS - 9 N2 - BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) are prone to frequent exacerbations which are a significant cause of morbidity and mortality. Stable COPD patients often have lower airway bacterial colonisation which may be an important stimulus to airway inflammation and thereby modulate exacerbation frequency. METHODS: Twenty nine patients with COPD (21 men, 16 current smokers) of mean (SD) age 65.9 (7.84) years, forced expiratory volume in 1 second (FEV(1)) 1.06 (0.41) l, FEV(1) % predicted 38.7 (15.2)%, FEV(1)/FVC 43.7 (14.1)%, inhaled steroid dosage 1.20 (0.66) mg/day completed daily diary cards for symptoms and peak flow over 18 months. Exacerbation frequency rates were determined from diary card data. Induced sputum was obtained from patients in the stable state, quantitative bacterial culture was performed, and cytokine levels were measured. RESULTS: Fifteen of the 29 patients (51.7%) were colonised by a possible pathogen: Haemophilus influenzae (53.3%), Streptococcus pneumoniae (33.3%), Haemophilus parainfluenzae (20%), Branhamella catarrhalis (20%), Pseudomonas aeruginosa (20%). The presence of lower airway bacterial colonisation in the stable state was related to exacerbation frequency (p=0.023). Patients colonised by H influenzae in the stable state reported more symptoms and increased sputum purulence at exacerbation than those not colonised. The median (IQR) symptom count at exacerbation in those colonised by H influenzae was 2.00 (2.00-2.65) compared with 2.00 (1.00-2.00) in those not colonised (p=0.03). The occurrence of increased sputum purulence at exacerbation per patient was 0.92 (0.56-1.00) in those colonised with H influenzae and 0.33 (0.00-0.60) in those not colonised (p=0.02). Sputum interleukin (IL)-8 levels correlated with the total bacterial count (rho=0.459, p=0.02). CONCLUSION: Lower airway bacterial colonisation in the stable state modulates the character and frequency of COPD exacerbations. SN - 0040-6376 UR - https://www.unboundmedicine.com/medline/citation/12200518/Relationship_between_bacterial_colonisation_and_the_frequency_character_and_severity_of_COPD_exacerbations_ L2 - http://thorax.bmj.com/cgi/pmidlookup?view=long&pmid=12200518 DB - PRIME DP - Unbound Medicine ER -