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Effect of interactions between lower airway bacterial and rhinoviral infection in exacerbations of COPD.
Chest 2006; 129(2):317-24Chest

Abstract

STUDY OBJECTIVES

The inflammatory responses and associated clinical severity of COPD exacerbations are greatly variable, and the determinants of these factors are poorly understood. We examined the hypothesis that bacteria and viruses may modulate this heterogeneity and that interactions between bacterial and viral infection may affect changes in airway bacterial load and the clinical features and inflammatory responses of exacerbations in patients with COPD.

DESIGN

Prospective cohort study.

SETTING

Outpatient Department, London Chest Hospital, London, UK.

PATIENTS

Thirty-nine patients with COPD.

MEASUREMENTS

We prospectively studied 56 COPD exacerbations, obtaining clinical data and paired sputum and serum samples at baseline and exacerbation. Qualitative and quantitative microbiology, polymerase chain reaction detection for rhinovirus, and estimation of cytokine levels by enzyme-linked immunosorbent assay were performed.

RESULTS

A total of 69.6% of exacerbations were associated with a bacterial pathogen, most commonly Haemophilus influenzae. Rhinovirus was identified in 19.6% of exacerbations. The rise in bacterial load at exacerbation correlated with the rise in sputum interleukin (IL)-8 (r = 0.37, p = 0.022) and fall in FEV1 (r = 0.35, p = 0.048). Exacerbations with both rhinovirus and H. influenzae had higher bacterial loads (10(8.56) cfu/mL vs 10(8.05)cfu/mL, p = 0.018) and serum IL-6 (13.75 pg/mL vs 6.29 pg/mL, p = 0.028) than exacerbations without both pathogens. In exacerbations with both cold symptoms (a marker of putative viral infection) and a bacterial pathogen, the FEV1 fall was greater (20.3% vs 3.6%, p = 0.026) and symptom count was higher (p = 0.019) than those with a bacterial pathogen alone.

CONCLUSIONS

The clinical severity and inflammatory responses in COPD exacerbations are modulated by the nature of the infecting organism: bacterial and viral pathogens interact to cause additional rises in inflammatory markers and greater exacerbation severity.

Authors+Show Affiliations

Academic Unit of Respiratory Medicine, St. Bartholomew's and the Royal London School of Medicine, St. Bartholomew's Hospital, London, 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

16478847

Citation

Wilkinson, Tom M A., et al. "Effect of Interactions Between Lower Airway Bacterial and Rhinoviral Infection in Exacerbations of COPD." Chest, vol. 129, no. 2, 2006, pp. 317-24.
Wilkinson TM, Hurst JR, Perera WR, et al. Effect of interactions between lower airway bacterial and rhinoviral infection in exacerbations of COPD. Chest. 2006;129(2):317-24.
Wilkinson, T. M., Hurst, J. R., Perera, W. R., Wilks, M., Donaldson, G. C., & Wedzicha, J. A. (2006). Effect of interactions between lower airway bacterial and rhinoviral infection in exacerbations of COPD. Chest, 129(2), pp. 317-24.
Wilkinson TM, et al. Effect of Interactions Between Lower Airway Bacterial and Rhinoviral Infection in Exacerbations of COPD. Chest. 2006;129(2):317-24. PubMed PMID: 16478847.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of interactions between lower airway bacterial and rhinoviral infection in exacerbations of COPD. AU - Wilkinson,Tom M A, AU - Hurst,John R, AU - Perera,Wayomi R, AU - Wilks,Mark, AU - Donaldson,Gavin C, AU - Wedzicha,Jadwiga A, PY - 2006/2/16/pubmed PY - 2006/3/23/medline PY - 2006/2/16/entrez SP - 317 EP - 24 JF - Chest JO - Chest VL - 129 IS - 2 N2 - STUDY OBJECTIVES: The inflammatory responses and associated clinical severity of COPD exacerbations are greatly variable, and the determinants of these factors are poorly understood. We examined the hypothesis that bacteria and viruses may modulate this heterogeneity and that interactions between bacterial and viral infection may affect changes in airway bacterial load and the clinical features and inflammatory responses of exacerbations in patients with COPD. DESIGN: Prospective cohort study. SETTING: Outpatient Department, London Chest Hospital, London, UK. PATIENTS: Thirty-nine patients with COPD. MEASUREMENTS: We prospectively studied 56 COPD exacerbations, obtaining clinical data and paired sputum and serum samples at baseline and exacerbation. Qualitative and quantitative microbiology, polymerase chain reaction detection for rhinovirus, and estimation of cytokine levels by enzyme-linked immunosorbent assay were performed. RESULTS: A total of 69.6% of exacerbations were associated with a bacterial pathogen, most commonly Haemophilus influenzae. Rhinovirus was identified in 19.6% of exacerbations. The rise in bacterial load at exacerbation correlated with the rise in sputum interleukin (IL)-8 (r = 0.37, p = 0.022) and fall in FEV1 (r = 0.35, p = 0.048). Exacerbations with both rhinovirus and H. influenzae had higher bacterial loads (10(8.56) cfu/mL vs 10(8.05)cfu/mL, p = 0.018) and serum IL-6 (13.75 pg/mL vs 6.29 pg/mL, p = 0.028) than exacerbations without both pathogens. In exacerbations with both cold symptoms (a marker of putative viral infection) and a bacterial pathogen, the FEV1 fall was greater (20.3% vs 3.6%, p = 0.026) and symptom count was higher (p = 0.019) than those with a bacterial pathogen alone. CONCLUSIONS: The clinical severity and inflammatory responses in COPD exacerbations are modulated by the nature of the infecting organism: bacterial and viral pathogens interact to cause additional rises in inflammatory markers and greater exacerbation severity. SN - 0012-3692 UR - https://www.unboundmedicine.com/medline/citation/16478847/Effect_of_interactions_between_lower_airway_bacterial_and_rhinoviral_infection_in_exacerbations_of_COPD_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0012-3692(15)38752-3 DB - PRIME DP - Unbound Medicine ER -