Tags

Type your tag names separated by a space and hit enter

Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations.
Am J Respir Crit Care Med 2006; 173(10):1114-21AJ

Abstract

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.

Authors+Show Affiliations

Research Center on Asthma and COPD, Department of Respiratory Diseases, University of Modena and Reggio Emilia, Via del Pozzo 71, I-41100 Modena, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

16484677

Citation

Papi, Alberto, et al. "Infections and Airway Inflammation in Chronic Obstructive Pulmonary Disease Severe Exacerbations." American Journal of Respiratory and Critical Care Medicine, vol. 173, no. 10, 2006, pp. 1114-21.
Papi A, Bellettato CM, Braccioni F, et al. Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations. Am J Respir Crit Care Med. 2006;173(10):1114-21.
Papi, A., Bellettato, C. M., Braccioni, F., Romagnoli, M., Casolari, P., Caramori, G., ... Johnston, S. L. (2006). Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations. American Journal of Respiratory and Critical Care Medicine, 173(10), pp. 1114-21.
Papi A, et al. Infections and Airway Inflammation in Chronic Obstructive Pulmonary Disease Severe Exacerbations. Am J Respir Crit Care Med. 2006 May 15;173(10):1114-21. PubMed PMID: 16484677.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations. AU - Papi,Alberto, AU - Bellettato,Cinzia Maria, AU - Braccioni,Fausto, AU - Romagnoli,Micaela, AU - Casolari,Paolo, AU - Caramori,Gaetano, AU - Fabbri,Leonardo M, AU - Johnston,Sebastian L, Y1 - 2006/02/16/ PY - 2006/2/18/pubmed PY - 2006/6/23/medline PY - 2006/2/18/entrez SP - 1114 EP - 21 JF - American journal of respiratory and critical care medicine JO - Am. J. Respir. Crit. Care Med. VL - 173 IS - 10 N2 - 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. SN - 1073-449X UR - https://www.unboundmedicine.com/medline/citation/16484677/Infections_and_airway_inflammation_in_chronic_obstructive_pulmonary_disease_severe_exacerbations_ L2 - http://www.atsjournals.org/doi/full/10.1164/rccm.200506-859OC?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -