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Inflammatory profile of new bacterial strain exacerbations of chronic obstructive pulmonary disease.
Am J Respir Crit Care Med 2008; 177(5):491-7AJ

Abstract

RATIONALE

Whether the airway and systemic inflammatory profile in bacterial exacerbations of chronic obstructive pulmonary disease (COPD) is distinct from nonbacterial exacerbations is unclear. Previous studies have not used molecular typing of bacterial pathogens, which is required to accurately define bacterial infection in COPD. The relationship between clinical severity and course of exacerbation and inflammation is also not fully understood.

OBJECTIVES

To determine if (1) systemic and airway inflammation is distinct in new bacterial strain exacerbations and (2) clinical severity and resolution of exacerbations is related to airway and systemic inflammation.

METHODS

In a prospective longitudinal cohort study in COPD, sputum and serum samples obtained before, at, and following exacerbations during a 2-year period were studied.

MEASUREMENTS AND MAIN RESULTS

Clinical information, molecular typing of bacterial pathogens, sputum IL-8, tumor necrosis factor (TNF)-alpha and neutrophil elastase, and serum C-reactive protein. From 46 patients, 177 exacerbations were grouped as new strain, preexisting strain, other pathogen, and pathogen negative. New strain exacerbations were associated with significantly greater increases from baseline in sputum TNF-alpha and neutrophil elastase, and in serum C-reactive protein compared with the other three groups. Increases in inflammatory markers were similar among the other three groups. Clinical resolution was accompanied by resolution of inflammation to preexacerbation levels, whereas persistent symptoms were paralleled by persistently elevated inflammation. Clinical exacerbation severity was significantly correlated with levels of all four markers.

CONCLUSIONS

Neutrophilic airway inflammation and systemic inflammation are more intense with well-defined bacterial exacerbations than with nonbacterial exacerbations. Clinical course of exacerbation and inflammation are closely linked.

Authors+Show Affiliations

Division of Pulmonary and Critical Care and Sleep Medicine, Department of Medicine, University at Buffalo, State University of New York, USA. ssethi@buffalo.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18079493

Citation

Sethi, Sanjay, et al. "Inflammatory Profile of New Bacterial Strain Exacerbations of Chronic Obstructive Pulmonary Disease." American Journal of Respiratory and Critical Care Medicine, vol. 177, no. 5, 2008, pp. 491-7.
Sethi S, Wrona C, Eschberger K, et al. Inflammatory profile of new bacterial strain exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2008;177(5):491-7.
Sethi, S., Wrona, C., Eschberger, K., Lobbins, P., Cai, X., & Murphy, T. F. (2008). Inflammatory profile of new bacterial strain exacerbations of chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 177(5), pp. 491-7.
Sethi S, et al. Inflammatory Profile of New Bacterial Strain Exacerbations of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2008 Mar 1;177(5):491-7. PubMed PMID: 18079493.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Inflammatory profile of new bacterial strain exacerbations of chronic obstructive pulmonary disease. AU - Sethi,Sanjay, AU - Wrona,Catherine, AU - Eschberger,Karen, AU - Lobbins,Phyllis, AU - Cai,Xueya, AU - Murphy,Timothy F, Y1 - 2007/12/13/ PY - 2007/12/15/pubmed PY - 2008/3/14/medline PY - 2007/12/15/entrez SP - 491 EP - 7 JF - American journal of respiratory and critical care medicine JO - Am. J. Respir. Crit. Care Med. VL - 177 IS - 5 N2 - RATIONALE: Whether the airway and systemic inflammatory profile in bacterial exacerbations of chronic obstructive pulmonary disease (COPD) is distinct from nonbacterial exacerbations is unclear. Previous studies have not used molecular typing of bacterial pathogens, which is required to accurately define bacterial infection in COPD. The relationship between clinical severity and course of exacerbation and inflammation is also not fully understood. OBJECTIVES: To determine if (1) systemic and airway inflammation is distinct in new bacterial strain exacerbations and (2) clinical severity and resolution of exacerbations is related to airway and systemic inflammation. METHODS: In a prospective longitudinal cohort study in COPD, sputum and serum samples obtained before, at, and following exacerbations during a 2-year period were studied. MEASUREMENTS AND MAIN RESULTS: Clinical information, molecular typing of bacterial pathogens, sputum IL-8, tumor necrosis factor (TNF)-alpha and neutrophil elastase, and serum C-reactive protein. From 46 patients, 177 exacerbations were grouped as new strain, preexisting strain, other pathogen, and pathogen negative. New strain exacerbations were associated with significantly greater increases from baseline in sputum TNF-alpha and neutrophil elastase, and in serum C-reactive protein compared with the other three groups. Increases in inflammatory markers were similar among the other three groups. Clinical resolution was accompanied by resolution of inflammation to preexacerbation levels, whereas persistent symptoms were paralleled by persistently elevated inflammation. Clinical exacerbation severity was significantly correlated with levels of all four markers. CONCLUSIONS: Neutrophilic airway inflammation and systemic inflammation are more intense with well-defined bacterial exacerbations than with nonbacterial exacerbations. Clinical course of exacerbation and inflammation are closely linked. SN - 1535-4970 UR - https://www.unboundmedicine.com/medline/citation/18079493/Inflammatory_profile_of_new_bacterial_strain_exacerbations_of_chronic_obstructive_pulmonary_disease_ L2 - http://www.atsjournals.org/doi/full/10.1164/rccm.200708-1234OC?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -