Abstract
BackgroundRecurrent acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are common, debilitating, costly and often difficult to prevent.MethodsWe reviewed records of patients who had COPD and immunoglobulin (Ig) treatment as adjunctive preventative treatment for AECOPD, and documented all AECOPD episodes for one year before and after initiation of Ig treatment. We graded AECOPD episodes as moderate for prescription of antibiotics and/or corticosteroids or for visit to the Emergency Department, and as severe for hospital admission. We conducted a retrospective within-subject self-controlled risk interval analysis to compare the outcome of annual AECOPD rate before and after treatment.ResultsWe identified 22 cases of certain COPD, of which three had early discontinuation of Ig treatment due to rash and local swelling to subcutaneous Ig, and five had incomplete records leaving 14 cases for analyses. The median baseline IgG level was 5.9 g/L (interquartile range 4.1–7.4). Eight had CT radiographic bronchiectasis. Overall, the incidence of AECOPD was consistently and significantly reduced in frequency from mean 4.7 (± 3.1) per patient-year before, to 0.6 (± 1.0) after the Ig treatment (p = 0.0001). There were twelve episodes of severe AECOPD (in seven cases) in the year prior, and one in the year after Ig treatment initiation (p = 0.016).ConclusionsIg treatment appears to decrease the frequency of moderate and severe recurrent AECOPD. A prospective, controlled evaluation of adjunctive Ig treatment to standard therapy of recurrent AECOPD is warranted.
Highlights
Patients with COPD are prone to recurrent episodes of acute exacerbation (AECOPD), which have short- and long-term morbidity and mortality [1,2,3,4]
We identified 22 cases of certain COPD, of which three had early discontinuation of Ig treatment due to rash and local swelling to subcutaneous Ig, and five had incomplete records leaving 14 cases for analyses
Several non-steroidal immunomodulatory agents have been tried as adjuvant therapy in attempts to further reduce the frequency of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) but failed to elicit significant efficacy [11,12,13,14,15]
Summary
Patients with COPD are prone to recurrent episodes of acute exacerbation (AECOPD), which have short- and long-term morbidity and mortality [1,2,3,4]. Patients with frequent AECOPD use healthcare services disproportionately, with increased healthcare costs [5,6]. The majority of this cost is driven by the exacerbations for which patients are hospitalized [7]. Macrolides have anti-inflammatory effect [16] and are used in patients with severe COPD and a history of frequent exacerbations [17]. Recurrent acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are common, debilitating, costly and often difficult to prevent
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