Abstract
BackgroundChronic obstructive pulmonary disease (COPD) is characterized by irreversible airflow limitation and airway inflammation, accompanied by decreased health status. It is still unknown which factors are responsible for the impaired health status in COPD. We postulated that airway inflammation negatively contributes to health status in COPD.MethodsIn 114 COPD patients (99 male, age: 62 ± 8 yr, 41 [31–55] pack-years, no inhaled or oral corticosteroids, postbronchodilator FEV1: 63 ± 9% pred, FEV1/IVC: 48 ± 9%) we obtained induced sputum and measured health status (St. George's respiratory questionnaire (SGRQ)), postbronchodilator FEV1, hyperinflation (RV/TLC), and airway hyperresponsiveness to methacholine (PC20). Sputum was induced by hypertonic saline and differential cell counts were obtained in 102 patients.ResultsUnivariate analysis showed that SGRQ total and symptom score were positively associated with % sputum macrophages (r = 0.20, p = 0.05; and r = 0.20, p = 0.04, respectively). Multiple regression analysis confirmed these relationships, providing significant contributions of % sputum macrophages (B = 0.25, p = 0.021) and RV/TLC (B = 0.60, p = 0.002) to SGRQ total score. Furthermore, SGRQ symptom score was associated with % sputum macrophages (B = 0.30, p = 0.03) and RV/TLC (B = 0.48, p = 0.044), whilst SGRQ activity score was associated with % sputum macrophages (B = 0.46, p = 0.002), RV/TLC (B = 0.61, p = 0.015), and PC20 (B = -9.3, p = 0.024). Current smoking and FEV1 were not significantly associated with health status in the multiple regression analysis.ConclusionWe conclude that worse health status in COPD patients is associated with higher inflammatory cell counts in induced sputum. Our findings suggest that airway inflammation and hyperinflation independently contribute to impaired health status in COPD. This may provide a rationale for anti-inflammatory therapy in this disease.
Highlights
Chronic obstructive pulmonary disease (COPD) is characterized by irreversible airflow limitation and airway inflammation, accompanied by decreased health status
Patients had moderate to severe COPD as based on their postbronchodilator FEV1 (mean ± SD 63% ± 9 of predicted) and exhibited a wide range in residual volume (RV)/Total lung capacity (TLC) and PC20 (geometric mean, inter quartile range (IQR) 0.6 [0.17–2.40])
The median St. George's respiratory questionnaire (SGRQ) scores were indicative of moderately impaired health status
Summary
Chronic obstructive pulmonary disease (COPD) is characterized by irreversible airflow limitation and airway inflammation, accompanied by decreased health status. Chronic obstructive pulmonary disease (COPD) is a major and growing cause of morbidity and mortality [1,2] It is characterized by progressive and not fully reversible airflow limitation, as measured with the forced expiratory volume in one second (FEV1). In daily life COPD patients are bothered by airway symptoms such as dyspnea, cough and sputum production [2,3] This is accompanied by a serious decrease of health status [4]. George's respiratory questionnaire (SGRQ) provides only weak associations with the degree of airflow limitation, as measured by FEV1 [5,6] This suggests that other factors contribute to the health status in COPD. One of those may be dynamic hyperinflation, i.e. increased residual volume and total lung capacity [7], possibly as a consequence of chronic inflammation and restructuring of the airways and/or parenchyma [8,9]
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