Abstract
Exacerbations of COPD (ECOPD) represent a major burden for patients and health care systems. Innovative sampling techniques have led to the identification of several pulmonary biomarkers. Although some molecules are promising, their usefulness in clinical practice is not yet established. Medline and Highwire databases were used to identify studies evaluating pulmonary sampled biomarkers in ECOPD. We combined 3 terms for ECOPD, 3 for biomarkers and 6 for the sampling method. Seventy-nine studies were considered eligible for inclusion in the review and were analyzed further. Pulmonary biomarkers sampled with non-invasive, semi-invasive and invasive methods were evaluated for their potential to illustrate the disease’s clinical course, to correlate to clinical variables and to predict clinical outcomes, ECOPD etiology and response to treatment. According to published data several pulmonary biomarkers assessed in ECOPD have the potential to illustrate the natural history of disease through the modification of their levels. Among the clinically relevant molecules, those that have been studied the most and appear to be promising are spontaneous and induced sputum biomarkers for reflecting clinical severity and symptomatic recovery, as well as for directing towards an etiological diagnosis. Current evidence on the clinical usefulness of exhaled breath condensate and bronchoalveolar lavage biomarkers in ECOPD is limited. In conclusion, pulmonary biomarkers have the potential to provide information on the mechanisms underlying ECOPD, and several correlate with clinical variables and outcomes. However, on the basis of published evidence, no single molecule is adequately validated for wide clinical use. Clinical trials that incorporate biomarkers in decisional algorithms are required.
Highlights
The natural history of chronic obstructive pulmonary disease (COPD) is marked by episodes of deterioration, called exacerbations of COPD (ECOPD) which lead to increased morbidity and mortality [1]
With the exception of one study which assessed four volatile biomarkers simultaneously [8], fractional exhaled nitric oxide (FeNO) is the only exhaled biomarker studied in Exacerbations of COPD (ECOPD) (Table 1)
FeNO at ECOPD onset is characterized by a wide range of concentrations and initially elevated levels as compared to controls have not Potentially relevant articles identified through electronic databases and reference checking (n=229)
Summary
The natural history of chronic obstructive pulmonary disease (COPD) is marked by episodes of deterioration, called exacerbations of COPD (ECOPD) which lead to increased morbidity and mortality [1]. In addition to the functional and imaging markers, increasing evidence suggests that sampling, either local or systemic, of biological. Studies were considered pertinent if they evaluated non-systemic, pulmonary sampled biological molecules in the context of ECOPD. Biomarkers sampled with non-invasive, semiinvasive or invasive methods were evaluated for their potential: 1) to illustrate the natural history of ECOPD through the modification of their levels, 2) to correlate with clinical variables [e.g. symptoms, clinical severity, pulmonary function tests (PFTs) and arterial blood gas (ABG)] and 3) to serve as predictors of clinical outcomes (e.g. recovery, length of hospital stay and ECOPD frequency), ECOPD etiology and response to treatment. ‘Baseline’ refers to a time-point of clinical stability, before the development of ECOPD (used for longitudinal studies). ‘ECOPD onset’ refers to the first time-point at which ECOPD patients were assessed by the investigators. ‘Stable COPD’ refers to cross-sectional studies comparing ECOPD patients with another group of COPD patients
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