Episodes Of Acute Exacerbations Of Chronic Obstructive Pulmonary Disease Research Articles

Protocolo de manejo de pacientes con enfermedad pulmonar obstructiva crónica tras agudización en urgencias

In chronic obstructive pulmonary disease, an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is an episode of clinical instability due to the worsening of expiratory airflow limitation or of the underlying inflammatory process. The severity of AECOPD depends on baseline risk stratification and the intensity of the acute episode. Primary Care is the epicenter of the AECOPD care circuit, but it can be extended to the out-of-hospital emergency department and the hospital itself depending on the clinical situation, the level of severity, the availability of complementary tests, and the therapeutic resources required for each patient. Recording clinical data, history, triggering factors, treatment, and evolution of previous episodes of AECOPD in the electronic medical record is an essential aspect to adjust current treatment and prevent the occurrence of future episodes.

Prevention of Re-Hospitalization for Acute Exacerbations: Perspectives of People with Chronic Obstructive Pulmonary Disease: A Qualitative Study.

Current guidelines for prevention of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) reflect clinical understanding of the causes of exacerbations but with a limited recognition of person-specific contributing factors. As part of a randomized trial of a person-centered intervention aiming to promote self-determination, we describe personal perspectives of those with chronic obstructive pulmonary disease (COPD) on what they saw as the causes and best ways to stay well and prevent rehospitalization after an AECOPD. Twelve participants (mean age 69.3 years, six female, six male; eight New Zealand European, two Māori, one Pacific, and one other) were interviewed about their experiences of staying well and out of hospital. Data were collected via individual semi-structured interviews one year following an index hospital admission for AECOPD and focused on the participants' views and experiences of their health condition, their beliefs about staying well, and the causes of and factors preventing further exacerbations and hospitalizations. Data were analyzed using constructivist grounded theory methods. Three main themes were identified that described participants' views on what helped or hindered them to stay well and out of hospital: 1) Being Positive: The importance of having a positive mindset; 2) Being Proactive: Practical steps to reduce the risk of, and consequences from, episodes of AECOPD; and 3) Being in Control: Feeling in command of one's life and health. Each of these was affected by Being Connected: The influence of significant others, particularly close family. This research expands our understanding of how patients manage COPD and adds patient perspectives to current knowledge on how to prevent recurrent AECOPD. Programs which promote self-efficacy and positivity would be beneficial additions to AECOPD prevention strategies, as could the inclusion of family or significant others in wellbeing plans.

FIZZ2 as a Biomarker for Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Found in inflammatory zone 2 (FIZZ2) is associated with lung inflammation. The aim of the study was to investigate the expression and utility of FIZZ2 as a marker for chronic obstructive pulmonary disease (COPD). Immunohistochemistry was used to detect the expression of FIZZ2 in COPD. The serum concentration of FIZZ2 was measured by enzyme-linked immunosorbent assay and the episodes of acute exacerbations of COPD (AECOPD) in the following year were recorded. FIZZ2 expression was elevated in bronchial epithelial cells (0.217 ± 0.021 vs 0.099 ± 0.010, p < 0.0001) and negatively correlated with the pulmonary function (FEV1/FVC%) (p = 0.0149) and positively correlated with the smoking index (p = 0.0241). Serum level of FIZZ2 in COPD were significantly higher than that in healthy controls (561.6 ± 70.71 vs 52.24 ± 20.52pg/ml, p < 0.0001) and increased with the COPD severity. Serum levels of FIZZ2 negatively correlated with the pulmonary function [Forced Vital Capacity (FVC), Forced Expiratory Volume (FEV1), FEV1%, FEV1/FVC) (r = - 0.3086, - 0.3529, - 0.3343, and - 0.2676, respectively, p = 0.0003, p < 0.0001, p < 0.0001, p = 0.0014). The expression of human serum FIZZ2 was positively correlated with the smoking index (r = 0.2749, p = 0.0015). There was a positive correlation between the FIZZ2 concentration and the frequency of AECOPD episodes in the following year (r = 0.7291, p < 0.0001). FIZZ2 expression was elevated in patients with COPD and its serum concentration might be a potential biomarker for AECOPD.

Breathing-swallow dysfunction in COPD: How silent aspiration may be contributing to exacerbations.

Breathing-swallow dysfunction in COPD: How silent aspiration may be contributing to exacerbations.

Acute Exacerbation of a Chronic Obstructive Pulmonary Disease Prediction System Using Wearable Device Data, Machine Learning, and Deep Learning: Development and Cohort Study.

BackgroundThe World Health Organization has projected that by 2030, chronic obstructive pulmonary disease (COPD) will be the third-leading cause of mortality and the seventh-leading cause of morbidity worldwide. Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with an accelerated decline in lung function, diminished quality of life, and higher mortality. Accurate early detection of acute exacerbations will enable early management and reduce mortality.ObjectiveThe aim of this study was to develop a prediction system using lifestyle data, environmental factors, and patient symptoms for the early detection of AECOPD in the upcoming 7 days.MethodsThis prospective study was performed at National Taiwan University Hospital. Patients with COPD that did not have a pacemaker and were not pregnant were invited for enrollment. Data on lifestyle, temperature, humidity, and fine particulate matter were collected using wearable devices (Fitbit Versa), a home air quality–sensing device (EDIMAX Airbox), and a smartphone app. AECOPD episodes were evaluated via standardized questionnaires. With these input features, we evaluated the prediction performance of machine learning models, including random forest, decision trees, k-nearest neighbor, linear discriminant analysis, and adaptive boosting, and a deep neural network model.ResultsThe continuous real-time monitoring of lifestyle and indoor environment factors was implemented by integrating home air quality–sensing devices, a smartphone app, and wearable devices. All data from 67 COPD patients were collected prospectively during a mean 4-month follow-up period, resulting in the detection of 25 AECOPD episodes. For 7-day AECOPD prediction, the proposed AECOPD predictive model achieved an accuracy of 92.1%, sensitivity of 94%, and specificity of 90.4%. Receiver operating characteristic curve analysis showed that the area under the curve of the model in predicting AECOPD was greater than 0.9. The most important variables in the model were daily steps walked, stairs climbed, and daily distance moved.ConclusionsUsing wearable devices, home air quality–sensing devices, a smartphone app, and supervised prediction algorithms, we achieved excellent power to predict whether a patient would experience AECOPD within the upcoming 7 days. The AECOPD prediction system provided an effective way to collect lifestyle and environmental data, and yielded reliable predictions of future AECOPD events. Compared with previous studies, we have comprehensively improved the performance of the AECOPD prediction model by adding objective lifestyle and environmental data. This model could yield more accurate prediction results for COPD patients than using only questionnaire data.

Polyvalent Immunoglobulin as a Potential Treatment Option for Patients with Recurrent COPD Exacerbations.

Chronic obstructive pulmonary disease (COPD) is characterized by chronic airway inflammation and episodes of worsening respiratory symptoms and pulmonary function, termed acute exacerbations of COPD (AECOPD). AECOPD episodes are associated with heightened airway inflammation and are often triggered by infection. A subset of COPD patients develops frequent exacerbations despite maximal existing standard medical therapy. It is therefore clear that a targeted and more effective prevention strategy is needed. Immunoglobulins are glycoprotein molecules that are secreted by B lymphocytes and plasma cells and play a critical role in the adaptive immune response against many pathogens. Altered serum immunoglobulin levels have been observed in patients with immunodeficiencies and inflammatory diseases. Serum immunoglobulin has also been identified as potential biomarkers of AECOPD frequency. Since plasma-derived polyvalent immunoglobulin treatment is effective in preventing recurrent infections in immunodeficient patients and in suppressing inflammation in many inflammatory diseases, it may be conceivable that immunoglobulin treatment may be effective in preventing recurrent AECOPD. In this article, we provide a review of the current knowledge on immunoglobulin treatment in patients with COPD and discuss plausible mechanisms as to how immunoglobulin treatment may work to reduce AECOPD frequency.

Effectiveness, safety and cost analysis of add-on pidotimod in maintenance therapy for exacerbation of chronic obstructive pulmonary disease in adults

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the sudden worsening in airway function and respiratory symptoms in patients with COPD which range from self-limited diseases to episodes of florid respiratory failure requiring mechanical ventilation. An average patient with COPD might experience 2 episodes of AECOPD per year and 10% of these episodes require hospitalization. Pidotimod, an immunostimulant, has shown promising results in conditions with underlying cause of suppressed cell-mediated immunity like chronic bronchitis and recurrent respiratory tract infection (RRTI). The current study evaluated the safety, efficacy and cost effectiveness of Pidotimod in adult Indian patients with COPD as an add-on drug in maintenance therapy of acute exacerbations. In this prospective, open label, single arm, single centre study, Pidotimod was administered as an add-on therapy for 2 months in 114 patients (? 18 years and ? 55years; mean age: 59.51± 8.66 years) with COPD having experienced two or more exacerbation that required antibiotics. The study comprised of screening visit, enrolment and 3 follow-up visits (at the end of 2, 6 and 12 months). Of the 111 patients at baseline, only one patient had an AECB episode at 2 and 6 months. At the end of 12 months, none of the patient had an AECB. Only one subject was prescribed with antibiotic treatment at the end of 2 and 6 months. No episodes of either exacerbations or antibiotic prescription at the end of 12 months were reported. A significant reduction (p Keywords: Immunostimulant, Pidotimod, Acute exacerbations of chronic bronchitis (AECB), Cost-analysis, Respiratory infections.

Prediction models for pulmonary function during acute exacerbation of chronic obstructive pulmonary disease

Objective:The pulmonary function test is an effort-dependent test; however, during acute exacerbation of chronic obstructive pulmonary disease (AECOPD), patients are unable to effectively cooperate due to poor health. The present study aimed to establish prediction models that only require demographic and inflammatory parameters to predict pulmonary function indexes: forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). Approach: The goal was to establish prediction models based on multi-output support vector regression. A total of 143 subjects received a peripheral blood examination and pulmonary function test. The demographic and inflammatory parameters were used as input features, and FEV1 and FVC were used as the target features in prediction models. Three models (mixed model, severe model and nonsevere model) were established with FEV1 < 1 l as the threshold of severe episodes of AECOPD. The values of FEV1 and FVC from the pulmonary function tests were compared with the prediction models to validate the performances of the developed prediction models. Main results: The severe and nonsevere models’ prediction performances were better than that of the mixed model. The mean squared errors were lower than 0.05 l2, and the decision coefficients (R 2) were higher than 0.40. The two-tailed t-test results showed that for both severe and nonsevere models, the absolute percentage errors of FEV1 and FVC were within 10%. Significance: Our study shows the feasibility of predicting the pulmonary function indexes FEV1 and FVC with demographic and inflammatory parameters when the pulmonary function test fails to be implemented, which is beneficial for the treatment of AECOPD.

Microbiological Etiology of Chronic Cough Associated with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD): A Study from Karachi, Pakistan

Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) worsens the respiratory symptoms that are usually triggered by infection with bacteria or viruses or by environmental pollutants. Therefore, the aim of this study was to determine the bacterial etiology from sputum culture in patients suffering from acute exacerbation of COPD, admitted in hospital. Methods: The study was cross sectional observational, where sputum bacterial cultures were analyzed from the patients with Acute exacerbation COPD treated in the ICU of a tertiary care hospital for pulmonary disease from January 2019 to December 2019. Two sputum samples were collected from each patient for bacterial examination. The results of sputum bacterial culture findings were expressed as frequency and percentage by using SPSS. Results: In the present study, there were 1296 patients, both males 749 (57.8%) and females 547 (42.2%). The mean age of patients was 57.39±19.74years. 470 (36.3%) showed negative culture reports. 440 (34.0%) patients had Moraxella infection, which was most common organism in all patients, and 149 (11.5%) patients had Pseudomonas infection, 157(12.1%) patients had Yeast Albicans and in only 1 (0.1%) patient Enterobacter infection were found. Other pathogens in low frequency identified were Haemophilus parainfluenzae, Streptococcus pneumoniae, Escherichia coli and Haemophilus influenzae. It was observed that the frequency of infections was linked with increasing age. Conclusion: With increasing age, people are prone to acquire pulmonary infections specifically COPD. It is therefore very important to perform sputum culture to identify the causative agents and treat the patients with appropriate antibiotic to reduce the episodes of AECOPD. Keywords: Bacteria; Sputum Culture; COPD; Antibiotic; Cough.

Chronic obstructive pulmonary disease exacerbation episodes derived from electronic health record data validated using clinical trial data

PurposeTo validate an algorithm for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) episodes derived in an electronic health record (EHR) database, against AECOPD episodes collected in a randomized clinical trial using an electronic case report form (eCRF).MethodsWe analyzed two data sources from the Salford Lung Study in COPD: trial eCRF and the Salford Integrated Record, a linked primary‐secondary routine care EHR database of all patients in Salford. For trial participants, AECOPD episodes reported in eCRF were compared with algorithmically derived moderate/severe AECOPD episodes identified in EHR. Episode characteristics (frequency, duration), sensitivity, and positive predictive value (PPV) were calculated. A match between eCRF and EHR episodes was defined as at least 1‐day overlap.ResultsIn the primary effectiveness analysis population (n = 2269), 3791 EHR episodes (mean [SD] length: 15.1 [3.59] days; range: 14‐54) and 4403 moderate/severe AECOPD eCRF episodes (mean length: 13.8 [16.20] days; range: 1‐372) were identified. eCRF episodes exceeding 28 days were usually broken up into shorter episodes in the EHR. Sensitivity was 63.6% and PPV 71.1%, where concordance was defined as at least 1‐day overlap.ConclusionsThe EHR algorithm performance was acceptable, indicating that EHR‐derived AECOPD episodes may provide an efficient, valid method of data collection. Comparing EHR‐derived AECOPD episodes with those collected by eCRF resulted in slightly fewer episodes, and eCRF episodes of extreme lengths were poorly captured in EHR. Analysis of routinely collected EHR data may be reasonable when relative, rather than absolute, rates of AECOPD are relevant for stakeholders' decision making.

Assessment of a Domiciliary Integrated Pulmonary Rehabilitation Program for Patients with a History of Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Retrospective 12-Month Observational Study.

BackgroundIntegrated pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) may prevent acute exacerbations of COPD (AECOPD). The aim of this study was to evaluate the effectiveness, before and 12 months after, the use of an integrated PR program in patients discharged from hospital for AECOPD.Material/MethodsA retrospective observational clinical study included patients diagnosed with COPD who participated in a domiciliary integrated PR program that included a weekly phone interview supervised by a respiratory team. A six-minute walk test (6MWT), COPD assessment test (CAT), and the modified Medical Research Council scale (mMRC) were evaluated every three months.ResultsOf the 303 eligible patients, 267 patients (88.1%), with a mean age of 64.9±8.7 years, a mean FEV1 percentage predicted of 48.8±12.9%, successfully completed the 12-month study program and achieved a significant improvement in their clinical performance with a significantly reduced frequency of episodes of EACOPD (3.1±1.7 vs. 2.0±1.4) (p<0.001), a significant reduction in emergency department visits (2.5±1.5 vs. 1.2±1.1) (p<0.001), and significantly reduced episodes of hospitalization (2.0±1.2 vs. 1.4±1.2) (p<0.001). Significant patient benefits were found during the 12-month study, on CAT, mMRC, and patient well-being when compared with the end of the study after 12 months (p<0.001).ConclusionsA multidisciplinary integrated PR program maintained a significant clinical improvement, in patients with COPD by reducing episodes of AECOPD, CAT, mMRC, emergency hospital admissions, and improved patient well-being, for the duration of the program.

The cumulative effect of air pollutants on the acute exacerbation of COPD in Shanghai, China

BackgroundEpidemiologic studies have shown the effect of air pollutants on acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, little is known regarding the dose-response relationship. This study aimed to investigate the cumulative effect of air pollutants on AECOPD. MethodsWe collected 101 patients with AECOPD from November 2010 through August 2011 in Shanghai. Multiple logistic regression was used to estimate associations between air pollutants and AECOPD. Poisson regression was then applied to determine the cumulative effect of air pollutants including particulate matter 10 (PM10), PM2.5, nitrogen dioxide (NO2), sulphur dioxide (SO2) and ozone (O3) on AECOPD, of which the seasonal variation was further explored. ResultsThe monthly episodes of AECOPD were associated with the concentrations of PM2.5 (r=0.884, p<0.05) and NO2 (r=0.763, p<0.05). The cutoff value of PM2.5 and NO2 for predicting AECOPD was 83.0μg/m3 and 53.5μg/m3, respectively. It showed that per 10μg/m3 increment in PM2.5 increased the relative risks (RR) for AECOPD was 1.09 with 3days cumulative effect in cold season, whereas 7days in warm season. The RR for AECOPD for per 10μg/m3 increment in NO2 was 1.07, with a 5-day cumulative effect without seasonal variation. ConclusionsHigh consecutive levels of PM2.5 and NO2 increase the risk of developing AECOPD. Cumulative effect of PM2.5 and NO2 appears before the exacerbation onset. These gradations were more evident in the PM2.5 during different seasons.

Evaluation of plasma leptin, tumor necrosis factor-α, and prealbumin as prognostic biomarkers during clinical recovery from acute exacerbations of chronic obstructive pulmonary disease.

Background:Inflammatory and nutritional biomarkers have an important bearing on outcomes of acute exacerbations of chronic obstructive pulmonary disease (AECOPD), but the temporal profile of these compounds during an acute episode is unclear.Patients and Methods:Plasma leptin, prealbumin, and tumor necrosis factor-alpha (TNF-α) were estimated at baseline and before hospital discharge in patients with AECOPD.Results:A total of 82 patients were evaluated (66 males; mean (standard deviation) age, 61.6 (10.1) years. Of these, 74 subjects (90.2%) were current or former smokers, with median (range) pack-years of 15 (0–96), duration of COPD of 8 years (range, 2–25 years) and duration of current symptoms being 5 days (range, 1–30 days). Majority (41.5%) had type I (severe) exacerbation. During the current episode, 46 patients (58.9%) required mechanical ventilation for a median of 6 days (range, 1–34). The median duration of hospital stay was 13 days, (range, 1–110). At discharge, significant reduction was observed in dyspnea, total leukocyte count, erythrocyte sedimentation rate (ESR), partial pressure of carbon dioxide, hemoglobin, urea, creatinine, potassium, aspartate transferase, and TNF-α levels compared to baseline, whereas arterial pH, PO2, serum albumin, prealbumin, and leptin significantly improved. No difference was seen in leptin, prealbumin, and TNF-α between patients with mild/moderate and severe exacerbation, or between patients who required or did not require mechanical ventilation. Change in leptin correlated with body mass index and change in ESR; no associations were observed between leptin, prealbumin, and TNF-α with other clinico-laboratory variables.Conclusion:Plasma levels of novel inflammatory and nutritional biomarkers, i.e., leptin, TNF-α, and prealbumin are altered in AECOPD episodes and lag behind other parameters during recovery. These biomarkers are not reliable predictors of clinical outcomes in these patients.

A Retrospective Longitudinal Within-Subject Risk Interval Analysis of Immunoglobulin Treatment for Recurrent Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

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.

Fine particulate matter in acute exacerbation of COPD.

Chronic obstructive pulmonary disease (COPD) is a common airway disorder. In particular, acute exacerbations of COPD (AECOPD) can significantly reduce pulmonary function. The majority of AECOPD episodes are attributed to infections, although environmental stress also plays a role. Increasing urbanization and associated air pollution, especially in developing countries, have been shown to contribute to COPD pathogenesis. Elevated levels of particulate matter (PM) in polluted air are strongly correlated with the onset and development of various respiratory diseases. In this review, we have conducted an extensive literature search of recent studies of the role of PM2.5 (fine PM) in AECOPD. PM2.5 leads to AECOPD via inflammation, oxidative stress (OS), immune dysfunction, and altered airway epithelial structure and microbiome. Reducing PM2.5 levels is a viable approach to lower AECOPD incidence, attenuate COPD progression and decrease the associated healthcare burden.

P153 Stratifying Pneumonic Episodes And Acute Exacerbations In Copd Patients - A Continuum Or Discrete Phenomena?

Background Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are characterised by an acute worsening of symptoms beyond the normal day-to-day variability. Pneumonic episodes, confirmed by new chest X-ray (CXR) infiltrates, are common in patients with COPD but are difficult to distinguish in primary care from non-pneumonic exacerbations. It is uncertain whether AECOPD and pneumonic episodes in COPD patients are distinct clinical events in terms of aetiology and/or response to oral therapy. We performed a longitudinal study to characterise these events and to determine clinically meaningful differences associated with CXR changes in the outpatient setting. Methods The Acute Exacerbation and Respiratory Infections in COPD (AERIS) study is a longitudinal epidemiological study to assess how changes in the COPD airway microbiome contribute to the incidence and severity of AECOPD. Patients with moderate to very severe COPD aged 40–85 years were followed monthly for 2 years, and reviewed within 72 h of onset of symptoms of AECOPD. We compared markers of systemic and airway inflammation between pneumonic AECOPD characterised by new CXR infiltrates, and non-pneumonic AECOPD, in a sub-cohort of 36 patients. Results In the first year of study participation 122 exacerbations were recognised of which 120 had a CXR performed. Of these, 20 (16.7%, n = 12 patients) were identified as having new radiographic infiltrates. Statistically significant differences occurred in mean white blood cell count, blood neutrophil count, C-reactive protein, fibrinogen and sputum percentage neutrophil count between those AECOPD with new CXR infiltrates and those without (Table 1). Furthermore, there was a trend towards more severe symptom scores with pneumonic episodes using the EXACT-PRO score (p = 0.057). Conclusion Pneumonic episodes are common in the context of clinical events presenting as outpatient AECOPD. The profile of airway and systemic inflammation is greater during these events than those without CXR changes. Understanding whether the biology and clinical course of these events is distinct from other exacerbations is key, particularly as patients are encouraged to self-manage based on symptom changes alone. Further study of the AERIS cohort will investigate links between aetiology, outcomes and prognostic markers at exacerbation including radiological and clinical indices.

Bacterial Infection, Airway and Systemic Inflammation and Clinical Outcomes before and after Treatment of AECOPD, a Longitudinal and Cross-sectional Study

Bacterial infection is a major cause of acute exacerbations of chronic obstructive pulmonary disease (AECOPD), which are associated with significantly increased airway and systemic inflammation. However, the relationship among bacteriology, the resolution of inflammation and clinical outcomes is largely unknown. In this study, we recruited consecutive patients hospitalized for AECOPD with purulent sputum. We measured the airway and systemic inflammation levels, the COPD assessment test (CAT) score and adverse outcomes between patients with and without potentially pathogenic microorganisms (PPM). Among sputum samples collected from the 135 episodes of AECOPD, 42 (31.1%) were PPM-positive at admission. Compared with those in the PPM-negative group, more patients in the PPM-positive group had ≥2 exacerbations in previous year and Anthonisen type I at admission and higher drop in sputum neutrophil, serum hs-CRP and CAT value from exacerbation to the subsequent baseline. No significant differences in the adverse outcomes between the two groups were observed. Among the 38 PPM-positive patients who survived and were discharged from hospital, 19 remained PPM-positive (bacterial persistence group) and 19 PPM-negative (bacterial clearance group). Both inflammation indices and CAT score decreased compared to admission in the two groups, regardless of the bacteriology at discharge. Our data suggest uncultivated bacteria and/or virus might also play important roles in causing inflammation and AECOPD.

Macrolide therapy for the prevention of acute exacerbations in chronic obstructive pulmonary disease

Acute exacerbations are a major contributor to health care costs and a leading cause of death in patients with chronic obstructive pulmonary disease (COPD). A reduction in acute exacerbations of COPD (AECOPD) would lead to significant improvements in patient well-being and survival. Bacterial and viral infections cause a majority of AECOPD episodes; however, with the exception of influenza and pneumococcal vaccines, preventative therapies for exacerbations do not directly address these infectious causes of AECOPD. Antibiotics were shown to have marginal benefit in preventing AECOPD several decades ago; however, since then, pathogens and antibiotics have changed substantially. Macrolides display immunomodulatory and anti-inflammatory effects in addition to their direct antibacterial effect. Several studies have examined macrolides in AECOPD prevention, with a recent landmark study by Albert et al. clearly demonstrating the efficacy of azithromycin in preventing AECOPD. Unfortunately, the rate of isolation of macrolide-resistant pathogens does increase with such treatment. Macrolides could also suppress bacterial colonization and thus decrease airway inflammation, thereby interrupting the vicious cycle of inflammation and infection in COPD. COPD patients with two or more exacerbations a year in spite of appropriate standard therapy are potential candidates for this therapeutic approach. However, optimal duration and dosing of macrolide prophylaxis for AECOPD remains uncertain.

Antimicrobial Susceptibilities and Serotypes of Streptococcus pneumoniae Isolates from Elderly Patients with Pneumonia and Acute Exacerbation of Chronic Obstructive Pulmonary Disease

In the elderly, Streptococcus pneumoniae is the most common cause of pneumonia and one of the most frequently isolated pathogens in cases of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study was conducted to compare the pneumococcal isolates obtained during episodes of AECOPD and pneumonia in patients of ≥65 years old and to analyze whether in patients with AECOPD and pneumonia within a short interval, the same isolate caused both episodes. This laboratory-based study was performed between 2005 and 2008. Pneumococcal isolates from episodes of pneumonia (n = 401) and AECOPD (n = 398), matched one-to-one by date of isolation, were characterized. The serotypes and genotypes of other pneumococcal isolates causing pneumonia and AECOPD in the same patient were compared. In patients with pneumonia, COPD as an underlying disease was not associated with more-drug-resistant pneumococci. In contrast, isolates causing AECOPD showed higher rates of resistance than those causing pneumonia. Serotypes 1, 3, and 7F were more frequent in pneumonia. The same pneumococcus was involved in 25.7% (9/35 patients) of patients with two consecutive AECOPD episodes but in only 6.3% (2/32 patients) of COPD patients with pneumonia and exacerbation (Fisher's exact test; P = 0.047). Less invasive serotypes were isolated more often in AECOPD and were more resistant to antimicrobials. The presence of a specific pneumococcal serotype in AECOPD does not predict the etiology of subsequent pneumonia.

Flore bactérienne des exacerbations aiguës de bronchopneumopathie chronique obstructive (BPCO) à Kunming, Chine

Objective Chinese recommendations for the management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) include antibiotic treatments targeting the most frequently isolated pathogens according to the severity of COPD. The study objective was to check the relevance of these recommendations in Yunnan, a Southern Chinese province. Patients and methods A descriptive and analytical survey was conducted in the Kunming Medical University hospital among patients over 60 years of age, hospitalized with AECOPD, between March 2007 and June 2008. Results The 74 included patients were predominantly male (90%), with a mean age of 78.6 years, active or ex-smokers (81%), mainly with moderate (43%) or severe COPD (34%). Out of 87 AECOPD episodes, 47 (54%) yielded significant quantitative sputum cultures for S. pneumoniae (10%), P. aeruginosa (10%), H. influenzae (7%), M. catarrhalis (7%), and K. pneumoniae (7%). The positivity of sputum cultures was significantly linked with a history of smoking ( P = 0.002). More than half of the P. aeruginosa isolates were multidrug resistant. Conclusions The distribution of pathogens isolated from EABPCO in Kunming corroborates published results. It does not question Chinese recommendations for first-line antibiotic therapy, but the high prevalence of P. aeruginosa and Enterobacteriaceae requires a periodic screening for acquired antibiotic resistance.