Severity Of COPD Exacerbations Research Articles

Relation between airway cellular and bacterial findings and severity of COPD exacerbations: A multicentric study

<b>Aim: </b>To evaluate the relationships between sputum and bronchoalveolar lavage (BAL) cellular and bacterial findings and severity of exacerbation of chronic obstructive pulmonary disease (ECOPD).<br /> <b>Patients & methods: </b>A cross-section study was conducted on 307 patients with ECOPD. They underwent sputum and BAL inflammatory cell count and bacterial culture.<br /> <b>Results:</b> Patients with severe ECOPD have significantly higher neutrophils percentage (neut.%), lower lymphocytes percentage (lymph.%), lower eosinophils percentage (eosin.%) and higher neutrophil/lymphocyte ratio (NLR) as compared to patients with mild ECOPD. It was also shown that patients with severe ECOPD had significantly higher BAL neut.%, lower lymph.%, lower eosin.%, and higher NLR as compared to the other two subgroups. Also, patients with severe ECOPD have significantly higher frequency of cases with monomicrobial (71.30% vs. 36.10%) and polymicrobial (21.25% vs. 2.10%) growths in comparison to patients with mild ECOPD.<br /> <b>Conclusions: </b>Cellular and bacterial findings in sputum and BAL are related to severity of ECOPD.

Increased Red Blood Cell Distribution Predicts Severity of Chronic Obstructive Pulmonary Disease Exacerbation.

Increased red blood cell distribution width (RDW) has been reported to be related to underlying chronic inflammation. Our aim is to investigate the relationship of different complete blood count (CBC) parameters such as hemoglobin level, mean corpuscular volume (MCV), mean platelet volume (MPV) or RDW with COPD exacerbation severity. In the present retrospective analysis, consecutive patients admitted with the diagnosis of "COPD Exacerbation" between 1 January 2012 and 31 December 2015 were evaluated. The study population included 804 patients with COPD exacerbation. The maximal partial pressure of carbon dioxide in the arterial blood (PaCO2) during hospital stay was significantly higher in patients with high MCV (p < 0.001), and in patients with a high RDW (p < 0.001). The hospitalization duration was significantly longer in patients with high RDW (p < 0.001) and in patients with elevated C-reactive protein (CRP) levels (p < 0.001). CRP levels strongly correlated to RDW (p = 0.001). Our study demonstrated that different CBC parameters, such as MCV and RDW, are in correlation with the severity of acute exacerbation of COPD reflected by the PaCO2 level and the duration of hospitalization. Furthermore, we also found a positive correlation between RDW and CRP levels. This finding supports the hypothesis that RDW is a good biomarker of acute inflammation.

Clinical aspects of the use of erdosteine in respiratory diseases

Erdosteine is a drug based on thiol and used at the beginning only as a mucolytic. The main indication for it is the treatment of acute and chronic lung diseases, accompanied by difficult sputum discharge. The therapeutic effect of erdosteine is due to the action of thiol metabolites, which, in addition to mucoactive, have antioxidant, anti-inflammatory and antibacterial activities. Experimental studies have shown that this drug reduces the degree of damage to lung tissue caused by oxidative stress, primarily by reducing the production of reactive oxygen species. It increases the concentration of IgA in the respiratory mucosa, thereby reducing the damaging effect of tobacco smoke on endothelial and macrophage cells. In the RESTORE clinical study, which studied the effect of erdosteine on the frequency of exacerbations of chronic obstructive pulmonary disease, it was demonstrated that it significantly reduces the risk, frequency and severity of COPD exacerbations, regardless of patients taking inhaled corticosteroids and eosinophil levels. Recent experimental studies have shown that erdosteine also has the ability to slow the progression rate of fibrosis in pulmonary tissue. It has been shown to inhibit the development of bleomycin-induced fibrosis. The authors of the study suggested that this effect may be related to the suppression of neutrophil migration metabolite erastheine, the inhibition of lipid peroxidation and, in general, the regulation of antioxidant protection mechanisms Data obtained in recent studies also open up new possibilities for the use of erdosteine in patients with bronchial asthma and idiopathic pulmonary fibrosis, significantly expanding the indications for its use.

Neutrophil to lymphocyte ratio is a better indicator of COPD exacerbation severity in neutrophilic endotypes than eosinophilic endotypes.

BackgroundComplete blood count parameters provide novel inflammatory markers, namely neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). We aimed to assess any differences in these novel inflammatory markers according to exacerbation severity in patients with COPD in both eosinophilic and neutrophilic endotypes.MethodThis retrospective cross-sectional study was conducted at a tertiary education hospital. Previously diagnosed COPD patients admitted to the hospital with acute COPD exacerbation (AECOPD) were enrolled into the study. Patients were grouped according to COPD endotype, eosinophilic (peripheral blood eosinophil rate ≥2%) and neutrophilic (peripheral blood eosinophil rate <2%), and further subdivided according to place of admission (outpatient clinic, ward, or intensive care unit [ICU]) as an indicator of disease severity. Complete blood count, biochemistry, C-reactive protein (CRP), NLR, PLR, and platelet to mean platelet volume values were recorded from an electronic hospital database system and compared among all groups.ResultsOf the 10,592 patients included in the study, 7,864 were admitted as outpatients, 2,233 to the wards, and 495 to ICU. Neutrophilic COPD patients (n=6,536, 62%) had increased inflammatory markers compared with eosinophilic COPD patients (n=4,056, 38%); median NLR was 5.11 vs 2.62 (P<0.001), PLR was 175.66 vs 130.00 (P<0.001), and CRP was 11.6 vs 7.7 (P<0.001). All values increased relative to admission to the outpatient clinic, ward, or ICU: median NLR was 3.20, 6.33, and 5.94, respectively, median PLR was 140.43, 208.46, and 207.39, respectively, and median CRP was 6.4, 15.0, and 22.8, respectively. The median NLR values of patients in outpatients/ward/ICU increased in neutrophilic and eosinophilic endotypes: 4.21/7.57/8.60 (P<0.001) and 2.50/3.43/3.42 (P=0.81), respectively. CRP showed a similar increased pattern according to severity of AECOPD endotypes.ConclusionIn COPD exacerbation, the inflammatory markers show different increases in each COPD endotypes. These findings may be crucial for defining exacerbation endotypes, the severity of exacerbation, and treatment response during follow-up in COPD patients.

Mood disorders in elderly patients hospitalized for acute exacerbation of COPD

IntroductionChronic obstructive pulmonary disease (COPD) represents the most common cause of chronic respiratory failure and it's associated with several comorbidities such as depression. Depression is about four times more frequent in elderly patients with COPD compared to peers who are not affected and its prevalence increases with the degree of disease severity.ObjectiveTo assess mood and perception of the quality of life in elderly patients hospitalized for acute exacerbation of COPD.MethodsThirty-five elderly patients hospitalized for reactivation of COPD were examined; they were subjected to spirometry test for the calculation of FEV1 and to COPD Assessment Test (CAT) and Hamilton Rating Scale for Depression (HAM-D) to evaluate impact of COPD on patients’ quality of life and depressive symptomatology, respectively. The number of COPD exacerbations in the last year prior to hospitalization and the number of recovery days required for the stabilization of patients were also recorded.ResultsThere were strongly significative correlations (P &lt; 0.001), positive between HAM-D scores, CAT scores, number of exacerbation in the last year and hospital length of stay and negative between HAM-D scores and FEV1 values. Furthermore, females were more depressed, with lower FEV 1 (P = 0.043) and with a longer length of stay (P = 0.039) as compared to males.ConclusionsA greater severity of depressive symptoms is related to a greater severity of COPD exacerbations, disability associated with it and perceived by the patient, as well as a higher number of recovery days and annual acute exacerbations, particularly in female gender.

Colds as predictors of the onset and severity of COPD exacerbations.

RationaleCommon colds are associated with acute respiratory symptom exacerbations in COPD patients.ObjectiveTo determine exacerbation risk and severity in COPD patients with/without coincident self-reported colds.MethodsGlobal initiative for chronic Obstructive Lung Disease stage I–IV COPD patients electronically transmitted respiratory symptom diaries to research staff daily between December 2006 and April 2009. Respiratory symptom worsening prompted contact by a study nurse and patient assessment to determine if a cold was present or an exacerbation underway. A composite daily symptom score was derived for each subject from diarized symptom data. The exacerbation/cold/virus relation was examined using a Poisson regression model, the relation of colds to respiratory symptom severity using generalized estimating equation models.ResultsDaily diary transmission compliance of >97% enabled detection of all possible exacerbations. Among 262 exacerbations meeting Anthonisen criteria, 218 (83%) had cold-like symptoms present at their inception, but respiratory viruses were detected in only 106 (40%). Within-subject exacerbation risk was 30 times (95% confidence interval [CI]: 20, 47; P<0.001) greater with colds present. Compared to cold- and virus-negative exacerbations (n=57), the mean increase in composite symptom score in those cold and virus positive (n=79) was 0.93 (95% CI: 0.61, 1.25; P<0.001), cold-positive and virus-negative exacerbations (n=100) 0.51 (95% CI: 0.21, 0.81; P<0.001), cold-negative and virus-positive exacerbations (n=26) 0.58 (95% CI: 0.23, 0.94; P<0.001).ConclusionThis study emphasizes the importance of colds in COPD exacerbation risk and severity, even in the absence of virus detection. COPD patients should act promptly when cold symptoms appear to facilitate early intervention for exacerbation prevention or management.

The Clinical Significance of Highly Sensitive Cardiac Troponin T in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in the Emergency Department

Introduction: Chronic obstructive pulmonary disease is one of the main causes of morbidity, mortality, and health-care costs entire the world. During acute exacerbations, whether or not with a history of Cor pulmonale have an increased cardiac burden. Patients with COPD are at increased risk of cardiovascular disease, exacerbations increase strain on the heart. The prognostic and predictive value of highly sensitive troponin T seen during COPD exacerbations has been investigated. Aim: Assessment the clinical significance of highly sensitive troponin T (Hs cTnT) as a predictive and prognostic factor in patients with acute exacerbations of COPD. Patients and methods: This observational cross sectional study was carried on 79 patients from 2 May 2013 to 1 May 2015 with acute COPD exacerbation. Inclusion criteria: Patients with acute exacerbation of COPD. Exclusion criteria: Patients with severe renal impairment, persistent hemodynamic instability, myocardial infarction and cardiac arrest before admission demographics. full medical history, vital signs, ABGs and ECG were recorded. Serum cardiac enzymes CK, CK-MB and highly sensitive cardiac troponin T (hs cTnT) were measured. Results: 79 patients with acute exacerbation of COPD were enrolled. Mortality rate was (2.53%) Hs cTnT level showed a statistically significant difference comparing four reported categories of COPD exacerbation severity. Only life threatening form showed significantly higher hscTnT level compared to moderate and severe forms. Conclusion: The study showed that highly sensitive cardiac Troponin T was significantly elevated in COPD patients with exacerbation. Troponin T may help the assessment and the prognosis in patients with COPD exacerbations.

COPD exacerbation severity and frequency is associated with impaired macrophage efferocytosis of eosinophils.

BackgroundEosinophilic airway inflammation is observed in 10-30% of COPD subjects. Whether increased eosinophils or impairment in their clearance by macrophages is associated with the severity and frequency of exacerbations is unknown.MethodsWe categorised 103 COPD subjects into 4 groups determined by the upper limit of normal for their cytoplasmic macrophage red hue (<6%), an indirect measure of macrophage efferocytosis of eosinophils, and area under the curve sputum eosinophil count (≥3%/year). Eosinophil efferocytosis by monocyte-derived macrophages was studied in 17 COPD subjects and 8 normal controls.ResultsThere were no differences in baseline lung function, health status or exacerbation frequency between the groups: A-low red hue, high sputum eosinophils (n = 10), B-high red hue, high sputum eosinophils (n = 16), C-low red hue, low sputum eosinophils (n = 19) and D- high red hue, low sputum eosinophils (n = 58). Positive bacterial culture was lower in groups A (10%) and B (6%) compared to C (44%) and D (21%) (p = 0.01). The fall in FEV1 from stable to exacerbation was greatest in group A (ΔFEV1 [95 % CI] -0.41 L [-0.65 to -0.17]) versus group B (-0.16 L [-0.32 to -0.011]), C (-0.11 L [-0.23 to -0.002]) and D (-0.16 L [-0.22 to -0.10]; p = 0.02). Macrophage efferocytosis of eosinophils was impaired in COPD versus controls (86 [75 to 92]% versus 93 [88 to 96]%; p = 0.028); was most marked in group A (71 [70 to 84]%; p = 0.0295) and was inversely correlated with exacerbation frequency (r = -0.63; p = 0.006).ConclusionsMacrophage efferocytosis of eosinophils is impaired in COPD and is related to the severity and frequency of COPD exacerbations.

Pneumococcal vaccination using 23-valent vaccine: clinical efficacy in urban and rural inhabitants suffering from chronic obstructive pulmonary disease

Summary. The follow-up involved 201 adults with chronic obstructive pulmonary disease – COPD (100 were city dwellers and 101 were rural inhabitants). Of them, 100 patients were vaccinated against pneumococcal infection using the pneumococcal polysaccharide vaccine PPSV23, 101 patients were not vaccinated and formed the control group. We analyzed a rate and severity of COPD exacerbations 1 year before and after the vaccination. Vaccinated urban and rural residents with COPD demonstrated a 2.4-fold and a 2.5-fold decrease in the exacerbation rate, respectively. Among all vaccinated patients, 58 % of rural inhabitants and 25 % of city dwellers with COPD did not have COPD exacerbations during the year after the vaccination. The observed clinical effect demonstrated that PPSV23 can be used as one of tools to maintain the public health and to increase life expectancy.

Effect of Interactions Between Lower Airway Bacterial and Rhinoviral Infection in Exacerbations of COPD

Study objectivesThe inflammatory responses and associated clinical severity of COPD exacerbations are greatly variable, and the determinants of these factors are poorly understood. We examined the hypothesis that bacteria and viruses may modulate this heterogeneity and that interactions between bacterial and viral infection may affect changes in airway bacterial load and the clinical features and inflammatory responses of exacerbations in patients with COPD.DesignProspective cohort study.SettingOutpatient Department, London Chest Hospital, London, UK.PatientsThirty-nine patients with COPD.MeasurementsWe prospectively studied 56 COPD exacerbations, obtaining clinical data and paired sputum and serum samples at baseline and exacerbation. Qualitative and quantitative microbiology, polymerase chain reaction detection for rhinovirus, and estimation of cytokine levels by enzyme-linked immunosorbent assay were performed.ResultsA total of 69.6% of exacerbations were associated with a bacterial pathogen, most commonly Haemophilus influenzae. Rhinovirus was identified in 19.6% of exacerbations. The rise in bacterial load at exacerbation correlated with the rise in sputum interleukin (IL)-8 (r = 0.37, p = 0.022) and fall in FEV1 (r = 0.35, p = 0.048). Exacerbations with both rhinovirus and H influenzae had higher bacterial loads (108.56 cfu/mL vs 108.05cfu/mL, p = 0.018) and serum IL-6 (13.75 pg/mL vs 6.29 pg/mL, p = 0.028) than exacerbations without both pathogens. In exacerbations with both cold symptoms (a marker of putative viral infection) and a bacterial pathogen, the FEV1 fall was greater (20.3% vs 3.6%, p = 0.026) and symptom count was higher (p = 0.019) than those with a bacterial pathogen alone.ConclusionsThe clinical severity and inflammatory responses in COPD exacerbations are modulated by the nature of the infecting organism: bacterial and viral pathogens interact to cause additional rises in inflammatory markers and greater exacerbation severity.

Corticosteroids in Chronic Obstructive Pulmonary Disease: Clinical Benefits and Risks

The use of systemic and inhaled corticosteroids for COPD has increased appreciably over the past 20 years. Clearer indications for corticosteroid therapy in COPD are beginning to emerge as the results from large clinical trials become available. Systemic corticosteroids are only modestly effective for acute COPD exacerbations, increase the risk for hyperglycemia, and should be given for no more than 2 weeks. The efficacy of long-term systemic corticosteroid therapy has not been adequately evaluated in this patient population. If longer term use of systemic steroids in COPD should be found to be useful, this conclusion would have to be weighed against the risk for serious adverse effects. High doses of inhaled corticosteroids cause a small sustained increase of the FEV1 in patients with mild and moderately severe COPD, but they do not slow the rate of FEV1 decline. Based on analyses of secondary outcome, inhaled corticosteroids may improve the respiratory symptoms and decrease the number and severity of COPD exacerbations in patients with more advanced disease. Low doses of inhaled corticosteroids appear to be safe, but there is growing awareness that higher doses may not be so benign.