Chronic Obstructive Pulmonary Disease Status Research Articles

Subgingival microflora in chronic obstructive pulmonary disease

Objective: Recent reports have shown an association between periodontitis and chronic obstructive pulmonary disease (COPD). Our objective was to assess the subgingival microfl ora in relation to COPD status. Methods: Eighteen subjects were classifi ed into four different groups according to clinical periodontal status and the diagnosis of COPD. DNA from subgingival plaque samples was extracted and the bacterial 16S rRNA genes were PCR amplifi ed, cloned, and sequenced to determine species identity. Results: From a total of 1041 clones, 168 species or phylotypes were detected. Higher amounts of Actinomyces spp., Veillonella spp., and Campylobacter gracilis were detected in the subgingival microfl ora of periodontally healthy COPD subjects, as compared with controls. COPD status was found to have little infl uence on the subgingival microfl ora in periodontitis subjects. Conclusion: COPD status does seem to infl uence the healthy but not the diseased subgingival microfl ora in periodontitis. Although preliminary, these fi ndings indicate that there may be host factors responsible for the increased susceptibility of COPD subjects to periodontal disease.

Subgingival microflora in chronic obstructive pulmonary disease

Objective : Recent reports have shown an association between periodontitis and chronic obstructive pulmonary disease (COPD). Our objective was to assess the subgingival microflora in relation to COPD status. Methods : Eighteen subjects were classified into four different groups according to clinical periodontal status and the diagnosis of COPD. DNA from subgingival plaque samples was extracted and the bacterial 16S rRNA genes were PCR amplified, cloned, and sequenced to determine species identity. Results : From a total of 1041 clones, 168 species or phylotypes were detected. Higher amounts of Actinomyces spp., Veillonella spp., and Campylobacter gracilis were detected in the subgingival microfl ora of periodontally healthy COPD subjects, as compared with controls. COPD status was found to have little influence on the subgingival microflora in periodontitis subjects. Conclusion : COPD status does seem to influence the healthy but not the diseased subgingival microflora in periodontitis. Although preliminary, these findings indicate that there may be host factors responsible for the increased susceptibility of COPD subjects to periodontal disease. Key words: Periodontitis, subgingival bacteria, 16S rRNA gene, sequence analysis

Free-living physical activity in COPD: assessment with accelerometer and activity checklist.

To assess physical activity and disability in chronic obstructive pulmonary disease (COPD), we evaluated the use of an accelerometer and checklist to measure free-living physical activity. Seventeen males with stable COPD completed a daily activity checklist for 14 days. Ten subjects concurrently wore an Actiped accelerometer (FitSense, Southborough, Massachussetts) that records steps per day. Regression models assessed relationships between steps per day, number of daily checklist activities performed, and clinical measures of COPD status. The average steps per day ranged from 406 to 4,856. The median intrasubject coefficient of variation for steps per day was 0.52 (interquartile range [IQR] 0.41-0.58) and for number of daily checklist activities performed was 0.28 (IQR 0.22-0.32). A higher number of steps per day was associated with a greater distance walked on the 6-minute walk test and better health-related quality of life. A higher number of daily checklist activities performed was associated with a higher force expiratory volume in 1 s percent predicted and lowerbody mass index, airflow obstruction, dyspnea, exercise capacity (BODE) index. Prospectively measuring free-living physical activity in COPD using an unobtrusive accelerometer and simple activity checklist is feasible. Low intrasubject variation was found in free-living physical activity, which is significantly associated with clinical measures of COPD status.

Circulating visfatin in chronic obstructive pulmonary disease

Objective Malnutrition and continuous systemic inflammation occur frequently in patients with chronic obstructive pulmonary disease (COPD). Visfatin is a new adipokine, which increases in some inflammatory diseases. Its plasma level and relation with nutritional status and inflammation in COPD remain unknown. This study compared visfatin levels, nutritional status, and inflammation markers in patients with COPD and healthy controls. Methods Plasma visfatin, tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) were measured in 35 patients with COPD and 28 healthy controls. Body composition was assessed with bioelectrical impedance analysis. Results Significantly lower body mass index and percentage of body fat were observed in patients with COPD compared with control subjects. The levels of plasma visfatin were higher in the COPD group compared with healthy controls (2.07 ± 0.18 versus 1.88 ± 0.15 ng/mL, P < 0.001). Levels of TNF-α and CRP were also significantly higher in patients with COPD compared with controls. Plasma CRP and TNF-α were positively correlated with visfatin in the COPD group. No significant correlations were found between visfatin and body mass index or percentage of body fat in both groups. Conclusion Plasma visfatin levels increased in patients with COPD. This increased adipocytokine was significantly correlated with TNF-α and CRP. Visfatin may be a new proinflammatory adipocytokine in this disease.

Non-Pharmacological Interventions to Improve Health Status in COPD

Health status is one of the most important outcome measures to evaluate the effects of integrated care of patients with mild to very severe chronic obstructive pulmonary disease (COPD). Indeed, to improve the health status of patients with COPD has been set as one of the main goals of effective COPD management. Pharmacological treatment has been shown to reduce the deterioration of health status over time in COPD, in comparison with placebo treatment. Nevertheless, health status appears to decrease over time even though COPD patients did receive pharmacological treatments for their respiratory symptoms. Indeed, patients with COPD suffer from multiple extrapulmonary features, which in turn may result in a reduced health status. The present review will summarize the effects of pulmonary rehabilitation, nutritional interventions and of surgical interventions on the health status in the patients with COPD. Based on the present review of the literature, the authors conclude that besides optimal pharmacological interventions, management of COPD has to consist of non-pharmacological treatments, which has been shown to positively influence patients health status. In particular, pulmonary rehabilitation programs have been shown to have positive short-term effects on health status in COPD. Keywords: Pulmonary rehabilitation, nutritional interventions, lung transplantation, lung volume reduction surgery, respiratory questionnaires

Endothelial Dysfunction in Chronic Obstructive Pulmonary Disease

Cardiovascular diseases are prevalent in people with chronic obstructive pulmonary disease (COPD). We hypothesized that endothelial dysfunction could be a marker of the proatherogen status in COPD. We measured endothelial dysfunction by flow-mediated dilation (FMD) and after sublingual administration of nitroglycerin (nitrate-mediated dilation: NMD) in 44 COPD patients and 48 controls. Compared with controls COPD patients had worse mean FMD (5.4% vs 8.2%, P < .001) and NMD (12.0% vs 13.9%, P = .007). FMD was inversely related to FEV1/VC ratio (r = -0.327, P = .030). The negative association between COPD and FMD was confirmed after correction for potential confounders in a multiple linear regression model (beta = -0.019, P = .002). In the same model NMD (beta = 0.396, P < .001) was positively associated with FMD. Endothelial-dependent and, to a lesser extent, endothelial-independent dilations are significantly impaired in COPD, and the impairment is proportional to the severity of bronchial obstruction.

From the authors

From the authors: M.A. Puhan raises several issues that are frequently used to argue against the use of inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD). First, he implicitly equates hormone replacement (HRT) and celecoxib therapies with the use of ICS in COPD. This is neither fair nor justified based on the existing literature. Unlike these drugs, ICS have been vigorously evaluated through many large randomised controlled trials (RCTs). Over the past 20 yrs, clinical trials involving >7,000 patients (and 17,000 person-yrs of observation) have unequivocally demonstrated the benefits of ICS therapy in ameliorating symptoms, reducing exacerbations and improving health status in COPD 1, 2. In combination with long-acting …

What determines subjective health status in patients with chronic obstructive pulmonary disease: importance of symptoms in subjective health status of COPD patients.

BackgroundSubjective health status is the result of an interaction between physiological and psychosocial factors in patients with chronic obstructive pulmonary disease (COPD). However, there is little understanding of multivariate explanations of subjective health status in COPD. The purpose of this study was to explore what determines subjective health status in COPD by evaluating the relationships between background variables such as age and sex, predicted FEV1%, oxygen saturation, breathlessness, anxiety and depression, exercise capacity, and physical and mental health.MethodsThis study had a cross-sectional design, and included 100 COPD patients (51% men, mean age 66.1 years). Lung function was assessed by predicted FEV1%, oxygen saturation by transcutaneous pulse oximeter, symptoms with the St George Respiratory Questionnaire and the Hospital Anxiety and Depression Scale, physical function with the Incremental Shuttle Walking Test, and subjective health status with the SF-36 health survey. Linear regression analysis was used.ResultsOlder patients reported less breathlessness and women reported more anxiety (p < 0.050). Women, older patients, those with lower predicted FEV1%, and those with greater depression had lower physical function (p < 0.050). Patients with higher predicted FEV1%, those with more breathlessness, and those with more anxiety or depression reported lower subjective health status (p < 0.050). Symptoms explained the greatest variance in subjective health status (35%–51%).ConclusionSymptoms are more important for the subjective health status of patients with COPD than demographics, physiological variables, or physical function. These findings should be considered in the treatment and care of these patients.

Impact of Chronic Obstructive Pulmonary Disease on Long-Term Outcome of Patients Hospitalized for Heart Failure

Chronic obstructive pulmonary disease (COPD) is a frequently neglected co-morbidity in patients with heart failure (HF). The aim of this study was to evaluate the prognostic impact of COPD in patients hospitalized for HF. Consecutive patients (n=799) admitted for a first episode of HF in all healthcare establishments of the Somme department (France) during 2000 were prospectively enrolled. Baseline characteristics and long-term prognosis were compared according to COPD status. COPD was diagnosed in 156 patients (19.5%). Compared with the no-COPD group, patients with COPD were predominantly men, more often smokers, and had lower discharge prescription rates of beta blockers (6% vs 27%, p<0.001). Five-year survival rate in patients with COPD was significantly lower than that of the no-COPD group (31% vs 42%, p=0.03). Compared with the expected survival of the age- and gender-matched general population, the 5-year survival rate in patients with COPD was dramatically lower (31% vs 71%). On multivariable analysis, COPD was a strong predictor of poorer outcome (hazard ratio 1.53, 95% confidence interval 1.21 to 1.94, p<0.001). COPD was an independent predictor of mortality in patients with preserved left ventricular ejection fraction and in patients with reduced ejection fraction. In conclusion, patients with HF and associated COPD have a poor prognosis with an impressive excess mortality compared to HF patients without COPD and the general population. Beta-blocker prescription rates remain deceptively low in this category of patients with HF.

Correlation of oxidative status with BMI and lung function in COPD

Objectives: The imbalance in oxidative status together with nutrition depletion and low body weight play a vital role in the pathogenesis and severity of chronic obstructive pulmonary disease (COPD). The study was undertaken to ascertain if a relationship existed between oxidative status and BMI in COPD. In addition, association of oxidative status and BMI with lung function of the disease was also examined. Materials and methods: In 202 COPD patients and 136 healthy controls plasma lipid peroxidation (LPO), reduced glutathione (GSH), glutathione peroxidase (GPx), catalase (CAT) activities, BMI and FEV 1% predicted were looked for interactions. Results: The patients had increased LPO ( p = 0.006) and decreased antioxidants (GSH, p = 0.005; GPx, p = 0.035 and CAT, p = 0.008, respectively). Of note are the correlations of oxidative stress markers with BMI and FEV 1% predicted in the patients. LPO inversely and GSH, GPx, and CAT positively correlated with both BMI ( p = 0.007, p < 0.001, p = 0.045 and p = 0.009, respectively), and FEV 1% of predicted (LPO, p = 0.001; GSH, p < 0.001; GPx, p = 0.043 and CAT, p < 0.001) in the patients. Further, a positive correlation existed between BMI and FEV 1% predicted ( p = 0.016) in COPD. Conclusion: The intimate relationship of oxidative status with BMI and lung function, and the direct correlation between BMI and FEV 1 may potentiate severity of the disease.

Living with chronic obstructive pulmonary disease (COPD): Part II. RNs’ experience of nursing care for patients with COPD and impaired nutritional status

This study is the second part of a project with the main purpose of obtaining a deeper understanding of the consequences of living with chronic obstructive pulmonary disease (COPD) concerning meal-related situations and an impaired nutritional status. COPD is a slowly progressive lung disease that results in several complications, including malnutrition. Nutritional status is an important part of COPD treatment, and there are criteria recommended for nutritional assessment and interventions among patients with COPD. Despite this, patients with extreme malnutrition and unnoticed weight loss are reported. The aim of the study was to investigate how Registered Nurses (RNs) in primary care describe nutritional assessment practices and interventions in COPD patients with impaired nutritional status. An interview approach using semistructured questions and case vignettes was chosen. The sample included 19 RNs working specifically with COPD patients. Data from interviews were analysed using qualitative content analysis, and nine categories corresponding to the aim were identified. The RNs reported that their assessment of nutritional status was based largely on intuition. Assessment also included detection of the patients' current beliefs and being sensible about information provision - When and How. Interventions were supportive eating interventions, practical and cognitive participation, and making patients aware of the illness trajectory. An overall category that influenced nursing was respecting patients' feelings of shame and guilt about a self-inflicted disease. It seems that RNs use intuition because of a lack of knowledge of systematic methods of nutritional assessment. The findings also indicate that the RNs attempted to build a relationship of trust with the patients rather than provide early information on sensitive topics (e.g. nutritional information). The study reports areas of nursing care for COPD patients that must be improved in the future.

Home-based exercise training in chronic obstructive pulmonary disease

The role of rehabilitation programmes in chronic obstructive pulmonary disease (COPD) patients is to lower dyspnoea, improve exercise tolerance and quality of life. We have developed a short-course, home-based, rehabilitation programme of physical exercise for lower limb muscles, based on walking at patients' fastest pace. The aim of the study was to investigate the effectiveness of such a programme regarding the exercise tolerance, pulmonary functions and quality of life. Twenty-nine individuals with stable COPD (22 males, 7 females), with a mean age of 59.6 +/- 8.9 years participated in the study. Subjects were assessed before and after the 8-week rehabilitation programme using the six-minute walking test (6MWT), Borg breathlessness score, oxygen saturation, St. George's Hospital Respiratory Questionnaire (SGRQ), the Hospital Anxiety and Depression Scale (HADS) and spirometry. The 6MWT distance improved significantly from 337 to 362 m, representing 8.3% (25 m) improvement over baseline. SGRQ activity, impact and total scores improved significantly after the rehabilitation programme (p < 0.01) and quality of life, too. Anxiety and depression scores were significantly lower than the baseline (p < 0.01), as well as dyspnoea sensation (p < 0.01). Pulmonary function improved after an eight-week exercise programme, too (p < 0.01). This short-term and simple home-based exercise programme improved health status in COPD. It also improved exercise tolerance, breathlessness sensation and quality of life in COPD patients.

Airway inflammation contributes to health status in COPD: a cross-sectional study

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.

Chronic Obstructive Pulmonary Disease: Linking Outcomes and Pathobiology of Disease Modification

Recent guidelines define chronic obstructive pulmonary disease (COPD) as a preventable and treatable disease characterized by airflow limitation and systemic consequences. Airflow limitation in COPD worsens over years as assessed by the forced expiratory volume in one second (FEV(1)). Regardless, while it is likely that cardiovascular and other systemic components also worsen as COPD progresses, there are no accepted or validated outcomes to measure such pathophysiologic changes as they relate to COPD disease progression. It is clear that health status in COPD is more closely related to levels of patients' physical functional capacity than it is to changes in FEV(1). Furthermore, the relative contributions of pathoanatomic changes such as small airways fibrosis and pulmonary emphysema to declining airflow remain unknown. These features may even progress at different rates in the same individuals. Although stopping smoking is the only intervention shown to alter the relentless progression of COPD, the resultant slowing of FEV(1) decline takes several years to evince and requires at least 1,000 subjects to demonstrate annual therapeutic benefits of as little as 20 ml. The FEV(1) cannot distinguish between peribronchiolar fibrosis and emphysema and it is feasible that, as techniques are developed and validated, lung imaging methodologies may become important and sensitive outcomes measures of time- and age-dependent lung structural changes in COPD. The development of biomarkers of lung damage, pulmonary inflammation, and systemic disease will be essential to our further understanding of the natural history of COPD and the discovery of new, effective treatments for its progression.

Does pulmonary rehabilitation give additional benefit over tiotropium therapy in primary care management of chronic obstructive pulmonary disease? Randomized controlled clinical trial in Hong Kong Chinese

To evaluate whether multidisciplinary pulmonary rehabilitation programme (PRP) provides additional benefit over tiotropium therapy in managing chronic obstructive pulmonary disease (COPD) in primary care. A randomized controlled trial to analyse the difference in outcomes of COPD patients receiving tiotropium plus PRP vs. tiotropium treatment alone. Two primary care teaching clinics affiliated with a university which serves a population of 600,000. Fifty primary care COPD patients. Fifty subjects underwent spirometry and their status of COPD was confirmed by using the Vitalograph Gold Standard. They were then assessed by the 6-min walking distance (6MWD), Peak Visual Analogue Scale (Peak VAS) and Chronic Respiratory Disease Questionnaire (CRQ). All subjects were given tiotropium to optimize their treatment. After a 6-week period, half were randomized to the intervention group (i.e. receiving PRP), whereas the rest were randomized to control group which received only medication. Spirometry, 6MWD, Peak VAS and CRQ were performed in both groups at 6 weeks, 12 weeks and 3 months. Spirometry, 6MWD, Peak VAS and CRQ. Significant improvement (P < 0.05) was seen in 6MWD, symptoms of dyspnoea measured by Peak VAS and CRQ. The improvement was sustained at 3-month follow-up. However, no additional significant improvement was seen in the intervention group when compared with control. Tiotropium therapy has improved health outcomes in COPD patients in primary care settings. A 6 weekly PRP did not give any additional benefits in patients already given tiotropium.

POLYUNSATURATED FATTY ACIDS IMPROVE EXERCISE CAPACITY IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE

BACKGROUND: Muscle wasting and decreased muscle oxidative capacity commonly occur in patients with chronic obstructive pulmonary disease (COPD). Polyunsaturated fatty acids (PUFA) have been shown to mediate several inflammatory and metabolic pathways which may be involved in the pathogenesis of muscle impairment in COPD. The aim of this study was to investigate the effect of PUFA modulation on systemic inflammation, reversal of muscle wasting, and functional status in COPD. METHODS: Eighty patients with COPD (57 men) with forced expiratory volume in 1 second (FEV1) 37.3 (13.8)% predicted received 9 g PUFA or placebo daily in a double blind randomised fashion during an 8 week rehabilitation programme. Body composition (bioelectrical impedance), functional capacity (lung function, incremental cycle ergometry test, submaximal cycle test, isokinetic quadriceps strength) and inflammatory markers (C-reactive protein (CRP), interleukin (IL)-6 and tumour necrosis factor (TNF)-alpha) were assessed at baseline and after 8 weeks. RESULTS: Both groups had similar increases in weight, fat-free mass (FFM), and muscle strength. The peak load of the incremental exercise test increased more in the PUFA group than in the placebo group (difference in increase 9.7 W (95% CI 2.5 to 17.0), p = 0.009) even after adjustment for FFM. The duration of the constant work rate test also increased more in patients receiving PUFA (difference in increase 4.3 min (95% CI 0.6 to 7.9), p = 0.023). The positive effects of PUFA could not be attributed to a decrease in systemic levels of CRP, IL-6 and TNF-alpha. CONCLUSIONS: This is the first study to show beneficial effects of PUFA on exercise capacity in patients with COPD.

A field test of functional status as performance of activities of daily living in COPD patients

Patients with chronic obstructive pulmonary disease (COPD) frequently experience activity restrictions and discomfort during activities of daily living (ADL). Functional status refers to the capacity to perform ADL. Available tests only partly measure this domain. Our aim was therefore to establish an assessment tool for functional status in COPD, the Glittre ADL-test. This field test includes a standardised set of ADL-like activities: Walking stairs, carrying, lifting objects, bending down and rising from a seated position. The primary variable was time to complete the test (ADL-time). Validity was investigated in 57 COPD patients by correlating ADL-time to pulmonary function, 6-min walking distance (6MWD) and questionnaires addressing health-related quality of life. Responsiveness was investigated in another 40 patients comparing ADL-time before and after rehabilitation. Median ADL-time was 4.16 min (range 2.57-14.47). Spearman rho=0.93 for test-retest reliability. ADL-time correlated with forced expiratory volume in 1s (rho=-0.61), St. George's Respiratory Questionnaire activity subscore (rho=0.43), dyspnoea during ADL (rho=0.35) and hospitalisation rate (rho=0.35). Despite a close overall correlation with 6MWD (rho=-0.82), variability was substantial, particularly for the more disabled patients. ADL-time improved significantly after rehabilitation. Glittre ADL-test yields information complementary to 6MWD. It is a valid and reliable measure of functional status, useful for assessment of individual patients and rehabilitation programs.

Local and Systemic Inflammation in Chronic Obstructive Pulmonary Disease

There is growing evidence for systemic inflammation in chronic obstructive pulmonary disease (COPD). Increased circulating levels of inflammatory cytokines and acute phase proteins occur in stable disease, and COPD exacerbations are notably associated with pulmonary and systemic inflammation. Although the course of inflammation is determined by the balance between pro- and antiinflammatory mediators, in COPD most attention has focused on the former. During exacerbation, however, upregulation of antiinflammatory markers occurs. The main causes of systemic inflammation in COPD remain to be elucidated, although systemic hypoxia is a candidate factor. Although a relationship between lung and systemic inflammation has been suggested, experimental evidence indicates no direct correlations in the regulation of inflammation in the pulmonary and systemic compartments. Longitudinal studies are needed to unravel the role of systemic inflammation in the course of COPD, to analyze the role of acute exacerbations on the chronicity of inflammation, and to evaluate the response of systemic inflammation to different interventions. Emphasis should be placed on the identification of signaling pathways induced and/or altered in skeletal muscle by inflammation, as muscle wasting is a prominent feature of chronic inflammatory disease conditions and contributes significantly to impaired physical functioning and health status in COPD.

The effect of oral clarithromycin on health status and sputum bacteriology in stable COPD

Chronic obstructive pulmonary disease (COPD) is characterised by airway inflammation, poor health status and recurrent infective exacerbations. Macrolide antibiotics have been shown to improve symptoms and exacerbation rate in chronic lung disease, particularly cystic fibrosis (CF) and diffuse pan-bronchiolitis. The effect of long-term oral clarithromycin on health status, sputum bacterial numbers and exacerbation rate in subjects with clinically stable COPD is undetermined. Subjects with moderate-to-severe COPD were recruited into a prospective, double-blind, randomised-controlled trial of 3-months oral clarithromycin (Klaricid XL) or placebo once-daily. The effect of clarithromycin on health status (St. George respiratory and Short Form-36 questionnaires), sputum quantitative bacterial numbers and exacerbation rate were investigated. Sixty-seven subjects (46 males) were recruited; 31 and 36 subjects received clarithromycin and placebo, respectively. There were 7(10%) withdrawals. Compared to placebo, clarithromycin did not significantly improve health status, sputum bacterial numbers, or exacerbation rate. Three months of oral clarithromycin given to subjects with stable COPD does not improve health status, sputum bacterial numbers or exacerbation rate. Treatment of COPD with clarithromycin during the clinical stable state yields no clinical advantages and therefore cannot be recommended as means of eliminating sputum bacteria or preventing infective exacerbations.

Impact of sputum bacteria on airway inflammation and health status in clinical stable COPD.

Chronic obstructive pulmonary disease (COPD) is characterised by sputum production, bacterial colonisation, neutrophilic bronchial airway inflammation and poor health status. The aim of this study was to determine the impact of sputum potentially pathogenic microorganisms (PPMs) on bronchial airway inflammation, health status and plasma fibrinogen levels in subjects with moderate-to-severe COPD during the clinical stable state. Sputum total cell and neutrophil counts, supernatant interleukin-8, leukotriene B4, tumour necrosis factor-alpha and neutrophil elastase levels, neutrophil chemotaxis and plasma fibrinogen levels were estimated. Health status was determined using the St George's Respiratory Questionnaire and the 36-item Short-Form Health Survey questionnaire. Twenty-seven (40%) subjects had PPMs and 40 (60%) non-PPMs in their sputum. Both groups were of similar age, body mass index, smoking history and lung function. The PPMs group showed significantly higher levels of interleukin-8, leukotriene B4, tumour necrosis factor-a, neutrophil elastase and increased neutrophil chemotaxis. They also exhibited worse health status and raised plasma fibrinogen levels compared to the non-PPMs group. In conclusion, subjects with clinically stable moderate-to-severe chronic obstructive pulmonary disease who had potentially pathogenic microorganisms in their sputum demonstrated an exaggerated airway inflammatory response, poorer health status and increased plasma fibrinogen levels than those who had nonpotentially pathogenic microorganisms.