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Lindenauer PK, Shieh MS, Stefan MS, Fisher KA, Haessler SD, Pekow PS, Rothberg MB, Krishnan JA, Walkey AJ. Hospital Procalcitonin Testing and Antibiotic Treatment of Patients Admitted for Chronic Obstructive Pulmonary Disease Exacerbation. Ann Am Thorac Soc 2017; 14:1779-1785. [PMID: 28795838 PMCID: PMC5711260 DOI: 10.1513/annalsats.201702-133oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 08/08/2017] [Indexed: 12/21/2022] Open
Abstract
RATIONALE Randomized trials suggest that assessment of serum procalcitonin (PCT) levels can be used to safely limit antibiotic use among patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD). OBJECTIVES To determine the impact of PCT testing on antibiotic treatment of patients hospitalized for exacerbations of COPD in routine practice. METHODS We conducted a series of cross-sectional and longitudinal multivariable analyses using data from 2009 to 2011 and 2013 to 2014 from a sample of 505 U.S. hospitals. RESULTS Of 203,177 patients hospitalized for COPD exacerbation in 2013 to 2014, nearly 9 out of 10 were treated with antibiotics. Hospital PCT testing rates ranged from 0 to 83%. In cross-sectional analysis, there was a weak negative association between the rate of PCT testing and risk-adjusted rates of antibiotic initiation (Spearman correlation, -0.12; P = 0.005); each 10-point increase in the percentage of patients undergoing PCT testing was associated with a 0.7% decline in risk-adjusted antibiotic use (P = 0.001). There was no association between hospital rates of PCT testing and duration of antibiotic treatment. In a longitudinal analysis, comparing treatment patterns in 2009 to 2011 and 2013 to 2014, we did not observe a significant difference in the change in antibiotic treatment rates or duration of therapy between hospitals that had adopted PCT testing compared with those that had not. CONCLUSIONS As currently implemented, PCT testing appears to have had little impact on decisions to initiate antibiotic therapy or on duration of treatment for COPD exacerbations. Implementation research is necessary to translate the promising outcomes from PCT testing observed in randomized trials into clinical practice.
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Affiliation(s)
- Peter K. Lindenauer
- Institute for Healthcare Delivery and Population Science, and
- Department of Medicine, University of Massachusetts Medical School–Baystate, Springfield, Massachusetts
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | | | - Mihaela S. Stefan
- Institute for Healthcare Delivery and Population Science, and
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Kimberly A. Fisher
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Sarah D. Haessler
- Institute for Healthcare Delivery and Population Science, and
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
- Division of Infectious Disease, Baystate Medical Center, Springfield, Massachusetts
| | - Penelope S. Pekow
- Institute for Healthcare Delivery and Population Science, and
- School of Public Health and Health Sciences, University of Massachusetts––Amherst, Amherst, Massachusetts
| | | | - Jerry A. Krishnan
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois–Chicago, Chicago, Illinois; and
| | - Allan J. Walkey
- The Pulmonary Center, Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
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Bruguera-Avila N, Marin A, Garcia-Olive I, Radua J, Prat C, Gil M, Ruiz-Manzano J. Effectiveness of treatment with nebulized colistin in patients with COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:2909-2915. [PMID: 29042767 PMCID: PMC5634377 DOI: 10.2147/copd.s138428] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives To analyze whether the introduction of nebulized colistin in patients with chronic obstructive pulmonary disease (COPD) and infection with Pseudomonas aeruginosa (PA) is associated with a decrease of the number and duration of severe exacerbations. Materials and methods Thirty six patients with COPD and infection with PA treated with nebulized colistin attending a day hospital during a 5-year (January 2010–December 2014) period were prospectively included. Repeated-measures t-tests were used to assess whether the introduction of colistin was associated with changes in the number of exacerbations or the length of the hospitalizations, comparing for each patient the year prior to the introduction of colistin with the year after. Results After the introduction of colistin, the number of admissions decreased from 2.0 to 0.9 per individual year (P=0.0007), and hospitalizations were shorter (23.3 vs 10.9 days, P=0.00005). These results persisted when patients with and without bronchiectasis or with and without persistence of Pseudomonas were separately analyzed. No pre–post differences were detected in the number of exacerbations not requiring admission. Conclusion Nebulized colistin seems associated with a strong decrease in the number and duration of hospitalizations due to exacerbation in patients with COPD and infection with PA. Clinical trials with a larger number of patients are needed in order to confirm these results.
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Affiliation(s)
- Nuria Bruguera-Avila
- Department of Medicine, Hospital Sant Jaume de Calella, Calella, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellatera, Spain.,Department of Pulmonary Medicine, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet sn, Badalona, Barcelona, Spain
| | - Alicia Marin
- Department of Pulmonary Medicine, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet sn, Badalona, Barcelona, Spain.,Ciber de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Carretera del Canyet sn, Badalona, Barcelona, Spain
| | - Ignasi Garcia-Olive
- Department of Pulmonary Medicine, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet sn, Badalona, Barcelona, Spain.,Ciber de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Carretera del Canyet sn, Badalona, Barcelona, Spain
| | - Joaquim Radua
- Department of Statistics, FIDMAG Germanes Hospitalaries Research Unit, Sant Boi de Llobregat, Barcelona, Spain.,CiberSam - Ciber de Salud Mental, Madrid, Spain.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Cristina Prat
- Ciber de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Department of Microbiology, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet sn, Badalona, Barcelona, Spain.,Department of Genetics and Microbiology of Universitat Autònoma de Barcelona, Bellatera, Spain
| | - Montserrat Gil
- Department of Pulmonary Medicine, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet sn, Badalona, Barcelona, Spain
| | - Juan Ruiz-Manzano
- Department of Medicine, Universitat Autònoma de Barcelona, Bellatera, Spain.,Department of Pulmonary Medicine, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet sn, Badalona, Barcelona, Spain.,Ciber de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Carretera del Canyet sn, Badalona, Barcelona, Spain
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53
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McCarthy H, Jackson M, Corcoran M, McElligott M, MacHale E, Sulaiman I, Cushen B, Costello RW, Humpreys H. Colonisation of Irish patients with chronic obstructive pulmonary disease by Streptococcus pneumoniae and analysis of the pneumococcal vaccine coverage: a non-interventional, observational, prospective cohort study. BMJ Open 2017; 7:e013944. [PMID: 28694340 PMCID: PMC5541633 DOI: 10.1136/bmjopen-2016-013944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To characterise the pattern of colonisation and serotypes of Streptococcus pneumoniae among patients with chronic obstructive pulmonary disease (COPD) who currently receive the 23-valent pneumococcal polysaccharide vaccine (PPV-23) according to vaccination status, use of antibiotics and steroids. To investigate the prevalence of PPV-23 and 13-valent pneumococcal conjugate vaccine (PCV-13) serotypes within the study cohort. DESIGN A non-interventional, observational, prospective cohort study with a 12 -month follow-up period inclusive of quarterly study visits. SETTING Beaumont Hospital and The Royal College of Surgeons in Ireland Clinical Research Centre, Dublin, Ireland. PARTICIPANTS Patients with an established diagnosis of COPD attending a tertiary medical centre. PRIMARY OUTCOME MEASURE Colonisation rate of S. pneumoniae in patients with COPD and characterisation of serotypes of S. pneumoniae with correlation to currently available pneumococcal vaccines. Sputum and oropharyngeal swab samples were collected for the isolation of S. pneumoniae. SECONDARY OUTCOME MEASURE Seasonality of colonisation of S. pneumoniae and its relationship with the incidence of exacerbations of COPD. RESULTS S. pneumoniae was detected in 16 of 417 samples, a colonisation incident rate of 3.8% and in 11 of 133 (8%) patients at least once during the study. The majority of S. pneumoniae isolates were identified in spring and were non-vaccine serotypes for either the PPV-23 or PCV-13 (63%). The colonisation incident rate of S. pneumoniae fluctuated over the four seasons with a peak of 6.6% in spring and the lowest rate of 2.2% occurring during winter. Antibiotic use was highest during periods of low colonisation. CONCLUSIONS There is seasonal variation in S. pneumoniae colonisation among patients with COPD which may reflect antibiotic use in autumn and winter. The predominance of non-vaccine types suggests that PCV-13 may have limited impact among patients with COPD in Ireland who currently receive PPV-23. TRIAL REGISTRATION NUMBER NCT02535546; post-results.
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Affiliation(s)
- Hannah McCarthy
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Beaumont, Dublin, Republic of Ireland
| | - Mandy Jackson
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Beaumont, Dublin, Republic of Ireland
| | - Mary Corcoran
- Irish Pneumococcal Reference Laboratory, Epidemiology and Molecular Biology Unit Laboratory, Temple Street Children’s University Hospital, Dublin, Republic of Ireland
| | - Martha McElligott
- Irish Pneumococcal Reference Laboratory, Epidemiology and Molecular Biology Unit Laboratory, Temple Street Children’s University Hospital, Dublin, Republic of Ireland
| | - Elaine MacHale
- Department of Respiratory Medicine, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Beaumont, Dublin, Republic of Ireland
| | - Imran Sulaiman
- Department of Respiratory Medicine, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Beaumont, Dublin, Republic of Ireland
| | - Breda Cushen
- Department of Respiratory Medicine, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Beaumont, Dublin, Republic of Ireland
| | - Richard W Costello
- Department of Respiratory Medicine, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Beaumont, Dublin, Republic of Ireland
| | - Hilary Humpreys
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Beaumont, Dublin, Republic of Ireland
- Department of Microbiology, Beaumont Hospital, Beaumont, Dublin, Republic of Ireland
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54
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Diao W, Shen N, Du Y, Qian K, He B. Characterization of throat microbial flora in smokers with or without COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:1933-1946. [PMID: 28740374 PMCID: PMC5503495 DOI: 10.2147/copd.s140243] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The study aimed to determine the relationship between throat microbiome and COPD. Sixty-five Chinese males (n=20, smokers without COPD; n=45 smokers with COPD) were included. Nonmetric multidimensional scaling indicated differences of microbiome between COPD and controls, but no difference was observed between COPD patients with differing degrees of lung function or disease severity. Rarefaction analyses suggested that operational taxonomic units (OTUs, species-level) richness decreased in COPD. The dominant taxa between COPD and controls were similar, but the proportions of taxonomic distribution were different. The dominant phyla were Bacteroidetes, Proteobacteria, Firmicutes and Fusobacteria. The dominant genera were Haemophilus, Leptotrichia, Porphyromonas, Fusobacterium, Veillonella, Streptococcus, Neisseria and Prevotella. Two dominant OTUs, otu3 (Veillonella_dispar) and otu4 (Streptococcus_unclassified), were identified. Otu3 and its father-level taxa, which were negatively correlated with predicted percent of forced expiratory volume in a second (FEV1%pred), were increased in COPD. By contrast, otu4 and its father-level taxa, which were positively correlated with FEV1%pred, were decreased in COPD. Otu4 also showed a slight potential as a COPD biomarker. To conclude, the throat microbiome was different between smokers with or without COPD, which is similar to findings from the lower respiratory tract. This study may strengthen our understanding of the relationship between microbiomes of different airway sites and COPD.
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Affiliation(s)
- Wenqi Diao
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China
| | - Ning Shen
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China
| | - Yipeng Du
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China
| | - Ke Qian
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China
| | - Bei He
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China
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55
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Monsó E. Microbiome in chronic obstructive pulmonary disease. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:251. [PMID: 28706919 DOI: 10.21037/atm.2017.04.20] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The introduction of culture-independent techniques for the microbiological analysis of respiratory samples has confirmed that the respiratory system hosts a large number of microorganisms, which include a wide range of bacteria. The regular exposure to tobacco smoke changes the microbiome in healthy smokers, first in the oropharynx, increasing the presence of a restricted number of genera which attain high relative abundance, a pattern that may be considered as dysbiosis. In chronic obstructive pulmonary disease (COPD), microbiome analyses of sputum samples have demonstrated an important decline in bacterial diversity, with a change to a restricted flora with an overrepresentation of the Proteobacteria phylum, which include most of the bacteria commonly considered as potentially pathogenic microorganisms, paralleled by a decline in the relative abundance of microorganisms part of the Firmicutes phylum. In exacerbations, specific bacteria overrepresented in microbiome analyses and potentially causal of the acute episode may not be recovered by sputum culture, while colonizing microorganisms grow easily, in spite that their relative abundance have not changed from previous stability. This situation has been described in patients showing chronic colonization by Pseudomonas aeruginosa, who suffer from exacerbations that in most cases are due to other PPMs, in spite of the persistence of positive cultures for the colonizing Pseudomonas strains. Interaction between different microorganisms can be addressed through microbiome analyses, and functional metagenomics, that describes the genomic potential of the community, has shown that, in spite that the bronchial microbiome as a whole may not change significantly, clear changes in carbohydrate metabolism, cancer, cell growth and death, transport and catabolism pathways often appear during exacerbations. These functional changes may be important because through them the resident community as a whole show its power to modify important metabolic patterns.
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Affiliation(s)
- Eduard Monsó
- Respiratory Diseases Department, Parc Taulí University Hospital, Sabadell, Barcelona, Spain
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56
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Rapid Differentiation of Haemophilus influenzae and Haemophilus haemolyticus by Use of Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry with ClinProTools Mass Spectrum Analysis. J Clin Microbiol 2017. [PMID: 28637909 DOI: 10.1128/jcm.00267-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Haemophilus influenzae is associated with severe invasive disease, while Haemophilus haemolyticus is considered part of the commensal flora in the human respiratory tract. Although the addition of a custom mass spectrum library into the matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) system could improve identification of these two species, the establishment of such a custom database is technically complicated and requires a large amount of resources, which most clinical laboratories cannot afford. In this study, we developed a mass spectrum analysis model with 7 mass peak biomarkers for the identification of H. influenzae and H. haemolyticus using the ClinProTools software. We evaluated the diagnostic performance of this model using 408 H. influenzae and H. haemolyticus isolates from clinical respiratory specimens from 363 hospitalized patients and compared the identification results with those obtained with the Bruker IVD MALDI Biotyper. The IVD MALDI Biotyper identified only 86.9% of H. influenzae (311/358) and 98.0% of H. haemolyticus (49/50) clinical isolates to the species level. In comparison, the ClinProTools mass spectrum model could identify 100% of H. influenzae (358/358) and H. haemolyticus (50/50) clinical strains to the species level and significantly improved the species identification rate (McNemar's test, P < 0.0001). In conclusion, the use of ClinProTools demonstrated an alternative way for users lacking special expertise in mass spectrometry to handle closely related bacterial species when the proprietary spectrum library failed. This approach should be useful for the differentiation of other closely related bacterial species.
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57
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Draft Genome Sequences of Four Pseudomonas aeruginosa Isolates Obtained from Patients with Chronic Obstructive Pulmonary Disease. GENOME ANNOUNCEMENTS 2017; 5:5/24/e00147-17. [PMID: 28619787 PMCID: PMC5473256 DOI: 10.1128/genomea.00147-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Patients suffering chronic obstructive pulmonary disease are frequently infected by Pseudomonas aeruginosa. Nevertheless, the number of sequenced isolates causing this type of infection is low. Here, we present the draft genomes of four P. aeruginosa isolates obtained from patients presenting chronic obstructive pulmonary disease.
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58
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Sriram KB, Cox AJ, Clancy RL, Slack MPE, Cripps AW. Nontypeable Haemophilus influenzae and chronic obstructive pulmonary disease: a review for clinicians. Crit Rev Microbiol 2017; 44:125-142. [PMID: 28539074 DOI: 10.1080/1040841x.2017.1329274] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide. In the lower airways of COPD patients, bacterial infection is a common phenomenon and Haemophilus influenzae is the most commonly identified bacteria. Haemophilus influenzae is divided into typeable and nontypeable (NTHi) strains based on the presence or absence of a polysaccharide capsule. While NTHi is a common commensal in the human nasopharynx, it is associated with considerable inflammation when it is present in the lower airways of COPD patients, resulting in morbidity due to worsening symptoms and increased frequency of COPD exacerbations. Treatment of lower airway NTHi infection with antibiotics, though successful in the short term, does not offer long-term protection against reinfection, nor does it change the course of the disease. Hence, there has been much interest in the development of an effective NTHi vaccine. This review will summarize the current literature concerning the role of NTHi infections in COPD patients and the consequences of using prophylactic antibiotics in patients with COPD. There is particular focus on the rationale, findings of clinical studies and possible future directions of NTHi vaccines in patients with COPD.
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Affiliation(s)
- Krishna Bajee Sriram
- a Department of Respiratory Medicine , Gold Coast University Hospital, Gold Coast Health , Southport , Australia.,b Griffith University School of Medicine , Southport , Australia
| | - Amanda J Cox
- c Menzies Health Institute , Griffith University School of Medical Science , Gold Coast , Australia
| | - Robert L Clancy
- d Faculty of Health and Medicine , University of Newcastle , Callaghan , Australia
| | - Mary P E Slack
- b Griffith University School of Medicine , Southport , Australia
| | - Allan W Cripps
- b Griffith University School of Medicine , Southport , Australia
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59
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Roberts C, Jones TL, Gunatilake S, Storrar W, Elliott S, Glaysher S, Green B, Rule S, Fogg C, Dewey A, Auton KA, Chauhan AJ. The SENSOR Study: Protocol for a Mixed-Methods Study of Self-Management Checks to Predict Exacerbations of Pseudomonas Aeruginosa in Patients with Long-Term Respiratory Conditions. JMIR Res Protoc 2017; 6:e89. [PMID: 28526665 PMCID: PMC5457528 DOI: 10.2196/resprot.6636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 03/12/2017] [Accepted: 03/20/2017] [Indexed: 11/24/2022] Open
Abstract
Background There are an estimated three million people in the United Kingdom with chronic obstructive pulmonary disease (COPD), and the incidence of bronchiectasis is estimated at around 0.1% but is more common in COPD and severe asthma. Both COPD and bronchiectasis are characterized by exacerbations in which bacteria play a central role. Pseudomonas aeruginosa is isolated from sputum samples from 4% to 15% of adults with COPD and is more likely to be isolated from patients with severe disease. Earlier detection of exacerbations may improve morbidity and mortality by expediting treatment. Aseptika Ltd has developed a system for patients to self-monitor important physiological measurements including levels of physical activity, peak flow, forced expiratory volume (FEV1), and biomarkers for P aeruginosa in sputum. Objective We aim to test this system in 20 participants with P aeruginosa colonization and 10 controls with Haemophilus influenzae. Methods We plan to recruit 30 adult participants with COPD or non-CF bronchiectasis who have cultured P aeruginosa or H influenzae during an exacerbation in the last 6 months. They must produce sputum on most days and should have been stable for 4 weeks prior to entry. Daily data collected will include symptoms, health care usage, medication, weight, FEV1, physical activity level, blood pressure, oxygen saturation, and temperature. Sputum and urine samples will be provided daily. These data will be analyzed to assess predictive value in detecting upcoming exacerbations. Qualitative data will be gathered through self-administered questionnaires and semistructured interviews to gather information on participant coping and their use of the technology involved. Results Recruitment has been completed and results from the study should be available at the end of 2017. Conclusions The SENSOR study aims to test a home-monitoring system in people with chronic airway infection and is currently underway.
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Affiliation(s)
- Claire Roberts
- Department of Research and Innovation, Portsmouth Hospitals National Health Service Trust, Portsmouth, United Kingdom
| | - Thomas L Jones
- Department of Research and Innovation, Portsmouth Hospitals National Health Service Trust, Portsmouth, United Kingdom
| | - Samal Gunatilake
- Department of Research and Innovation, Portsmouth Hospitals National Health Service Trust, Portsmouth, United Kingdom
| | - Will Storrar
- Department of Research and Innovation, Portsmouth Hospitals National Health Service Trust, Portsmouth, United Kingdom
| | - Scott Elliott
- Department of Research and Innovation, Portsmouth Hospitals National Health Service Trust, Portsmouth, United Kingdom
| | - Sharon Glaysher
- Department of Research and Innovation, Portsmouth Hospitals National Health Service Trust, Portsmouth, United Kingdom
| | - Ben Green
- Department of Respiratory Medicine, Portsmouth Hospitals National Health Service Trust, Portsmouth, United Kingdom
| | - Steven Rule
- Department of Research and Innovation, Portsmouth Hospitals National Health Service Trust, Portsmouth, United Kingdom
| | - Carole Fogg
- Department of Research and Innovation, Portsmouth Hospitals National Health Service Trust, Portsmouth, United Kingdom.,School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, United Kingdom
| | - Ann Dewey
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, United Kingdom
| | | | - Anoop J Chauhan
- Department of Research and Innovation, Portsmouth Hospitals National Health Service Trust, Portsmouth, United Kingdom
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Rao D, Perraud AL, Schmitz C, Gally F. Cigarette smoke inhibits LPS-induced FABP5 expression by preventing c-Jun binding to the FABP5 promoter. PLoS One 2017; 12:e0178021. [PMID: 28542209 PMCID: PMC5436865 DOI: 10.1371/journal.pone.0178021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 04/10/2017] [Indexed: 12/21/2022] Open
Abstract
Cigarette smoking is the primary cause of chronic obstructive pulmonary disease (COPD) with repeated and sustained infections linked to disease pathogenesis and exacerbations. The airway epithelium constitutes the first line of host defense against infection and is known to be impaired in COPD. We have previously identified Fatty Acid Binding Protein 5 (FABP5) as an important anti-inflammatory player during respiratory infections and showed that overexpression of FABP5 in primary airway epithelial cells protects against bacterial infection and inflammation. While cigarette smoke down regulates FABP5 expression, its mechanism remains unknown. In this report, we have identified three putative c-Jun binding sites on the FABP5 promoter and show that cigarette smoke inhibits the binding of c-Jun to its consensus sequence and prevents LPS-induced FABP5 expression. Using chromatin immunoprecipitation, we have determined that c-Jun binds the FABP5 promoter when stimulated with LPS but the presence of cigarette smoke greatly reduces this binding. Furthermore, cigarette smoke or a mutation in the c-Jun binding site inhibits LPS-induced FABP5 promoter activity. These data demonstrate that cigarette smoke interferes with FABP5 expression in response to bacterial infection. Thus, functional activation of FABP5 may be a new therapeutic strategy when treating COPD patients suffering from exacerbations.
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Affiliation(s)
- Deviyani Rao
- Department of Biomedical Research, National Jewish Health, Denver, Colorado, United States of America
| | - Anne-Laure Perraud
- Department of Biomedical Research, National Jewish Health, Denver, Colorado, United States of America
- Department of Immunology and Microbiology, University of Colorado Denver, United States of America
| | - Carsten Schmitz
- Department of Biomedical Research, National Jewish Health, Denver, Colorado, United States of America
- Department of Immunology and Microbiology, University of Colorado Denver, United States of America
| | - Fabienne Gally
- Department of Biomedical Research, National Jewish Health, Denver, Colorado, United States of America
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61
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[Appropriate investigations during an acute COPD exacerbation requiring hospitalization]. Rev Mal Respir 2017; 34:375-381. [PMID: 28499638 DOI: 10.1016/j.rmr.2017.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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62
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Leung JM, Tiew PY, Mac Aogáin M, Budden KF, Yong VFL, Thomas SS, Pethe K, Hansbro PM, Chotirmall SH. The role of acute and chronic respiratory colonization and infections in the pathogenesis of COPD. Respirology 2017; 22:634-650. [PMID: 28342288 PMCID: PMC7169176 DOI: 10.1111/resp.13032] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 02/09/2017] [Accepted: 02/09/2017] [Indexed: 12/16/2022]
Abstract
COPD is a major global concern, increasingly so in the context of ageing populations. The role of infections in disease pathogenesis and progression is known to be important, yet the mechanisms involved remain to be fully elucidated. While COPD pathogens such as Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae are strongly associated with acute exacerbations of COPD (AECOPD), the clinical relevance of these pathogens in stable COPD patients remains unclear. Immune responses in stable and colonized COPD patients are comparable to those detected in AECOPD, supporting a role for chronic colonization in COPD pathogenesis through perpetuation of deleterious immune responses. Advances in molecular diagnostics and metagenomics now allow the assessment of microbe-COPD interactions with unprecedented personalization and precision, revealing changes in microbiota associated with the COPD disease state. As microbial changes associated with AECOPD, disease severity and therapeutic intervention become apparent, a renewed focus has been placed on the microbiology of COPD and the characterization of the lung microbiome in both its acute and chronic states. Characterization of bacterial, viral and fungal microbiota as part of the lung microbiome has the potential to reveal previously unrecognized prognostic markers of COPD that predict disease outcome or infection susceptibility. Addressing such knowledge gaps will ultimately lead to a more complete understanding of the microbe-host interplay in COPD. This will permit clearer distinctions between acute and chronic infections and more granular patient stratification that will enable better management of these features and of COPD.
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Affiliation(s)
- Janice M. Leung
- Centre for Heart Lung InnovationVancouverBritish ColumbiaCanada
- Division of Respiratory Medicine, St Paul's HospitalUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Pei Yee Tiew
- Department of Respiratory and Critical Care MedicineSingapore General HospitalSingapore
| | - Micheál Mac Aogáin
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore
| | - Kurtis F. Budden
- Priority Research Centre for Healthy LungsUniversity of NewcastleNewcastleNew South WalesAustralia
- Hunter Medical Research InstituteNewcastleNew South WalesAustralia
| | | | - Sangeeta S. Thomas
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore
| | - Kevin Pethe
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore
| | - Philip M. Hansbro
- Priority Research Centre for Healthy LungsUniversity of NewcastleNewcastleNew South WalesAustralia
- Hunter Medical Research InstituteNewcastleNew South WalesAustralia
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Park MJ, Rhee CK, Kim YH, Kim DJ, Kim DG, Lee SY, Kim JY. Efficacy and safety of HL301 in the treatment of acute bronchitis and acute exacerbation of chronic bronchitis: a phase 2, randomized, double-blind, placebo-controlled, multicenter study. Curr Med Res Opin 2017; 33:919-925. [PMID: 28277874 DOI: 10.1080/03007995.2017.1295030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The efficacy and safety of Chinese herbs for symptomatic treatment of bronchitis is not well established. We evaluated the efficacy and safety of a combination product of seven herbs (HL301) for the treatment of acute bronchitis (AB) and acute exacerbation of chronic bronchitis (AECB) using a randomized, double-blind, placebo-controlled, multicenter trial design. METHODS A total of 160 patients with AB or with AECB were randomized to receive placebo or one of three doses of HL301 (0.6 g/day, 1.2 g/day, or 1.8 g/day) for a total of 7 days. The primary study endpoint was the change in bronchitis severity score (BSS) from the baseline visit (visit 2) to the end of treatment visit (visit 3). Other efficacy variables were percentage BSS systemic sign efficacy after treatment and change in individual BSS parameters after treatment. FINDINGS Changes in BSS from visit 2 to visit 3 in the three treatment groups (4.63 ± 2.24, 4.08 ± 1.63, and 4.15 ± 1.74 in the HL301 0.6 g/day, 1.2 g/day, and 1.8 g/day groups, respectively) were higher than that of the placebo group (2.88 ± 2.57) in the per protocol set (PPS) (P < .05), and it was also valid in the full analysis set (FAS). The number of participants whose symptoms (measured by BSS) improved at least 30% after treatment was higher in all three treatment groups compared to the placebo group in both the FAS and the PPS (P < .05, for all). IMPLICATIONS Three different doses of HL301 (0.6 g/day, 1.2 g/day, and 1.8 g/day) were effective in decreasing the BSS index compared to placebo. HL301 may be effective for symptomatic treatment of both AB and AECB. LIMITATIONS Essential components of HL301 have not been delineated in the study and patients with AB and AECB were indiscriminately enrolled in the present study. Respective evaluation of the efficacy of HL301 for AB and AECB will be necessary in the future.
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Affiliation(s)
- Myung Jae Park
- a Kyung Hee University School of Medicine , Department of Pulmonology and Critical Care Medicine , Seoul , Republic of Korea
| | - Chin Kook Rhee
- b The Catholic University of Korea , Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine , Seoul , Republic of Korea
| | - Yee Hyung Kim
- c Kyung Hee Univerisity Hospital at Gangdong , Department of Pulmonary and Critical Care Medicine , Seoul , Republic of Korea
| | - Do Jin Kim
- d Soonchunhyang University Bucheon Hospital , Department of Internal Medicine , Bucheon , Republic of Korea
| | - Dong Gyu Kim
- e Hallym University Sacred Heart Hospital , Department of Internal Medicine , Seoul , Republic of Korea
| | - Sang Yeub Lee
- f College of Medicine, Korea University , Department of Internal Medicine , Seoul , Republic of Korea
| | - Jae Yeol Kim
- g Chung Ang University Hospital Ringgold Standard Institution , Internal Medicine, Seoul , Republic of Korea
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Thulborn SJ, Dilpazir M, Haldar K, Mistry V, Brightling CE, Barer MR, Bafadhel M. Investigating the role of pentraxin 3 as a biomarker for bacterial infection in subjects with COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:1199-1205. [PMID: 28458531 PMCID: PMC5402921 DOI: 10.2147/copd.s123528] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background Pentraxin 3 (PTX3) is an acute phase protein, involved in antibacterial resistance. Recent studies have shown PTX3 levels to be elevated in the presence of a bacterial infection and in a murine sepsis model. Objective We aim to investigate if sputum PTX3 can be used as a biomarker for bacterial infection in subjects with COPD. Materials and methods Sputum samples from 142 COPD patients (102 men) with a mean (range) age of 69 years (45–85) and mean (SD) post-bronchodilator percentage predicted forced expiratory volume in 1 second (FEV1) of 50% (19) were analyzed for PTX3, using a commercial assay at stable state and during an exacerbation. Association with bacteria, from culture, quantitative real-time polymerase chain reaction (qPCR) and colony-forming units (CFU) was investigated. Results The geometric mean (95% CI) PTX3 level at stable state was 50.5 ng/mL (41.4–61.7). PTX3 levels correlated with absolute neutrophil count in sputum (r=0.37; P<0.01), but not FEV1 or health status. There was a weak correlation between PTX3 and bacterial load (CFU: r=0.29, P<0.01; 16S qPCR: r=0.18, P=0.05). PTX3 was a poor predictor of bacterial colonization (defined as >105 CFU/mL at stable state) with a receiver-operating characteristic (ROC) area under the curve (AUC) of 0.59 and 95% confidence interval (CI) 0.43–0.76 (P=0.21). During an exacerbation, there was a modest increase in PTX3 (fold difference 0.15, 95% of difference 0.02–0.29; P=0.02), and PTX3 fared better at identifying a bacteria-associated exacerbation (ROC AUC 0.65, 95% CI 0.52–0.78, P=0.03). Conclusion PTX3 is associated with bacterial infection in patients with COPD, but its utility as a biomarker for identifying a bacteria-associated exacerbation warrants further studies.
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Affiliation(s)
- Samantha J Thulborn
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford
| | - Madiha Dilpazir
- Department of Biological and Medical Sciences, Oxford Brookes University, Oxford
| | - Koirobi Haldar
- Department of Immunity, Infection & Inflammation, University of Leicester, Leicester, UK
| | - Vijay Mistry
- Department of Immunity, Infection & Inflammation, University of Leicester, Leicester, UK
| | | | - Michael R Barer
- Department of Immunity, Infection & Inflammation, University of Leicester, Leicester, UK
| | - Mona Bafadhel
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford
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Garcia-Nuñez M, Marti S, Puig C, Perez-Brocal V, Millares L, Santos S, Ardanuy C, Moya A, Liñares J, Monsó E. Bronchial microbiome, PA biofilm-forming capacity and exacerbation in severe COPD patients colonized by P. aeruginosa. Future Microbiol 2017; 12:379-392. [PMID: 28339291 DOI: 10.2217/fmb-2016-0127] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM The bronchial microbiome of severe chronic obstructive pulmonary disease patients colonized by Pseudomonas aeruginosa was analyzed using 16S rRNA gene sequencing to identify differences related to biofilm-forming capacity. PATIENTS & METHODS Patient sputum samples from 21 patients were studied. RESULTS Statistically significant differences related to biofilm-forming capacity were only found for genera with relative abundances <1%, and Fusobacterium was over-represented when biofilm-forming capacity was high. Genera with relative abundances >50% which increased from baseline were observed in 10/14 exacerbations, but corresponded to Pseudomonas only in three episodes, while other pathogenic genera were identified in seven. CONCLUSION The bronchial microbiome shows differences according with P. aeruginosa biofilm-forming capacity. Pathogenic microorganisms other than P. aeruginosa cause a significant part of the exacerbations in colonized chronic obstructive pulmonary disease patients.
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Affiliation(s)
- Marian Garcia-Nuñez
- CIBER de Enfermedades Respiratorias (CIBERes), Instituto de Salud Carlos III, Madrid, Spain E-28029
- Department of Respiratory Medicine, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain E-08208
- Fundació Institut d'Investigació Germans Trias i Pujol, Badalona, Spain E-08916
- Universitat Autonoma de Barcelona, Esfera UAB, Barcelona, Spain E-08193
| | - Sara Marti
- CIBER de Enfermedades Respiratorias (CIBERes), Instituto de Salud Carlos III, Madrid, Spain E-28029
- Microbiology Department, Hospital Universitari Bellvitge, Universitat de Barcelona-IDIBELL, Barcelona, Spain E-08908
| | - Carmen Puig
- CIBER de Enfermedades Respiratorias (CIBERes), Instituto de Salud Carlos III, Madrid, Spain E-28029
- Microbiology Department, Hospital Universitari Bellvitge, Universitat de Barcelona-IDIBELL, Barcelona, Spain E-08908
| | - Vicente Perez-Brocal
- Genomics & Health Area, Centro Superior de Investigación en Salud Pública - Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (CSISP-FISABIO), Valencia, Spain E-46020
- Department of Genetics, Institut Cavanilles de Biodiversitat i Biologia Evolutiva, (ICBiBE) Universitat de València, València, Spain E-46020
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain E-28029
| | - Laura Millares
- CIBER de Enfermedades Respiratorias (CIBERes), Instituto de Salud Carlos III, Madrid, Spain E-28029
- Department of Respiratory Medicine, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain E-08208
- Fundació Institut d'Investigació Germans Trias i Pujol, Badalona, Spain E-08916
- Universitat Autonoma de Barcelona, Esfera UAB, Barcelona, Spain E-08193
| | - Salud Santos
- CIBER de Enfermedades Respiratorias (CIBERes), Instituto de Salud Carlos III, Madrid, Spain E-28029
- Department of Pulmonary Medicine, Hospital Universitari de Bellvitge, Institut d'Investigacions Biomèdiques de Bellvitge (IDIBELL), Universitat de Barcelona, Barcelona, Spain E-08908
| | - Carmen Ardanuy
- CIBER de Enfermedades Respiratorias (CIBERes), Instituto de Salud Carlos III, Madrid, Spain E-28029
- Microbiology Department, Hospital Universitari Bellvitge, Universitat de Barcelona-IDIBELL, Barcelona, Spain E-08908
| | - Andres Moya
- Genomics & Health Area, Centro Superior de Investigación en Salud Pública - Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (CSISP-FISABIO), Valencia, Spain E-46020
- Department of Genetics, Institut Cavanilles de Biodiversitat i Biologia Evolutiva, (ICBiBE) Universitat de València, València, Spain E-46020
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain E-28029
| | - Josefina Liñares
- CIBER de Enfermedades Respiratorias (CIBERes), Instituto de Salud Carlos III, Madrid, Spain E-28029
- Microbiology Department, Hospital Universitari Bellvitge, Universitat de Barcelona-IDIBELL, Barcelona, Spain E-08908
| | - Eduard Monsó
- CIBER de Enfermedades Respiratorias (CIBERes), Instituto de Salud Carlos III, Madrid, Spain E-28029
- Department of Respiratory Medicine, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain E-08208
- Fundació Institut d'Investigació Germans Trias i Pujol, Badalona, Spain E-08916
- Universitat Autonoma de Barcelona, Esfera UAB, Barcelona, Spain E-08193
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Reechaipichitkul W. Precipitating causes and outcomes of chronic obstructive pulmonary disease exacerbation at a tertiary care center in northeast Thailand. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0802.283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a leading cause of hospitalization and economic burden. Frequent exacerbations impair quality of life and effect decline of lung function.
Objective: We evaluated characteristics of COPD patients with frequent exacerbations. The precipitating causes, outcomes, hospital stay, and cost of admission were also determined.
Methods: The study population included COPD patients admitted because of acute COPD exacerbation at Srinagarind Hospital between 1 January 2006 and 31 December 2010.
Results: Over the 5-year period, 183 patients were admitted. Their mean age was 74.9 (SD 9.28) years and the male to female ratio was 170:13. Most patients (144; 79%) had one exacerbation per year and 39 (21%) had more than one per year. The group with more exacerbations, had a higher stage of the disease than those with only one exacerbation (p = 0.023), but there was no significant difference in the mortality rate (18% vs 14%, p = 0.53). A total of 245 episodes of acute exacerbation of COPD occurred in 183 patients. The mean duration of symptoms was 4.1 (SD 3.46) days. Forty-seven percent presented with Anthonisen type III, 42.4% with Anthonisen type II, and 10.6% with Anthonisen type I exacerbations. For 44 exacerbations (18%), the precipitating causes were not determined. The most common precipitating cause was pneumonia, which occurred in 90 episodes (36.7%). The second common was bronchitis (27.8%); followed by heart failure (8.2%), infected bronchiectasis (5.3%), diarrhea (1.2%), acute urinary retention (0.8%), unstable angina (0.4%), pneumothorax (0.4%), urinary tract infection (0.4%), atrial fibrillation (0.4%) and drug induced cough (0.4%). The organisms responsible for respiratory tract infection were identified in 31% cases of pneumonia and 18% of bronchitis cases. The top three common pathogens for pneumonia were Pseudomonas aeruginosa (9%), Acinetobacter baumannii (8%), and Klebsiella pneumoniae (8%). The top three common pathogens for bronchitis were P aeruginosa (7%), Haemophilus influenza (6%), and K pneumoniae (4%). About one quarter (25.3%) of acute exacerbations were complicated by respiratory failure. The mean duration of admission was 17.3 days (range 1-682 days). The mean cost of admission per exacerbation was 80,010 Thai baht (US $2,666) (range, 2,779-3,433,108 baht). The total cost for 245 exacerbations was 19.6 million baht ($653,000).
Conclusion: Respiratory tract infections were common causes of COPD exacerbation and one quarter of which developed respiratory failure. Preventive measures such as vaccination, smoking cessation, lung rehabilitation, and appropriate drug use are helpful.
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Affiliation(s)
- Wipa Reechaipichitkul
- Division of Pulmonary and Critical Care, Department of Medicine, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, 40002, Thailand
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Huang YJ, Erb-Downward JR, Dickson RP, Curtis JL, Huffnagle GB, Han MK. Understanding the role of the microbiome in chronic obstructive pulmonary disease: principles, challenges, and future directions. Transl Res 2017; 179:71-83. [PMID: 27392936 PMCID: PMC5164976 DOI: 10.1016/j.trsl.2016.06.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/09/2016] [Accepted: 06/15/2016] [Indexed: 12/23/2022]
Abstract
In the past several years, advances in sequencing platforms and bioinformatics have transformed our understanding of the relationship between microbial ecology and human health. Both the normal and diseased lung are host to hundreds of bacterial genera, blurring the lines between "colonization" and "infection". However, whereas in health the respiratory microbiome is determined primarily by the dynamic balance of immigration and elimination, in chronic disease conditions become much more favorable for the reproduction of resident bacteria. Recent studies demonstrate that the microbiota of the chronic obstructive pulmonary disease (COPD) lung differ from the healthy lung although significant intrasubject and intersubject heterogeneity are still present with variation impacted by factors such as disease stage and inhaled medications. Changes in the relative abundance of specific bacterial taxa during COPD exacerbations have also been noted although further longitudinal analyses are needed to ascertain the malleability and resilience of this ecological system and its role in the occurrence and frequency of exacerbations. Whether patients with a "frequent exacerbator" phenotype possess specific or greater alterations in their airway microbiome that predispose them to recurrent exacerbations as compared with nonfrequent exacerbators needs to be determined. Although recent data suggest that the presence of bacteria has the potential to influence the host immune response, a key challenge in the next few years will be to continue to move beyond descriptive studies to define the clinical relevance of differences in lung microbiota associated with COPD.
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Affiliation(s)
- Yvonne J Huang
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, Mich
| | - John R Erb-Downward
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, Mich
| | - Robert P Dickson
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, Mich
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, Mich; Pulmonary & Critical Care Medicine Section, Medical Service, VA, Ann Arbor, Mich
| | - Gary B Huffnagle
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, Mich
| | - MeiLan K Han
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, Mich.
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Teepe J, Broekhuizen BDL, Loens K, Lammens C, Ieven M, Goossens H, Little P, Butler CC, Coenen S, Godycki-Cwirko M, Verheij T. Disease Course of Lower Respiratory Tract Infection With a Bacterial Cause. Ann Fam Med 2016; 14:534-539. [PMID: 28376440 PMCID: PMC5389387 DOI: 10.1370/afm.1974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/29/2016] [Accepted: 05/09/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Bacterial pathogens are assumed to cause an illness course different from that of nonbacterial causes of acute cough, but evidence is lacking. We evaluated the disease course of lower respiratory tract infection (LRTI) with a bacterial cause in adults with acute cough. METHODS We conducted a secondary analysis of a multicenter European trial in which 2,061 adults with acute cough (28 days' duration or less) were recruited from primary care and randomized to amoxicillin or placebo. For this analysis only patients in the placebo group (n = 1,021) were included, reflecting the natural course of disease. Standardized microbiological and serological analyses were performed at baseline to define a bacterial cause. All patients recorded symptoms in a diary for 4 weeks. The disease course between those with and without a bacterial cause was compared by symptom severity in days 2 to 4, duration of symptoms rated moderately bad or worse, and a return consultation. RESULTS Of 1,021 eligible patients, 187 were excluded for missing diary records, leaving 834 patients, of whom 162 had bacterial LRTI. Patients with bacterial LRTI had worse symptoms at day 2 to 4 after the first office visit (P = .014) and returned more often for a second consultation, 27% vs 17%, than those without bacterial LRTI (P = .004). Resolution of symptoms rated moderately bad or worse did not differ (P = .375). CONCLUSIONS Patients with acute bacterial LRTI have a slightly worse course of disease when compared with those without an identified bacterial cause, but the relevance of this difference is not meaningful.
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Affiliation(s)
- Jolien Teepe
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Berna D L Broekhuizen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Katherine Loens
- University of Antwerp, Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), Antwerp, Belgium
| | - Christine Lammens
- University of Antwerp, Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), Antwerp, Belgium
| | - Margareta Ieven
- University of Antwerp, Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), Antwerp, Belgium
| | - Herman Goossens
- University of Antwerp, Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), Antwerp, Belgium
| | - Paul Little
- University of Southampton Medical School, Primary Care Medical Group, Southampton, United Kingdom
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, United Kingdom.,Cwm Taf University Health Board, Abercynon, United Kingdom
| | - Samuel Coenen
- University of Antwerp, Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), Antwerp, Belgium.,University of Antwerp, Centre for General Practice, Department of Primary and Interdisciplinary Care (ELIZA), Antwerp, Belgium
| | | | - Theo Verheij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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Teepe J, Broekhuizen BDL, Loens K, Lammens C, Ieven M, Goossens H, Little P, Butler CC, Coenen S, Godycki-Cwirko M, Verheij TJM. Predicting the presence of bacterial pathogens in the airways of primary care patients with acute cough. CMAJ 2016; 189:E50-E55. [PMID: 27777252 DOI: 10.1503/cmaj.151364] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 08/16/2016] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Bacterial testing of all patients who present with acute cough is not feasible in primary care. Furthermore, the extent to which easily obtainable clinical information predicts bacterial infection is unknown. We evaluated the diagnostic value of clinical examination and testing for C-reactive protein and procalcitonin for bacterial lower respiratory tract infection. METHODS Through a European diagnostic study, we recruited 3104 adults with acute cough (≤ 28 days) in primary care settings. All of the patients underwent clinical examination, measurement of C-reactive protein and procalcitonin in blood, and chest radiography. Bacterial infection was determined by conventional culture, polymerase chain reaction and serology, and positive results were defined by the presence of Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Bordetella pertussis or Legionella pneumophila. Using multivariable regression analysis, we examined the association of diagnostic variables with the presence of bacterial infection. RESULTS Overall, 539 patients (17%) had bacterial lower respiratory tract infection, and 38 (1%) had bacterial pneumonia. The only item with diagnostic value for lower respiratory tract infection was discoloured sputum (area under the receiver operating characteristic [ROC] curve 0.56, 95% confidence interval [CI] 0.54-0.59). Adding C-reactive protein above 30 mg/L increased the area under the ROC curve to 0.62 (95% CI 0.59-0.65). For bacterial pneumonia, comorbidity, fever and crackles on auscultation had diagnostic value (area under ROC curve 0.68, 95% CI 0.58-0.77). Adding C-reactive protein above 30 mg/L increased the area under the ROC curve to 0.79 (95% CI 0.71-0.87). Procalcitonin did not add diagnostic information for any bacterial lower respiratory tract infection, including bacterial pneumonia. INTERPRETATION In adults presenting with acute lower respiratory tract infection, signs, symptoms and C-reactive protein showed diagnostic value for a bacterial cause. However, the ability of these diagnostic indicators to exclude a bacterial cause was limited. Procalcitonin added no clinically relevant information.
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Affiliation(s)
- Jolien Teepe
- Julius Center for Health Sciences and Primary Care (Teepe, Broekhuizen, Verheij), University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO) (Loens, Lammens, Ieven, Goossens, Coenen), and Centre for General Practice, Primary and Interdisciplinary Care (Coenen), University of Antwerp, Antwerp, Belgium; Primary Care Medical Group (Little), University of Southampton Medical School, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Butler), University of Oxford, Oxford, UK; Faculty of Health Sciences (Godycki-Cwirko), Medical University of Lodz, Lodz, Poland
| | - Berna D L Broekhuizen
- Julius Center for Health Sciences and Primary Care (Teepe, Broekhuizen, Verheij), University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO) (Loens, Lammens, Ieven, Goossens, Coenen), and Centre for General Practice, Primary and Interdisciplinary Care (Coenen), University of Antwerp, Antwerp, Belgium; Primary Care Medical Group (Little), University of Southampton Medical School, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Butler), University of Oxford, Oxford, UK; Faculty of Health Sciences (Godycki-Cwirko), Medical University of Lodz, Lodz, Poland
| | - Katherine Loens
- Julius Center for Health Sciences and Primary Care (Teepe, Broekhuizen, Verheij), University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO) (Loens, Lammens, Ieven, Goossens, Coenen), and Centre for General Practice, Primary and Interdisciplinary Care (Coenen), University of Antwerp, Antwerp, Belgium; Primary Care Medical Group (Little), University of Southampton Medical School, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Butler), University of Oxford, Oxford, UK; Faculty of Health Sciences (Godycki-Cwirko), Medical University of Lodz, Lodz, Poland
| | - Christine Lammens
- Julius Center for Health Sciences and Primary Care (Teepe, Broekhuizen, Verheij), University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO) (Loens, Lammens, Ieven, Goossens, Coenen), and Centre for General Practice, Primary and Interdisciplinary Care (Coenen), University of Antwerp, Antwerp, Belgium; Primary Care Medical Group (Little), University of Southampton Medical School, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Butler), University of Oxford, Oxford, UK; Faculty of Health Sciences (Godycki-Cwirko), Medical University of Lodz, Lodz, Poland
| | - Margareta Ieven
- Julius Center for Health Sciences and Primary Care (Teepe, Broekhuizen, Verheij), University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO) (Loens, Lammens, Ieven, Goossens, Coenen), and Centre for General Practice, Primary and Interdisciplinary Care (Coenen), University of Antwerp, Antwerp, Belgium; Primary Care Medical Group (Little), University of Southampton Medical School, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Butler), University of Oxford, Oxford, UK; Faculty of Health Sciences (Godycki-Cwirko), Medical University of Lodz, Lodz, Poland
| | - Herman Goossens
- Julius Center for Health Sciences and Primary Care (Teepe, Broekhuizen, Verheij), University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO) (Loens, Lammens, Ieven, Goossens, Coenen), and Centre for General Practice, Primary and Interdisciplinary Care (Coenen), University of Antwerp, Antwerp, Belgium; Primary Care Medical Group (Little), University of Southampton Medical School, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Butler), University of Oxford, Oxford, UK; Faculty of Health Sciences (Godycki-Cwirko), Medical University of Lodz, Lodz, Poland
| | - Paul Little
- Julius Center for Health Sciences and Primary Care (Teepe, Broekhuizen, Verheij), University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO) (Loens, Lammens, Ieven, Goossens, Coenen), and Centre for General Practice, Primary and Interdisciplinary Care (Coenen), University of Antwerp, Antwerp, Belgium; Primary Care Medical Group (Little), University of Southampton Medical School, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Butler), University of Oxford, Oxford, UK; Faculty of Health Sciences (Godycki-Cwirko), Medical University of Lodz, Lodz, Poland
| | - Chris C Butler
- Julius Center for Health Sciences and Primary Care (Teepe, Broekhuizen, Verheij), University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO) (Loens, Lammens, Ieven, Goossens, Coenen), and Centre for General Practice, Primary and Interdisciplinary Care (Coenen), University of Antwerp, Antwerp, Belgium; Primary Care Medical Group (Little), University of Southampton Medical School, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Butler), University of Oxford, Oxford, UK; Faculty of Health Sciences (Godycki-Cwirko), Medical University of Lodz, Lodz, Poland
| | - Samuel Coenen
- Julius Center for Health Sciences and Primary Care (Teepe, Broekhuizen, Verheij), University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO) (Loens, Lammens, Ieven, Goossens, Coenen), and Centre for General Practice, Primary and Interdisciplinary Care (Coenen), University of Antwerp, Antwerp, Belgium; Primary Care Medical Group (Little), University of Southampton Medical School, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Butler), University of Oxford, Oxford, UK; Faculty of Health Sciences (Godycki-Cwirko), Medical University of Lodz, Lodz, Poland
| | - Maciek Godycki-Cwirko
- Julius Center for Health Sciences and Primary Care (Teepe, Broekhuizen, Verheij), University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO) (Loens, Lammens, Ieven, Goossens, Coenen), and Centre for General Practice, Primary and Interdisciplinary Care (Coenen), University of Antwerp, Antwerp, Belgium; Primary Care Medical Group (Little), University of Southampton Medical School, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Butler), University of Oxford, Oxford, UK; Faculty of Health Sciences (Godycki-Cwirko), Medical University of Lodz, Lodz, Poland
| | - Theo J M Verheij
- Julius Center for Health Sciences and Primary Care (Teepe, Broekhuizen, Verheij), University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO) (Loens, Lammens, Ieven, Goossens, Coenen), and Centre for General Practice, Primary and Interdisciplinary Care (Coenen), University of Antwerp, Antwerp, Belgium; Primary Care Medical Group (Little), University of Southampton Medical School, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Butler), University of Oxford, Oxford, UK; Faculty of Health Sciences (Godycki-Cwirko), Medical University of Lodz, Lodz, Poland
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70
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Basilico P, Cremona TP, Oevermann A, Piersigilli A, Benarafa C. Increased Myeloid Cell Production and Lung Bacterial Clearance in Mice Exposed to Cigarette Smoke. Am J Respir Cell Mol Biol 2016; 54:424-35. [PMID: 26273827 DOI: 10.1165/rcmb.2015-0017oc] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Pneumonia is a leading cause of hospitalization in patients with chronic obstructive pulmonary disease (COPD). Although most patients with COPD are smokers, the effects of cigarette smoke exposure on clearance of lung bacterial pathogens and on immune and inflammatory responses are incompletely defined. Here, clearance of Streptococcus pneumoniae and Pseudomonas aeruginosa and associated immune responses were examined in mice exposed to cigarette smoke or after smoking cessation. Mice exposed to cigarette smoke for 6 weeks or 4 months demonstrated decreased lung bacterial burden compared with air-exposed mice when infected 16 to 24 hours after exposure. When infection was performed after smoke cessation, bacterial clearance kinetics of mice previously exposed to smoke reversed to levels comparable to those of control mice, suggesting that the observed defects were not dependent on adaptive immunological memory to bacterial determinants found in smoke. Comparing cytokine levels and myeloid cell production before infection in mice exposed to cigarette smoke with mice never exposed or after smoke cessation revealed that reduced bacterial burden was most strongly associated with higher levels of IL-1β and granulocyte-macrophage colony-stimulating factor in the lungs and with increased neutrophil reserve and monocyte turnover in the bone marrow. Using Serpinb1a-deficient mice with reduced neutrophil numbers and treatment with granulocyte colony-stimulating factor showed that increased neutrophil numbers contribute only in part to the effect of smoke on infection. Our findings indicate that cigarette smoke induces a temporary and reversible increase in clearance of lung pathogens, which correlates with local inflammation and increased myeloid cell output from the bone marrow.
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Affiliation(s)
- Paola Basilico
- 1 Theodor Kocher Institute.,2 Graduate School for Cellular and Biomedical Sciences
| | - Tiziana P Cremona
- 1 Theodor Kocher Institute.,2 Graduate School for Cellular and Biomedical Sciences
| | - Anna Oevermann
- 3 Neurocenter, Department of Clinical Research and Veterinary Public Health, Vetsuisse Faculty, and
| | - Alessandra Piersigilli
- 4 Institute of Animal Pathology, University of Bern, Bern, Switzerland; and.,5 School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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71
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Bellinghausen C, Gulraiz F, Heinzmann ACA, Dentener MA, Savelkoul PHM, Wouters EF, Rohde GG, Stassen FR. Exposure to common respiratory bacteria alters the airway epithelial response to subsequent viral infection. Respir Res 2016; 17:68. [PMID: 27259950 PMCID: PMC4891894 DOI: 10.1186/s12931-016-0382-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/24/2016] [Indexed: 12/21/2022] Open
Abstract
Background Colonization of the airways with potential pathogenic bacteria is observed in a number of chronic respiratory diseases, such as COPD or cystic fibrosis. Infections with respiratory viruses are known triggers of exacerbations of these diseases. We here investigated if pre-exposure to bacteria alters the response of lung epithelial cells to subsequent viral infection. Methods Bronchial epithelial cells (BEAS-2B cells and primary bronchial epithelial cells) were exposed to heat-inactivated Haemophilus influenzae, Pseudomonas aeruginosa or Streptococcus pneumoniae and subsequently infected with respiratory syncytial virus (RSV), type 2 human adenovirus or influenza B. Levels of pro-inflammatory cytokines, viral replication and expression of pattern recognition receptors were determined in culture supernatants and/or cell lysates. Results Exposure of BEAS-2B cells to H. influenzae before and during RSV-infection synergistically increased the release of IL-6 (increase above calculated additive effect at 72 h: 56 % ± 3 %, mean ± SEM) and IL-8 (53 % ± 12 %). This effect was sustained even when bacteria were washed away before viral infection and was neither associated with enhanced viral replication, nor linked to increased expression of key pattern recognition receptors. P. aeruginosa enhanced the release of inflammatory cytokines to a similar extent, yet only if bacteria were also present during viral infection. S. pneumoniae did not enhance RSV-induced cytokine release. Surprisingly, adenovirus infection significantly reduced IL-6 release in cells exposed to either of the three tested bacterial strains by on average more than 50 %. Infection with influenza B on the other hand did not affect cytokine production in BEAS-2B cells exposed to the different bacterial strains. Conclusion Pre-exposure of epithelial cells to bacteria alters the response to subsequent viral infection depending on the types of pathogen involved. These findings highlight the complexity of microbiome interactions in the airways, possibly contributing to the susceptibility to exacerbations and the natural course of airway diseases. Electronic supplementary material The online version of this article (doi:10.1186/s12931-016-0382-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carla Bellinghausen
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Fahad Gulraiz
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.,Department of Cell Biology and Immunology, University of North Texas Health Science Center (UNT Health Science Center), Fort Worth, TX, USA
| | - Alexandra C A Heinzmann
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Mieke A Dentener
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Paul H M Savelkoul
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.,Department of Medical Microbiology & Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - Emiel F Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Gernot G Rohde
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frank R Stassen
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands. .,, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands.
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72
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Abstract
Antibiotic therapy in patients currently treated with corticosteroids is common in chronic respiratory diseases when exacerbation symptoms attributable to infection appear. Among them, obstructive diseases such as asthma and chronic obstructive pulmonary disease (COPD) are major health issues affecting hundreds of million people worldwide that are frequently treated with inhaled corticosteroids. Systemic corticosteroids are also used for idiopathic pulmonary fibrosis, a less prevalent chronic respiratory disease. In this issue of EMBO Molecular Medicine, Earl et al (2015) report a potentially baleful relationship between steroid and antibiotic treatment in chronic respiratory diseases, affecting colonization persistence and antibiotic tolerance for Haemophilus influenzae, one of the leading potentially pathogenic microorganisms (PPMs) of the respiratory system.
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Affiliation(s)
- Joachim Reidl
- Institute of Molecular Biosciences, University of Graz, Graz, Austria
| | - Eduard Monsó
- Servei de Pneumologia, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain Ciber de Enfermedades Respiratorias - Ciberes Universitat Autònoma de Barcelona, Cerdanyola, Barcelona, Spain
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73
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Liapikou A, Torres A. The clinical management of lower respiratory tract infections. Expert Rev Respir Med 2016; 10:441-452. [PMID: 26894943 DOI: 10.1586/17476348.2016.1156537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The 2010 Global Burden of Disease Study reported that lower respiratory tract infections, including pneumonia, are the fourth most common cause of death globally. The etiology of acute bronchitis and asthma exacerbations is mostly viral and the therapy is symptomatic. Management decisions in community acquired pneumonia regarding site of care, extent of assessment, and level of treatment are based primarily on disease severity (outpatient, inpatient, ICU admission). Antibiotics are the main choice of treatment for patients with pneumonia, acute exacerbations (AE) of COPD (including increased sputum purulence and worsening shortness of breath) and AE of non-CF bronchiectasis. Inhaled antibiotics may represent a more optimal approach for the treatment and prevention of AE of non-CF bronchiectasis. Approved strategies for the prevention of exacerbations include smoking cessation and rehabilitation programs, drug therapy and vaccination.
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Affiliation(s)
| | - Antoni Torres
- b Department of Pneumology, Institut Clinic del Tórax, Institut d'investigacions Biomèdiques August Pi i Sunyer - IDIBAPS , University of Barcelona - UB - Ciber de Enfermedades Respiratorias - CIBERES, Hospital Clinic , Barcelona , Spain
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74
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Du Q, Jin J, Liu X, Sun Y. Bronchiectasis as a Comorbidity of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0150532. [PMID: 26978269 PMCID: PMC4792534 DOI: 10.1371/journal.pone.0150532] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 02/15/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Bronchiectasis revealed by chest computed tomography in COPD patients and its comorbid effect on prognosis have not been addressed by large-sized studies. Understanding the presence of bronchiectasis in COPD is important for future intervention and preventing disease progression. METHODS Observational studies were identified from electronic literature searches in Cochrane library, PubMed, ScienceDirect databases, American Thoracic Society and European Respiratory Society meeting abstracts. A systematic review and meta-analysis of studies was performed to summarize the factors associated with bronchiectasis in COPD patients. Primary outcomes included the risks for exacerbation frequency, isolation of a potentially pathogenic microorganism, severe airway obstruction and mortality. Odds ratios (ORs) were pooled by random effects models. RESULTS Fourteen observational studies were eligible for the study. Compared with COPD without bronchiectasis, comorbid bronchiectasis in COPD increased the risk of exacerbation (1.97, 95% CI, 1.29-3.00), isolation of a potentially pathogenic microorganism (4.11, 95%CI, 2.16-7.82), severe airway obstruction (1.31, 95% CI, 1.09-1.58) and mortality (1.96, 95% CI, 1.04-3.70). CONCLUSIONS The presence of bronchiectasis in patients with COPD was associated with exacerbation frequency, isolation of a potentially pathogenic microorganism, severe airway obstruction and mortality.
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Affiliation(s)
- Qingxia Du
- Department of Respiratory Medicine and Department of Emergency, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Jianmin Jin
- Department of Respiratory Medicine and Department of Emergency, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Xiaofang Liu
- Department of Respiratory Medicine and Department of Emergency, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yongchang Sun
- Department of Respiratory Medicine and Department of Emergency, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, 100191 China
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75
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Fan VS, Gharib SA, Martin TR, Wurfel MM. COPD disease severity and innate immune response to pathogen-associated molecular patterns. Int J Chron Obstruct Pulmon Dis 2016; 11:467-77. [PMID: 27019597 PMCID: PMC4786062 DOI: 10.2147/copd.s94410] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The airways of COPD patients are often colonized with bacteria leading to increased airway inflammation. This study sought to determine whether systemic cytokine responses to microbial pathogen-associated molecular patterns (PAMPs) are increased among subjects with severe COPD. In an observational cross-sectional study of COPD subjects, PAMP-induced cytokine responses were measured in whole blood ex vivo. We used PAMPs derived from microbial products recognized by toll-like receptors 1, 2, 4, 5, 6, 7, and 8. Patterns of cytokine response to PAMPs were assessed using hierarchical clustering. One-sided Student's t-tests were used to compare PAMP-induced cytokine levels in blood from patients with and without severe COPD, and for subjects with and without chronic bronchitis. Of 28 male patients, 12 had moderate COPD (FEV1 50%-80%) and 16 severe COPD (FEV1 <50%); 27 participants provided data on self-reported chronic bronchitis, of which 15 endorsed chronic bronchitis symptoms and 12 did not. Cytokine responses to PAMPs in severe COPD were generally lower than in subjects with milder COPD. This finding was particularly strong for PAMP-induced interleukin (IL)-10, granulocyte colony stimulating factor, and IL-1β. Subjects with chronic bronchitis showed higher PAMP-induced IL-1RA responses to most of the PAMPs evaluated. COPD patients with more severe disease demonstrated a diminished cytokine response to PAMPs, suggesting that chronic colonization with bacteria may dampen the systemic innate immune response.
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Affiliation(s)
- Vincent S Fan
- VA Puget Sound Health Care System, Seattle, WA, USA
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Washington, Seattle WA, USA
| | - Sina A Gharib
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Washington, Seattle WA, USA
- Computational Medicine Core, Center for Lung Biology, University of Washington, Seattle, WA, USA
| | - Thomas R Martin
- VA Puget Sound Health Care System, Seattle, WA, USA
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Washington, Seattle WA, USA
| | - Mark M Wurfel
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Washington, Seattle WA, USA
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76
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D’Anna SE, Balbi B, Cappello F, Carone M, Di Stefano A. Bacterial-viral load and the immune response in stable and exacerbated COPD: significance and therapeutic prospects. Int J Chron Obstruct Pulmon Dis 2016; 11:445-53. [PMID: 27042037 PMCID: PMC4780195 DOI: 10.2147/copd.s93398] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation and an abnormal inflammatory response of the lung. Bacteria and viruses are a major cause of COPD exacerbations and may contribute to COPD progression by perpetuating the inflammatory response in the airways. Bacterial variety diminishes with increasing COPD severity. Respiratory viruses can colonize the lower respiratory tract in stable COPD, altering the respiratory microbiome and facilitating secondary bacterial infections. In this review, we present the most updated information about the role of bacteria and viruses in stable and exacerbated COPD. In our opinion, to optimize therapeutic strategies, the dynamic events involving bacterial-viral infections and related immune response in COPD phenotypes need to be better clarified. Our paper would address these points that we consider of great importance for the clinical management of COPD.
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Affiliation(s)
- Silvestro Ennio D’Anna
- Department of Rehabilitation, Cardiorespiratory Unit, Fondazione Istituto G. Giglio di Cefalù, University of Palermo, Palermo, Italy
| | - Bruno Balbi
- Pneumology Unit and Laboratory of Cytoimmunopathology of Heart and Lung, Fondazione Salvatore Maugeri, IRCCS, Veruno (NO) and Cassano delle Murge (BA), University of Palermo, Palermo, Italy
| | - Francesco Cappello
- Human Anatomy Section, Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
- Euro-Mediterranean Institute of Science and Technology, Palermo, Italy
| | - Mauro Carone
- Pneumology Unit and Laboratory of Cytoimmunopathology of Heart and Lung, Fondazione Salvatore Maugeri, IRCCS, Veruno (NO) and Cassano delle Murge (BA), University of Palermo, Palermo, Italy
| | - Antonino Di Stefano
- Pneumology Unit and Laboratory of Cytoimmunopathology of Heart and Lung, Fondazione Salvatore Maugeri, IRCCS, Veruno (NO) and Cassano delle Murge (BA), University of Palermo, Palermo, Italy
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77
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Ween M, Ahern J, Carroll A, Hodge G, Pizzutto S, Jersmann H, Reynolds P, Hodge S. A small volume technique to examine and compare alveolar macrophage phagocytosis of apoptotic cells and non typeable Haemophilus influenzae (NTHi). J Immunol Methods 2016; 429:7-14. [DOI: 10.1016/j.jim.2015.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/07/2015] [Accepted: 12/07/2015] [Indexed: 12/11/2022]
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78
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Shukla SD, Muller HK, Latham R, Sohal SS, Walters EH. Platelet-activating factor receptor (PAFr) is upregulated in small airways and alveoli of smokers and COPD patients. Respirology 2015; 21:504-10. [PMID: 26662379 DOI: 10.1111/resp.12709] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/01/2015] [Accepted: 10/01/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVE PAFr is a cell adhesion site for specific bacteria, notably non-typeable Haemophilus influenzae (NTHi) and Streptococcus pneumoniae. We previously published that PAFr expression is significantly upregulated in the large airways of smokers, especially in COPD. We have now investigated PAFr expression in the epithelium and Rbm of small airways and in the alveolar compartment in smokers and patients with both COPD and small airway disease. METHODS We evaluated PAFr expression cross-sectionally in resected lung tissue from: eight smokers with normal lung function (NLFS); 10 with smoking-related small airway narrowing only; eight COPD smokers; 10 COPD ex-smokers, and compared these with nine control tissues. Anti-PAFr immunostaining was quantified using computer-aided image analysis. RESULTS Significantly increased PAFr expression in small airway epithelium of all clinical groups was found compared with controls (P < 0.01). Moreover, epithelial PAFr expression was upregulated in COPD smokers compared with NLFS (P < 0.05), but not when compared with COPD ex-smokers or patients with only small airways disease. Smoking history (pack-year) correlated significantly with PAFr expression in the currently smoking individuals, especially in NLFS (r = 0.9; P < 0.002). An increase above normal in PAFr-expressing cells in the airway epithelial Rbm was only significant in COPD smokers (P < 0.007). An upregulation of PAFr-expressing cell in alveolar epithelium was uniformly found in all clinical groups compared with normal control (P < 0.01). CONCLUSION Epithelial PAFr expression is upregulated in small airways and alveoli in smokers and COPD. Increased expression of PAFr could be crucial in facilitating acute and chronic respiratory infection with specific respiratory pathogens.
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Affiliation(s)
- Shakti Dhar Shukla
- NHMRC Centre of Research Excellence for Chronic Respiratory Disease, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Hans Konrad Muller
- NHMRC Centre of Research Excellence for Chronic Respiratory Disease, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Roger Latham
- NHMRC Centre of Research Excellence for Chronic Respiratory Disease, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Sukhwinder Singh Sohal
- NHMRC Centre of Research Excellence for Chronic Respiratory Disease, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.,School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Eugene Haydn Walters
- NHMRC Centre of Research Excellence for Chronic Respiratory Disease, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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79
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Martin C, Burgel PR, Lepage P, Andréjak C, de Blic J, Bourdin A, Brouard J, Chanez P, Dalphin JC, Deslée G, Deschildre A, Gosset P, Touqui L, Dusser D. Host-microbe interactions in distal airways: relevance to chronic airway diseases. Eur Respir Rev 2015; 24:78-91. [PMID: 25726559 PMCID: PMC9487770 DOI: 10.1183/09059180.00011614] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This article is the summary of a workshop, which took place in November 2013, on the roles of microorganisms in chronic respiratory diseases. Until recently, it was assumed that lower airways were sterile in healthy individuals. However, it has long been acknowledged that microorganisms could be identified in distal airway secretions from patients with various respiratory diseases, including cystic fibrosis (CF) and non-CF bronchiectasis, chronic obstructive pulmonary disease, asthma and other chronic airway diseases (e.g. post-transplantation bronchiolitis obliterans). These microorganisms were sometimes considered as infectious agents that triggered host immune responses and contributed to disease onset and/or progression; alternatively, microorganisms were often considered as colonisers, which were considered unlikely to play roles in disease pathophysiology. These concepts were developed at a time when the identification of microorganisms relied on culture-based methods. Importantly, the majority of microorganisms cannot be cultured using conventional methods, and the use of novel culture-independent methods that rely on the identification of microorganism genomes has revealed that healthy distal airways display a complex flora called the airway microbiota. The present article reviews some aspects of current literature on host–microbe (mostly bacteria and viruses) interactions in healthy and diseased airways, with a special focus on distal airways. Understanding host–microbe interactions in distal airways may lead to novel therapies for chronic airway diseaseshttp://ow.ly/HfENz
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Affiliation(s)
- Clémence Martin
- Hôpital Cochin, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pierre-Régis Burgel
- Hôpital Cochin, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Patricia Lepage
- UMR1913-Microbiologie de l'Alimentation au Service de la Santé, l'Institut National de la Recherche Agronomique, Jouy-en-Josas, France
| | - Claire Andréjak
- Respiratory Intensive Care Unit, Centre Hospitalier Universitaire Sud, Amiens, France
| | - Jacques de Blic
- Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
| | - Arnaud Bourdin
- Hôpital Arnaud de Villeneuve, CHU Montpellier, Montpellier, France
| | - Jacques Brouard
- Dept of Pediatrics, CHU de Caen, Research Unit EA 4655 U2RM, Caen, France
| | - Pascal Chanez
- Dépt des Maladies Respiratoires, AP-HM, Laboratoire d'immunologie INSERM CNRS U 1067, UMR 7733, Aix Marseille Université, Marseille, France
| | | | - Gaetan Deslée
- Dept of Pulmonary Medicine, University Hospital of Reims, Reims, France
| | | | - Philippe Gosset
- Unité de défense innée et inflammation, Institut Pasteur, Paris, France INSERM U874, Paris, France
| | - Lhousseine Touqui
- Institut Pasteur de Lille, Centre d'Infection et d'Immunité de Lille, Lille, France
| | - Daniel Dusser
- Hôpital Cochin, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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80
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Boixeda R, Almagro P, Díez-Manglano J, Cabrera FJ, Recio J, Martin-Garrido I, Soriano JB. Bacterial flora in the sputum and comorbidity in patients with acute exacerbations of COPD. Int J Chron Obstruct Pulmon Dis 2015; 10:2581-91. [PMID: 26664106 PMCID: PMC4671781 DOI: 10.2147/copd.s88702] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To determine in patients admitted with an acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) the association between the isolation of potential pathogens in a conventional sputum culture and comorbidities. PATIENTS AND METHODS The ESMI study is a multicenter observational study. Patients with AE-COPD admitted to the Internal Medicine departments of 70 hospitals were included. The clinical characteristics, treatments, and comorbidities were gathered. The results of conventional sputum cultures were recorded. RESULTS A total of 536 patients were included, of which 161 produced valid sputum and a potentially pathogenic microorganism was isolated from 88 subjects (16.4%). The isolation of Pseudomonas aeruginosa (30.7%) was associated with a greater severity of the lung disease (previous admissions [P= 0.026], dyspnea scale [P=0.047], post-broncodilator forced expiratory volume in 1 second (FEV1) [P=0.005], and the BODEx index [P=0.009]); also with higher prevalence of cor pulmonale (P=0.017), heart failure (P=0.048), and cerebrovascular disease (P=0.026). Streptococcus pneumoniae (26.1%) was associated with more comorbidity according to number of diseases (P=0.018); notably, peripheral artery disease (P=0.033), hypertension (P=0.029), dyslipidemia (P=0.039), osteoporosis (P=0.0001), and depression (P=0.005). CONCLUSION Patients with AE-COPD and P. aeruginosa present higher severity of COPD, while those with S. pneumoniae present greater comorbidity. The potentially pathogenic microorganism obtained in the sputum culture depends on the associated comorbidities.
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Affiliation(s)
- Ramon Boixeda
- Internal Medicine Department, Hospital de Mataró – CSDM, Universitat Autònoma de Barcelona, Mataró, Barcelona, Spain
| | - Pere Almagro
- Internal Medicine Department, Hospital Mútua de Terrassa, Terrassa, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Jesús Díez-Manglano
- Internal Medicine Department, Hospital Royo Villanova, Zaragoza, Zaragoza, Spain
| | - Francisco Javier Cabrera
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Jesús Recio
- Internal Medicine Department, Hospital Vall d’Hebrón, Barcelona, Barcelona, Spain
| | | | - Joan B Soriano
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Lindel, Madrid, Spain
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81
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Slack MPE. A review of the role of Haemophilus influenzae in community-acquired pneumonia. Pneumonia (Nathan) 2015; 6:26-43. [PMID: 31641576 PMCID: PMC5922337 DOI: 10.15172/pneu.2015.6/520] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 03/04/2015] [Indexed: 01/01/2023] Open
Abstract
In an era when Haemophilus influenzae type b (Hib) conjugate vaccine is widely used, the incidence of Hib as a cause of community-acquired pneumonia (CAP) has dramatcally declined. Non-typeable H. influenzae (NTHi) strains and, occasionally, other encapsulated serotypes of H. influenzae are now the cause of the majority of invasive H. influenzae infectons, including bacteraemic CAP. NTHi have long been recognised as an important cause of lower respiratory tract infecton, including pneumonia, in adults, especially those with underlying diseases. The role of NTHi as a cause of non-bacteraemic CAP in children is less clear. In this review the evidence for the role of NTHi and capsulated strains of H. influenzae will be examined.
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Affiliation(s)
- Mary P E Slack
- 15Gold Coast Campus, Griffith University, Queensland, Australia.,25Institute of Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
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82
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Ouanes I, Ouanes-Besbes L, Ben Abdallah S, Dachraoui F, Abroug F. Trends in use and impact on outcome of empiric antibiotic therapy and non-invasive ventilation in COPD patients with acute exacerbation. Ann Intensive Care 2015; 5:30. [PMID: 26429357 PMCID: PMC4591222 DOI: 10.1186/s13613-015-0072-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 09/22/2015] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Empiric antibiotic therapy is routinely prescribed in patients with acute COPD exacerbations (AECOPD) requiring ventilatory support on the basis of studies including patients conventionally ventilated. Whether this practice remains valid to current management with first-line non-invasive ventilation (NIV) is unclear. METHODS In a cohort of ICU patients admitted between 2000 and 2012 for AECOPD, we analyzed the trends in empiric antibiotic therapy and in primary ventilatory support strategy, and their respective impact on patients' outcome. RESULTS 440 patients admitted for 552 episodes were included; primary NIV use increased from 29 to 96.7 % (p < 0.001), whereas NIV failure rate decreased significantly (p = 0.004). In parallel, ventilator-associated pneumonia (VAP) rate, VAP density and empiric antibiotic therapy use decreased (p = 0.037, p = 0.002, and p < 0.001, respectively). These figures were associated with a trend toward lower ICU mortality rate (p = 0.058). Logistic regression showed that primary NIV use per se was protective against fatal outcome [odds ratios (OR) = 0.08, 95 %CI 0.03-0.22; p < 0.001], whereas NIV failure, VAP occurrence, and cardiovascular comorbidities were associated with increased ICU mortality [OR = 17.6 (95 %CI 5.29-58.93), 11.5 (95 %CI 5.17-25.45), and 3 (95 %CI 1.37-6.63), respectively]. Empiric antibiotic therapy was associated with decreased VAP rate (log rank; p < 0.001), but had no effect on mortality (log rank; p = 0.793). CONCLUSIONS The sustained increase in NIV use allowed a decrease in empiric antibiotic prescriptions in AECOPD requiring ventilatory support. Primary NIV use and its success, but not empiric antibiotic therapy, were associated with a favorable impact on patients' outcome.
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Affiliation(s)
- Islem Ouanes
- Intensive Care Unit, Fattouma Bourguiba University Hospital, Rue 1er juin, 5000, Monastir, Tunisia. .,Laboratoire de Recherche (LR12SP15), University of Monastir, Monastir, Tunisia.
| | - Lamia Ouanes-Besbes
- Intensive Care Unit, Fattouma Bourguiba University Hospital, Rue 1er juin, 5000, Monastir, Tunisia. .,Laboratoire de Recherche (LR12SP15), University of Monastir, Monastir, Tunisia.
| | - Saoussen Ben Abdallah
- Intensive Care Unit, Fattouma Bourguiba University Hospital, Rue 1er juin, 5000, Monastir, Tunisia. .,Laboratoire de Recherche (LR12SP15), University of Monastir, Monastir, Tunisia.
| | - Fahmi Dachraoui
- Intensive Care Unit, Fattouma Bourguiba University Hospital, Rue 1er juin, 5000, Monastir, Tunisia. .,Laboratoire de Recherche (LR12SP15), University of Monastir, Monastir, Tunisia.
| | - Fekri Abroug
- Intensive Care Unit, Fattouma Bourguiba University Hospital, Rue 1er juin, 5000, Monastir, Tunisia. .,Laboratoire de Recherche (LR12SP15), University of Monastir, Monastir, Tunisia.
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83
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Sobhy KE, Abd El-Hafeez AM, Shoukry FA, Refaai ES. Pattern of sputum bacteriology in acute exacerbations of chronic obstructive pulmonary disease. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2015. [DOI: 10.4103/1687-8426.158065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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84
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Titova E, Aune MW, Fonn K, Henriksen AH, Åsberg A. Neutrophil CD64 Expression as a Diagnostic Marker in Patients Hospitalized with Exacerbations of COPD: A Prospective Observational Study. Lung 2015; 193:717-24. [PMID: 26174093 DOI: 10.1007/s00408-015-9762-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/01/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE The expression of the neutrophil high-affinity Fc-gamma receptor (CD64) can be used as a diagnostic marker for bacterial infection and sepsis. The aims of this study were to determine the diagnostic accuracy of CD64 compared to C-reactive protein (CRP) and white blood cell count (WBC) in patients hospitalized with acute exacerbations of COPD (AECOPD) and to investigate the kinetics of CD64 expression. METHODS The present study is a prospective, single-centre observation study. Blood samples were collected from patients hospitalized with AECOPD at admission and after 6, 24 and 48 h. Retrospective reviews on the patients' medical records were performed blinded to the CD64 results. The CD64 was measured using the Leuko64 kit from Trillium Diagnostics, LLC (Maine, USA) with the CELL-DYN Sapphire Haematology System (Abbott Laboratories, Illinois, USA). Diagnostic accuracy of the CD64, CRP and WBC was compared using a receiver operating characteristic (ROC) curve analysis. RESULTS A total of 113 patients were included. Thirty-six patients (32 %) had pulmonary infiltrate on chest X-ray at admission (PI). The CD64 was higher in samples from patients with AECOPD and PI than those without PI at admission (median 1.25 vs. 0.60, p = 0.002) and during 48 h of follow-up. The area under the ROC curve of CD64, CRP and WBC was 0.69, 0.73 and 0.64, respectively, (p = 0.42 for the test of difference). CONCLUSION Neutrophil CD64 expression has about the same diagnostic accuracy as CRP in diagnosing pneumonia in patients hospitalized with AECOPD, but does not add to the diagnostic accuracy of CRP and WBC count.
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Affiliation(s)
- Elena Titova
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, 7006, Trondheim, Norway. .,Department of Thoracic Medicine, Trondheim University Hospital, 7006, Trondheim, Norway.
| | - Marthe Wedø Aune
- Department of Immunology and Transfusion Medicine, Trondheim University Hospital, 7006, Trondheim, Norway.
| | - Kristin Fonn
- Department of Immunology and Transfusion Medicine, Trondheim University Hospital, 7006, Trondheim, Norway.
| | - Anne Hildur Henriksen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, 7006, Trondheim, Norway. .,Department of Thoracic Medicine, Trondheim University Hospital, 7006, Trondheim, Norway.
| | - Arne Åsberg
- Department of Clinical Chemistry, Trondheim University Hospital, Trondheim, 7006, Norway.
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85
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Mao B, Lu HW, Li MH, Fan LC, Yang JW, Miao XY, Xu JF. The existence of bronchiectasis predicts worse prognosis in patients with COPD. Sci Rep 2015; 5:10961. [PMID: 26077673 PMCID: PMC4468518 DOI: 10.1038/srep10961] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/06/2015] [Indexed: 11/13/2022] Open
Abstract
Bronchiectasis is prevalent in patients with COPD. The objective of this study was to assess the clinical characteristics and prognostic value of bronchiectasis in patients with COPD in China. Data from patients diagnosed with COPD at the Shanghai Pulmonary Hospital between January 2009 and December 2013 were retrospectively collected and analyzed. SPSS statistical software was used to analyze the data. Data from 896 patients with COPD were analyzed. Bronchiectasis was present in 311 patients. The isolation of pseudomonas aeruginosa (PA) from sputum was the variable most significantly associated with the presence of bronchiectasis in patients with COPD (hazard ratio (HR), 2.93; 95% confidence interval (CI), 1.35–6.37; P = 0.007). During follow-up (median of 21 months; interquartile range: 10-39 months), there were 75 deaths, of which 39 were in the bronchiectasis group. The presence of bronchiectasis (HR, 1.77; 95% CI, 1.02–3.08; P = 0.043) was associated with an increase in all-cause mortality in patients with COPD. These results suggest that bronchiectasis in patients with COPD was associated with the isolation of PA from the sputum. Bronchiectasis was an independent risk factor for all-cause mortality in patients with COPD.
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Affiliation(s)
- Bei Mao
- 1] Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, China [2] Soochow University, Suzhou, China
| | - Hai-Wen Lu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, China
| | - Man-Hui Li
- 1] Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, China [2] Soochow University, Suzhou, China
| | - Li-Chao Fan
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, China
| | - Jia-Wei Yang
- 1] Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, China [2] Soochow University, Suzhou, China
| | - Xia-Yi Miao
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, China
| | - Jin-Fu Xu
- 1] Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, China [2] Soochow University, Suzhou, China
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86
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King PT, Sharma R. The Lung Immune Response to Nontypeable Haemophilus influenzae (Lung Immunity to NTHi). J Immunol Res 2015; 2015:706376. [PMID: 26114124 PMCID: PMC4465770 DOI: 10.1155/2015/706376] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 05/12/2015] [Accepted: 05/13/2015] [Indexed: 11/18/2022] Open
Abstract
Haemophilus influenzae is divided into typeable or nontypeable strains based on the presence or absence of a polysaccharide capsule. The typeable strains (such as type b) are an important cause of systemic infection, whilst the nontypeable strains (designated as NTHi) are predominantly respiratory mucosal pathogens. NTHi is present as part of the normal microbiome in the nasopharynx, from where it may spread down to the lower respiratory tract. In this context it is no longer a commensal and becomes an important respiratory pathogen associated with a range of common conditions including bronchitis, bronchiectasis, pneumonia, and particularly chronic obstructive pulmonary disease. NTHi induces a strong inflammatory response in the respiratory tract with activation of immune responses, which often fail to clear the bacteria from the lung. This results in recurrent/persistent infection and chronic inflammation with consequent lung pathology. This review will summarise the current literature about the lung immune response to nontypeable Haemophilus influenzae, a topic that has important implications for patient management.
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Affiliation(s)
- Paul T. King
- Monash Lung and Sleep, Monash Medical Centre, Melbourne, VIC 3168, Australia
- Monash University Department of Medicine, Monash Medical Centre, Melbourne, VIC 3168, Australia
| | - Roleen Sharma
- Monash Lung and Sleep, Monash Medical Centre, Melbourne, VIC 3168, Australia
- Monash University Department of Medicine, Monash Medical Centre, Melbourne, VIC 3168, Australia
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87
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Yang YM, Guo YF, Zhang HS, Sun TY. Antimicrobial peptide LL-37 circulating levels in chronic obstructive pulmonary disease patients with high risk of frequent exacerbations. J Thorac Dis 2015; 7:740-5. [PMID: 25973241 DOI: 10.3978/j.issn.2072-1439.2015.04.33] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 12/04/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Exacerbations of chronic obstructive pulmonary disease (COPD) increase the decline in lung function, deterioration in health status and risk of death. The assessment of exacerbation risk is important in the grading of COPD. The most common cause of COPD exacerbation is respiratory tract infection. The only known human cathelicidin antimicrobial peptide, LL-37, play an important role in innate defense against infection. Its gene expression is regulated by the bioactive form of vitamin D. The objective of the present study was to explore the relationship between LL-37 plasma levels, vitamin D status and exacerbation risk in patients with COPD. METHODS COPD patients and normal subjects were recruited from Beijing Hospital for this study. COPD patients were divided into low risk group and high risk group according to the criteria of GOLD strategy. The plasma concentrations of LL-37 were measured by ELISA technique to explore the difference in LL-37 levels between groups. The plasma levels of 25-hydroxy vitamin D [25(OH)D] were analyzed using electrochemiluminescence immunoassay (ECLIA). RESULTS A total of 84 COPD patients and 51 normal subjects (control group) were recruited. COPD patients were divided into low risk group (37 cases) and high risk group (47 cases), depending on forced expiratory volume in one second (FEV1)%pred and exacerbation frequency in the previous year. The plasma concentrations of LL-37 in control group, low risk group and high risk group were 20.7±5.8, 19.5±4.1 and 17.9±3.9 µg/L respectively. The plasma concentration of LL-37 was significantly lower in high risk group than in control group (P=0.006). But there was no significant difference between low risk group and high risk group (P=0.152). The plasma concentrations of 25(OH)D in control group, low risk group and high risk group were 18.1±9.4, 13.1±6.9 and 9.3±5.8 ng/mL respectively. The plasma concentration of 25(OH)D was significantly higher in control group than in low risk group (P=0.004) or high risk group (P<0.001). The plasma concentration of 25(OH)D was significantly lower in high risk group than in low risk group (P=0.031). Hospitalization frequency for COPD exacerbations was negative correlated with plasma levels of LL-37 (r=-0.290, P=0.048) and 25(OH)D (r=-0.341, P=0.020) in high risk group. There was not significant correlation between LL-37 and 25(OH)D in COPD patients (r=0.115, P=0.303). CONCLUSIONS The plasma levels of LL-37 and 25(OH)D were lower in COPD patients with high risk of frequent exacerbations than normal subjects. Low plasma levels of LL-37 and 25(OH)D might be predictors of exacerbation risk in COPD patients.
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Affiliation(s)
- Yi-Meng Yang
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, Beijing 100730, China
| | - Yan-Fei Guo
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, Beijing 100730, China
| | - Hong-Sheng Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, Beijing 100730, China
| | - Tie-Ying Sun
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, Beijing 100730, China
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88
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Inhaled antimicrobial therapy – Barriers to effective treatment. Adv Drug Deliv Rev 2015; 85:24-43. [DOI: 10.1016/j.addr.2014.08.013] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/20/2014] [Accepted: 08/25/2014] [Indexed: 02/08/2023]
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89
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McGarry Houghton A. Matrix metalloproteinases in destructive lung disease. Matrix Biol 2015; 44-46:167-74. [DOI: 10.1016/j.matbio.2015.02.002] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 02/05/2015] [Accepted: 02/06/2015] [Indexed: 01/09/2023]
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90
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Påhlman LI, Jögi A, Gram M, Mori M, Egesten A. Hypoxia down-regulates expression of secretory leukocyte protease inhibitor in bronchial epithelial cells via TGF-β1. BMC Pulm Med 2015; 15:19. [PMID: 25851169 PMCID: PMC4379733 DOI: 10.1186/s12890-015-0016-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/20/2015] [Indexed: 11/10/2022] Open
Abstract
Background Secretory leukocyte protease inhibitor (SLPI) is a protein with anti-protease and antimicrobial properties that is constitutively secreted from the airway epithelium. The importance of maintaining a balance between proteases and anti-proteases, and robust innate defence mechanisms in the airways, is exemplified by inflammatory lung conditions such as chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF). Both conditions present with a high protease burden in the airways which leads to tissue destruction. These patients also have an impaired innate immune system in the lungs with bacterial colonization and frequent airway infections. Moreover, both diseases are associated with airway hypoxia due to inflammation and mucus plugs. The aim of the present study was to investigate the role of hypoxia on SLPI production from the airway epithelium. Methods Primary human bronchial epithelial cells were grown in sub-immersed cultures or as differentiated epithelium in air liquid interface cultures. Cells were incubated at 21% O2 (normoxia) or 1% O2 (hypoxia), and the release of SLPI was analysed with ELISA. RT-PCR was used to study the expression of SLPI and transforming growth factor β1 (TGF-β1). Results Hypoxia decreased the constitutive production of SLPI by bronchial epithelial cells. The multifunctional cytokine TGF-β1, which is known to affect SLPI expression, showed increased expression in hypoxic bronchial epithelial cells. When bronchial epithelial cells were exposed to exogenous TGF-β1 during normoxia, the SLPI production was down-regulated. Addition of TGF-β1-neutralizing antibodies partially restored SLPI production during hypoxia, showing that TGF-β1 is an important regulator of SLPI during hypoxic conditions. Conclusions The mechanism described here adds to our knowledge of the pathogenesis of severe pulmonary diseases associated with hypoxia, e.g. COPD and CF. The hypoxic down-regulation of SLPI may help explain the protease/anti-protease imbalance associated with these conditions and vulnerability to airway infections. Furthermore, it provides an interesting target for the treatment and prevention of exacerbation in these patients. Electronic supplementary material The online version of this article (doi:10.1186/s12890-015-0016-0) contains supplementary material, which is available to authorized users.
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91
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Segal LN, Weiden MD, Horowitz HW. Acute Exacerbations of Chronic Obstructive Pulmonary Disease. MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7152150 DOI: 10.1016/b978-1-4557-4801-3.00067-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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92
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Identification of airway bacterial colonization by an electronic nose in Chronic Obstructive Pulmonary Disease. Respir Med 2014; 108:1608-14. [DOI: 10.1016/j.rmed.2014.09.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/03/2014] [Accepted: 09/10/2014] [Indexed: 11/22/2022]
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93
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Understanding nontypeable Haemophilus influenzae and chronic obstructive pulmonary disease. Curr Opin Pulm Med 2014; 20:159-64. [PMID: 24441573 DOI: 10.1097/mcp.0000000000000023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Bacteria are frequently implicated in acute exacerbations of chronic obstructive pulmonary disease (COPD), but their influence on airway inflammation remains unclear. This review will focus on nontypeable Haemophilus influenzae (NTHi), its impact on host immune responses, and the potential for vaccination strategies in COPD. RECENT FINDINGS NTHi is associated with impaired immune function in patients with COPD. Features of the bacterium itself potentiate its ability to colonize the lower airways. An imbalance between bacterial load and host immunity may lend itself to the development of exacerbations. Oral immunotherapy may be a method of augmenting the host immune response and could provide protection from exacerbations. SUMMARY A causal link between NTHi and COPD exacerbations has not been clearly established. However, colonization of the lower airways by NTHi likely plays a significant role in the inflammatory state of COPD.
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94
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Finney LJ, Ritchie A, Pollard E, Johnston SL, Mallia P. Lower airway colonization and inflammatory response in COPD: a focus on Haemophilus influenzae. Int J Chron Obstruct Pulmon Dis 2014; 9:1119-32. [PMID: 25342897 DOI: 10.2147/copd.s54477] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Bacterial infection of the lower respiratory tract in chronic obstructive pulmonary disease (COPD) patients is common both in stable patients and during acute exacerbations. The most frequent bacteria detected in COPD patients is Haemophilus influenzae, and it appears this organism is uniquely adapted to exploit immune deficiencies associated with COPD and to establish persistent infection in the lower respiratory tract. The presence of bacteria in the lower respiratory tract in stable COPD is termed colonization; however, there is increasing evidence that this is not an innocuous phenomenon but is associated with airway inflammation, increased symptoms, and increased risk for exacerbations. In this review, we discuss host immunity that offers protection against H. influenzae and how disturbance of these mechanisms, combined with pathogen mechanisms of immune evasion, promote persistence of H. influenzae in the lower airways in COPD. In addition, we examine the role of H. influenzae in COPD exacerbations, as well as interactions between H. influenzae and respiratory virus infections, and review the role of treatments and their effect on COPD outcomes. This review focuses predominantly on data derived from human studies but will refer to animal studies where they contribute to understanding the disease in humans.
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Affiliation(s)
- Lydia J Finney
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Andrew Ritchie
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | - Sebastian L Johnston
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Patrick Mallia
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
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95
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Fruchter O, Rosengarten D, Goldberg E, Ben-Zvi H, Tor R, Kramer MR. Airway bacterial colonization and serum C-reactive protein are associated with chronic obstructive pulmonary disease exacerbation following bronchoscopic lung volume reduction. CLINICAL RESPIRATORY JOURNAL 2014; 10:239-45. [PMID: 25196428 DOI: 10.1111/crj.12211] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 08/05/2014] [Accepted: 08/27/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Stable chronic obstructive pulmonary disease (COPD) patients often have lower airway bacterial colonization (ABC) which may modulate exacerbation frequency. Data regarding the association between ABC and post-procedural COPD exacerbations following bronchoscopic lung volume reduction (BLVR) are scant. OBJECTIVES Our aim was to explore the correlation among ABC, serum C-reactive protein (CRP) level and the risk of COPD exacerbation within a month following BLVR. METHODS Pre-procedure bronchoalveolar lavage (BAL) quantitative bacterial cultures and serum levels of CRP were evaluated in severe COPD patients (N = 70, mean FEV1 = 34.6%) before BLVR by polymeric lung sealant. RESULTS Colonization with potential pathogenic microorganism (PPM) was observed in 40 (57.1%) patients. Out of 28 patients (40%) who had COPD exacerbation within 30 days of BLVR, 23 (82.1%) had PPM in BAL culture compared with only 14 (33.3%) out of 42 patients who had uneventful procedure (P = 0.0027). Serum CRP level was significantly higher in patients with exacerbation compared with those with no exacerbation (mean 47.8 ± 66.0 mg/L vs 13.05 ± 27.7 mg/L, respectively, P = 0.0063). The combination of CRP level above 3.12 mg/L and PPM growth in BAL was observed in 89.2% of patients with exacerbation compared with only 52.3% of patients without exacerbation (P = 0.0031). CONCLUSIONS ABC is common in severe COPD patients undergoing BLVR, and along with elevated CRP level both are associated with high risk of immediate post-procedural COPD exacerbation. These patients should be identified, carefully observed and possibly benefit from prophylactic microbiologically directed antibiotic treatment.
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Affiliation(s)
- Oren Fruchter
- Pulmonary Institute, Rabin Medical Center, Petah Tikva, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Dror Rosengarten
- Pulmonary Institute, Rabin Medical Center, Petah Tikva, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Elad Goldberg
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Internal Medicine, Rabin Medical Center, Petah Tikva, Israel
| | - Haim Ben-Zvi
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Medical Laboratory, Rabin Medical Center, Petah Tikva, Israel
| | - Ruth Tor
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Medical Laboratory, Rabin Medical Center, Petah Tikva, Israel
| | - Mordechai R Kramer
- Pulmonary Institute, Rabin Medical Center, Petah Tikva, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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96
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Aydemir Y, Aydemir Ö, Kalem F. Relationship between the GOLD combined COPD assessment staging system and bacterial isolation. Int J Chron Obstruct Pulmon Dis 2014; 9:1045-51. [PMID: 25298733 PMCID: PMC4186572 DOI: 10.2147/copd.s70620] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Acute exacerbations, which are a significant cause of mortality and morbidity, adversely affect chronic obstructive pulmonary disease (COPD) prognosis by accelerating loss of lung function. It is important to know the microorganisms that commonly cause exacerbations in the patient groups classified according to clinical and functional characteristics for fast and accurate treatment of acute exacerbations. Objectives The last Global Initiative for Chronic Obstructive Lung Disease (GOLD) publication recommended a new staging system containing obstruction degree, frequency of exacerbations, and quality of life questionnaires. This study is designed to analyze the relationship between the bacteria isolated in acute exacerbations and new GOLD stages. Methods Potentially pathogenic bacteria (PPB) isolation with culture and polymerase chain reaction methods were obtained from 114 acute exacerbation COPD patients, classified into A, B, C, and D groups by analyzing the forced expiratory volume in 1 second (FEV1) value, COPD Assessment Test (CAT) score, and exacerbation frequency according to the new GOLD staging system. Results There was a significant correlation between exacerbation frequency and PPB isolation (P=0.002). There was no relationship between GOLD stage, FEV1, and CAT score with PPB isolation. The isolated bacteria diversity and mixed infection frequency were higher in the GOLD stage D group. Pseudomonas aeruginosa, Escherichia coli, and Acinetobacter baumannii were isolated only from D group patients. Conclusion Bacterial infection may cause an acute exacerbation equally in each stage for COPD. The difference in bacterial etiology is more related to exacerbation frequency than FEV1 and CAT scores for an acute exacerbation. Determining exacerbation frequency is significant for treatment success in empirical antibiotic selection.
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Affiliation(s)
- Yusuf Aydemir
- Department of Respiratory Medicine, Sakarya University, Sakarya, Turkey
| | - Özlem Aydemir
- Department of Microbiology, Sakarya University, Sakarya, Turkey
| | - Fatma Kalem
- Department of Microbiology, Konya Numune Hospital, Konya, Turkey
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97
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Singh R, Mackay AJ, Patel AR, Garcha DS, Kowlessar BS, Brill SE, Donnelly LE, Barnes PJ, Donaldson GC, Wedzicha JA. Inflammatory thresholds and the species-specific effects of colonising bacteria in stable chronic obstructive pulmonary disease. Respir Res 2014; 15:114. [PMID: 25218165 PMCID: PMC4173051 DOI: 10.1186/s12931-014-0114-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 09/02/2014] [Indexed: 12/04/2022] Open
Abstract
Background There has been increasing interest in the use of newer, culture-independent techniques to study the airway microbiome of COPD patients. We investigated the relationships between the three common potentially pathogenic microorganisms (PPMs) Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis, as detected by quantitative PCR (qPCR), and inflammation and health status in stable patients in the London COPD cohort. Methods We prospectively collected sputum, serum and plasma samples for analysis of airway bacterial presence and load, and airway and systemic inflammation from 99 stable COPD patients between January 2011 and October 2012. Health status was measured with St George’s Respiratory Questionnaire and COPD Assessment Test. Results Airway inflammation and plasma fibrinogen, but not C-reactive protein, were greater in samples with PPM detection (p < 0.001, p = 0.049 and p = 0.261, respectively). Increasing total bacterial load was associated with increasing airway (p < 0.01) but not systemic inflammation (p > 0.05). Samples with high total bacterial loads had significantly higher airway inflammation than both samples without PPM detection and those with lower loads. Haemophilus influenzae presence was associated with significantly higher levels of airway but not systemic inflammation for all given pathogen loads (p < 0.05), and was significantly greater than with other PPMs. No association was observed between inflammation and health status (p > 0.05). Conclusions Airway and systemic inflammation, as measured by fibrinogen, is greater in stable COPD patients with PPMs detected using the culture-independent qPCR technique. The airway, but not systemic inflammatory response, appears to have a total pathogen-load threshold and appears attributable to Haemophilus influenzae. However, discordance between inflammation and health status was observed. Electronic supplementary material The online version of this article (doi:10.1186/s12931-014-0114-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Richa Singh
- Airway Disease Section, National Heart and Lung Institute, Imperial College, Dovehouse Street, London SW3 6LR, UK.
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98
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Liapikou A, Adamantia L, Torres A, Torres A. Pharmacotherapy for lower respiratory tract infections. Expert Opin Pharmacother 2014; 15:2307-18. [PMID: 25216725 DOI: 10.1517/14656566.2014.959927] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Bacterial infections play an important role as etiological agents in acute exacerbations of chronic obstructive pulmonary disease (AECOPD), and exacerbations of non-cystic fibrosis (CF) bronchiectasis. In acute bronchitis and asthma exacerbations their role is less well defined than with patients with COPD. The clinical features, causative pathogens and therapies of common acute respiratory tract infections are detailed in this review. AREAS COVERED This article covers medical literature published in any language from 2000 to 2014, on 'lower respiratory tract infections', identified using PubMed, MEDLINE and ClinicalTrial.gov. The search terms used were 'COPD exacerbations', 'bronchiectasis', 'macrolides' and 'inhaled antibiotics'. EXPERT OPINION Given that almost half of AECOPD are caused by bacteria, administration of antibacterial agents is recommended for patients with severe exacerbations or severe underlying COPD. Chronic prophylactic use of macrolides seems to be of benefit, particularly in patients with bronchiectasis and chronic mucous hypersecretion. In an effort to manage chronic airway infection non-CF bronchiectasis due to drug-resistant pathogens, aerosolized antibiotics may be of value, and the data from recent studies are examined to demonstrate the potential value of this therapy, which is often used as an adjunctive measure to systemic antimicrobial therapy.
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Affiliation(s)
| | - Liapikou Adamantia
- Sotiria Hospital, 6th Respiratory Department , Mesogion 152, 11527, Athens , Greece +30 2107763458 ;
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99
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Huang YJ, Sethi S, Murphy T, Nariya S, Boushey HA, Lynch SV. Airway microbiome dynamics in exacerbations of chronic obstructive pulmonary disease. J Clin Microbiol 2014; 52:2813-23. [PMID: 24850358 PMCID: PMC4136157 DOI: 10.1128/jcm.00035-14] [Citation(s) in RCA: 226] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Specific bacterial species are implicated in the pathogenesis of exacerbations of chronic obstructive pulmonary disease (COPD). However, recent studies of clinically stable COPD patients have demonstrated a greater diversity of airway microbiota, whose role in acute exacerbations is unclear. In this study, temporal changes in the airway microbiome before, at the onset of, and after an acute exacerbation were examined in 60 sputum samples collected from subjects enrolled in a longitudinal study of bacterial infection in COPD. Microbiome composition and predicted functions were examined using 16S rRNA-based culture-independent profiling methods. Shifts in the abundance (≥ 2-fold, P < 0.05) of many taxa at exacerbation and after treatment were observed. Microbiota members that were increased at exacerbation were primarily of the Proteobacteria phylum, including nontypical COPD pathogens. Changes in the bacterial composition after treatment for an exacerbation differed significantly among the therapy regimens clinically prescribed (antibiotics only, oral corticosteroids only, or both). Treatment with antibiotics alone primarily decreased the abundance of Proteobacteria, with the prolonged suppression of some microbiota members being observed. In contrast, treatment with corticosteroids alone led to enrichment for Proteobacteria and members of other phyla. Predicted metagenomes of particular microbiota members involved in these compositional shifts indicated exacerbation-associated loss of functions involved in the synthesis of antimicrobial and anti-inflammatory products, alongside enrichment in functions related to pathogen-elicited inflammation. These trends reversed upon clinical recovery. Further larger studies will be necessary to determine whether specific compositional or functional changes detected in the airway microbiome could be useful indicators of exacerbation development or outcome.
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Affiliation(s)
- Yvonne J Huang
- Division of Pulmonary/Critical Care/Allergy/Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Sanjay Sethi
- Division of Pulmonary/Critical Care/Sleep Medicine, Veterans Western New York Health System, Buffalo, New York, USA Department of Medicine, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Timothy Murphy
- Department of Medicine, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Snehal Nariya
- Division of Pulmonary/Critical Care/Allergy/Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Homer A Boushey
- Division of Pulmonary/Critical Care/Allergy/Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Susan V Lynch
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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100
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Millares L, Ferrari R, Gallego M, Garcia-Nuñez M, Pérez-Brocal V, Espasa M, Pomares X, Monton C, Moya A, Monsó E. Bronchial microbiome of severe COPD patients colonised by Pseudomonas aeruginosa. Eur J Clin Microbiol Infect Dis 2014; 33:1101-11. [PMID: 24449346 PMCID: PMC4042013 DOI: 10.1007/s10096-013-2044-0] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 12/20/2013] [Indexed: 02/07/2023]
Abstract
The bronchial microbiome in severe COPD during stability and exacerbation in patients chronically colonised by Pseudomonas aeruginosa (PA), has not been defined. Our objective was to determine the characteristics of the bronchial microbiome of severe COPD patients colonised and not colonised by P. aeruginosa and its changes during exacerbation. COPD patients with severe disease and frequent exacerbations were categorised according to chronic colonisation by P. aeruginosa. Sputum samples were obtained in stability and exacerbation, cultured, and analysed by 16S rRNA gene amplification and pyrosequencing. Sixteen patients were included, 5 of them showing chronic colonisation by P. aeruginosa. Pseudomonas genus had significantly higher relative abundance in stable colonised patients (p = 0.019), but no significant differences in biodiversity parameters were found between the two groups (Shannon, 3 (2-4) vs 3 (2-3), p = 0.699; Chao1, 124 (77-159) vs 140 (115-163), p = 0.364). In PA-colonised patients bronchial microbiome changed to a microbiome similar to non-PA-colonised patients during exacerbations. An increase in the relative abundance over 20 % during exacerbation was found for Streptococcus, Pseudomonas, Moraxella, Haemophilus, Neisseria, Achromobacter and Corynebacterium genera, which include recognised potentially pathogenic microorganisms, in 13 patients colonised and not colonised by P. aeruginosa with paired samples. These increases were not identified by culture in 5 out of 13 participants (38.5 %). Stable COPD patients with severe disease and PA-colonised showed a similar biodiversity to non-PA-colonised patients, with a higher relative abundance of Pseudomonas genus in bronchial secretions. Exacerbation in severe COPD patients showed the same microbial pattern, independently of previous colonisation by P. aeruginosa.
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Affiliation(s)
- L. Millares
- Fundació Parc Taulí, Sabadell, Spain
- CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Spain
- Universitat Autònoma de Barcelona, Esfera UAB, Barcelona, Spain
- Fundació Institut d’Investigació Germans Trias i Pujol, Badalona, Spain
| | - R. Ferrari
- Genomics and Health Area, Centro Superior de Investigación en Salud Pública—Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (CSISP-FISABIO), Valencia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Department of Genetics, Institut Cavanilles de Biodiversitat i Biologia Evolutiva, (ICBiBE) Universitat de València, Valencia, Spain
| | - M. Gallego
- CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Spain
- Department of Respiratory Medicine, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - M. Garcia-Nuñez
- Fundació Parc Taulí, Sabadell, Spain
- CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Spain
- Fundació Institut d’Investigació Germans Trias i Pujol, Badalona, Spain
| | - V. Pérez-Brocal
- Genomics and Health Area, Centro Superior de Investigación en Salud Pública—Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (CSISP-FISABIO), Valencia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Department of Genetics, Institut Cavanilles de Biodiversitat i Biologia Evolutiva, (ICBiBE) Universitat de València, Valencia, Spain
| | - M. Espasa
- Department of Microbiology, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - X. Pomares
- Department of Respiratory Medicine, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - C. Monton
- Department of Respiratory Medicine, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - A. Moya
- Genomics and Health Area, Centro Superior de Investigación en Salud Pública—Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (CSISP-FISABIO), Valencia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Department of Genetics, Institut Cavanilles de Biodiversitat i Biologia Evolutiva, (ICBiBE) Universitat de València, Valencia, Spain
| | - E. Monsó
- CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Spain
- Universitat Autònoma de Barcelona, Esfera UAB, Barcelona, Spain
- Department of Respiratory Medicine, Hospital Universitari Parc Taulí, Sabadell, Spain
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