Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 May;14(4):495-503.
doi: 10.1111/j.1440-1843.2009.01517.x.

Airway inflammation and anti-protease defences rapidly improve during treatment of an acute exacerbation of COPD

Sushil Pant  1 , Eugene H Walters, Anne Griffiths, Richard Wood-Baker, David P Johns, David W Reid
Affiliations

Airway inflammation and anti-protease defences rapidly improve during treatment of an acute exacerbation of COPD

Sushil Pant et al. Respirology. 2009 May.

Abstract

Background and objective: There are few data on the short-term natural history of airway inflammation during severe episodes of acute exacerbation of COPD (AECOPD). An observational study was performed to determine how rapidly conventional treatment improves airway inflammation in patients admitted to hospital with AECOPD.

Methods: Twenty-four consecutive patients with AECOPD were recruited and changes in sputum inflammatory indices were assessed after 2 and 4 days of treatment. The primary end-points included presence of bacteria and viruses, changes in sputum total cell counts (TCC) and polymorphonuclear leukocyte (PMN) differential counts, and levels of secretory leukocyte protease inhibitor (SLPI), IL-8 and TNF-alpha.

Results: All patients received oral corticosteroids and 17 (71%) were also treated with oral antibiotics. A bacterial or viral pathogen was isolated from 12 patients (50%), and Aspergillus fumigatus was isolated from one. A positive bacterial culture was associated with increased sputum TCC and PMN count (P < 0.05), as well as higher levels of IL-8 and TNF-alpha (P < 0.05), and a trend towards lower sputum SLPI levels (P = 0.06). Sputum PMN numbers fell by 70% within the first 48 h of admission (P < 0.05), accompanied by an increase in sputum SLPI (P < 0.001) and reductions in the levels of TNF-alpha (P < 0.005) and IL-8 (P = 0.06), with no further significant change at 4 days.

Conclusions: Conventional treatment for severe AECOPD is associated with rapid reduction of neutrophilic inflammation and improvement in anti-protease defences.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Changes in sputum absolute neutrophil numbers over the surveillance period. P values indicate the significance of changes between baseline and 48 h and between 48 and 96 h. For clarity of presentation log transformed data are shown.
Figure 2
Figure 2
Changes in sputum secretory leukocyte protease inhibitor (SLPI) levels over the surveillance period. For clarity of presentation log transformed data are shown.
Figure 3
Figure 3
Changes in total symptom scores over the surveillance period.
See this image and copyright information in PMC

References

    1. Delmastro M, Balbi B. Acute exacerbations of COPD: is inflammation central to prevention and treatment strategies? Monaldi Arch. Chest Dis. 2002; 57: 293–6. - PubMed
    1. Aaron SD, Angel JB, Lunau M, Wright K, Fex C et al. Granulocyte inflammatory markers and airway infection during acute exacerbation of chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2001; 163: 349–55. - PubMed
    1. Crooks SW, Bayley DL, Hill SL, Stockley RA. Bronchial inflammation in acute bacterial exacerbations of chronic bronchitis: the role of leukotriene B4. Eur. Respir. J. 2000; 15: 274–80. - PubMed
    1. Mercer PF, Shute JK, Bhowmik A, Donaldson GC, Wedzicha JA et al. MMP‐9, TIMP‐1 and inflammatory cells in sputum from COPD patients during exacerbation. Respir. Res. 2005; 6: 151. - PMC - PubMed
    1. Stockley RA, O'Brien C, Pye A, Hill SL. Relationship of sputum color to nature and outpatient management of acute exacerbations of COPD. Chest 2000; 117: 1638–45. - PubMed

MeSH terms

Substances