[Protected bacteriologic brushing in patients with severe copd]

Abstract

To determine the presence of germs and their concentration in a group of patients with severe chronic obstructive pulmonary disease (COPD) (FEV1 < 50%), some of whom were in stable condition and others of whom were in acute phase. Twenty-six patients with severe COPD (14 stable and 12 acute phase) were enrolled. None had received prior antibiotic or corticoid treatment. The stable patients had no signs or symptoms of exacerbation, whereas the acute-phase patients had increased dyspnea, sputum volume and purulence. The patients received aerosol rather than liquid anesthesia when PSB sampling was performed. A PSB finding was considered positive at a level > or = 10(3) CFU/ml. There were no significant differences between the groups with respect to age, sex, proportion of smokers and ex-smokers or packs per year. The only spirometric measure that was significantly different was (FEV1/FVC, which was lower in the acute-phase group (p < 0.05). Positive PSB findings were recorded for 57.1% of the stable patients and for 66.7% of the acute-phase patients (p = NS). H. influenzae was the microorganism found most often in both groups. The mean CFU/ml level was 8,625 in stable patients and 17,375 in acute-phase patients (p = NS). A large proportion of stable patients (57.1%) with severe COPD harbor significant concentrations of germs as revealed by PSB sampling. Germ concentrations were found in a non significantly greater number of acute-phase patients, confirming the lack of congruence between clinical status and bacteriological condition.