Conclusions Age, admission NEWS and blood parameters differed significantly between those who were managed on the ward with AECOPD and those who either died or whose care was escalated to ICU. This could form the basis for a prediction score, automatically calculable on admission to hospital using available technology to highlight those patients judged at greatest risk of deterioration. Introduction Chronic obstructive pulmonary disease (COPD) is characterised by breathlessness, fatigue and reduced daily activity which worsens acutely at exacerbation. A three year observational study has shown a reduction in 6MWT over time that correlates with increase over the same period in plasma Interleukin-6 and C-reactive protein (CRP) levels (Ferrari, Tanni et al. 2013). We therefore investigated whether acute changes in 6MWT at exacerbation were associated with changes in systemic inflammatory markers and the perception of fatigue. Methods Forty four patients from the London COPD cohort who had a mean age of (±SD) 71(±7) years; FEV 1 52(±17)% predicted; male gender 72% and still smoking 30% were asked to performed a 6MWT and completed a FACIT-F questionnaire when stable (baseline) and 3 days after first presenting with the exacerbation. Blood was drawn for assay of CRP and fibrinogen. REFERENCE

Poster sessions A156Thorax 2012;67(Suppl 2):A1-A204 symptom being major (dyspnoea, sputum purulence or volume) and the other a major or minor symptom (wheeze, cold, sore throat, cough). Reverse-transcription quantitative PCR was used to detect rhinovirus and real-time quantitative PCR was utilised to identify typical bacteria in sputum samples collected at exacerbation presentation (median 2 days after symptom onset), and at days 3, 7, 14 and 35 post-presentation. Results Nineteen patients with moderate to severe COPD (mean age 68.8 years (SD±8.1); FEV 1 48.4% predicted (±19.2%); current smoker 37%; FEV 1 /FVC 0.46 (SD±0.14); FEV 1 1.2L (SD±0.4); male gender 74%) provided 89 of 110 potential sputum samples at 5 time points during 22 exacerbations. Rhinovirus prevalence progressively fell from 71.4% at exacerbation presentation to 0% at day 35 with significant decreases in prevalence between presentation and days 7, 14 and 35 (all p<0.002) (Figure 1). No exacerbation was negative for rhinovirus detection at presentation but positive at later time points. For typical bacteria, 64.7% of samples taken at presentation were positive. This proportion fell at days 3 and 7 but these falls were non-significant (p=0.08 and p=0.09, respectively) -all events were treated with antibiotics. Seven of the 22 exacerbations (31.8%) were positive for both CRMs at presentation. Conclusion The prevalence of CRMs varies during recovery from a COPD exacerbation. Rhinovirus prevalence steadily decreases over 2 weeks whilst bacterial prevalence is more variable, presumably due to the background effects of lower airway bacterial colonisation. This emphasises the importance of rhinovirus as a major exacerbation trigger. ASSESSING THE REPEATABILITY OF BACTERIAL DETECTION IN STABLE COPD USING SEVERAL METHODS

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Introduction COPD exacerbations are clinically important events, commonly triggered by bacterial infection. Defective phagocytosis of potentially pathogenic microorganisms (PPMs) in stable COPD has been demonstrated in both alveolar and monocyte-derived macrophages (MDMs). We hypothesised that phagocytosis may be suppressed further during an acute COPD exacerbation and relate to bacterial aetiology of the exacerbation. Methods Whole blood was collected from patients in the London COPD cohort at both stable state and at exacerbation, as defined by prospectively completed daily symptom diary cards (Seemungal et al., 1998). Monocytes were isolated and cultured with GM-CSF (2ng/ml) for 12 days to generate MDMs. MDM phagocytosis of fluorescently-labelled polystyrene beads, Haemophilus influenzae (HI) and Streptococcus pneumoniae (SP) was measured by fluorimetry. Diary card data was used to determine prodromal symptoms, exacerbation duration and exacerbation symptom intensity. Sputa collected at exacerbation were cultured for PPMs. Results MDMs were cultured from 13 COPD patients at paired stable and exacerbation states. 54% were male, mean age 72.8 years (SD 6.2), FEV 1 predicted 55.7% (20.5) and 38% current smokers. The median time between stable and exacerbation states was 147 days .Two distinct patterns of change in phagocytic ability were seen between the stable and exacerbation state. Eight patients significantly decreased their phagocytic capacity compared to stable state for beads, HI and SP (p = 0.004, p = 0.008 and p = 0.020 respectively, Figure 1A). Five of these eight patients (63%) had a PPM isolated in their exacerbation sputum sample. Five of 13 patients increased phagocytosis at exacerbation (Figure 1B), but only SP reached statistical significance (p = 0.031). Only one of these five (20%) had a PPM in their exacerbation sputum sample.There was no significant difference between the presence of prodromal symptoms, exacerbation duration or symptom intensity between the two patterns.Conclusion Phagocytosis of bacteria is suppressed further during some COPD exacerbations. This may contribute to bacterial aetiology of these exacerbations. Phagocytosis appears partially more effective in other exacerbations. Further work is needed to understand these apparently dichotomous changes and their impact on clinical outcomes. Severe deficiency of the major anti-elastase a 1 -antitrypsin (AT) due to the Z (Glu342Lys) variant is associated with earlyonset emphysema which can require lung transplantation. AT is mainly produced by the liver and a lesser proportion (around 10%) is produced in the lung. Therefore individuals with Z-AT post-lung transplantation remain severely deficient in AT. We studied patients with and without AT deficiency with infection (post lung transplantation) to examine the relationship between deficiency of AT and oxidative/nitrosative stress.BALF was obtained at scheduled surveillance, and when clinically indicated to assess for infection, rejection and airway injury. 25 patients post-trans...

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