Changes in bronchial inflammation during acute exacerbations of chronic bronchitis

Gompertz, Simon; O’Brien, Claire; Bayley, D L; Hill, S L; Stockley, Robert A.

doi:10.1183/09031936.01.99114901

Cited by 263 publications

(223 citation statements)

References 26 publications

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“…Purulence is strongly related to colour, but is even more subjective. In prospective studies, mucoid sputum is usually described as colourless to white, and purulent sputum as ranging from pale yellow to dark green [20]. We found a significant and consistent relationship between purulence and the presence of a PPM in sputum, although it had less predictive value than the colour of the sample.…”

Section: Discussionmentioning

confidence: 52%

Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis

Miravitlles

Kruesmann²,

Haverstock³

et al. 2011

Eur Respir J

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We examined the correlation between sputum colour and the presence of potentially pathogenic bacteria in acute exacerbations of chronic bronchitis (AECBs).Data were pooled from six multicentre studies comparing moxifloxacin with other antimicrobials in patients with an AECB. Sputum was collected before antimicrobial therapy, and bacteria were identified by culture and Gram staining. Association between sputum colour and bacteria was determined using logistic regression.Of 4,089 sputum samples, a colour was reported in 4,003; 1,898 (46.4%) were culture-positive. Green or yellow sputum samples were most likely to yield bacteria (58.9% and 45.5% of samples, respectively), compared with 18% of clear and 39% of rust-coloured samples positive for potentially pathogenic microorganisms. Factors predicting a positive culture were sputum colour (the strongest predictor), sputum purulence, increased dyspnoea, male sex and absence of fever. Green or yellow versus white sputum colour was associated with a sensitivity of 94.7% and a specificity of 15% for the presence of bacteria.Sputum colour, particularly green and yellow, was a stronger predictor of potentially pathogenic bacteria than sputum purulence and increased dyspnoea in AECB patients. However, it does not necessarily predict the need for antibiotic treatment in all patients with AECB.

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Section: Discussionmentioning

confidence: 52%

Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis

Miravitlles

Kruesmann²,

Haverstock³

et al. 2011

Eur Respir J

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“…As neutrophils comprise the predominant infl ammatory cell in COPD airspaces and, as noted earlier, lymphocytic infi ltrates within lung tissue per se are highly correlated with disease severity, it follows that IL-8 could play a part in the development of emphysema. IL-8 levels are increased in sputum of patients with COPD (Keatings et al 1996;Yamamoto et al 1997), and are further augmented during disease exacerbations, presumably in association with neutrophilic infl ammation triggered by bacteria (Crooks et al 2000;Aaron et al 2001;Gompertz et al 2001). Airway microbes induce IL-8 secretion by epithelial cells, and levels of this cytokine have been shown to correlate with airway bacterial load Patel et al 2002).…”

Section: Interleukin-8 (Il-8)mentioning

confidence: 99%

Role of T-lymphocytes and pro-inflammatory mediators in the pathogenesis of chronic obstructive pulmonary disease

Gadgil

Duncan

2008

COPD

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Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the US and a major worldwide healthcare problem. The pathophysiologic mechanisms that drive development and progression of this disease are complex and only poorly understood. While tobacco smoking is the primary risk factor, other disease processes also appear to play a role. Components of the innate immune system (eg, macrophages and neutrophils) have long been believed to be important in the development of COPD. More recent evidence also suggests involvement of the adaptive immune system in pathogenesis of this disease. Here we will review the literature supporting the participation of T-cells in the development of COPD, and comment on the potential antigenic stimuli that may account for these responses. We will further explore the prospective contributions of T-cell derived mediators that could contribute to the infl ammation, alveolar wall destruction, and small airway fi brosis of advanced COPD. A better understanding of these complex immune processes will lead to new insights that could result in improved preventative and/or treatment strategies.

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“…There was also an increase in IL-6. In bacterial infections due to Haemophilus influenzae or Moraxella catarrhalis there was an increase in neutrophil elastase activity and LTB 4 , which fell with recovery, and the sputum was mucopurulant or purulant [85]. Smaller changes were observed with H. parainfluenzae and in mucoid exacerbations.…”

Section: Sputum Inflammatory Markers In Chronic Obstructive Pulmonarymentioning

confidence: 83%

“…Validation of the intensity of the neutrophilia and recognition of an eosinophilia requires cell counts. The former can also be indicated by fluid-phase neutrophil elastase levels [85].…”

Section: Interpretation Of Sputum Measurementsmentioning

confidence: 99%

Airway inflammation in COPD: physiological outcome measures and induced sputum

Crapo

Jensen²,

Hargreave³

2003

Eur Respir J

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Chronic obstructive pulmonary disease (COPD) is a result of airway inflammation, and the best predictor of COPD is the early detection of airflow limitation by spirometry. The Global Initiative for Obstructive Lung Disease Workshop Report defines airflow limitation using simple spirometric indices. Available guidelines categorise the severity of COPD using forced expiratory volume in one second (FEV1) and forced vital capacity (FVC), with symptoms playing a minor role in the assessment.Current standards define COPD by progressive loss of FEV1, and thus longitudinal decline in FEV1 will be the primary outcome variable for intervention studies aimed at preventing or reducing the loss of pulmonary function. There is evidence, however, that the variable FEV1/FVC and FEV1 are often not measured properly in all settings.This article will discuss the roles of physiological measurements in diagnosing COPD and physiological outcome measures for COPD. It does not formally compare physiological measures with other outcome measures, such as symptoms or quality of life. Additionally, improved treatment of established disease requires a better understanding of the inflammatory process and its clinical effects and treatment.The inflammatory process, and how drugs affect it, can be studied noninvasively or relatively noninvasively by using refined methods of examining spontaneous or induced sputum. Enhanced understanding of the use of induced sputum will assist in predicting patients9 responses to short-and long-term inhaled corticosteroid treatment, and the methods of sputum examination need to be simplified so that they can be applied more easily to clinical practice. Eur Respir J 2003; 21: Suppl. 41, 19s- Chronic obstructive pulmonary disease (COPD) is defined by the Global Initiative for Obstructive Lung Disease (GOLD) as a "disease state characterised by airflow limitation that is not fully reversible. …The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases" [1]. The absence of reversibility tends to exclude asthma by definition, although asthma can coexist with COPD. Methods of assessing airflow limitation: current recommendations and their limitationsAvailable guidelines categorise the severity of COPD primarily by using forced expiratory volume in one second (FEV1), whereas symptoms play a minor role in the assessment [1][2][3][4][5]. This tight link between FEV1 and COPD reflects the fact that spirometry is the standard for defining the presence of airway obstruction and the progressive loss of FEV1, the physiological variable that characterises COPD severity and predicts its mortality. Spirometry has become the standard, in part, because good quality and inexpensive tests are widely available.The GOLD Workshop Report explicitly defines airflow limitation using simple spirometric indices. Specifically, airflow limitation is defined as an FEV1/forced vital capacity (FVC)v70% and a postbronchodilator FEV1v80% of predict...

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Changes in bronchial inflammation during acute exacerbations of chronic bronchitis

Cited by 263 publications

References 26 publications

Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis

Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis

Role of T-lymphocytes and pro-inflammatory mediators in the pathogenesis of chronic obstructive pulmonary disease

Airway inflammation in COPD: physiological outcome measures and induced sputum

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