Relationship between the GOLD combined COPD assessment staging system and bacterial isolation

Abstract

BackgroundAcute 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.ObjectivesThe 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.MethodsPotentially 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.ResultsThere 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.ConclusionBacterial 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.

Host Response to the Lung Microbiome in Chronic Obstructive Pulmonary Disease

“…Despite this obvious shortcoming the experimental approach described here provides preliminary evidence in support of the hypothesis that there is a host response to the microbiome in COPD and that it is primarily directed at OTUs within the expanding Proteobacteria and Actinobacteria phyla that have successfully competed for space on a reduced alveolar surface. Furthermore, even though none of the patients receiving a transplant had an exacerbation at the time of transplantation, we postulate that the milieu present within the lung microbiome might encourage the emergence of strains from within the expanding Proteobacteria phylum, which is known to contribute many of the organisms that produce acute exacerbations of COPD (36,37). n Author disclosures are available with the text of this article at www.atsjournals.org.…”

Role of infection in exacerbations of chronic obstructive pulmonary disease

“…Bacteria are more frequently the cause of exacerbations in frequent exacerbators and the same microorganisms isolated during the exacerbation may persist after recovery in up to 50% of cases [22,23]. In patients with the most severe exacerbations requiring mechanical ventilation, other bacteria such as Pseudomonas aeruginosa and enteric Gram-negative bacilli (e.g.…”

Pseudomonas aeruginosa and risk of death and exacerbations in patients with chronic obstructive pulmonary disease: an observational cohort study of 22 053 patients

“…Although the evidence is sparse and the methodology variable, it has been suggested that P. aeruginosa is associated with prolonged hospitalization, increased exacerbation rate and poor long-term prognosis in COPD patients [8e10]. However, no definitive conclusions regarding the clinical impact of P. aeruginosa in COPD patients can be made since the bacterium is seen primarily in advanced disease [6,11], which is in itself a strong predictor for poor prognosis [12].…”