Sputum microbiology predicts health status in COPD

Abstract

BackgroundSpontaneous sputum production occurs in a subset of COPD patients; however, its clinical relevance has not been established. Differences in health status and clinical outcomes between patients with and without positive sputum cultures are unknown.ObjectiveTo compare clinical characteristics and health status of spontaneous sputum producers with a positive culture (SC+) and negative culture (SC−) with nonsputum producers (NP) in a cohort of COPD patients referred for pulmonary rehabilitation.MethodsIn total, 518 clinically stable patients with mild-to-very severe COPD were recruited (mean age: 64.1±9.1 years, 55.6% males, forced expiratory volume in 1 second 48.6%±20.0% predicted). Health status was measured using COPD Assessment Test, St George’s Respiratory Questionnaire, and the Clinical COPD Questionnaire. Symptoms of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Exercise capacity was measured using the 6-minute walking distance. Spontaneously expectorated sputum was cultured for microbiology.ResultsAlmost one-third of patients spontaneously produced sputum (n=164, 31.7%). Despite comparable lung function, SC+ reported more frequent exacerbations than NP (≥2 exacerbations <1 year: 43 [81.1%] vs 179 [50.6%], P<0.001). COPD Assessment Test total score and the Clinical COPD Questionnaire total score were significantly worse in SC+ than NP (23.9±6.1 vs 21.1±6.7, P=0.012; 3.1±1.0 vs 2.5±1.0, P=0.002; respectively). Hospital Anxiety and Depression Scale-D score was significantly higher in SC+ than NP (8.7±4.1 vs 7.2±4.3, P=0.046).ConclusionSpontaneous sputum production is common in COPD. Particularly, patients with positive cultures have worse health status and more symptoms of depression. Impact on disease progression and long-term outcomes remain to be established.Clinical trial registrationNTR3416, registered at www.trialregister.nl.

Infección bronquial crónica en EPOC estable

“…Lejos de ser una situación inocua, tanto el aislamiento de algunos MPP como la presencia de una IBC (aislamientos repetidos) en pacientes con EPOC (aun fuera de una fase de agudización) se han asociado a diferentes circunstancias negativas de la enfermedad como una mayor inflamación bronquial 29 , una mayor gravedad clínica 30 , peor calidad de vida relacionada con la salud 31 , mayor número y gravedad de las agudizaciones 23 , presencia de bronquiectasias 24 , mayor consumo de fármacos 26 , mayor número de eventos cardiovasculares 17 , e incluso mayor mortalidad 28 . Sin embargo, esta relación no se establece de forma constante ya que depende fundamentalmente del tipo de MPP del que se trate, siendo hasta el momento la infección por PA la mejor documentada 10 .…”

Microbiota of the Bronchopulmonary Apparatus in the Exacerbation of the Obstructive Pulmonary Disease of Professional Etiology

“…Узагальнення наукових публікацій останніх років показує, що перебування мікроорганізмів у дихальних шляхах є складовою патогенезу ХОЗЛ і, навіть, поза стадії загострення, вони приймають участь у прогресуванні ХОЗЛ, в більшості випадків, через активацію ефекторних клітин запалення [15,16,19,20,23,24].…”