The Effect of Chronic Sputum Production on Respiratory Symptoms in Severe COPD

Kim, Victor; Garfield, Jamie L.; Grabianowski, Carla; Krahnke, Jason S.; Gaughan, John; Jacobs, Michael; Criner, Gerard J.

doi:10.3109/15412555.2011.558546

Cited by 18 publications

(10 citation statements)

References 28 publications

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“…When we look for number of patients having more than one exacerbation in previous years, studies show that exacerbation was found more in smoker group than non-smoker which is similar to other studies. 12 None of the patients in our study had malnutrition (BMI<20), but it was found lower for smoker COPD than non-smoker COPD which is in line with other studies. 13 Our studies shows that severe & very severe COPD was more prevalent in non-smoker when compared to smoker but moderate COPD was more frequent in smoker group.…”

Section: Resultssupporting

confidence: 92%

Phenotypic Difference Between Smoker and Non- Smoker Chronic Obstructive Pulmonary Disease

Kumar¹,

Kumar²,

Anshuman³

et al. 2017

jemds

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Section: Resultssupporting

confidence: 92%

Phenotypic Difference Between Smoker and Non- Smoker Chronic Obstructive Pulmonary Disease

Kumar¹,

Kumar²,

Anshuman³

et al. 2017

jemds

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“…In a telemedicine study of 50 patients with severe COPD with more than 14,500 observation days, those who complained of more sputum symptoms on a daily basis also complained of more dyspnea, cough, wheeze, and nasal congestion and had lower peak flow measurements (69). Compared with subjects without CB, GOLD stage 2 to 4 subjects with CB symptoms in the COPDGene cohort also had more severe dyspnea, more allergic nasal and ocular symptoms, more frequent nocturnal awakenings by cough and dyspnea, and worse St. George's Respiratory Questionnaire disease-specific quality of life scores (6).…”

Section: Health-related Quality Of Lifementioning

confidence: 99%

Chronic Bronchitis and Chronic Obstructive Pulmonary Disease

Kim

Criner

2013

Am J Respir Crit Care Med

Self Cite

388

276

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Chronic bronchitis (CB) is a common but variable phenomenon in chronic obstructive pulmonary disease (COPD). It has numerous clinical consequences, including an accelerated decline in lung function, greater risk of the development of airflow obstruction in smokers, a predisposition to lower respiratory tract infection, higher exacerbation frequency, and worse overall mortality. CB is caused by overproduction and hypersecretion of mucus by goblet cells, which leads to worsening airflow obstruction by luminal obstruction of small airways, epithelial remodeling, and alteration of airway surface tension predisposing to collapse. Despite its clinical sequelae, little is known about the pathophysiology of CB and goblet cell hyperplasia in COPD, and treatment options are limited. In addition, it is becoming increasingly apparent that in the classic COPD spectrum, with emphysema on one end and CB on the other, most patients lie somewhere in the middle. It is known now that many patients with severe emphysema can develop CB, and small airway pathology has been linked to worse clinical outcomes, such as increased mortality and lesser improvement in lung function after lung volume reduction surgery. However, in recent years, a greater understanding of the importance of CB as a phenotype to identify patients with a beneficial response to therapy has been described. Herein we review the epidemiology of CB, the evidence behind its clinical consequences, the current understanding of the pathophysiology of goblet cell hyperplasia in COPD, and current therapies for CB.Keywords: chronic obstructive pulmonary disease; chronic bronchitis; goblet cell hyperplasia; N-acetylcysteine; roflumilast Chronic obstructive pulmonary disease (COPD) is a common disease characterized by irreversible airflow obstruction and persistent inflammation to noxious environmental stimuli, usually cigarette smoke. It affects 12 to 16 million people in the United States and is the third leading cause of death and disease burden worldwide (1). COPD encompasses a spectrum of diseases, with chronic bronchitis (CB) at one end and emphysema at the other, with most individuals having some characteristics of both. The CB definition used in epidemiologic studies has been variable, but the classic definition is chronic cough and sputum production for at least 3 months per year for two consecutive years (2). CB has numerous clinical consequences, including an increased exacerbation rate, accelerated decline in lung function, worse health-related quality of life (HRQoL), and possibly increased mortality (3-6). We review the clinical phenotype of CB, the current understanding of its pathophysiology, and treatment options. EPIDEMIOLOGYCB is common in the general population. Table 1 provides an overview of the prevalence of cough and sputum production in population-based studies. CB is seen in 3.4 to 22.0% of adults (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). This wide range of prevalence estimates may be due to varying definitions of CB (i.e., chronic phlegm ver...

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“…It is difficult for some patients with severe to very severe AECOPD to expel sputum, necessitating respiratory support (Kim et al, 2011). Sputum-based longitudinal airway microbiome studies have been performed for the deep exploration of therapeutic targets and the development of improved treatment options (Wang et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…As symptoms progress, patients experience severe shortness of breath and extreme dyspnea. This makes the collection of sputum samples challenging (Kim et al, 2011), as sputum examination requires the use of a high-permeability 5% saltwater spray, and patients often find it difficult to tolerate atomization, resulting in failure to induce sputum production for sampling. According to the World Health Organization, COPD will become the third most common cause of death globally by 2020 and will be the fifth most economically burdensome disease.…”

Section: Introductionmentioning

confidence: 99%

Oropharyngeal and Sputum Microbiomes Are Similar Following Exacerbation of Chronic Obstructive Pulmonary Disease

et al. 2017

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Growing evidence suggests that the airway microbiota might be involved in acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Understanding this relationship requires examination of a large-scale population for a long duration to accurately monitor changes in the microbiome. This type of longitudinal study requires an appropriate sampling strategy; two options are the collection of sputum or oropharyngeal swabs. Comparative analysis of the changes that occur in these two specimen types has not been previously performed. This observational study was conducted to explore oropharyngeal microbial community dynamics over time and to examine the relationship between oropharyngeal swabs and sputum. A total of 114 samples were collected from four patients suffering from severe AECOPD. Bacterial and fungal communities were evaluated using 16S rRNA and ITS sequencing. Inter-individual differences were found in bacterial community structure, but the core genera were shared by both sample types and included 32 lineages. Most of the core genera were members of the phyla Proteobacteria, Firmicutes and Ascomycota. Although the oropharyngeal samples showed higher bacterial alpha diversity, the two sample types generated rather similar taxonomic profiles. These results suggest that the sputum microbiome is remarkably similar to the oropharyngeal microbiome. Thus, oropharyngeal swabs can potentially be used instead of sputum samples for patients with exacerbation of COPD.

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The Effect of Chronic Sputum Production on Respiratory Symptoms in Severe COPD

Abstract: Increased sputum production in severe COPD is frequently encountered daily and is associated with more respiratory symptoms, worse airflow obstruction, and less emphysema.

Cited by 18 publications

References 28 publications

Phenotypic Difference Between Smoker and Non- Smoker Chronic Obstructive Pulmonary Disease

Phenotypic Difference Between Smoker and Non- Smoker Chronic Obstructive Pulmonary Disease

Chronic Bronchitis and Chronic Obstructive Pulmonary Disease

Oropharyngeal and Sputum Microbiomes Are Similar Following Exacerbation of Chronic Obstructive Pulmonary Disease

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