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Airway inflammation and etiology of acute exacerbations of chronic bronchitis.

Abstract：

STUDY OBJECTIVES:The etiologic role of bacterial pathogens isolated from sputum culture in 40 to 50% of acute exacerbations of chronic bronchitis (AECB) is controversial. If bacterial pathogens cause these AECB, they should be associated with greater neutrophilic airway inflammation than pathogen-negative exacerbations. DESIGN:This hypothesis was tested by comparing levels of interleukin (IL)-8, tumor necrosis factor (TNF)-alpha, and neutrophil elastase (NE) in 81 sputum samples obtained from 45 patients with AECB. Four groups were compared. In the first three groups, nontypable Haemophilus influenzae (n = 20), Haemophilus parainfluenzae (n = 27), and Moraxella catarrhalis (n = 14) were isolated as sole pathogens, respectively. In the fourth group, only normal flora was isolated (n = 20). Paired samples, obtained from individual patients at different times, that differed in their culture results were also compared. SETTING:An outpatient research clinic at a Veterans Affairs Medical Center. PATIENTS:These patients were participating in a prospective, longitudinal study of the dynamics of bacterial infection in chronic bronchitis, for which they were seen in the study clinic on a monthly basis as well as when they were experiencing symptoms suggestive of AECB. INTERVENTIONS:None. MEASUREMENTS AND RESULTS:H influenzae exacerbations were associated with significantly higher sputum IL-8, TNF-alpha, and NE. M catarrhalis exacerbations demonstrated significantly higher sputum TNF-alpha and NE when compared to pathogen-negative exacerbations. H parainfluenzae-associated exacerbations had an inflammatory profile similar to pathogen-negative exacerbations. Sputum elastase level distinguished bacterial from nonbacterial AECB and correlated with clinical severity of the AECB. CONCLUSIONS:Increased airway inflammation associated with isolation of H influenzae and M catarrhalis supports an etiologic role of these pathogens in AECB.

journal_name

Chest

journal_title

Chest

authors

Sethi S,Muscarella K,Evans N,Klingman KL,Grant BJ,Murphy TF

doi

10.1378/chest.118.6.1557

subject

Has Abstract

pub_date

2000-12-01 00:00:00

pages

1557-65

issue

eissn

0012-3692

issn

1931-3543

pii

S0012-3692(15)37860-0

journal_volume

118

pub_type

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Airway inflammation and etiology of acute exacerbations of chronic bronchitis.