Time course of inflammation resolution in patients with frequent exacerbations of chronic obstructive pulmonary disease
Chun Chang, Wanzhen Yao
(Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China (mainland))
Med Sci Monit 2014; 20:311-320
When exacerbation of chronic obstructive pulmonary disease (AECOPD) occurs frequently, patients have high levels of airway and systemic inflammation and a poor quality of life. This study compared the nature and course of systemic and airway inflammation during AECOPD between patients who experienced frequent exacerbations and those with non-frequent exacerbations.
Material and Methods: Consecutive hospitalized patients with AECOPD were recruited and divided into 2 groups according to the frequency of AECOPD they had experienced in the previous year. Frequent exacerbators (defined as 2 or more AECOPD in the previous year) and non-frequent exacerbators (defined as zero or 1 AECOPD in the previous year). Inflammatory (interleukin 6, interleukin 8, myeloperoxidase, and C-reactive protein) and clinical (dyspnea, COPD assessment test (CAT), and peak expiratory flow) indices were assessed on the day of admission before starting therapy, day 7 of treatment, the day of planned discharge (day 10–14), and 8 weeks after discharge.
Results: We analyzed data from 135 patients; 78 (57.8%) were non-frequent exacerbators and 57 (42.2%) were frequent exacerbators. In both groups, the inflammatory and clinical indices at day 7, the day of planned discharge (day 10–14), and 8 weeks were significantly improved compared to those at admission. Frequent exacerbators had a smaller reduction in their inflammatory indices and CAT scores between exacerbation onset and all the other time points compared with infrequent exacerbators.
Conclusions: Frequent exacerbators have a reduced response to treatment of AECOPD in terms of inflammatory indices and quality of life.
Keywords: Bronchitis - physiopathology, Aged, C-Reactive Protein - metabolism, China, Dyspnea - pathology, Female, Humans, Inflammation - physiopathology, Interleukin-6 - metabolism, Interleukin-8 - metabolism, Lung Diseases, Obstructive - physiopathology, Male, Middle Aged, Peak Expiratory Flow Rate - physiology, Peroxidase - metabolism, Prospective Studies, Quality of Life, Recurrence, Statistics, Nonparametric, Time Factors