ORIGINAL ARTICLE
Relation between airway cellular and bacterial findings and severity of COPD exacerbations: A multicentric study
More details
Hide details
1
Department of Chest Diseases, Al-Azhar University, Cairo, EGYPT
2
Department of Chest Diseases, Ain Shams University, Cairo, EGYPT
3
Department of Clinical Pathology, Al-Azhar University, Cairo, EGYPT
4
Department of Chest Diseases, Zagazig University, Zagazig, EGYPT
Online publication date: 2024-02-12
Publication date: 2024-03-01
Electron J Gen Med 2024;21(2):em573
KEYWORDS
ABSTRACT
Aim:
To evaluate the relationships between sputum and bronchoalveolar lavage (BAL) cellular and bacterial
findings and severity of exacerbation of chronic obstructive pulmonary disease (ECOPD).
Patients & methods:
A cross-section study was conducted on 307 patients with ECOPD. They underwent sputum
and BAL inflammatory cell count and bacterial culture.
Results:
Patients with severe ECOPD have significantly higher neutrophils percentage (neut.%), lower
lymphocytes percentage (lymph.%), lower eosinophils percentage (eosin.%) and higher neutrophil/lymphocyte
ratio (NLR) as compared to patients with mild ECOPD. It was also shown that patients with severe ECOPD had
significantly higher BAL neut.%, lower lymph.%, lower eosin.%, and higher NLR as compared to the other two
subgroups. Also, patients with severe ECOPD have significantly higher frequency of cases with monomicrobial
(71.30% vs. 36.10%) and polymicrobial (21.25% vs. 2.10%) growths in comparison to patients with mild ECOPD.
Conclusions:
Cellular and bacterial findings in sputum and BAL are related to severity of ECOPD.
REFERENCES (22)
1.
Aksoy E, Karakurt Z, Gungor S, et al. Neutrophil to lymphocyte ratio is a better indicator of COPD exacerbation severity in neutrophilic endotypes than eosinophilic endotypes. Int J Chron Obstruct Pulmon Dis. 2018;13:2721-30.
https://doi.org/10.2147/COPD.S... PMid:30233162 PMCid:PMC6130304.
2.
Hurst JR, Skolnik N, Hansen GJ, et al. Understanding the impact of chronic obstructive pulmonary disease exacerbations on patient health and quality of life. Eur J Intern Med. 2020;73:1-6.
https://doi.org/10.1016/j.ejim... PMid:31954592.
3.
An TJ, Yoo YJ, Lim JU, et al. Diaphragm ultrasound is an imaging biomarker that distinguishes exacerbation status from stable chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2022;17:3-12.
https://doi.org/10.2147/COPD.S... PMid:35018095 PMCid:PMC8742578.
4.
Freeman CM, Martinez CH, Todt JC, et al. Acute exacerbations of chronic obstructive pulmonary disease are associated with decreased CD4+ & CD8+ T cells and increased growth & differentiation factor-15 (GDF-15) in peripheral blood. Respir Res. 2015;16(1):94.
https://doi.org/10.1186/s12931... PMid:26243260 PMCid:PMC4531816.
5.
King PT, MacDonald M, Bardin PG. Bacteria in COPD; their potential role and treatment. Transl Respir Med. 2013;1(1):13.
https://doi.org/10.1186/2213-0... PMid:27234394 PMCid:PMC6733427.
6.
D’silva L, Hassan N, Wang HY, et al. Heterogeneity of bronchitis in airway diseases in tertiary care clinical practice. Can Respir J. 2011;18(3):144-8.
https://doi.org/10.1155/2011/4... PMid:21766077 PMCid:PMC3328881.
7.
Yang H, Wen X, Wu F, Zheng Y, Dai C, Zhao N, et al. Inter-relationships among neutrophilic inflammation, air trapping and future exacerbation in COPD: An analysis of ECOPD study. BMJ Open Respir Res. 2023;10(1):e001597.
https://doi.org/10.1136/bmjres... PMid:37028910 PMCid:PMC10083880.
8.
Hogea SP, Tudorache E, Fildan AP, Fira-Mladinescu O, Marc M, Oancea C. Risk factors of chronic obstructive pulmonary disease exacerbations. Clin Respir J. 2020;14(3):183-97.
https://doi.org/10.1111/crj.13... PMid:31814260.
9.
Global Initiative for Chronic Obstructive Lung Disease. Guidelines 2022: Management and treatment. Available at:
https://goldcopd.org (Accessed: 16 November 2023).
10.
Shepherd E. Specimen collection 4: Procedure for obtaining a sputum specimen. Nurs Times. 2017;113(10):49-51.
11.
Millares L, Monso E. The microbiome in COPD: Emerging potential for microbiome-targeted interventions. Int J Chron Obstruct Pulmon Dis. 2022;12(17):1835-45.
https://doi.org/10.2147/COPD.S... PMid:35983167 PMCid:PMC9380728.
12.
Seo H, Sim YS, Min KH, et al. The relationship between comorbidities and microbiologic findings in patients with acute exacerbation of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2022;20(17):855-67.
https://doi.org/10.2147/COPD.S... PMid:35480555 PMCid:PMC9035445.
13.
Baselski V, Klutts JS, Baselski V, Klutts JS. Quantitative cultures of bronchoscopically obtained specimens should be performed for optimal management of ventilator-associated pneumonia. J Clin Microbiol. 2013;51(3):740-4.
https://doi.org/10.1128/JCM.03... PMid:23284021 PMCid:PMC3592072.
14.
Kandemir Y, Dogan NO, Yaka E, Pekdemir M, Yilmaz S. Clinical characteristics of neutrophilic, eosinophilic and mixed-type exacerbation phenotypes of COPD. Am J Emerg Med. 2021;45:237-41.
https://doi.org/10.1016/j.ajem... PMid:33041140.
15.
Koutsokera A, Kostikas K, Nicod LP, Fitting JW. Pulmonary biomarkers in COPD exacerbations: A systematic review. Respir Res. 2013;14(1):111.
https://doi.org/10.1186/1465-9... PMid:24143945 PMCid:PMC4014989.
16.
Martínez-García MÁ , Sánchez CP , Moreno RMG. . The double-edged sword of neutrophilic inflammation in bronchiectasis. Eur Respir J 2015;46:898900.
https://doi.org/10.1183/139930... PMid:26424521.
17.
Cho Y, Szabo G. Two faces of neutrophils in liver disease development and progression. Hepatology. 2021;74(1):503-12.
https://doi.org/10.1002/hep.31... PMid:33314193 PMCid:PMC9235297.
18.
Hu Y, Long H, Cao Y, Guo Y. Prognostic value of lymphocyte count for in-hospital mortality in patients with severe AECOPD. BMC Pulm Med. 2022;22(1):376.
https://doi.org/10.1186/s12890... PMid:36199131 PMCid:PMC9533979.
19.
Acarturk Tuncay E, Karakurt Z, Aksoy E, et al. Eosinophilic and non-eosinophilic COPD patients with chronic respiratory failure: Neutrophil-to-lymphocyte ratio as an exacerbation marker. Int J Chron Obstruct Pulmon Dis. 2017;12:3361-70.
https://doi.org/10.2147/COPD.S... PMid:29200843 PMCid:PMC5703161.
20.
Choi J, Oh JY, Lee YS, et al. Bacterial and viral identification rate in acute exacerbation of chronic obstructive pulmonary disease in Korea. Yonsei Med J. 2019;60(2):216-22.
https://doi.org/10.3349/ymj.20... PMid:30666844 PMCid:PMC6342712.
21.
Makled A, El Khyat A, Agha M, Khallaf H. Klebsiella pneumoniae in patients with acute exacerbation of chronic obstructive pulmonary disease in Menoufia University hospitals. Egypt J Med Microbiol. 2019;28(2):51-60.
https://doi.org/10.21608/ejmm.....
22.
Khatun T, Das A, Banik GC, et al. Bacteriological spectrum of sputum in acute exacerbation of chronic obstructive pulmonary disease (COPD). J Med. 2022;23(1):30-5.
https://doi.org/10.3329/jom.v2....