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Respir Res. 2018 Jul 28;19(1):143. doi: 10.1186/s12931-018-0842-8.

Impact of radiologically stratified exacerbations: insights into pneumonia aetiology in COPD.

Author information

1
Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK. NPWilliams@doctors.org.uk.
2
Southampton NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, UK. NPWilliams@doctors.org.uk.
3
Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK.
4
Southampton NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, UK.
5
GSK Vaccines, Rixensart, Belgium.
6
Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
7
Present address: Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK.
8
Wessex Investigational Sciences Hub, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK.
9
Department of Radiology, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton, UK.
10
Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK.
11
Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.

Abstract

BACKGROUND:

COPD patients have increased risk of developing pneumonia, which is associated with poor outcomes. It can be symptomatically indistinguishable from exacerbations, making diagnosis challenging. Studies of pneumonia in COPD have focused on hospitalised patients and are not representative of the ambulant COPD population. Therefore, we sought to determine the incidence and aetiology of acute exacerbation events with evidence of pneumonic radiographic infiltrates in an outpatient COPD cohort.

METHODS:

One hundred twenty-seven patients with moderate to very severe COPD aged 42-85 years underwent blood and sputum sampling over one year, at monthly stable visits and within 72 h of exacerbation symptom onset. 343 exacerbations with chest radiographs were included.

RESULTS:

20.1% of exacerbations had pneumonic infiltrates. Presence of infiltrate was highly seasonal (Winter vs summer OR 3.056, p = 0.027). In paired analyses these exacerbation events had greater increases in systemic inflammation. Bacterial detection rate was higher in the pneumonic group, with Haemophilus influenzae the most common bacteria in both radiological groups. Viral detection and sputum microbiota did not differ with chest radiograph appearance.

CONCLUSIONS:

In an outpatient COPD cohort, pneumonic infiltrates at exacerbation were common, and associated with more intense inflammation. Bacterial pathogen detection and lung microbiota were not distinct, suggesting that exacerbations and pneumonia in COPD share common infectious triggers and represent a continuum of severity rather than distinct aetiological events.

TRIAL REGISTRATION:

Trial registration Number: NCT01360398 .

KEYWORDS:

COPD; Exacerbations; Infiltrates; Pneumonia

PMID:
30055608
PMCID:
PMC6064093
DOI:
10.1186/s12931-018-0842-8
[Indexed for MEDLINE]
Free PMC Article

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