Chest
Volume 131, Issue 1, January 2007, Pages 37-43
Journal home page for Chest

Original Research: Copd
Systemic Cytokines, Clinical and Physiological Changes in Patients Hospitalized for Exacerbation of COPD

https://doi.org/10.1378/chest.06-0668Get rights and content

Abstract

Background:Systemic inflammation in patients with COPD may worsen during exacerbations, but there is limited information relating levels of systemic inflammatory markers with symptoms and physiologic changes during an exacerbation

Methods:We measured dyspnea using the visual analog scale, pulmonary function tests, hemograms, and plasma levels for interleukin (IL)-6, IL-8, leukotriene B4(LTB4), tumor necrosis factor-A, and secretory leukocyte protease inhibitor (SLPI) in 20 patients on admission to a hospital for exacerbation of COPD (ECOPD), 48 h later (interim), and 8 weeks after hospital discharge (recovery).

Results:Dyspnea was present in all patients. Inspiratory capacity improved faster than FEV1. Compared to recovery, there was a significant increase in the mean (± SD) hospital admission plasma levels of IL-6 (6.38 ± 0.72 to 2.80 ± 0.79 pg/mL; p = 0.0001), IL-8 (8.18 ± 0.85 to 3.72 ± 0.85 pg/mL; p = 0.002), and LTB4 (8,675 ± 1,652 to 2,534 ± 1,813 pg/mL; p = 0.003), and the percentages of segmented neutrophils (79 to 69%; p < 0.02) and band forms (7.3 to 1.0%; p < 0.01) in peripheral blood, with no changes in TNF-A and SLPI. There were significant correlations between changes in IL-6 (r= 0.61; p = 0.01) and IL-8 (r= 0.56; p = 0.04) with changes in dyspnea and levels of IL-6 (r= −0.51; p = 0.04) and TNF-A (r= −0.71; p < 0.02) with changes in FEV1.

Conclusions:Hospitalized patients with ECOPDs experience significant changes in systemic cytokine levels that correlate with symptoms and lung function. An ECOPD represents not only a worsening of airflow obstruction but also increased systemic demand in a host with limited ventilatory reserve.

Section snippets

Methods and Materials

We studied 20 consecutive patients who had been admitted with an ECOPD to Caritas St. Elizabeth's Hospital. The protocol approved by the institutional review board of the hospital was signed by all participants. The diagnosis of ECOPD was confirmed if patients had two or more of the following three symptoms of exacerbations16: worsened dyspnea; worsened sputum volume and/or change in its color; and new or worsening cough. All patients had received a diagnosis of COPD based on smoking history (>

Results

The characteristics of the patients are shown inTable 1. The patients were elderly ex-smokers with preexacerbation mean FEV1values of 41 ± 13% predicted. On hospital admission, the majority of patients (67%) required oxygen therapy and had increased WBC counts with predominant segmented neutrophils and increased band forms.

Discussion

There were several findings in this study of patients admitted with an ECOPD. First, the most prevalent symptom was measurable dyspnea. Physiologically, there was tachypnea and decreased IC. The IC improved rapidly and correlated with tachypnea. In contrast, the changes in FEV1and FVC were more gradual, being significant only after hospital discharge. Second, the plasma levels of IL-6, IL-8, and LTB4were increased at the moment of the initial evaluation, with rapid reductions for IL-6 and IL-8

References (33)

  • JH Vernooy et al.

    Local and systemic inflammation in patients with chronic obstructive pulmonary disease

    Am J Respir Crit Care Med

    (2002)
  • A Noguera et al.

    Expression of adhesion molecules and G proteins in circulating neutrophils in chronic obstructive pulmonary disease

    Am J Respir Crit Care Med

    (1998)
  • S Gompertz et al.

    Changes in bronchial inflammation during acute exacerbations of chronic bronchitis

    Eur Respir J

    (2001)
  • SD Aaron et al.

    Granulocyte inflammatory markers and airway infection during acute exacerbation of chronic obstructive pulmonary disease

    Am J Respir Crit Care Med

    (2001)
  • A Bhowmik et al.

    Relation of sputum inflammatory markers to symptoms and lung function changes in COPD exacerbations

    Thorax

    (2000)
  • SA Kharitonov et al.

    Exhaled markers of pulmonary disease

    Am J Respir Crit Care Med

    (2001)
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    This research was supported by an unrestricted grants from GlaxoSmithKline, Thoracic Overholt Foundation.

    Drs. Masdin and Linacre are employees of GlaxoSmithKline, a pharmaceutical company with financial interest in COPD. All of the authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestjournal.org/misc/reprints.shtml).

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