Increased systemic inflammation is a risk factor for COPD exacerbations

Department of Respiratory Medicine, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, the Netherlands.
Chest (Impact Factor: 7.48). 03/2008; 133(2):350-7. DOI: 10.1378/chest.07-1342
Source: PubMed


COPD is characterized by episodic increases in respiratory symptoms, so-called exacerbations. COPD exacerbations are associated with an increase in local and systemic inflammation. Data of a previously published study in a well-characterized COPD cohort were analyzed to define predictive factors of acute exacerbations, particularly focusing on systemic inflammation.
To determine if an elevated systemic inflammatory status measured at baseline is related to the occurrence of acute exacerbations in patients with COPD.
The occurrence of moderate (requiring oral prednisolone) and severe exacerbations (requiring hospitalization) was prospectively recorded over 1 year. At the beginning of the study, lung function values (FEV1, FVC, functional residual capacity, and diffusion capacity of the lung for carbon monoxide [Dlco]) and serum levels of C-reactive protein, fibrinogen, lipopolysaccharide binding protein, tumor necrosis factor (TNF)-alpha, and its soluble receptors (soluble TNF receptors 55 and 75) as markers of systemic inflammation were determined.
Two hundred seventy-seven person-years of follow-up were analyzed in the total group of 314 patients: 186 patients were responsible for 411 exacerbations (374 moderate and 37 severe). Multivariate analyses showed that a higher initial fibrinogen level and a lower FEV1 predicted a higher rate of both moderate and severe exacerbations. Additional independent predictors of a severe exacerbation were a higher number of prestudy severe exacerbations and lower Dlco. A higher number of prestudy moderate exacerbations was the only additional independent risk factor for the rate of moderate exacerbations.
This study demonstrates that besides lung function impairment systemic inflammation manifested by elevated fibrinogen levels is an independent risk factor for exacerbations of COPD. Attenuation of systemic inflammation may offer new perspectives in the management of COPD patients to reduce the burden of exacerbations.


Available from: Pascal Wielders
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    • "roids are often used in combination with β 2 - agonist and anticholinergic bronchodilators in the treatment of COPD ( Johnson , 2005 ) . COPD exacerbations are , at the cellular level , characterized by increasing systemic and bronchial inflammation that , at least in part , can be influenced by long - term treatment with inhaled corticosteroids ( Groenewegen et al . , 2008 ; Burge et al . , 2000 ; Wouters et al . , 2005 ; Jones et al . , 2003 ; Vestbo et al . , 1999 ) . Long - acting β 2 - agonist therapy alone is unable to reduce exacerbation rates and severity to a clinically meaningful extent ( Calverley et al . , 2007 ) . We studied the effect of corticosteroids , β 2 - agonists , and anticholinergic "
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    • "COPD is a growing cause of morbidity and mortality worldwide , and will be the third leading cause of death by 2020 [16]. Systemic inflammation and physical inactivity have been identified as relevant extrapulmonary marker of the severity of COPD, as both conditions are related to exacerbations, hospitalizations , and mortality in this patient population [17] [18] [19] [20]. "
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