TY - JOUR
T1 - Airway bacterial colonization and serum C-reactive protein are associated with chronic obstructive pulmonary disease exacerbation following bronchoscopic lung volume reduction
AU - Fruchter, Oren
AU - Rosengarten, Dror
AU - Goldberg, Elad
AU - Ben-Zvi, Haim
AU - Tor, Ruth
AU - Kramer, Mordechai R.
N1 - Publisher Copyright:
© 2016 John Wiley & Sons Ltd.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Introduction: Stable chronic obstructive pulmonary disease (COPD) patients often have lower airway bacterial colonization (ABC) which may modulate exacerbation frequency. Data regarding the association between ABC and post-procedural COPD exacerbations following bronchoscopic lung volume reduction (BLVR) are scant. Objectives: Our aim was to explore the correlation among ABC, serum C-reactive protein (CRP) level and the risk of COPD exacerbation within a month following BLVR. Methods: Pre-procedure bronchoalveolar lavage (BAL) quantitative bacterial cultures and serum levels of CRP were evaluated in severe COPD patients (N = 70, mean FEV1 = 34.6%) before BLVR by polymeric lung sealant. Results: Colonization with potential pathogenic microorganism (PPM) was observed in 40 (57.1%) patients. Out of 28 patients (40%) who had COPD exacerbation within 30days of BLVR, 23 (82.1%) had PPM in BAL culture compared with only 14 (33.3%) out of 42 patients who had uneventful procedure (P = 0.0027). Serum CRP level was significantly higher in patients with exacerbation compared with those with no exacerbation (mean 47.8 ± 66.0mg/L vs 13.05 ± 27.7mg/L, respectively, P = 0.0063). The combination of CRP level above 3.12mg/L and PPM growth in BAL was observed in 89.2% of patients with exacerbation compared with only 52.3% of patients without exacerbation (P = 0.0031). Conclusions: ABC is common in severe COPD patients undergoing BLVR, and along with elevated CRP level both are associated with high risk of immediate post-procedural COPD exacerbation. These patients should be identified, carefully observed and possibly benefit from prophylactic microbiologically directed antibiotic treatment.
AB - Introduction: Stable chronic obstructive pulmonary disease (COPD) patients often have lower airway bacterial colonization (ABC) which may modulate exacerbation frequency. Data regarding the association between ABC and post-procedural COPD exacerbations following bronchoscopic lung volume reduction (BLVR) are scant. Objectives: Our aim was to explore the correlation among ABC, serum C-reactive protein (CRP) level and the risk of COPD exacerbation within a month following BLVR. Methods: Pre-procedure bronchoalveolar lavage (BAL) quantitative bacterial cultures and serum levels of CRP were evaluated in severe COPD patients (N = 70, mean FEV1 = 34.6%) before BLVR by polymeric lung sealant. Results: Colonization with potential pathogenic microorganism (PPM) was observed in 40 (57.1%) patients. Out of 28 patients (40%) who had COPD exacerbation within 30days of BLVR, 23 (82.1%) had PPM in BAL culture compared with only 14 (33.3%) out of 42 patients who had uneventful procedure (P = 0.0027). Serum CRP level was significantly higher in patients with exacerbation compared with those with no exacerbation (mean 47.8 ± 66.0mg/L vs 13.05 ± 27.7mg/L, respectively, P = 0.0063). The combination of CRP level above 3.12mg/L and PPM growth in BAL was observed in 89.2% of patients with exacerbation compared with only 52.3% of patients without exacerbation (P = 0.0031). Conclusions: ABC is common in severe COPD patients undergoing BLVR, and along with elevated CRP level both are associated with high risk of immediate post-procedural COPD exacerbation. These patients should be identified, carefully observed and possibly benefit from prophylactic microbiologically directed antibiotic treatment.
KW - Bronchial colonization
KW - COPD
KW - Exacerbation
KW - Lung volume reduction
KW - Postoperative respiratory infection
KW - Risk factors
UR - http://www.scopus.com/inward/record.url?scp=84959332838&partnerID=8YFLogxK
U2 - 10.1111/crj.12211
DO - 10.1111/crj.12211
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C2 - 25196428
AN - SCOPUS:84959332838
SN - 1752-6981
VL - 10
SP - 239
EP - 245
JO - Clinical Respiratory Journal
JF - Clinical Respiratory Journal
IS - 2
ER -