Asthma and lower airway diseaseThe sputum microbiome, airway inflammation, and mortality in chronic obstructive pulmonary disease
Graphical abstract
Section snippets
Study design
We performed a longitudinal observational study of patients with a diagnosis of COPD nested within a population-based COPD registry (the Tayside Allergic and Respiratory Disease Information System) in the East of Scotland.16,20 Patients were invited to participate in a microbiome substudy and were included if they were more than 40 years old, had an FEV1/FVC ratio less than 70% at screening, and had a clinical diagnosis of COPD. Exclusion criteria included the inability to give informed
Results
A total of 296 participants were enrolled in the study; after exclusion of 44 patients whose baseline sputum samples failed DNA extraction and sequencing quality controls, the final cohort consisted of 252 participants (Fig 1); their baseline characteristics are shown in Table I. Sequencing controls are shown in Fig E1 in this article's Online Repository at www.jacionline.org. The predominant phyla observed in the microbiome were Proteobacteria and Firmicutes, with fewer OTUs identified as
Discussion
To the authors’ knowledge, this is the first study to demonstrate that the sputum microbiome in patients with stable COPD is associated with long-term survival in a prospective cohort of patients; a recent study has linked the microbiome (reduced alpha diversity, increased Staphylococcus, and reduced Veillonella) at acute exacerbation of COPD requiring hospitalization with increased mortality.25 Taken together, these studies suggest that the respiratory microbiome is associated with long-term
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This study was funded by GlaxoSmithKline and by the British Lung Foundation through the GSK-BLF Chair of Respiratory Research to J.D.C.
Disclosure of potential conflict of interest: J. D. Chalmers reports grants from GlaxoSmithKline for this research; in addition, he reports grants and personal fees from GlaxoSmithKline, Boehringer Ingelheim, AstraZeneca, Pfizer, Bayer Healthcare, Grifols, Napp, Aradigm Corporation, and Insmed outside the submitted work. H. Mullerova and R. Tal-Singer were employees of GlaxoSmithKline when this study was conducted. R. Tal-Singer is a shareholder of GlaxoSmithKline. B. E. Miller is an employee and shareholder of GlaxoSmithKline. The rest of the authors declare that they have no relevant conflicts of interest.