Elsevier

Respiratory Medicine

Volume 101, Issue 11, November 2007, Pages 2409-2415
Respiratory Medicine

Longitudinal follow-up of systemic inflammation after acute exacerbations of COPD

https://doi.org/10.1016/j.rmed.2007.05.026Get rights and content
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Abstract

Background: Acute exacerbations are important in the clinical course of COPD, yet the underlying mechanisms are poorly understood. Systemic inflammation is now considered as an important component in the disease process. In this study we evaluated longitudinally the systemic inflammation during hospital treatment for acute exacerbation and after clinical recovery.

Methods: Blood was collected on day 0, 1, 4 and 8 in 21 patients admitted for an acute exacerbation of COPD and at 1 month, 3 months and 6 months after discharge. Systemic inflammation was determined by measurement of the pro-inflammatory markers interleukin (IL)-6, soluble tumor necrosis factor (TNF) receptors sTNFR55 and sTNFR75, the anti-inflammatory mediator sIL-1RII, and bactericidal permeability increasing protein (BPI) as a marker of neutrophil activation. In addition, plasma level of Trolox antioxidant capacity (TEAC) was determined. Healthy age-matched controls were measured for the same markers at one time-point.

Results: All inflammatory markers analyzed were elevated on first day of admission for exacerbation of COPD, as compared to healthy controls. During treatment, levels of IL-6, and sTNFR75 rapidly decreased, whereas sTNFR55 and BPI remained elevated. Moreover, sIL-1RII and TEAC increased during first 8 days of treatment. In the stable condition all inflammatory markers returned to values comparable to healthy controls, with the exception of BPI, which remained persistently elevated compared to healthy controls.

Conclusion: This study clearly demonstrates upregulation of systemic inflammation in acute exacerbations of COPD. Attenuation of systemic inflammation may offer new perspectives in the management of COPD patients to reduce the burden of exacerbations.

Abbreviations

ATS
American Thoracic Society
BAL
broncho alveolar lavage
BMI
body mass index
BPI
bactericidal permeability increasing protein
COPD
chronic obstructive pulmonary disease
CRP
C-reactive protein
ECP
eosinophilic cationic protein
FEV1
forced expiratory volume in one second
FVC
forced vital capacity
IL-6
interleukin 6
IL-8
interleukin 8
IVC
inspiratory vital capacity
MPO
myeloperoxidase
sIL-1 RII
soluble InterLeukin-1 receptor II
sTNF R55
soluble tumor necrosis factor receptor 55
sTNF R75
soluble tumor necrosis factor receptor 75
TEAC
trolox equivalent antioxidant capacity
TNF-α
tumor necrosis factor-α.

Keywords

COPD
Acute exacerbation
Systemic inflammation
Anti-oxidants

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This study was performed at the Department of Respiratory Medicine of the University Hospital Maastricht, Maastricht, The Netherlands. This study was supported by a research grant of Astra-Zeneca BV, The Netherlands.