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A prospective, observational cohort study of the seasonal dynamics of airway pathogens in the aetiology of exacerbations in COPD

A prospective, observational cohort study of the seasonal dynamics of airway pathogens in the aetiology of exacerbations in COPD
A prospective, observational cohort study of the seasonal dynamics of airway pathogens in the aetiology of exacerbations in COPD
Background: The aetiology of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is incompletely understood. Understanding the relationship between chronic bacterial airway infection and viral exposure may explain the incidence and seasonality of these events.

Methods: In this prospective, observational cohort study (NCT01360398), patients with COPD aged 40–85 years underwent sputum sampling monthly and at exacerbation for detection of bacteria and viruses. Results are presented for subjects in the full cohort, followed for one year. Interactions between exacerbation occurrence and pathogens were investigated by generalised estimating equation and stratified conditional logistic regression analyses.

Findings: The mean exacerbation rate per patient year was 3.04 (95% CI 2.63–3.50). At AECOPD, the most common bacterial species were non-typeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis, and the most common virus was rhinovirus. Logistic regression analyses (culture bacterial detection) showed significant odds ratio (OR) for AECOPD occurrence when M. catarrhalis was detected regardless of season (5.09 [95% CI 2.76–9.41]). When NTHi was detected, the increased risk of exacerbation was greater in high season (October–March, OR 3.04 [1.80–5.13]) than low season (OR 1.22 [0.68–2.22]). Bacterial and viral coinfection was more frequent at exacerbation (24.9%) than stable state (8.6%). A significant interaction was detected between NTHi and rhinovirus presence and AECOPD risk (OR 5.18 [1.92–13.99]; p=0.031).

Conclusions: AECOPD aetiology varies with season. Rises in incidence in winter may be driven by increased pathogen presence as well as an interaction between NTHi airway infection and effects of viral infection.
0040-6376
Wilkinson, Tom M.A.
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Aris, Emmanuel
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Bourne, Simon
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Clarke, Stuart C.
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Peeters, Mathieu
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Pascal, Thierry G.
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Schoonbroodt, Sonia
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Tuck, Andrew C.
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Kim, Viktoriya
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Ostridge, Kristoffer
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Staples, Karl J.
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Williams, Nicholas
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Williams, Anthony
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Wootton, Stephen
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Devaster, Jeanne-Marie
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Wilkinson, Tom M.A.
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Aris, Emmanuel
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Bourne, Simon
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Clarke, Stuart C.
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Peeters, Mathieu
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Pascal, Thierry G.
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Schoonbroodt, Sonia
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Tuck, Andrew C.
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Kim, Viktoriya
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Ostridge, Kristoffer
d2271bae-b078-4390-8919-8f8c0e20542c
Staples, Karl J.
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Williams, Nicholas
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Williams, Anthony
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Wootton, Stephen
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Devaster, Jeanne-Marie
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Wilkinson, Tom M.A., Aris, Emmanuel, Bourne, Simon, Clarke, Stuart C., Peeters, Mathieu, Pascal, Thierry G., Schoonbroodt, Sonia, Tuck, Andrew C., Kim, Viktoriya, Ostridge, Kristoffer, Staples, Karl J., Williams, Nicholas, Williams, Anthony, Wootton, Stephen and Devaster, Jeanne-Marie (2017) A prospective, observational cohort study of the seasonal dynamics of airway pathogens in the aetiology of exacerbations in COPD. Thorax. (doi:10.1136/thoraxjnl-2016-209023).

Record type: Article

Abstract

Background: The aetiology of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is incompletely understood. Understanding the relationship between chronic bacterial airway infection and viral exposure may explain the incidence and seasonality of these events.

Methods: In this prospective, observational cohort study (NCT01360398), patients with COPD aged 40–85 years underwent sputum sampling monthly and at exacerbation for detection of bacteria and viruses. Results are presented for subjects in the full cohort, followed for one year. Interactions between exacerbation occurrence and pathogens were investigated by generalised estimating equation and stratified conditional logistic regression analyses.

Findings: The mean exacerbation rate per patient year was 3.04 (95% CI 2.63–3.50). At AECOPD, the most common bacterial species were non-typeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis, and the most common virus was rhinovirus. Logistic regression analyses (culture bacterial detection) showed significant odds ratio (OR) for AECOPD occurrence when M. catarrhalis was detected regardless of season (5.09 [95% CI 2.76–9.41]). When NTHi was detected, the increased risk of exacerbation was greater in high season (October–March, OR 3.04 [1.80–5.13]) than low season (OR 1.22 [0.68–2.22]). Bacterial and viral coinfection was more frequent at exacerbation (24.9%) than stable state (8.6%). A significant interaction was detected between NTHi and rhinovirus presence and AECOPD risk (OR 5.18 [1.92–13.99]; p=0.031).

Conclusions: AECOPD aetiology varies with season. Rises in incidence in winter may be driven by increased pathogen presence as well as an interaction between NTHi airway infection and effects of viral infection.

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Accepted/In Press date: 13 March 2017
e-pub ahead of print date: 21 April 2017
Organisations: NIHR Southampton Biomedical Research Centre, Cancer Sciences, NIHR Southampton Respiratory Biomedical Research Unit, Human Development & Health, Clinical & Experimental Sciences

Identifiers

Local EPrints ID: 407344
URI: https://eprints.soton.ac.uk/id/eprint/407344
ISSN: 0040-6376
PURE UUID: 7d3361a0-532a-4f90-9746-d6469bf2b6f9
ORCID for Stuart C. Clarke: ORCID iD orcid.org/0000-0002-7009-1548
ORCID for Karl J. Staples: ORCID iD orcid.org/0000-0003-3844-6457

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Date deposited: 04 Apr 2017 01:03
Last modified: 10 Dec 2019 06:06

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Contributors

Author: Emmanuel Aris
Author: Simon Bourne
Author: Mathieu Peeters
Author: Thierry G. Pascal
Author: Sonia Schoonbroodt
Author: Andrew C. Tuck
Author: Viktoriya Kim
Author: Kristoffer Ostridge
Author: Karl J. Staples ORCID iD
Author: Nicholas Williams
Author: Stephen Wootton
Author: Jeanne-Marie Devaster

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