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Impact of radiologically stratified exacerbations: Insights into pneumonia aetiology in COPD

Impact of radiologically stratified exacerbations: Insights into pneumonia aetiology in COPD
Impact of radiologically stratified exacerbations: Insights into pneumonia aetiology in COPD
Background:
COPD patients have increased risk of developing pneumonia, which is associated with poor outcomes. It can be symptomatically indistinguishable from exacerbations, making diagnosis challenging. Studies of pneumonia in COPD have focused on hospitalised patients and are not representative of the ambulant COPD population. Therefore, we sought to determine the incidence and aetiology of acute exacerbation events with evidence of pneumonic radiographic infiltrates in an outpatient COPD cohort.
Methods:
127 patients with moderate to very severe COPD aged 42-85 years underwent blood and sputum sampling over one year, at monthly stable visits and within 72 hours of exacerbation symptom onset. 343 exacerbations with chest radiographs were included.
Results:
20.1% of exacerbations had pneumonic infiltrates. Presence of infiltrate was highly seasonal (Winter vs summer OR 3.056, p=0.027). In paired analyses these exacerbation events had greater increases in systemic inflammation. Bacterial detection rate was higher in the pneumonic group, with Haemophilus influenzae the most common bacteria in both radiological groups. Viral detection and sputum microbiota did not differ with chest radiograph appearance.
Conclusions:
In an outpatient COPD cohort, pneumonic infiltrates at exacerbation were common, and associated with more intense inflammation. Bacterial pathogen detection and lung microbiota were not distinct, suggesting that exacerbations and pneumonia in COPD share common infectious triggers and represent a continuum of severity rather than distinct aetiological events.
Trial Registration Number: NCT01360398
1465-9921
Williams, Nicholas P.
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Ostridge, Kristoffer
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Devaster, Jeanne-Marie
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Kim, Viktoriya
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Coombs, Ngaire A.
5281ab5b-6984-437e-a1ae-71cac3a5f5e5
Bourne, Simon
2b022ba8-a7f2-491d-aa41-038b1c8afccb
Clarke, Stuart C.
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Harden, Stephen
f53e511e-df8b-451f-aa1e-e8e80e1a4e46
Abbas, Ausami
a99d208f-3fd0-4cf4-a871-d0e6866c8b35
Aris, Emmanuel
2203e7f8-8fa1-40c0-be30-99f142655835
Lambert, Christophe
d0e69c96-97be-4b55-ab67-3db6d369f418
Tuck, Andrew
90d0a731-080b-4872-8fc0-45cd71db1e2c
Williams, Anthony
973ff46f-46f1-4d7c-b27d-0f53221e4c44
Wootton, Stephen
bf47ef35-0b33-4edb-a2b0-ceda5c475c0c
Staples, Karl J.
e0e9d80f-0aed-435f-bd75-0c8818491fee
Wilkinson, Tom M.A.
8c55ebbb-e547-445c-95a1-c8bed02dd652
Williams, Nicholas P.
00ee9f78-fdc9-434f-be3e-5ded7a8abe08
Ostridge, Kristoffer
d2271bae-b078-4390-8919-8f8c0e20542c
Devaster, Jeanne-Marie
36195bcf-0cae-40cc-8ee2-d389a4a65a13
Kim, Viktoriya
b7fe2e0f-95b4-4224-96a8-a7e66155625e
Coombs, Ngaire A.
5281ab5b-6984-437e-a1ae-71cac3a5f5e5
Bourne, Simon
2b022ba8-a7f2-491d-aa41-038b1c8afccb
Clarke, Stuart C.
f7d7f7a2-4b1f-4b36-883a-0f967e73fb17
Harden, Stephen
f53e511e-df8b-451f-aa1e-e8e80e1a4e46
Abbas, Ausami
a99d208f-3fd0-4cf4-a871-d0e6866c8b35
Aris, Emmanuel
2203e7f8-8fa1-40c0-be30-99f142655835
Lambert, Christophe
d0e69c96-97be-4b55-ab67-3db6d369f418
Tuck, Andrew
90d0a731-080b-4872-8fc0-45cd71db1e2c
Williams, Anthony
973ff46f-46f1-4d7c-b27d-0f53221e4c44
Wootton, Stephen
bf47ef35-0b33-4edb-a2b0-ceda5c475c0c
Staples, Karl J.
e0e9d80f-0aed-435f-bd75-0c8818491fee
Wilkinson, Tom M.A.
8c55ebbb-e547-445c-95a1-c8bed02dd652

Williams, Nicholas P., Ostridge, Kristoffer, Devaster, Jeanne-Marie, Kim, Viktoriya, Coombs, Ngaire A., Bourne, Simon, Clarke, Stuart C., Harden, Stephen, Abbas, Ausami, Aris, Emmanuel, Lambert, Christophe, Tuck, Andrew, Williams, Anthony, Wootton, Stephen, Staples, Karl J. and Wilkinson, Tom M.A. (2018) Impact of radiologically stratified exacerbations: Insights into pneumonia aetiology in COPD. Respiratory Research. (doi:10.1186/s12931-018-0842-8).

Record type: Article

Abstract

Background:
COPD patients have increased risk of developing pneumonia, which is associated with poor outcomes. It can be symptomatically indistinguishable from exacerbations, making diagnosis challenging. Studies of pneumonia in COPD have focused on hospitalised patients and are not representative of the ambulant COPD population. Therefore, we sought to determine the incidence and aetiology of acute exacerbation events with evidence of pneumonic radiographic infiltrates in an outpatient COPD cohort.
Methods:
127 patients with moderate to very severe COPD aged 42-85 years underwent blood and sputum sampling over one year, at monthly stable visits and within 72 hours of exacerbation symptom onset. 343 exacerbations with chest radiographs were included.
Results:
20.1% of exacerbations had pneumonic infiltrates. Presence of infiltrate was highly seasonal (Winter vs summer OR 3.056, p=0.027). In paired analyses these exacerbation events had greater increases in systemic inflammation. Bacterial detection rate was higher in the pneumonic group, with Haemophilus influenzae the most common bacteria in both radiological groups. Viral detection and sputum microbiota did not differ with chest radiograph appearance.
Conclusions:
In an outpatient COPD cohort, pneumonic infiltrates at exacerbation were common, and associated with more intense inflammation. Bacterial pathogen detection and lung microbiota were not distinct, suggesting that exacerbations and pneumonia in COPD share common infectious triggers and represent a continuum of severity rather than distinct aetiological events.
Trial Registration Number: NCT01360398

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Accepted/In Press date: 10 July 2018
e-pub ahead of print date: 28 July 2018

Identifiers

Local EPrints ID: 422391
URI: https://eprints.soton.ac.uk/id/eprint/422391
ISSN: 1465-9921
PURE UUID: f01523b0-e889-4444-8413-79b551d47ad2
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: 23 Jul 2018 16:30
Last modified: 14 Mar 2019 05:04

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Contributors

Author: Nicholas P. Williams
Author: Kristoffer Ostridge
Author: Jeanne-Marie Devaster
Author: Viktoriya Kim
Author: Ngaire A. Coombs
Author: Simon Bourne
Author: Stephen Harden
Author: Ausami Abbas
Author: Emmanuel Aris
Author: Christophe Lambert
Author: Andrew Tuck
Author: Stephen Wootton
Author: Karl J. Staples ORCID iD

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