1 Chesapeake Pulmonary and Critical Care Medicine, Chesapeake, Virginia.
Ann Am Thorac Soc. 2014 Mar;11(3):303-9. doi: 10.1513/AnnalsATS.201310-350OC.
Respiratory pathogens are frequently isolated from the airways of patients with chronic obstructive pulmonary disease (COPD) in the absence of an exacerbation. This bacterial "colonization" by potential pathogens is associated with host inflammatory and immune responses, which could increase respiratory symptoms.
To study whether bacterial colonization impacts daily respiratory symptoms in COPD.
In a longitudinal prospective observational study of COPD, patients recorded daily symptoms electronically on the Breathlessness, Cough, and Sputum Scale (BCSS). Sputum cultures and quantitative polymerase chain reaction (PCR) were performed every 2 weeks. The relationship of BCSS and bacterial colonization was analyzed with generalized linear mixed effects models, after controlling for exacerbations, weather conditions, lung function, and demographic variables.
A total of 41 patients recorded daily symptoms for 12,527 days. The average BCSS score was higher during the periods of colonization, determined by sputum culture with one or more of the following pathogens: nontypeable Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae, and Pseudomonas aeruginosa, compared to periods without colonization (5.28 vs. 4.46; P = 0.008) after controlling for confounding variables. The finding did not change when colonization was defined by quantitative PCR (average BCSS, 4.77 vs. 4.25; P = 0.006). Sputum IL-8 levels were elevated with bacterial colonization.
Even in the absence of clinical exacerbation, colonization by bacterial pathogens in COPD was associated with a clinically significant moderate increase in daily symptoms, likely mediated by increased airway inflammation. Novel therapies that decrease bacterial colonization in COPD could improve daily symptoms and quality of life.
在没有加重的情况下，慢性阻塞性肺疾病（COPD）患者的气道中经常分离出呼吸道病原体。潜在病原体的这种细菌“定植”与宿主炎症和免疫反应有关，这可能会增加呼吸道症状。
研究细菌定植是否会影响 COPD 患者的日常呼吸症状。
在一项 COPD 的纵向前瞻性观察研究中，患者使用呼吸困难、咳嗽和咳痰量表（BCSS）每天电子记录症状。每 2 周进行痰培养和定量聚合酶链反应（PCR）。在控制加重、天气条件、肺功能和人口统计学变量后，使用广义线性混合效应模型分析 BCSS 和细菌定植之间的关系。
共有 41 名患者记录了 12527 天的日常症状。在通过痰培养确定定植期（以下一种或多种病原体：非典型流感嗜血杆菌、卡他莫拉菌、肺炎链球菌和铜绿假单胞菌）时，BCSS 评分高于无定植期（5.28 与 4.46；P = 0.008），调整混杂变量后。当通过定量 PCR 定义定植时，该发现并未改变（平均 BCSS，4.77 与 4.25；P = 0.006）。痰 IL-8 水平随细菌定植而升高。
即使没有临床加重，COPD 中细菌病原体的定植与日常症状的中度显著增加有关，这可能是由气道炎症增加介导的。减少 COPD 中细菌定植的新型疗法可能会改善日常症状和生活质量。
