Am. J. Respir. Crit. Care Med., Volume 162, Number 3, September 2000, 947-952

Airway Inflammation in Nonobstructive and Obstructive Chronic Bronchitis with Chronic Haemophilus influenzae Airway Infection
Comparison with Noninfected Patients with Chronic Obstructive Pulmonary Disease

PAUL BRESSER, THEO A. OUT, LOEK van ALPHEN, HENK M. JANSEN, and RENÉ LUTTER

Departments of Pulmonology and Clinical Microbiology, and Clinical and Laboratory Immunology Unit, Academic Medical Center, University of Amsterdam, and Laboratory for Experimental and Clinical Immunology, Central Laboratory of the Blood Transfusion Service (CLB), Sanquin Blood Supply Foundation, Amsterdam, The Netherlands

Nonencapsulated Haemophilus influenzae often causes chronic infections of the lower respiratory tract in both nonobstructive and obstructive chronic bronchitis. We assessed airway inflammation in clinically stable, chronically H. influenzae-infected patients with nonobstructive (CB-HI, n = 10) and in patients with obstructive chronic bronchitis (COPD-HI, n = 10) by analyses of the sol phase of spontaneously expectorated sputum (SSP). As compared with the CB-HI group, the COPD-HI group had significantly higher (p < 0.05) levels of myeloperoxidase (MPO) and tumor necrosis factor (TNF)- in their SSP, whereas the degree of plasma protein leakage (SSP-to-serum ratio of plasma proteins) and the levels of interleukin (IL)-8, secretory IgA, and lactoferrin were similar in the two groups. These findings point to differences in pathophysiology in CB-HI and COPD-HI. The high level of TNF- in the SSP of COPD-HI patients is in accord with the proposed role of TNF- in the development of airway obstruction in COPD patients. In apparent contradiction, low levels of TNF- were found in the SSP of noninfected but otherwise similar COPD patients (n = 9). This finding, however, does not exclude an exaggerated TNF- response to infection or another stimulus in the airways of COPD patients. The SSP levels of MPO and IL-8, and the degree of plasma protein leakage in the COPD-HI group, were retrospectively compared with and found significantly higher than those of noninfected COPD patients, suggesting a more marked inflammatory response in COPD-HI. Whether this reflects a direct cause-and-effect relationship should be addressed in a future long-term prospective study involving repeated measurements in the same patients.

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