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Am. J. Respir. Crit. Care Med., Volume 164, Number 9, November 2001, 1618-1623

Respiratory Viruses, Symptoms, and Inflammatory Markers in Acute Exacerbations and Stable Chronic Obstructive Pulmonary Disease

TERENCE SEEMUNGAL, RHIAN HARPER-OWEN, ANGSHU BHOWMIK, IVANA MORIC, GWENDOLYN SANDERSON, SIMON MESSAGE, PETER MACCALLUM, THOMAS W. MEADE, DONALD J. JEFFRIES, SEBASTIAN L. JOHNSTON, and JADWIGA A. WEDZICHA

Academic Departments of Respiratory Medicine and Virology, St. Bartholomew's and Royal London School of Medicine and Dentistry, London, UK; University Medicine, University of Southampton, Southampton, UK; National Heart and Lung Institute at St Mary's, Imperial College School of Medicine, London, UK; and Medical Research Council Epidemiology and Medical Care Unit, Wolfson Institute of Preventive Medicine, London, UK

The effects of respiratory viral infection on the time course of chronic obstructive pulmonary disease (COPD) exacerbation were examined by monitoring changes in systemic inflammatory markers in stable COPD and at exacerbation. Eighty-three patients with COPD (mean [SD] age, 66.6 [7.1] yr, FEV1, 1.06 [0.61] L) recorded daily peak expiratory flow rate and any increases in respiratory symptoms. Nasal samples and blood were taken for respiratory virus detection by culture, polymerase chain reaction, and serology, and plasma fibrinogen and serum interleukin-6 (IL-6) were determined at stable baseline and exacerbation. Sixty-four percent of exacerbations were associated with a cold occurring up to 18 d before exacerbation. Seventy-seven viruses (39 [58.2%] rhinoviruses) were detected in 66 (39.2%) of 168 COPD exacerbations in 53 (64%) patients. Viral exacerbations were associated with frequent exacerbators, colds with increased dyspnea, a higher total symptom count at presentation, a longer median symptom recovery period of 13 d, and a tendency toward higher plasma fibrinogen and serum IL-6 levels. Non-respiratory syncytial virus (RSV) respiratory viruses were detected in 11 (16%), and RSV in 16 (23.5%), of 68 stable COPD patients, with RSV detection associated with higher inflammatory marker levels. Respiratory virus infections are associated with more severe and frequent exacerbations, and may cause chronic infection in COPD. Prevention and early treatment of viral infections may lead to a decreased exacerbation frequency and morbidity associated with COPD.




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Eur. Respir. J., November 1, 2005; 26(5): 846 - 852.
[Abstract] [Full Text] [PDF]

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 Proc Am Thorac SocHome page
K. E. Belmonte
Cholinergic Pathways in the Lungs and Anticholinergic Therapy for Chronic Obstructive Pulmonary Disease
Proceedings of the ATS, November 1, 2005; 2(4): 297 - 304.
[Abstract] [Full Text] [PDF]

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 Proc Am Thorac SocHome page
P. Mallia and S. L. Johnston
Mechanisms and Experimental Models of Chronic Obstructive Pulmonary Disease Exacerbations
Proceedings of the ATS, November 1, 2005; 2(4): 361 - 366.
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 J. Virol.Home page
C. A. Hewson, A. Jardine, M. R. Edwards, V. Laza-Stanca, and S. L. Johnston
Toll-Like Receptor 3 Is Induced by and Mediates Antiviral Activity against Rhinovirus Infection of Human Bronchial Epithelial Cells
J. Virol., October 1, 2005; 79(19): 12273 - 12279.
[Abstract] [Full Text] [PDF]

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 ChestHome page
G. C. Donaldson, T. A. R. Seemungal, I. S. Patel, A. Bhowmik, T. M. A. Wilkinson, J. R. Hurst, P. K. MacCallum, and J. A. Wedzicha
Airway and Systemic Inflammation and Decline in Lung Function in Patients With COPD
Chest, October 1, 2005; 128(4): 1995 - 2004.
[Abstract] [Full Text] [PDF]

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 Eur Respir JHome page
P. Calverley, R. Pauwels{dagger}, C-G. Lofdahl, K. Svensson, T. Higenbottam, L-G. Carlsson, and E. Stahl
Relationship between respiratory symptoms and medical treatment in exacerbations of COPD
Eur. Respir. J., September 1, 2005; 26(3): 406 - 413.
[Abstract] [Full Text] [PDF]

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P. J. M. Openshaw
Antiviral Immune Responses and Lung Inflammation after Respiratory Syncytial Virus Infection
Proceedings of the ATS, August 1, 2005; 2(2): 121 - 125.
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 Proc Am Thorac SocHome page
S. L. Johnston
Overview of Virus-induced Airway Disease
Proceedings of the ATS, August 1, 2005; 2(2): 150 - 156.
[Abstract] [Full Text] [PDF]

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 Clin. Microbiol. Rev.Home page
P. J. M. Openshaw and J. S. Tregoning
Immune Responses and Disease Enhancement during Respiratory Syncytial Virus Infection
Clin. Microbiol. Rev., July 1, 2005; 18(3): 541 - 555.
[Abstract] [Full Text] [PDF]

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 Am. J. Physiol. Lung Cell. Mol. Physiol.Home page
J. C. L. Spurrell, S. Wiehler, R. S. Zaheer, S. P. Sanders, and D. Proud
Human airway epithelial cells produce IP-10 (CXCL10) in vitro and in vivo upon rhinovirus infection
Am J Physiol Lung Cell Mol Physiol, July 1, 2005; 289(1): L85 - L95.
[Abstract] [Full Text] [PDF]

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 Eur Respir JHome page
P. J. Barnes and R. A. Stockley
COPD: current therapeutic interventions and future approaches
Eur. Respir. J., June 1, 2005; 25(6): 1084 - 1106.
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 Am. J. Respir. Crit. Care Med.Home page
H. Yasuda, M. Yamaya, K. Nakayama, S. Ebihara, T. Sasaki, S. Okinaga, D. Inoue, M. Asada, M. Nemoto, and H. Sasaki
Increased Arterial Carboxyhemoglobin Concentrations in Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., June 1, 2005; 171(11): 1246 - 1251.
[Abstract] [Full Text] [PDF]

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 NEJMHome page
S. Sethi and T. F. Murphy
RSV Infection -- Not for Kids Only
N. Engl. J. Med., April 28, 2005; 352(17): 1810 - 1812.
[Full Text] [PDF]

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P. K. MacCallum
Markers of Hemostasis and Systemic Inflammation in Heart Disease and Atherosclerosis in Smokers
Proceedings of the ATS, April 1, 2005; 2(1): 34 - 43.
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 Am. J. Respir. Crit. Care Med.Home page
G. C. Donaldson, T. M. A. Wilkinson, J. R. Hurst, W. R. Perera, and J. A. Wedzicha
Exacerbations and Time Spent Outdoors in Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., March 1, 2005; 171(5): 446 - 452.
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 Eur Respir JHome page
H. Lode, J. Eller, A. Linnhoff, M. Ioanas, and the Evaluation of Therapy-Free Interval in COPD Pa
Levofloxacin versus clarithromycin in COPD exacerbation: focus on exacerbation-free interval
Eur. Respir. J., December 1, 2004; 24(6): 947 - 953.
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J R Hurst and J A Wedzicha
Chronic obstructive pulmonary disease: the clinical management of an acute exacerbation
Postgrad. Med. J., September 1, 2004; 80(947): 497 - 505.
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 Am. J. Respir. Crit. Care Med.Home page
I. S. Patel, I. Vlahos, T. M. A. Wilkinson, S. J. Lloyd-Owen, G. C. Donaldson, M. Wilks, R. H. Reznek, and J. A. Wedzicha
Bronchiectasis, Exacerbation Indices, and Inflammation in Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., August 15, 2004; 170(4): 400 - 407.
[Abstract] [Full Text] [PDF]

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 Eur Respir JHome page
M. Seki, K. Yanagihara, Y. Higashiyama, Y. Fukuda, Y. Kaneko, H. Ohno, Y. Miyazaki, Y. Hirakata, K. Tomono, J. Kadota, et al.
Immunokinetics in severe pneumonia due to influenza virus and bacteria coinfection in mice
Eur. Respir. J., July 1, 2004; 24(1): 143 - 149.
[Abstract] [Full Text] [PDF]

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 ChestHome page
M. Cazzola and R. Dahl
Inhaled Combination Therapy With Long-Acting {beta}2-Agonists and Corticosteroids in Stable COPD
Chest, July 1, 2004; 126(1): 220 - 237.
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 Am. J. Respir. Crit. Care Med.Home page
T. M. A. Wilkinson, G. C. Donaldson, J. R. Hurst, T. A. R. Seemungal, and J. A. Wedzicha
Early Therapy Improves Outcomes of Exacerbations of Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., June 15, 2004; 169(12): 1298 - 1303.
[Abstract] [Full Text] [PDF]

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 Eur Respir JHome page
N.R. Anthonisen
The British hypothesis revisited
Eur. Respir. J., May 1, 2004; 23(5): 657 - 658.
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 Proc Am Thorac SocHome page
R. A. Pauwels
Similarities and Differences in Asthma and Chronic Obstructive Pulmonary Disease Exacerbations
Proceedings of the ATS, April 1, 2004; 1(2): 73 - 76.
[Abstract] [Full Text] [PDF]

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S. I. Rennard and S. G. Farmer
Exacerbations and Progression of Disease in Asthma and Chronic Obstructive Pulmonary Disease
Proceedings of the ATS, April 1, 2004; 1(2): 88 - 92.
[Abstract] [Full Text] [PDF]

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 Proc Am Thorac SocHome page
J. A. Wedzicha
Role of Viruses in Exacerbations of Chronic Obstructive Pulmonary Disease
Proceedings of the ATS, April 1, 2004; 1(2): 115 - 120.
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 J. Immunol.Home page
D. Proud, S. P. Sanders, and S. Wiehler
Human Rhinovirus Infection Induces Airway Epithelial Cell Production of Human {beta}-Defensin 2 Both In Vitro and In Vivo
J. Immunol., April 1, 2004; 172(7): 4637 - 4645.
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 Am. J. Respir. Crit. Care Med.Home page
J. Schwarze, D. R. O'Donnell, A. Rohwedder, and P. J. M. Openshaw
Latency and Persistence of Respiratory Syncytial Virus Despite T Cell Immunity
Am. J. Respir. Crit. Care Med., April 1, 2004; 169(7): 801 - 805.
[Abstract] [Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
S. Sethi, C. Wrona, B. J. B. Grant, and T. F. Murphy
Strain-specific Immune Response to Haemophilus influenzae in Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., February 15, 2004; 169(4): 448 - 453.
[Abstract] [Full Text] [PDF]

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 ChestHome page
S. Kim, C. L. Emerman, R. K. Cydulka, B. H. Rowe, S. Clark, and C. A. Camargo
Prospective Multicenter Study of Relapse Following Emergency Department Treatment of COPD Exacerbation
Chest, February 1, 2004; 125(2): 473 - 481.
[Abstract] [Full Text] [PDF]

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S. D. Message and S. L. Johnston
Host defense function of the airway epithelium in health and disease: clinical background
J. Leukoc. Biol., January 1, 2004; 75(1): 5 - 17.
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 Eur Respir JHome page
G.C. Donaldson, T.A.R. Seemungal, I.S. Patel, S.J. Lloyd-Owen, T.M.A. Wilkinson, and J.A. Wedzicha
Longitudinal changes in the nature, severity and frequency of COPD exacerbations
Eur. Respir. J., December 1, 2003; 22(6): 931 - 936.
[Abstract] [Full Text] [PDF]


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