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Association of Chronic Obstructive Pulmonary Disease Severity and Pneumocystis Colonization

Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Southern California, Los Angeles; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and Department of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania; and University of British Columbia, McDonald Research Laboratories, St. Paul's Hospital, Vancouver, British Columbia, Canada

Correspondence and requests for reprints should be addressed to Alison Morris, M.D., M.S., Division of Pulmonary and Critical Care Medicine, 2011 Zonal Avenue, HMR 911, Los Angeles, CA 90033. E-mail: alison.morris{at}usc.edu

Factors modulating the variable progression of chronic obstructive pulmonary disease (COPD) are largely unknown, but infectious agents may play a role. Because Pneumocystis has previously been shown to induce a CD8⁺ lymphocyte- and neutrophil-predominant response similar to that in COPD, we explored the association of the organism with accelerated disease progression. We examined Pneumocystis colonization rates in lung tissue obtained during lung resection or transplantation in smokers with a range of airway obstruction severity and in a control group with lung diseases other than COPD. Using nested polymerase chain reaction, Pneumocystis colonization was detected in 36.7% of patients with very severe COPD (Global Health Initiative on Obstructive Lung Disease [GOLD] Stage IV) compared with 5.3% of smokers with normal lung function or less severe COPD (Stages 0, I, II, and III) (p = 0.004) and with 9.1% of control subjects (p = 0.007). Colonized subjects exhibited more severe airway obstruction (median FEV₁ = 21% predicted versus 62% in noncolonized subjects, p = 0.006). GOLD IV was the strongest predictor of Pneumocystis colonization (odds ratio = 7.3, 95% confidence interval = 2.4–22.4, p < 0.001) and was independent of smoking history. We conclude that there is a strong association between Pneumocystis colonization and severity of airflow obstruction in smokers, suggesting a possible pathogenic link with COPD progression.

Key Words: chronic obstructive pulmonary disease • epidemiology • Pneumocystis jiroveci

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