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Published ahead of print on May 6, 2004, doi:10.1164/rccm.200305-648OC

Am. J. Respir. Crit. Care Med., Volume 170, Number 4, August 2004, 400-407

A more recent version of this article appeared on August 15, 2004
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Submitted on May 13, 2003
Accepted on May 4, 2004

Bronchiectasis, Exacerbation Indices and Inflammation in Chronic Obstructive Pulmonary Disease

Irem S Patel1, Ioannis Vlahos2, Tom MA Wilkinson1, Simon J Lloyd-Owen1, Gavin C Donaldson1, Mark Wilks3, Rodney H Reznek2, and Jadwiga A Wedzicha1*

1 Academic Unit of Respiratory Medicine, St. Bartholomew's and the Royal London Hospital School of Medicine and Dentistry, London, United Kingdom, 2 Academic Radiology, St. Bartholomew's and the Royal London Hospital School of Medicine and Dentistry, London, United Kingdom, 3 Microbiology and Virology Clinical Group, St. Bartholomew's and the Royal London Hospital NHS Trust, London, United Kingdom

* To whom correspondence should be addressed. E-mail: j.a.wedzicha{at}qmul.ac.uk.

Relationships between high-resolution computerised tomography (HRCT) findings in chronic obstructive pulmonary disease (COPD), and bacterial colonisation, airway inflammation or exacerbation indices are unknown. 54 COPD patients (mean (standard deviation) age 69 (7) years, forced expiratory volume in one second (FEV1) 0.96 (0.33) litres, FEV1% predicted 38.1 (13.9) %, FEV1% /forced vital capacity 40.9 (11.8) %, arterial partial pressure of oxygen 8.77 (1.11) kilopascals, 50.5 (33.5) smoking pack years) underwent high-resolution CT scans of the chest to quantify the presence and extent of bronchiectasis or emphysema. Exacerbation indices were determined from diary cards over 2 years. Quantitative sputum bacteriology and cytokine measurements were performed. 27/54 (50%) patients had bronchiectasis on HRCT, most frequently in the lower lobes (18/54, 33.3%). Patients with bronchiectasis had higher levels of airway inflammatory cytokines (p= 0.001). Lower lobe bronchiectasis was associated with lower airway bacterial colonisation (p = 0.004), higher sputum interleukin (IL) -8 levels (p = 0.001) and longer symptom recovery time at exacerbation (p = 0.001). No relationship was seen between exacerbation frequency and HRCT changes. Evidence of moderate lower lobe bronchiectasis on HRCT is common in COPD and is associated with more severe COPD exacerbations, lower airway bacterial colonisation and increased sputum inflammatory markers.
Key words: CT scanning, bronchiectasis, COPD, exacerbation, inflammation




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