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Published ahead of print on February 10, 2006, doi:10.1164/rccm.200509-1525OC

Am. J. Respir. Crit. Care Med., Volume 173, Number 9, May 2006, 991-998

A more recent version of this article appeared on May 1, 2006
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Submitted on September 28, 2005
Accepted on February 10, 2006

Airway Inflammation and Bronchial Bacterial Colonization in Chronic Obstructive Pulmonary Disease

Sanjay Sethi1*, Jane Maloney2, Lori Grove2, Catherine Wrona2, and Charles S Berenson3

1 Department of Medicine, Division of Pulmonary/Critical Care and Sleep Medicine, University at Buffalo, Buffalo, NY, USA; Department of Veterans Affairs, Western New York Healthcare System, Buffalo, NY, USA, 2 Department of Medicine, Division of Infectious Diseases, University at Buffalo, Buffalo, NY, USA, 3 Department of Medicine, Division of Infectious Diseases, University at Buffalo, Buffalo, NY, USA; Department of Veterans Affairs, Western New York Healthcare System, Buffalo, NY, USA

* To whom correspondence should be addressed. E-mail: ssethi{at}buffalo.edu.

Rationale: Inflammation is now recognized as an integral part of the pathogenesis of chronic obstructive pulmonary disease (COPD). In contrast to the sterile airways of normal lungs, bacterial pathogens are often isolated from the airways in stable COPD. This 'colonization' of the tracheobronchial tree, currently thought to be innocuous, could serve as an inflammatory stimulus, independent of current tobacco smoke exposure. Objective: To test the hypothesis that bacterial 'colonization' is associated with airway inflammation in stable COPD. Methods: Bronchoscopy with bronchoalveolar lavage (BAL) was performed in three groups of subjects: 26 ex-smokers with stable COPD (COPD), 20 ex-smokers without COPD (ex-smokers) and 15 healthy non-smokers (non-smokers). Quantitative bacterial cultures, cell counts, chemokine, cytokine, proteinase/anti-proteinase and endotoxin levels in the BAL fluid were compared. Results: Potentially pathogenic bacteria were recovered at ≥100 colony forming units/ml in 34.6% of COPD, 0% of ex-smokers and in 6.7% of non-smokers [p=0.003]. Colonized COPD subjects had significantly greater relative [12.0(28.4) vs. 3.0(7.8)%, p=0.03] and absolute [4.98(5.26) x 104/ml vs. 3.04(2.82) x 104/ml, p=0.02] neutrophil counts, interleukin-8 [33.8(189.8) vs. 16.9(20.1)pg/ml, p=0.005], active matrix metalloproteinase-9 [2.16(4.30) vs. 0.84(0.99)units/ml, p=0.03] and endotoxin [36.0(72.6) vs. 3.55 7.17)mEU/ml, p=0.004] levels in the BAL than the non-colonized COPD subjects. These inflammatory constituents of BAL were also significantly elevated in colonized COPD subjects when compared to ex-smokers and non-smokers. Conclusions: Bacterial colonization is associated with neutrophilic airway lumen inflammation in ex-smokers with COPD and could contribute to progression of airway disease in COPD.
Key words: COPD, Bacterial colonization, Neutrophilic inflammation




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