Systemic markers of inflammation in stable bronchiectasis

Abstract

Patients with bronchiectasis have an active local and systemic inflammatory response during infective exacerbations. Systemic markers of inflammation were investigated during a stable phase of their illness, because continued inflammation could affect their general health and be involved in disease progression. The relationship between levels of various systemic markers of inflammation and extent of disease on computed tomographic scan, lung function, sputum bacteriology and health related quality of life (HRQoL) was investigated in 87 noncystic fibrosis bronchiectasis patients. Several markers were elevated and correlated with the extent of disease and poor lung function. The total white cell count, neutrophil count and erythrocyte sedimentation rate correlated with both disease measures. Sputum bacteriology did not correlate with inflammation markers and patients with positive and negative cultures were similar. C-reactive protein and total white cell count correlated with some components of a disease-specific HRQoL questionnaire. In conclusion, patients with bronchiectasis in a stable phase have raised systemic markers of inflammation. Some markers, particularly the neutrophil count, correlate with disease severity. This result is in keeping with the hypothesis that the level of inflammation determines disease progression and health status.

The heterogeneity of systemic inflammation in bronchiectasis

“…This effect was driven largely by the reduction in lung function, Pseudomonas colonisation and age. Our findings are in keeping with Wilson's 1998 report of an association between lung function and systemic inflammation in bronchiectasis [1]. Systemic inflammation may provide the link between airway inflammatory diseases and the increased cardiovascular risk observed in such conditions [5], of clinical importance because many patients with COPD, for example, die from co-morbid cardiovascular disease [21].…”

“…It has been known for some time that patients with bronchiectasis also present a systemic inflammatory response [1] including up-regulated expression of circulating leukocyte adhesion molecules [10] even when clinically stable. The former analysis of differential leukocyte count, CRP, erythrocyte sedimentation rate and serum immunoglobulins in 87 patients reported significant associations between systemic 14 inflammation and bronchiectasis severity as assessed both by CT scan and lung function.…”

“…Whilst it has been known for some time that bronchiectasis is also associated with systemic inflammation [1], the nature of this response has not been well studied in relation to bronchiectasis aetiology and severity.…”

Does airway colonization cause systemic inflammation in bronchiectasis?

“…Chronic airway infection, in turn, triggers an intense local inflammatory response (12). There is limited data about the presence of a systemic inflammatory component in addition to this local response during the clinically stable period in bronchiectasis (15). In this study, we sought to identify the presence of systemic inflammation in clinically stable bronchiectasis.…”

“…Recent evidence suggests the presence of systemic inflammation in chronic inflammatory airway diseases. Studies performed in patients with asthma and chronic obstructive pulmonary disease (COPD) have shown elevated levels of systemic inflammatory markers (13,14); however little is known regarding systemic inflammatory response in bronchiectasis (15).…”