The benefits of long-term systemic antimicrobial therapy in chronic obstructive pulmonary disease

Berim, Ilya; Sethi, Sanjay

doi:10.1177/1753465811398372

Cited by 4 publications

(4 citation statements)

References 42 publications

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“…Apparently, the NE group of patients usually displayed severe AECOPD and responded poorly to standard therapies. Because control of bacterial infection in the lung is crucial for the recovery of lung function [21], [22], it is important to determine the infected bacteria and their susceptibility to antibiotics to eliminate the infection effectively. Given that many patients in the NE group had higher levels of inflammatory mediators, regular treatment with antibiotics may be valuable for preventing the development of AECOPD patients.…”

Section: Discussionmentioning

confidence: 99%

Sputum Inflammatory Cell-Based Classification of Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Gao

Zhang

et al. 2013

PLoS ONE

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BackgroundPatients with chronic obstructive pulmonary disease (COPD) commonly suffer from acute exacerbations (AECOPD) and display varying disease severity. However, there is no available biomarker for the classification of AECOPD. This study is aimed at investigating the sputum cellular profiles to classify patients with AECOPD.MethodsA total of 83 patients with AECOPD and 26 healthy controls were recruited. Their demographic and clinical characteristics were recorded, and their lung function was examined. The phenotypes of sputum inflammatory cells were characterised, and the concentrations of sputum and serum amyloid-A (SAA), C-reactive protein (CRP), interleukin-6 (IL-6), and matrix metalloproteinase-9 (MMP-9) were measured. Based on the sputum inflammatory cell profiles, individual patients were categorized into one of the four subgroups with inflammatory eosinophilic, neutrophilic, paucigranulocytic, and mixed granulocytic AECOPD. Most AECOPD patients were reevaluated within 12–14 months after discharge.ResultsThere were 10 (12%) eosinophilic, 36 (43%) neutrophilic, 5 (6%) mixed granulocytic, and 32 (39%) paucigranulocytic AECOPD patients. The patients with mixed granulocytic or neutrophilic AECOPD had a higher BODE score, more sputum inflammatory cells, lower lung function, and longer hospital stay, accompanied by higher concentrations of sputum MMP-9, IL-6 and CRP, and serum SAA, IL-6 and CRP. Notably, 83% of patients with neutrophilic AECOPD displayed evidence of bacterial infection and many of them responded poorly to standard therapies. In addition, patients with mixed granulocytic or neutrophilic stable COPD remained at lower lung functions and higher levels of inflammation.ConclusionPatients with AECOPD display heterogeneous inflammation, and the profiles of sputum inflammatory cells may be used as valuable biomarkers for the classification of AECOPD patients.

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Section: Discussionmentioning

confidence: 99%

Sputum Inflammatory Cell-Based Classification of Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Gao

Zhang

et al. 2013

PLoS ONE

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“…46,47 These treatments appear to reduce exacerbations in COPD patients as well, but these initial results need to be validated by future research. 24 To date, to the best of the authors' knowledge, no economic evaluation has calculated the cost-effectiveness of long-term treatment with a macrolide in the prevention of COPD exacerbations. It is hypothesised that costeffectiveness will mainly depend on the additional costs of long-term macrolide treatment and on savings arising from fewer exacerbation-related hospitalisations.…”

Section: Discussionmentioning

confidence: 99%

“…It was considered that any earlier studies would be of limited relevance due to changes in antibiotics, bacterial pathogens and their susceptibility over time. 24 Articles could be published in English, Dutch or French.…”

Section: Inclusion/exclusion Criteriamentioning

confidence: 99%

Preventing COPD exacerbations with macrolides: A review and budget impact analysis

Simoens

Laekeman

Decramer

2013

Respiratory Medicine

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Long-term treatment with macrolides has recently been shown to reduce COPD exacerbations in doses lower than bactericidal doses. This article aims to critically review the international literature relating to the long-term effectiveness and safety of macrolides and to estimate the budget impact of preventing exacerbations with azithromycin in Belgium. Controlled clinical studies focusing on the prevention of COPD exacerbations with long-term macrolide treatment were identified in PubMed, EMBASE, Controlled Trials Registry of the Cochrane Library, and Social Science and Citation Index. The budget impact of preventing exacerbations with azithromycin in Belgium over a one-year period was calculated as the difference between the additional expenditure of annual treatment with azithromycin and the savings in hospital expenditure arising from fewer COPD exacerbations in patients with GOLD stages II-IV. Prevalence and resource use data were derived from the literature and unit cost data from Belgian sources. The literature review suggests that long-term treatment of COPD patients with azithromycin, erythromycin or clarithromycin is effective and safe, and reduces exacerbations and related hospitalizations. However, uncertainty remains about the specific patient population that is most likely to benefit from long-term macrolide treatment, the optimal dose and duration of macrolide treatment, and the potential impact of long-term macrolide treatment on resistance. The budget impact analysis demonstrated that annual hospital savings of €950 million resulting from fewer exacerbations outweighed additional expenditure on azithromycin of €595 million, implying that the prevention of COPD exacerbations with azithromycin is a cost saving strategy in Belgium.

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“…Further evidence on the impact of bacteria in COPD can be expected from the results of the currently ongoing clinical trials on antibiotics in stable COPD. 102,103 Finally, the relevance of the described microbiota on lung health must be established. Molecular culture-independent techniques have identified bacteria previously not amenable to culture.…”

Section: Role Of Viruses and Atypical Bacteria In Exacerbations Of Copdmentioning

confidence: 99%

Chronic bronchial infection in COPD. Is there an infective phenotype?

Matković

Miravitlles

2013

Respiratory Medicine

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Microorganisms, particularly bacteria, are frequently found in the lower airways of COPD patients, both in stable state and during exacerbations. The host-pathogen relationship in COPD is a complex, dynamic process characterised by frequent changes in pathogens, their strains and loads, and subsequent host immune responses. Exacerbations are detrimental events in the course of COPD and evidence suggests that 70% may be caused by microorganisms. When considering bacterial exacerbations, recent findings based on molecular typing have demonstrated that the acquisition of new strains of bacteria or antigenic changes in pre-existing strains are the most important triggers for exacerbation onset. Even in clinically stable COPD patients the presence of microorganisms in their lower airways may cause harmful effects and induce chronic low-grade airway inflammation leading to increased exacerbation frequency, an accelerated decline in lung function and impaired health-related quality of life. Besides intraluminal localisation in the distal airways, bacteria can be found in the bronchial walls and parenchymal lung tissue of COPD patients. Therefore, the isolation of pathogenic bacteria in stable COPD should be considered as a form of chronic infection rather than colonisation. This new approach may have important implications for the management of patients with COPD.

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The benefits of long-term systemic antimicrobial therapy in chronic obstructive pulmonary disease

Cited by 4 publications

References 42 publications

Sputum Inflammatory Cell-Based Classification of Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Sputum Inflammatory Cell-Based Classification of Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Preventing COPD exacerbations with macrolides: A review and budget impact analysis

Chronic bronchial infection in COPD. Is there an infective phenotype?

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