The <scp>S</scp>putum <scp>C</scp>olour <scp>C</scp>hart as a predictor of lung inflammation, proteolysis and damage in non‐cystic fibrosis bronchiectasis: A case–control analysis

Goeminne, Pieter; Vandooren, Jennifer; Moelants, Eva; Decraene, Ann; Rabaey, Evelyn; Pauwels, Ans; Seys, Sven; Opdenakker, Ghislain; Proost, Paul; Dupont, Lieven

doi:10.1111/resp.12219

Cited by 52 publications

(59 citation statements)

References 30 publications

(77 reference statements)

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“…NE is not the only airway protease found in the bronchiectasis lung, but Goeminne and colleagues, in a study of 63 patients, showed that NE accounted for 82% of the total gelatinolytic activity of sputum, making a greater contribution than matrix metalloproteinases (15). Goeminne and colleagues also showed a statistically significant association between NE and FEV 1 % predicted, which was not seen for matrix metalloproteinase-9 (MMP-9) (15).…”

Section: Discussionmentioning

confidence: 96%

“…However, in bronchiectasis, release of NE overwhelms the antiproteinase defense, which leads to detectable levels of NE proteolytic activity in sputum and bronchoalveolar lavage (13)(14)(15). This can be measured readily using assays that detect cleavage of chromogenic or fluorogenic peptide-based substrates in sputum, or downstream by measuring the endogenous degradation of mature elastin through the quantification of the unique covalent cross-linking amino acids desmosine and isodesmosine in serum and/or plasma (circulating desmosine [cDES]) (16,17).…”

mentioning

confidence: 99%

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Neutrophil Elastase Activity Is Associated with Exacerbations and Lung Function Decline in Bronchiectasis

Chalmers

Moffitt²,

Suárez-Cuartín

et al. 2017

Am J Respir Crit Care Med

268

202

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Rationale: Sputum neutrophil elastase and serum desmosine, which is a linked marker of endogenous elastin degradation, are possible biomarkers of disease severity and progression in bronchiectasis. This study aimed to determine the association of elastase activity and desmosine with exacerbations and lung function decline in bronchiectasis.Methods: This was a single-center prospective cohort study using the TAYBRIDGE (Tayside Bronchiectasis Registry Integrating Datasets, Genomics, and Enrolment into Clinical Trials) registry in Dundee, UK. A total of 433 patients with high-resolution computed tomographyconfirmed bronchiectasis provided blood samples for desmosine measurement, and 381 provided sputum for baseline elastase activity measurements using an activity-based immunosassay and fluorometric substrate assay. Candidate biomarkers were tested for their relationship with cross-sectional markers of disease severity, and with future exacerbations, mortality and lung function decline over 3 years.Measurement and Main Results: Elastase activity in sputum was associated with the bronchiectasis severity index (r = 0.49; P , 0.0001) and was also correlated with the Medical Research Council dyspnea score (r = 0.34; P , 0.0001), FEV 1 % predicted (r = 20.33; P , 0.0001), and the radiological extent of bronchiectasis (r = 0.29; P , 0.0001). During a 3-year follow-up, elevated sputum elastase activity was associated with a higher frequency of exacerbations (P , 0.0001) but was not independently associated with mortality. Sputum elastase activity was independently associated with FEV 1 decline (b coefficient, 20.139; P = 0.001). Elastase showed good discrimination for severe exacerbations with an area under the curve of 0.75 (95% confidence interval [CI], 0.72-0.79) and all-cause mortality (area under the curve, 0.70; 95% CI, 0.67-0.73). Sputum elastase activity increased at exacerbations (P = 0.001) and was responsive to treatment with antibiotics. Desmosine was correlated with sputum elastase (r = 0.42; P , 0.0001) and was associated with risk of severe exacerbations (hazard ratio 2.7; 95% CI, 1.42-5.29; P = 0.003) but not lung function decline.Conclusions: Sputum neutrophil elastase activity is a biomarker of disease severity and future risk in adults with bronchiectasis.

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Section: Discussionmentioning

confidence: 96%

mentioning

confidence: 99%

Neutrophil Elastase Activity Is Associated with Exacerbations and Lung Function Decline in Bronchiectasis

Chalmers

Moffitt²,

Suárez-Cuartín

et al. 2017

Am J Respir Crit Care Med

268

202

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“…Similar to subjects with cystic fibrosis, subjects with bronchiectasis reportedly yield higher levels of airway inflammation (mucus hypersecretion, 27 matrix metalloproteinases, [28][29][30] tissue inhibitor of matrix metalloproteinase imbalance, 30 and neutrophil infiltration 28,[30][31][32] ) compared with healthy subjects, which could be directly reflected by sputum color. [30][31][32] In our study, sputum purulence was increased during bronchiectasis exacerbations (Table E7 in the supplementary materials at http://www.rcjournal.…”

Section: Discussionmentioning

confidence: 82%

“…[30][31][32] In our study, sputum purulence was increased during bronchiectasis exacerbations (Table E7 in the supplementary materials at http://www.rcjournal. com), suggesting greater proteolytic activities because of matrix metalloproteinases release.…”

Section: Discussionmentioning

confidence: 91%

Inflammatory Responses, Spirometry, and Quality of Life in Subjects With Bronchiectasis Exacerbations

Guan

Gao

et al. 2015

Respir Care

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BACKGROUND: Bronchiectasis exacerbations are critical events characterized by worsened symptoms and signs (ie, cough frequency, sputum volume, malaise). Objectives: Our goal was to examine variations in airway and systemic inflammation, spirometry, and quality of life during steady state, bronchiectasis exacerbations, and convalescence (1 week following a 2-week antibiotic treatment) to determine whether potentially pathogenic microorganisms, including Pseudomonas aeruginosa, were associated with poorer conditions during bronchiectasis exacerbations. METHODS: Peripheral blood and sputum were sampled to detect inflammatory mediators and bacterial densities. Spirometry and quality of life (St George Respiratory Questionnaire [SGRQ]) were assessed during the 3 stages. RESULTS: Forty-eight subjects with bronchiectasis (43.2 ؎ 14.2 y of age) were analyzed. No notable differences in species and density of potentially pathogenic microorganisms were found during bronchiectasis exacerbations. Except for CXCL8 and tumor necrosis factor alpha (TNF-␣), serum inflammation was heightened during bronchiectasis exacerbations and recovered during convalescence. Even though sputum TNF-␣ was markedly higher during bronchiectasis exacerbations and remained heightened during convalescence, the variations in miscellaneous sputum markers were unremarkable. Bronchiectasis exacerbations were associated with notably higher SGRQ symptom and total scores, which recovered during convalescence. FVC, FEV 1 , and maximum mid-expiratory flow worsened during bronchiectasis exacerbations (median change from baseline of ؊2.2%, ؊0.8%, and ؊1.3%) and recovered during convalescence (median change from baseline of 0.6%, 0.7%, and ؊0.7%). Compared with no bacterial isolation, potentially pathogenic microorganism or P. aeruginosa isolation at baseline did not result in poorer clinical condition during bronchiectasis exacerbations. CONCLUSIONS: Bronchiectasis exacerbations are characterized by heightened inflammatory responses and poorer quality of life and spirometry, but not by increased bacterial density, which applies for subjects with and without potentially pathogenic microorganism isolation when clinically stable. (ClinicalTrials.gov registration NCT01761214.)

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“…Indeed, sputum color is one of the clinical criteria that improves specificity of the non-cystic fibrosis bronchiectasis exacerbation definition in children. 19 Moreover, Goeminne et al 20 …”

Section: Discussionmentioning

confidence: 98%

Reproducibility of the Sputum Color Evaluation Depends on the Category of Caregivers

Reychler

André

Couturiaux³

et al. 2016

Respir Care

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BACKGROUND: Sputum production and purulence were proposed as criteria for justifying the use of antimicrobial agents. The Sputum Color Chart was developed and validated to standardize purulence of sputum evaluation. The aim of this study was to observe the reproducibility of the Sputum Color Chart from different categories of health caregivers. METHODS: The color of 10 sputum samples was evaluated using photographs for intra-and inter-reliability. The observation was repeated 3 times. Eighteen volunteers from 6 categories of health caregivers (student in physiotherapy, senior chest physiotherapist, junior resident in pulmonology, medical microbiologist, pulmonologist, and general practitioner) were investigated. RESULTS: Poor inter-rater reliability was observed for all categories with the exception of senior chest physiotherapists. The best intrarater reliability was observed for microbiologists and senior chest physiotherapists. We found a great proportion (>40%) of important discrepancies in 2 categories (junior pulmonologist and general practitioner). The proportion of non-discrepancy between evaluators varied between 10 and 40%, depending on the category. CONCLUSIONS: Even if the Sputum Color Chart is a useful tool for the clinician in the context of clinical deterioration, it presents non-uniform reliability regarding the caregivers and their category.

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The Sputum Colour Chart as a predictor of lung inflammation, proteolysis and damage in non‐cystic fibrosis bronchiectasis: A case–control analysis

Abstract: We show that sputum purulence assessment in daily clinical practice using the SCC is a quick and easy tool that reflects severity of inflammation, destruction and proteolytic enzymatic activity/presence.

Cited by 52 publications

References 30 publications

Neutrophil Elastase Activity Is Associated with Exacerbations and Lung Function Decline in Bronchiectasis

Neutrophil Elastase Activity Is Associated with Exacerbations and Lung Function Decline in Bronchiectasis

Inflammatory Responses, Spirometry, and Quality of Life in Subjects With Bronchiectasis Exacerbations

Reproducibility of the Sputum Color Evaluation Depends on the Category of Caregivers

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