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* From the Department of Veterans Affairs Western New York Healthcare System, Division of Pulmonary and Critical Care Medicine and Division of Infectious Diseases of the Department of Medicine, State University of New York at Buffalo, Buffalo, NY.
Correspondence to: Sanjay Sethi, MD, Department of Veterans Affairs Western New York Healthcare System (151), 3495 Bailey Ave, Buffalo, NY 14215
Study objectives: The etiologic role of bacterial pathogens isolated from sputum culture in 40 to 50% of acute exacerbations of chronic bronchitis (AECB) is controversial. If bacterial pathogens cause these AECB, they should be associated with greater neutrophilic airway inflammation than pathogen-negative exacerbations.
Design: This hypothesis was tested by
comparing levels of interleukin (IL)-8, tumor necrosis factor
(TNF)-
, and neutrophil elastase (NE) in 81 sputum samples obtained
from 45 patients with AECB. Four groups were compared. In the first
three groups, nontypeable Haemophilus influenzae
(n = 20), Haemophilus parainfluenzae (n = 27), and
Moraxella catarrhalis (n = 14) were isolated as sole
pathogens, respectively. In the fourth group, only normal flora was
isolated (n = 20). Paired samples, obtained from individual patients
at different times, that differed in their culture results were also
compared.
Setting: An outpatient research clinic at a Veterans Affairs Medical Center.
Patients: These patients were participating in a prospective, longitudinal study of the dynamics of bacterial infection in chronic bronchitis, for which they were seen in the study clinic on a monthly basis as well as when they were experiencing symptoms suggestive of AECB.
Interventions: None.
Measurements and
results: H influenzae exacerbations were
associated with significantly higher sputum IL-8, TNF-, and NE.
M catarrhalis exacerbations demonstrated significantly
higher sputum TNF- and NE when compared to pathogen-negative
exacerbations. H parainfluenzae-associated exacerbations
had an inflammatory profile similar to pathogen-negative exacerbations.
Sputum elastase level distinguished bacterial from nonbacterial AECB
and correlated with clinical severity of the AECB.
Conclusions: Increased airway inflammation associated with isolation of H influenzae and M catarrhalis supports an etiologic role of these pathogens in AECB.
Key Words: airway inflammation • chronic bronchitis • exacerbation • Haemophilus moraxella
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