Clinical, functional and biochemical changes during recovery from COPD exacerbations

Koutsokera, Angela; Kiropoulos, Theodoros S.; Nikoulis, Dimitrios J.; Daniil, Zoe D.; Tsolaki, Vassiliki; Tanou, Kalliopi; Papaioannou, Andriana I.; Germenis, Anastasios; Gourgoulianis, Konstantinos I.; Kostikas, Konstantinos

doi:10.1016/j.rmed.2008.12.006

« Previous Next »Respiratory Medicine
Volume 103, Issue 6 , Pages 919-926, June 2009

Clinical, functional and biochemical changes during recovery from COPD exacerbations

Angela Koutsokera
- Department of Respiratory Medicine, University Hospital of Larissa, University of Thessaly Medical School, Larissa 41110, Greece
Theodoros S. Kiropoulos
- Department of Respiratory Medicine, University Hospital of Larissa, University of Thessaly Medical School, Larissa 41110, Greece
Dimitrios J. Nikoulis
- Department of Immunology and Histocompatibility, University Hospital of Larissa, University of Thessaly Medical School, Larissa 41110, Greece
Zoe D. Daniil
- Department of Respiratory Medicine, University Hospital of Larissa, University of Thessaly Medical School, Larissa 41110, Greece
Vassiliki Tsolaki
- Department of Respiratory Medicine, University Hospital of Larissa, University of Thessaly Medical School, Larissa 41110, Greece
Kalliopi Tanou
- Department of Respiratory Medicine, University Hospital of Larissa, University of Thessaly Medical School, Larissa 41110, Greece
Andriana I. Papaioannou
- Department of Respiratory Medicine, University Hospital of Larissa, University of Thessaly Medical School, Larissa 41110, Greece
Anastasios Germenis
- Department of Immunology and Histocompatibility, University Hospital of Larissa, University of Thessaly Medical School, Larissa 41110, Greece
Konstantinos I. Gourgoulianis
- Department of Respiratory Medicine, University Hospital of Larissa, University of Thessaly Medical School, Larissa 41110, Greece
Konstantinos Kostikas
- Department of Respiratory Medicine, University Hospital of Larissa, University of Thessaly Medical School, Larissa 41110, Greece
- Corresponding author. Tel.: +30 6944780616; fax: +30 2410670240.

Received 13 April 2008; accepted 4 December 2008. published online 05 January 2009.

Summary

The pathways underlying chronic obstructive pulmonary disease exacerbations (ECOPD) remain unclear. This study describes the clinical, functional and biochemical changes during recovery from ECOPD.

Thirty hospitalized patients with Anthonisen's type-I ECOPD were evaluated on days 0 (admission), 3, 10 and 40. A five-symptom score (TSS), performance status and quality of life were evaluated. Post-bronchodilator spirometry, blood gases, oxidative stress, C-reactive protein (CRP), serum amyloid-A (SAA), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and fibrinogen were also measured. Patients were classified as early- or late-recoverers, based on whether dyspnea had returned to pre-exacerbation level by day 10.

Most clinical, functional and biochemical parameters improved during follow-up. CRP and IL-6 levels reduced on Day 3 (p<0.05), whereas SAA on Day 10 (p<0.01). TNF-α was reduced on Days 3 and 10, but on Day 40 its levels returned to baseline. Fibrinogen and WBC reduced only by day 40. TSS and dyspnea were correlated inversely with FEV₁ on days 3, 10 and 40. Although late-recoverers had lower FEV₁ on admission, none of the reported measurements on admission and day 3 predicted early recovery.

During recovery from ECOPD, symptomatic improvement correlates only with post-bronchodilator FEV₁ whereas systemic inflammatory burden subsidence does not correlate with clinical and functional changes. Although late-recoverers have lower FEV₁ on admission, none of the measured parameters is able to predict early symptomatic recovery.

Keywords: Chronic obstructive pulmonary disease, Exacerbations, Recovery, Biomarkers

Abbreviations: ATS/ERS, American Thoracic Society/European Respiratory Society, BMI, body mass index, CBC, complete blood count, COPD, chronic obstructive pulmonary disease, CRP, C-reactive protein, ECOPD, exacerbations of chronic obstructive pulmonary disease, FEF_25–75%, forced mid-expiratory flow, FEV₁, forced expiratory volume in 1s, FiO₂, fraction of inspired oxygen, FVC, forced vital capacity, IL-6, interleukin-6, MNA, mini nutritional assessment, N/A, not assessed, PaO₂, partial arterial oxygen tension, PaCO₂, partial arterial carbon dioxide tension, SAA, serum amyloid-A, SGRQ, Saint George's Respiratory Questionnaire, TNF-α, tumor necrosis factor-alpha, TSS, total symptom score, WBC, white blood cells