Inflammatory changes, recovery and recurrence at COPD exacerbation

¹ Academic Unit of Respiratory Medicine, University College London, UK
² Epidemiology, GlaxoSmithKline, Greenford, UK

^* To whom correspondence should be addressed. E-mail: j.a.wedzicha{at}medsch.ucl.ac.uk.

	Abstract

COPD exacerbations are associated with increased airway and systemic inflammation, though relationships between exacerbation recovery, recurrent exacerbation and inflammation have not been previously reported. We related inflammatory changes at exacerbations to clinical non-recovery and recurrent exacerbations within 50 days.

Serum interleukin (IL)-6 and C-reactive protein (CRP), sputum IL-6 and IL-8 were measured in 73 COPD patients when stable, at exacerbation and at 7, 14 and 35 days post-exacerbation.

In 23% of patients, symptoms did not recover to baseline by day 35, these patients had persistently higher levels of serum CRP during the recovery period (p=0.03). 22% of patients who had recurrent exacerbations within 50 days had significantly higher levels of serum CRP at day 14, compared to those without recurrences; 8.8 mg·l^-1 vs. 3.4 mg·l^-1, p<0.01. Frequent exacerbators had a smaller reduction in systemic inflammation between exacerbation onset and day 35 compared to infrequent exacerbators; serum IL-6, CRP, both p<0.05.

Non-recovery of symptoms at COPD exacerbation is associated with persistently heightened systemic inflammation. The time-course of systemic inflammation following exacerbation is different between frequent and infrequent exacerbators. A high serum CRP concentration 14 days after an index exacerbation may be used as a predictor of recurrent exacerbations within 50 days.

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