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  • 1
    Language: English
    In: Chest, March, 2012, Vol.141(3), p.577(2)
    Keywords: Sentinel Surveillance -- Analysis ; Bacterial Cultures -- Analysis ; Respiratory Tract Infections -- Care And Treatment ; Virulence (Microbiology) -- Analysis ; Drug Targeting -- Reports
    ISSN: 0012-3692
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  • 2
    Language: English
    In: Chest, March 2012, Vol.141(3), pp.577-578
    Keywords: Medicine
    ISSN: 0012-3692
    E-ISSN: 1931-3543
    Source: ScienceDirect Journals (Elsevier)
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  • 3
    Language: English
    In: Clinical Infectious Diseases, 1 May 2011, Vol.52, pp.S290-S295
    Description: Acute exacerbations are significant events in the course of chronic obstructive pulmonary disease. Modern diagnostic techniques have revealed an infectious cause for the majority of exacerbations. Common respiratory viruses contribute to 25%—50% of exacerbations. Detection of viral nucleic acids in nasopharyngeal swab or sputum samples has become the preferred method to study viral exacerbations instead of viral cultures and serologic examination. Clinical application of such molecular detection requires additional studies to clarify interpretation of a positive result. Bacteria account for 25%—50% of exacerbations. Studies comparing molecular detection of bacteria in sputum with conventional culture techniques have shown that a substantial proportion of bacteria are not detected by the latter method. However, as with molecular viral detection, clinical application of molecular bacterial diagnosis requires additional studies. Although still faced with several challenges and requiring additional development, it is quite likely that molecular methods will become the preferred methods for determining the etiology of exacerbations of chronic obstructive pulmonary disease.
    Keywords: Health sciences -- Medical conditions -- Diseases ; Biological sciences -- Biology -- Physiology ; Biological sciences -- Biology -- Microbiology ; Health sciences -- Medical conditions -- Infections ; Biological sciences -- Biology -- Microbiology ; Biological sciences -- Biology -- Microbiology ; Health sciences -- Medical diagnosis -- Diagnostic methods ; Applied sciences -- Laboratory techniques -- Nucleic acid amplification techniques ; Health sciences -- Medical conditions -- Infections ; Health sciences -- Medical conditions -- Symptoms
    ISSN: 10584838
    Source: Archival Journals (JSTOR)
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  • 4
    Language: English
    In: Clinical Infectious Diseases, 1 May 2011, Vol.52, pp.S290-S295
    Description: Acute exacerbations are significant events in the course of chronic obstructive pulmonary disease. Modern diagnostic techniques have revealed an infectious cause for the majority of exacerbations. Common respiratory viruses contribute to 25%—50% of exacerbations. Detection of viral nucleic acids in nasopharyngeal swab or sputum samples has become the preferred method to study viral exacerbations instead of viral cultures and serologic examination. Clinical application of such molecular detection requires additional studies to clarify interpretation of a positive result. Bacteria account for 25%—50% of exacerbations. Studies comparing molecular detection of bacteria in sputum with conventional culture techniques have shown that a substantial proportion of bacteria are not detected by the latter method. However, as with molecular viral detection, clinical application of molecular bacterial diagnosis requires additional studies. Although still faced with several challenges and requiring additional development, it is quite likely that molecular methods will become the preferred methods for determining the etiology of exacerbations of chronic obstructive pulmonary disease.
    ISSN: 10584838
    Source: Archival Journals (JSTOR)
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  • 5
    Language: English
    In: JAMA, 12 June 2013, Vol.309(22), pp.2390-1
    Description: Mador and Sethi discuss the study by Thomsen et al reporting the findings from two large, population-based, prospective studies demonstrating that elevated levels of systemic inflammatory biomarkers (C-reactive protein, fibrinogen, and leukocyte count) were associated with future exacerbations of COPD. Examination of the value of these bio- markers with traditional methods of examining prediction models reveals that the addition of biomarkers to a basic model using known clinical factors to be associated with exacerbations increases the C statistic (area under the curve [AUCI) only modestly from 0.71 to 0.73. This was a statistically significant improvement but is of uncertain clinical significance. Appropriate development and use of interventions will need careful phenotyping of patients with COPD, using clinical and biomarker measures. Thomsen et al have shown that biomarkers may hold promise for identifying high-risk patients and that assessing combinations of biomarkers, rather than a single measurement, may be needed to improve risk stratification.
    Keywords: Leukocyte Count ; C-Reactive Protein -- Analysis ; Fibrinogen -- Analysis ; Inflammation -- Blood ; Pulmonary Disease, Chronic Obstructive -- Blood
    ISSN: 00987484
    E-ISSN: 1538-3598
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  • 6
    Language: English
    In: Chest, September 2011, Vol.140(3), pp.611-617
    Description: Pathogenic bacteria colonize the airways of 30% to 40% of patients with COPD and cause approximately 50% of exacerbations. New strains of nontypeable (NTHI) and are associated with exacerbations. Antimicrobial protein/peptides (AMPs) play important roles in innate lung defense against pathogens. To our knowledge, the changes in AMP baseline levels in respiratory secretions during bacterial colonization and exacerbation have not been described. The objective of this study was to elucidate the effects of the acquisition of a new strain of pathogenic bacteria on the airway levels of AMPs in patients with COPD. One hundred fifty-three samples from 11 patients were selected from COPD sputum samples collected prospectively over 6 years. Samples were grouped as culture-negative (no pathogenic bacteria), colonization, and exacerbation due to new strains of NTHI and Levels of lysozyme, lactoferrin, LL-37, and secretory leukocyte protease inhibitor (SLPI) were measured by enzyme-linked immunosorbent assay and compared among groups by paired analysis. Compared with baseline, sputum lysozyme levels were significantly lower during colonization and exacerbation by NTHI ( = .001 and = .013, respectively) and ( = .007 and = .018, respectively); SLPI levels were lower with exacerbation due to NTHI and ( = .002 and = .004, respectively), and during colonization by ( = 032). Lactoferrin levels did not change significantly; LL-37 levels were higher during exacerbation by NTHI and ( = .001 and = .018, respectively). Acquisition of NTHI and is associated with significant changes in airway levels of AMPs, with larger changes in exacerbation. Airway AMP levels are likely to be important in pathogen clearance and clinical outcomes of infection in COPD.
    Keywords: Medicine
    ISSN: 0012-3692
    E-ISSN: 1931-3543
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  • 7
    Language: English
    In: The Journal of infectious diseases, 15 December 2013, Vol.208(12), pp.2036-45
    Description: Alveolar macrophages in chronic obstructive pulmonary disease (COPD) have fundamental impairment of phagocytosis for nontypeable Haemophilus influenzae (NTHI). However, relative selectivity of dysfunctional phagocytosis among diverse respiratory pathogens: NTHI, Moraxella catarrhalis (MC), Streptococcus pneumoniae (SP), and nonbacterial particles, as well as the contribution of impaired phagocytosis to severity of COPD, has not been explored. Alveolar macrophages, obtained from nonsmokers (n = 20), COPD ex-smokers (n = 32), and COPD active smokers (n = 64), were incubated with labeled NTHI, MC, SP, and fluorescent microspheres. Phagocytosis was measured as intracellular percentages of each. Alveolar macrophages of COPD ex-smokers and active smokers had impaired complement-independent phagocytosis of NTHI (P = .003) and MC (P = .0007) but not SP or microspheres. Nonetheless, complement-mediated phagocytosis was enhanced within each group only for SP. Defective phagocytosis was significantly greater for NTHI than for MC among COPD active smokers (P 〈 .0001) and ex-smokers (P = .028). Moreover, severity of COPD (FEV1%predicted) correlated with impaired AM phagocytosis for NTHI (P = .0016) and MC (P = .01). These studies delineate pathogen- and host-specific differences in defective alveolar macrophages phagocytosis of respiratory bacteria in COPD, further elucidating the immunologic basis for bacterial persistence in COPD and provide the first demonstration of association of impaired phagocytosis to severity of disease.
    Keywords: Copd ; Moraxella Catarrhalis ; Streptococcus Pneumoniae ; Alveolar Macrophage ; Nontypeable Haemophilus Influenzae ; Phagocytosis ; Macrophages, Alveolar -- Physiology ; Phagocytosis -- Physiology ; Pulmonary Disease, Chronic Obstructive -- Physiopathology
    ISSN: 00221899
    E-ISSN: 1537-6613
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  • 8
    Language: English
    In: Clinical Infectious Diseases, July 15, 2005, Vol.41(2), p.S177(9)
    Description: BACKGROUND/PURPOSE: The significant impact of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is now recognized. This recognition has led to increased efforts to provide evidence-based, appropriate treatment of AECOPD, to minimize its negative impact. This article reviews the bacterial etiology of AECOPD and clinical trials (both placebo-controlled and antibiotic comparison trials) that support the use of antibiotics for AECOPD, with an emphasis on the role of newer fluoroquinolones for the treatment of patients with this condition. A discussion of patient stratification that permits identification of those who require initial aggressive antibiotic therapy is presented.MAIN FINDINGS: Among the treatment modalities for exacerbations, the role and choice of antibiotics is hotly debated. Current evidence supports the use of antibiotics in the treatment of AECOPD, because bacterial pathogens cause approximately half the exacerbations, and because empirical antibiotics have a significant benefit in most exacerbations. Several recent investigations have aided in the development of a rational antibiotic strategy for AECOPD. These include outcome studies that have identified patients who are likely to have a poor outcome of their exacerbation and, therefore, are candidates for aggressive initial antibiotic therapy. Studies of the new fluoroquinolone agents have shown superior short- and long-term clinical results among patients with AECOPD who are at risk of a poor outcome.CONCLUSIONS: Theoretical concerns about the emergence of resistance to the fluoroquinolones dictate not only the appropriate use of these drugs but, also, the use of the most-potent agents available in this class, to sustain their usefulness over time. Such selected use of the new fluoroquinolones balances individual benefit with societal concerns regarding the use of these agents for the treatment of AECOPD.
    Keywords: Moxifloxacin -- Dosage And Administration ; Chronic Obstructive Lung Disease -- Drug Therapy ; Chronic Obstructive Lung Disease -- Case Studies
    ISSN: 1058-4838
    E-ISSN: 15376591
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  • 9
    Language: English
    In: Chest, August 2018, Vol.154(2), pp.235-237
    Keywords: Medicine
    ISSN: 0012-3692
    E-ISSN: 1931-3543
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  • 10
    Language: English
    In: The American Journal of Medicine, December 2012, Vol.125(12), pp.1162-1170
    Description: Chronic obstructive pulmonary disease (COPD) is recognized by the Global Initiative for Chronic Obstructive Lung Disease guidelines as an inflammatory disease state, and treatment rationales are provided accordingly. However, not all physicians follow or are even aware of these guidelines. Research has shown that COPD inflammation involves multiple inflammatory cells and mediators and the underlying pathology differs from asthma inflammation. For these reasons, therapeutic agents that are effective in asthma patients may not be optimal in COPD patients. COPD exacerbations are intensified inflammatory events compared with stable COPD. The clinical and systemic consequences believed to result from the chronic inflammation observed in COPD suggest that inflammation intensity is a key factor in COPD and exacerbation severity and frequency. Although inhaled corticosteroids are commonly used and are essential in asthma management, their efficacy in COPD is limited, with only a modest effect at reducing exacerbations. The importance of inflammation in COPD needs to be better understood by clinicians, and the differences in inflammation in COPD versus asthma should be considered carefully to optimize the use of anti-inflammatory agents.
    Keywords: Anti-Inflammatory ; Copd ; Exacerbation ; Inflammation ; Medicine
    ISSN: 0002-9343
    E-ISSN: 1555-7162
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