Certain inflammatory biomarkers associated with increased risk of COPD exacerbations

June 11, 2013, The JAMA Network Journals

Simultaneously elevated levels of the biomarkers C-reactive protein, fibrinogen and leukocyte count in individuals with chronic obstructive pulmonary disease (COPD) were associated with increased risk of having exacerbations, even in those with milder COPD and in those without previous exacerbations, according to a study in the June 12 issue of JAMA.

" of respiratory symptoms in COPD are of major importance because of their profound and long-lasting adverse effects on patients. Frequent episodes accelerate loss of lung function, affect the quality of life of the patients, and are associated with poor survival," according to background information in the article. Some patients with COPD have evidence of low-grade with increased levels of certain inflammatory biomarkers during stable conditions, and previous studies have found that elevated levels of inflammatory biomarkers like C-reactive protein (CRP), fibrinogen, and leukocytes during stable COPD are associated with poor outcomes.

Mette Thomsen, M.D., of Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark, and colleagues tested the hypothesis that elevated levels of inflammatory biomarkers in individuals with stable COPD are associated with an increased risk of having exacerbations. The prospective study examined 61,650 participants with spirometry measurements from the Copenhagen City Heart Study (2001-2003) and the Copenhagen General Population Study (2003-2008). Of these, 6,574 had COPD. Baseline levels of CRP, and leukocyte count were measured in participants at a time when they were not experiencing symptoms of exacerbations. Exacerbations were recorded and defined as short-course treatment with alone or in combination with an antibiotic or as a due to COPD.

During a median (midpoint) 4 years of follow-up time, 3,083 exacerbations were recorded (average, 0.5/participant). The researchers found that the risk of having frequent exacerbations was increased approximately 4-fold in the first year of follow-up and 3-fold using maximum follow-up time in individuals with 3 high inflammatory biomarkers compared with individuals who had no elevated biomarkers. "Importantly, relative risk estimates were consistent even in those with milder COPD and in those with no history of frequent exacerbations, suggesting that these biomarkers provide additional information to the latest Global Initiative for Chronic Obstructive Lung Disease [GOLD] 2011 grading."

The highest 5-year absolute risks of having frequent exacerbations in those with 3 high biomarkers (vs. no high biomarkers) were 62 percent (vs. 24 percent) for those with GOLD grades C-D (n=558), 98 percent (vs. 64 percent) in those with a history of frequent exacerbations (n=127), and 52 percent (vs. 15 percent) for those with GOLD grades 3-4 (n=465).

"… our study provides novel information that may lead to a simpler assessment using measurements of inflammatory in individuals with stable COPD to further stratify preventive therapies based on absolute risk of frequent exacerbations. The potential benefits of such stratification should be tested in future clinical trials that could include drugs of particular current interest, such as macrolides or statins," the authors write.

Explore further: Allergic disease worsens respiratory symptoms and exacerbations in COPD

More information: JAMA. 2013;309(22):2353-2361

Related Stories

Allergic disease worsens respiratory symptoms and exacerbations in COPD

May 10, 2013
Patients with chronic obstructive pulmonary disease (COPD) who also have allergic disease have higher levels of respiratory symptoms and are at higher risk for COPD exacerbations, according to a new study from researchers ...

Shorter duration steroid therapy may offer similar effectiveness in reducing COPD exacerbations

May 21, 2013
Among patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) requiring hospital admission, a 5-day glucocorticoid treatment course was non-inferior (not worse than) to a 14-day course with regard ...

Assessment of COPD exacerbation severity with the COPD Assessment Test

January 27, 2012
Exacerbation severity in patients with chronic obstructive pulmonary disease (COPD) can be reliably assessed with the COPD Assessment Test (CAT), according to a new study from the UK.

Pulmonary artery enlargement predicts exacerbation in COPD

September 4, 2012
(HealthDay)—For patients with chronic obstructive pulmonary disease (COPD), computed tomographic (CT) measurement of pulmonary artery enlargement, as determined by a ratio of the diameter of the pulmonary artery to the ...

Inflammatory biomarkers improve the clinical prediction of mortality in COPD

March 16, 2012
The addition of changes in inflammatory biomarkers to established clinical variables improves the prediction of mortality in patients with chronic obstructive pulmonary disease (COPD), according to a new study.

Roflumilast improves lung function after 6 months compared with placebo

October 22, 2012
Roflumilast was associated with significant improvements in lung function in patients with moderate and severe chronic obstructive pulmonary disease (COPD) after 6 months of treatment compared with placebo.

Recommended for you

Chronic inflammation causes loss of muscle mass during aging

January 12, 2018
People start losing muscle mass at the age of 40—about some 10 percent of the total muscle mass for each 10-year period, which may lead to fall-related injuries, slowing metabolism and reduced quality of life. Today, very ...

Breathing exercises help asthma patients with quality of life

December 13, 2017
A study led by the University of Southampton has found that people who continue to get problems from their asthma, despite receiving standard treatment, experience an improved quality of life when they are taught breathing ...

Study highlights the need for research into prevention of inflammatory bowel disease

December 7, 2017
Countries in Africa, Asia, the Middle East and South America have seen a rise in incidence of inflammatory bowel disease as they have become increasingly industrialised and westernised, a new study has found.

Air pollution can increase asthma risk in adults, even at low levels

November 24, 2017
Living close to a busy road can be bad for your respiratory health if you are middle aged, new Australian research has found.

Evidence found of oral bacteria contributing to bowel disorders

October 20, 2017
(Medical Xpress)—An international team of researchers has found evidence that suggests certain types of oral bacteria may cause or exacerbate bowel disorders. In their paper published in the journal Science, the group describes ...

New compound discovered in fight against inflammatory disease

September 22, 2017
A 10-year study by University of Manchester scientists for a new chemical compound that is able to block a key component in inflammatory illness has ended in success.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.