Pneumonic vs nonpneumonic acute exacerbations of COPD.
OBJECTIVE
To describe and compare the background, clinical manifestations, disease course, and infectious etiologies of pneumonic acute exacerbations (PNAE) vs nonpneumonic acute exacerbations (NPAE) of COPD.


METHODS
A prospective, observational study.


METHODS
A tertiary university medical center in southern Israel.


METHODS
Twenty-three hospitalizations for PNAE and 217 hospitalizations for NPAE were included in the study. Paired sera were obtained for each of the hospitalizations and were tested serologically for 12 pathogens. Only a significant change in antibody titers or levels was considered diagnostic.


RESULTS
No significant differences were found between the two groups for any of the parameters related to COPD or comorbidity. The clinical type of the exacerbation was not significantly different between the groups. Compared to NPAE, patients with PNAE had lower PO(2) values at hospital admission (p = 0.004) but higher rates of abrupt onset (p = 0.005), ICU admissions (p = 0.006), invasive mechanical ventilation (p = 0.01), mortality (p = 0.007), and longer hospital stay (p = 0.001). In 22 PNAE hospitalizations (96%) and in 153 NPAE hospitalizations (71%), at least one infectious etiology was identified (p = 0.001). Mixed infection was found in 13 patients with PNAE (59%) and in 59 patients with NPAE (39%; not significant [NS]). Viral etiology was identified in 18 patients with PNAE (78%) compared with 99 patients with NPAE (46%; p = 0.003). Pneumococcal etiology was found in 10 patients with PNAE (43%) and in 38 patients with NPAE (18%; p = 0.006). An atypical etiology was identified in 8 patients with PNAE (35%) and 64 patients with NPAE (30%; NS).


CONCLUSIONS
Community-acquired pneumonia is common among patients hospitalized for an acute exacerbation of COPD and is generally manifested by more severe clinical and laboratory parameters. In PNAE, compared to NPAE, viral and pneumococcal etiologies are more common, but the rate of atypical pathogens is similar. The therapeutic significance of these findings should be investigated further.
Lieberman
David
D
Pulmonary Unit, Division of Internal Medicine, Soroka University Medical Center, the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel 84101. Lieberma@bgumail.bgu.ac.il
Lieberman
Devora
D
Gelfer
Yevgenia
Y
Varshavsky
Raiesa
R
Dvoskin
Bella
B
Leinonen
Maija
M
Friedman
Maureen G
MG
D000208:Acute Disease; D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D001784:Blood Gas Analysis; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000382:microbiology; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000382:microbiology*; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000382:microbiology; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013147:Spirometry