title: Airway and systemic inflammation and decline in lung function in patients with COPD.
abstract: OBJECTIVE
  Patients with COPD experience lower airway and systemic inflammation, and an accelerated decline in FEV1. There is no evidence on whether this inflammation changes over time, or if it is associated with a faster decline in FEV1.
  
  
  METHODS
  A cohort of 148 COPD patients (100 men) was monitored daily for a median of 2.91 years (interquartile range [IQR], 2.1 to 4.8). At recruitment, median age was 68.5 years (IQR, 62.5 to 73.6) and FEV1 as percentage of predicted (FEV1%Pred) was 38.5% (IQR, 27.7 to 50.3).
  
  
  RESULTS
  During the study, the patients experienced 1,389 exacerbations, a median of 2.52/yr (IQR, 1.48 to 3.96) and FEV1 declined by 40.2 mL/yr or as FEV1%Pred by 1.5%/yr. Concerning inflammatory markers, sputum interleukin (IL)-6 rose by 9 pg/mL/yr, sputum neutrophil count rose by 1.64 x 10(6) cells per gram sputum per year, an plasma fibrinogen rose by 0.10 g/L/yr (all p < 0.05). Patients with frequent exacerbations (> or = 2.52/yr) had a faster rise over time in plasma fibrinogen and sputum IL-6 of 0.063 g/L/yr (p = 0.046, n = 130) and 29.5 pg/mL/yr (p < 0.001, n = 98), respectively, compared to patients with infrequent exacerbations (< 2.52/yr). Using the earliest stable (nonexacerbation) measured marker, patients whose IL-6 exceeded the group median had a faster FEV1%Pred decline of 0.42%/yr (p = 0.018). Similarly, a high neutrophil count or fibrinogen were associated with a faster FEV1%Pred decline of 0.97%/yr (p = 0.001) and 0.40%/yr (p = 0.014), respectively.
  
  
  CONCLUSIONS
  In COPD, airway and systemic inflammatory markers increase over time; high levels of these markers are associated with a faster decline in lung function.
authors.affiliation: Academic Unit of Respiratory Medicine, St. Bartholomew's and Royal London Hospital School of Medicine and Dentistry, London, UK.
authors.forename: Gavin C
authors.initials: GC
authors.lastname: Donaldson
authors.forename: Terence A R
authors.initials: TA
authors.lastname: Seemungal
authors.forename: Irem S
authors.initials: IS
authors.lastname: Patel
authors.forename: Angshu
authors.initials: A
authors.lastname: Bhowmik
authors.forename: Tom M A
authors.initials: TM
authors.lastname: Wilkinson
authors.forename: John R
authors.initials: JR
authors.lastname: Hurst
authors.forename: Peter K
authors.initials: PK
authors.lastname: Maccallum
authors.forename: Jadwiga A
authors.initials: JA
authors.lastname: Wedzicha
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000032:analysis; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007249:Inflammation / Q000503:physiopathology*; D015850:Interleukin-6 / Q000032:analysis; D008297:Male; D018579:Patient Selection; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology*; D012129:Respiratory Function Tests; D013183:Sputum / Q000276:immunology
chemical_list: D015415:Biomarkers; D015850:Interleukin-6