Measurement of tumor necrosis factor-alpha, leukotriene B4, and interleukin 8 in the exhaled breath condensate in patients with acute exacerbations of chronic obstructive pulmonary disease.
BACKGROUND
Assessment of airway inflammation in the clinical course of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) may advance our understanding of the pathogenesis and treatment.


OBJECTIVE
To assess airway inflammation in patients during the course of AECOPD by serial analyses of their exhaled breath condensates (EBC).


METHODS
Twenty-six patients with AECOPD (22 males, mean[SD] percentage predicted forced expiratory volume in one second (FEV(1)) 44.8 [14.3]), 11 with stable COPD, and 14 age and sex-matched healthy controls were studied. Patients with AECOPD were treated with systemic steroid and antibiotic for 7 days. EBC was collected from each patient with AECOPD on Day 5, 14, 30, and 60 post-hospitalization using EcoScreen (VIASYS Healthcare, USA) during tidal breathing over 10 minutes. Concentrations of tumor necrosis factor-alpha (TNF-alpha), leukotriene B4 (LTB4), and interleukin-8 (IL-8) were measured by enzyme-linked immunosorbent assay.


RESULTS
The median (IQR) of TNF-alpha level on Day 5 was 5.08 (3.80-6.32) pg/ml, which was lower than on Day 14 (5.84 [4.91-9.14] pg/ml, p = 0.017), Day 30 (6.14 [3.82-7.67] pg/ml, p = 0.045), and Day 60 (5.60 [4.53-8.80] pg/ml, p = 0.009). On Day 60, subjects receiving inhaled corticosteroid (ICS) had a lower level of TNF-alpha than those who were not (4.82 [4.06-5.65] vs 7.66 [5.48-10.9] pg/ml, p = 0.02). EBC LTB4 level did not change significantly during recovery from AECOPD whereas IL-8 was mostly undetectable.


CONCLUSIONS
EBC TNF-alpha level was low in patients receiving systemic steroid and antibiotic therapy for AECOPD. These findings suggest a potential role for serial EBC TNF-alpha for non-invasive monitoring of disease activity.
Ko
Fanny W S
FW
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
Leung
Ting-Fan
TF
Wong
Gary W K
GW
Ngai
Jenny
J
To
Kin W
KW
Ng
Susanna
S
Hui
David S C
DS
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001944:Breath Tests; D016022:Case-Control Studies; D004359:Drug Therapy, Combination; D004797:Enzyme-Linked Immunosorbent Assay; D045853:Exhalation; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism*; D016209:Interleukin-8 / Q000378:metabolism*; D007975:Leukotriene B4 / Q000378:metabolism*; D008168:Lung / Q000187:drug effects / Q000276:immunology* / Q000503:physiopathology; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000276:immunology* / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; C508606:CXCL8 protein, human; D018836:Inflammation Mediators; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D007975:Leukotriene B4