title: Evidence of mycobacterial disease in COPD patients with lung volume reduction surgery; the importance of histological assessment of specimens: a cohort study.
abstract: BACKGROUND
  Patients with COPD are at risk of non-tuberculous mycobacterial infection (NTM). This study examined the histology of lung tissue from COPD patients following lung volume reduction with particular focus on evidence of mycobacterial infection.
  
  
  METHODS
  Retrospective histological study of 142 consecutive lung volume reduction surgical specimens (126 separate patients) at Royal Brompton Hospital between 2000 - 2013, with prospectively collected preoperative data on exacerbation rate, lung function and body mass index.
  
  
  RESULTS
  92% of patients had at least one other histological diagnosis in addition to emphysema. 10% of specimens had histological evidence of mycobacterial infection, one with co-existent aspergilloma. Mycobacteria were only identified in those patients with granulomas that were necrotising. These patients had higher exacerbation rates, lower TLCO and FEV1.
  
  
  CONCLUSIONS
  A proportion of severe COPD patients will have evidence of mycobacterial infection despite lack of clinical and radiological suspicion. This may have implications for long-term management of these patients.
authors.forename: Anjali
authors.initials: A
authors.lastname: Char
authors.forename: Nick S
authors.initials: NS
authors.lastname: Hopkinson
authors.forename: David M
authors.initials: DM
authors.lastname: Hansell
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Nicholson
authors.forename: Emily C
authors.initials: EC
authors.lastname: Shaw
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Clark
authors.forename: Philip
authors.initials: P
authors.lastname: Sedgwick
authors.forename: Robert
authors.initials: R
authors.lastname: Wilson
authors.forename: Simon
authors.initials: S
authors.lastname: Jordan
authors.affiliation: Royal Brompton and Harefield NHS Foundation Trust, London, UK. m.loebinger@rbht.nhs.uk.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Loebinger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume; D006099:Granuloma / Q000382:microbiology* / Q000473:pathology*; D006801:Humans; D008168:Lung / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications / Q000473:pathology*; D009336:Necrosis; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification*; D011013:Pneumonectomy; D057234:Preoperative Period; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies
references.citation: Chest. 1998 Mar;113(3):660-4
references.pmid: 9515839
references.citation: Thorax. 2000 Mar;55(3):210-8
references.pmid: 10679540
references.citation: Thorax. 2013 Mar;68(3):256-62
references.pmid: 22781123
references.citation: Clin Med (Lond). 2014 Apr;14(2):122-7
references.pmid: 24715121
references.citation: Am J Respir Crit Care Med. 2007 Feb 15;175(4):367-416
references.pmid: 17277290
references.citation: Chest. 1997 Apr;111(4):941-7
references.pmid: 9106573
references.citation: N Engl J Med. 2011 Aug 25;365(8):689-98
references.pmid: 21864166
references.citation: Ann Thorac Surg. 1997 Aug;64(2):303-6
references.pmid: 9262565
references.citation: Thorax. 2003 May;58(5):405-10
references.pmid: 12728160
references.citation: Am J Respir Crit Care Med. 2011 Oct 1;184(7):763-70
references.pmid: 21757623
references.citation: Am J Respir Crit Care Med. 2011 Oct 15;184(8):881-93
references.pmid: 21719757
references.citation: Chest. 2008 Jan;133(1):243-51
references.pmid: 18187749
references.citation: Am J Respir Crit Care Med. 2010 Oct 1;182(7):977-82
references.pmid: 20508209
references.citation: J Infect. 2009 Feb;58(2):108-12
references.pmid: 19195711
references.citation: Eur Respir J. 2008 Jun;31(6):1322-33
references.pmid: 18515557