Q&A: Chronic bronchial infections require close monitoring, care for patients with COPD
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Some patients with COPD experience lung function decline over time, and a study recently showed that chronic bronchial infection by any pathogenic microorganism can hasten this decline.
In a post-hoc analysis of a prospective study cohort published in Annals of the American Thoracic Society, researchers analyzed 201 patients (mean age, 70.3 years; 90.5% men) with COPD every 3 to 6 months for a total of 84 months to see if chronic bronchial infection (CBI), particularly by Pseudomonas aeruginosa, are related to FEV1 decline.
As Healio previously reported, researchers found that FEV1 decline was 33.7 mL per year overall, which significantly increased to 57.1 mL per year among patients with CBI by any pathogenic microorganism and to 48.5 mL per year among patients in whom P. aeruginosa was isolated at least once.
Researchers also observed that CBI by any pathogenic microorganism and at least one P. aeruginosa isolation were both independent factors related to rapid lung function decline in multivariable analysis.
To learn more about CBI and these findings, Healio spoke with lead study researcher Miguel Ángel Martínez-García, MD, PhD, FERS, section head of the pneumology department and coordinator of the sleep-disordered breathing unit at the University and Polytechnic La Fe Hospital in Valencia, Spain.
Healio: How prevalent is CBI among patients with COPD?
Martínez-García: The prevalence of CBI in COPD depends on several factors such as the severity of the disease, the types of pathogenic microorganism, the respiratory sample analyzed, the presence of bronchiectasis or the previous number of exacerbations.
In general terms, at least one pathogenic microorganism is isolated in their natural history among 25% to 50% of COPD patients. This percentage is higher in severe COPD (more than 50%) or with the coexistence of bronchiectasis (more than 80%). The repeated isolation of the same pathogenic microorganism (CBI) could appear (in general terms) in 20% to 25% of COPD patients and in more than 60% if there is concomitant bronchiectasis.
Healio: Were any of the study findings unexpected or surprising?
Martínez-García: No, the decline in lung function among patients with CBI and COPD has been also seen in other inflammatory airway diseases with CBI, such as bronchiectasis and cystic fibrosis. However, this is the largest study demonstrating that CBI is also an independent factor associated with lung function decline among patients with COPD.
Healio: Would you briefly characterize what the impact of the findings are for the everyday clinician?
Martínez-García: The results of the present study have a clear and direct impact in clinical practice. Because CBI has a direct impact in a faster decline in lung function and, in turn, faster decline in lung function is associated with higher morbidity and mortality among patients with COPD, it is very important that clinicians monitor the microbiological situation of their patients with COPD with analysis of sputum samples every medical visit. Whether a pathogenic microorganism is isolated, these patients should be controlled more closely and treated more aggressively if needed to avoid faster lung function decline.
Healio: How will future studies be different?
Martínez-García: In the future, we need randomized controlled trials to find the best treatment for these patients with COPD and CBI. Is it anti-inflammatory treatments, antibiotic prophylactic treatments, combinations of the treatments or other options? That’s what we need to find out.
Healio: What should readers remember walking away from your study?
Martínez-García: One of the key messages of our study is that we must not forget the infection dimension of caring for patients with COPD, especially those with more severe disease or more fragile patients, because of the deleterious impact CBI has on them and the possibility of a good choice for treatment.
For more information:
Miguel Ángel Martínez-García, MD, PhD, FERS, can be reached at mianmartinezgarcia@gmail.com.