Chest
Volume 117, Issue 5, Supplement 1, May 2000, Pages 291S-293S
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Bronchial Inflammation: Its Relationship to Colonizing Microbial Load and α1-Antitrypsin Deficiency

https://doi.org/10.1378/chest.117.5_suppl_1.291SGet rights and content

Neutrophil elastase is capable of generating many of the features of chronic bronchial disease. In patients with COPD, airways inflammation with neutrophil recruitment and elastase release is positively correlated with colonizing bacterial load in the stable clinical state (p < 0.0005). In addition, α1-antitrypsin deficiency is associated with a greater neutrophil load, higher elastase activity, leukotriene-B4 concentration, and serum protein leak than matched patients without deficiency (p < 0.005). These data confirm an effect of bronchial colonization on airways inflammation in COPD and indicate the role of α1-antitrypsin in its modulation.

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Materials and Methods

We studied 55 patients with chronic obstructive bronchitis, 64 patients with a similar degree of airflow obstruction related to α1-AT deficiency (phenotype Pi Z), and 43 patients with idiopathic bronchiectasis diagnosed by high-resolution CT scan. Sputum was collected over a 4-h period from rising from each patient, and an aliquot was removed and assessed for the colonizing microbial load as described previously.4 The remaining sample was ultracentrifuged to obtain the sputum sol phase. These

Results

Inflammation in the airway was clearly associated with the presence and size of colonizing microbial load as indicated by the positive correlations with MPO (r = 0.58; p < 0.0005), NE activity (r = 0.43; p < 0.0005), interleukin-8 (r = 0.67; p < 0.0001), LTB4 (r = 0.48; p < 0.0005), sputum-serum albumin ratio (r = 0.43; p < 0.0005), and a negative correlation with SLPI (r = − 0.52; p < 0.0005). The relationship indicated a microbial threshold of 106 cfu below which inflammation was present but

Discussion

The results presented here confirmed that subjects with chronic bronchial disease have inflammation present in their airways as indicated by the presence of neutrophils (quantified by the MPO concentration) and leakage of the serum protein albumin. It is well known that patients with chronic bronchial disease can be colonized with bacteria even in the stable clinical state.6 The current data confirm that some patients are colonized and that the bacterial load may vary from 105 to > 108 cfu/mL.

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Supported by a noncommercial educational grant from Bayer as part of the ADAPT Programme.

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