Pneumonic vs nonpneumonic acute exacerbations of COPD.

Content Provider	Europe PMC
Author	Lieberman, David Lieberman, Devora Gelfer, Yevgenia Varshavsky, Raiesa Dvoskin, Bella Leinonen, Maija Friedman, Maureen G.
Copyright Year	2002
Abstract	Study objectiveTo describe and compare the background, clinical manifestations, disease course, and infectious etiologies of pneumonic acute exacerbations (PNAE) vs nonpneumonic acute exacerbations (NPAE) of COPD.DesignA prospective, observational study.SettingA tertiary university medical center in southern Israel.PatientsTwenty-three hospitalizations for PNAE and 217 hospitalizations for NPAE were included in the study. Paired sera were obtained for each of the hospitalizations and were tested serologically for 12 pathogens. Only a significant change in antibody titers or levels was considered diagnostic.ResultsNo significant differences were found between the two groups for any of the parameters related to COPD or comorbidity. The clinical type of the exacerbation was not significantly different between the groups. Compared to NPAE, patients with PNAE had lower Po2 values at hospital admission (p = 0.004) but higher rates of abrupt onset (p = 0.005), ICU admissions (p = 0.006), invasive mechanical ventilation (p = 0.01), mortality (p = 0.007), and longer hospital stay (p = 0.001). In 22 PNAE hospitalizations (96%) and in 153 NPAE hospitalizations (71%), at least one infectious etiology was identified (p = 0.001). Mixed infection was found in 13 patients with PNAE (59%) and in 59 patients with NPAE (39%; not significant [NS]). Viral etiology was identified in 18 patients with PNAE (78%) compared with 99 patients with NPAE (46%; p = 0.003). Pneumococcal etiology was found in 10 patients with PNAE (43%) and in 38 patients with NPAE (18%; p = 0.006). An atypical etiology was identified in 8 patients with PNAE (35%) and 64 patients with NPAE (30%; NS).ConclusionsCommunity-acquired pneumonia is common among patients hospitalized for an acute exacerbation of COPD and is generally manifested by more severe clinical and laboratory parameters. In PNAE, compared to NPAE, viral and pneumococcal etiologies are more common, but the rate of atypical pathogens is similar. The therapeutic significance of these findings should be investigated further.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC7094389&blobtype=pdf
ISSN	00123692
Journal	Chest
Volume Number	122
DOI	10.1378/chest.122.4.1264
PubMed Central reference number	PMC7094389
Issue Number	4
PubMed reference number	12377851
e-ISSN	19313543
Language	English
Publisher	The American College of Chest Physicians. Published by Elsevier Inc.
Publisher Date	2002-10-01
Access Restriction	Open
Rights License	Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. © 2002 The American College of Chest Physicians
Subject Keyword	COPD exacerbation pneumonia, community-acquired
Content Type	Text
Resource Type	Article
Subject	Pulmonary and Respiratory Medicine Critical Care and Intensive Care Medicine Cardiology and Cardiovascular Medicine