OBJECTIVES: There is some evidence that chronic obstructive pulmonary disease and chronic kidney disease (CKD) may be related, perhaps through systemic inflammation, which is common to both. However, this relationship has not yet been clearly demonstrated. The aim of this study was to investigate the association between airflow obstruction, CKD, and C-reactive protein (CRP) levels in Japanese men.

METHODS: The study included 11,587 men, aged 40-88 years, who underwent a health check-up. Airflow obstruction was defined as a forced expiratory volume in 1 s/forced vital capacity of <70%, and its severity was based on the Global Initiative for Chronic Obstructive Lung Disease guidelines (GOLD). CKD was defined as an estimated glomerular filtration rate of <60 mL/min/1.73 m(2).

RESULTS: Airflow obstruction was present in 7.9% of the participants, and 10.6% of the participants had CKD. The average CRP levels were 0.11 ± 0.36, 0.13 ± 0.41, and 0.18 ± 0.41 mg/L for subjects with normal lung function, GOLD stage I, and GOLD stage II-IV, respectively. With regard to CKD, the average CRP levels were 0.11 ± 0.32 and 0.18 ± 0.6 mg/L for subjects without and with CKD, respectively. Analysis of covariance showed no significant differences between the CRP level and lung function status or CKD after age was adjusted for. Logistic regression analysis showed no association among subjects with the three different lung function statuses after age, body mass index, hypertension, diabetes, hyper-low-density-lipoprotein-cholesterolemia, smoking, physical activity, and alcohol intake were controlled for.

CONCLUSIONS: Based on the results of this study, we conclude that there is no interrelationship between CRP level, airflow obstruction, and CKD.

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Treatment with inhaled corticosteroids (ICS) for those with chronic obstructive pulmonary disease (COPD) has been shown to be associated with an increased incidence of pneumonia. However, it is unclear if this is associated with increased mortality. The aim of this study was to examine the effects of prior ICS use on clinical outcomes for patients with COPD hospitalized with pneumonia.

METHODS: We conducted a retrospective cohort study using the national administrative databases of the Department of Veterans Affairs. Eligible patients had a pre-existing diagnosis of COPD, a discharge diagnosis of pneumonia, and received treatment with one or more appropriate pulmonary medications prior to hospitalization. Outcomes included mortality, use of invasive mechanical ventilation, and vasopressor use.

RESULTS: There were 15,768 patients (8,271 with ICS use, 7,497 no ICS use) with COPD who were hospitalized for pneumonia. There was also a significant difference for 90-day mortality (ICS: 17.3% vs. No ICS: 22.8%, p<0.001). Multilevel regression analyses demonstrated that prior receipt of ICS was associated with decreased mortality at 30 days (odds ratio [OR] 0.80, 95% confidence interval [CI] 0.72-0.89) and 90 days (OR 0.78, 95% CI 0.72-0.85), and decreased use of mechanical ventilation (OR 0.83, 95% CI 0.72-0.94). There was no significant association between receipt of ICS and vasopressor use (OR 0.88, 95% CI 0.74-1.04)

CONCLUSIONS: For patients with COPD, prior ICS use is independently associated with decreased risk of short-term mortality and use of mechanical ventilation following hospitalization for pneumonia.

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RATIONALE: Although airway inflammation can persist for years after smoking cessation in patients with chronic obstructive pulmonary disease (COPD), the mechanisms of persistent inflammation are largely unknown.

OBJECTIVES: We investigated relationships between bronchial epithelial remodeling, polymeric immunoglobulin receptor (pIgR) expression, secretory IgA (SIgA), airway inflammation and mural remodeling in COPD.

METHODS: Lung tissue specimens and bronchoalveolar lavage (BAL) were obtained from lifetime non-smokers and former smokers with or without COPD. Epithelial structural changes were quantified by morphometric analysis. Expression of pIgR was determined by immunostaining and RT-PCR. Immunohistochemistry was performed for IgA, CD4 and CD8 lymphocytes, and cytomegalovirus and Epstein-Barr virus antigens. Total IgA and SIgA were measured by ELISA and IgA transcytosis was studied using cultured human bronchial epithelial cells.

MEASUREMENTS AND MAIN RESULTS: Areas of bronchial mucosa covered by normal pseudo-stratified ciliated epithelium were characterized by pIgR expression with SIgA present on the mucosal surface. In contrast, areas of bronchial epithelial remodeling had reduced pIgR expression, localized SIgA deficiency, and increased CD4(+) and CD8(+) lymphocyte infiltration. In small airways (< 2 mm), these changes were associated with presence of herpesvirus antigens, airway wall remodeling, and airflow limitation in patients with COPD. COPD patients had reduced SIgA in BAL. Air-liquid interface epithelial cell cultures revealed that complete epithelial differentiation was required for normal pIgR expression and IgA transcytosis.

CONCLUSIONS: Our findings indicate that epithelial structural abnormalities lead to localized SIgA deficiency in COPD airways. Impaired mucosal immunity may contribute to persistent airway inflammation and progressive airway remodeling in COPD.

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Primary care specialists provide first-line care of chronic obstructive pulmonary disease (COPD), characterized by progressive, partially reversible airflow limitation induced mainly by smoking. Spirometry and questionnaires are important for COPD diagnosis, staging and prognosis. Smoking cessation, immunizations, pulmonary rehabilitation and self-management action plans comprise nonpharmacologic COPD management.

The Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT®) and Towards a Revolution in COPD Health (TORCH) megatrials provide evidence for maintenance pharmacotherapy to reduce exacerbations and improve patient symptoms and health-related quality of life. Although the primary outcomes-lung function decline (UPLIFT®) and mortality (TORCH)-were negative, long-acting bronchodilators in both trials reduced exacerbation rates and improved health status. Tiotropium added to usual care (in UPLIFT®) and salmeterol/fluticasone therapy (in TORCH) improved key patient-centered outcomes with no significant mortality risk or excess in serious cardiac adverse events associated with the study drugs.

These results provide strong evidence of efficacy and acceptable safety profiles of maintenance pharmacotherapies in patient-centered outcomes and support combination drug regimens in patients with moderate to very severe COPD.

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