Obstructive pulmonary disease : Studies of acute exacerbations and immunologic status

Abstract: In this thesis, different aspects of the treatment and care of patients with asthma and chronic obstructive pulmonary disease (COPD) have been studied.In a study of 50 patients seeking medical care for an acute exacerbation of asthma or COPD, we studied inflammatory markers in blood, sputum and urine. Patients were followed up after one and four weeks. Patients with high levels of eosinophil markers responded better to treatment than patients with low levels. In patients with a short smoking history (<= 5 pack-years); mainly asthmatics, this relationship was seen in serum, while, in patients with a long smoking history (> 5 pack-years), mainly COPD patients, this relationship was seen in sputum. Inflammatory markers in blood were followed after treatment. In short-term smokers, patients with a large decrease in eosinophil markers displayed a greater improvement in lung function, which was not seen in long-term smokers. Our results suggest that there are different mechanisms for the attraction and activation of eosinophils in asthma and COPD.Psychological status was assessed using the hospital anxiety and depression (HAD) questionnaire. Relapses were recorded during one month. Patients who reported anxiety and/or depression displayed a far greater tendency to relapse than other patients. Lung function was significantly lower in the relapse group, but, in a multilogistic model, lung function was not a significant predictor. Psychological factors and psychiatric co-morbidity should be looked for in patients making repeated emergency visits.Markers of bone turnover were studied in 20 patients with asthma receiving high doses of prednisolone during the first week. Elderly patients displayed a significant decline in markers of bone resorption after one week, while younger patients instead experienced a slight increase. The corresponding difference could not be seen in markers of bone formation. The results indicate the inhibition of bone resorption in the elderly.Delayed type of hypersensitivity (DTH) and late allergic reaction (LAR) were tested in a group of COPD patients in the stable phase and in healthy controls. The patients had diminished DTH and LAR reactions, but no correlation to anthropometric variables was seen. The size of LAR was inversely correlated to the number of exacerbations within one year and could therefore be a prognostic marker in COPD.