Richness of sputum microbiome in acute exacerbations of eosinophilic chronic obstructive pulmonary disease

Background:The eosinophilic chronic obstructive pulmonary disease(COPD)is known to be more sensitive to corticosteroid.The sputum microbiome has been shown to affect COPD prognosis,but its role in acute exacerbations of eosinophilic COPD is unclear.This study aimed to investigate the dynamic changes of the airway microbiome in patients with acute exacerbations of eosinophilic COPD.Methods:Fifty-seven patients with acute exacerbations of COPD from the First Affiliated Hospital of Guangxi Medical University between June 2017 and June 2018 were divided into two groups.Patients with eosinophils≥300 cells/mL in the peripheral venous blood were assigned to the eosinophilic group(Eos)and the rest to the non-eosinophilic group(Noneos).All patients received similar treatment including inhaled budesonide according to the guidelines.The induced sputum microbiome was analyzed on the 1st and 7th day of treatment using the 16S ribosomal RNA(rRNA)method.The levels of interleukin(IL)-6 and IL-8 were measured in the plasma and the sensitivity to corticosteroids was determined in isolated peripheral blood mononuclear cells.Quantitative data were compared between the two groups using the independent samples t test or Mann-Whitney U test.Categorical data were evaluated using Chi-squared test or Fisher’s exact test.Results:Twenty-six patients were classified into Eos group and 31 patients were classified into Noneos group.Prior to treatment,the alpha diversity(Shannon index)(2.65±0.63 vs.2.56±0.54,t=0.328,P=0.747)and the structure of the sputum microbiome were similar in the Eos group and the Noneos group.After 7 days of treatment,alpha diversity increased in both groups,while the microbiome richness(Ace index)was significantly lower in the Eos group(561.87±109.13 vs.767.88±148.48,t=-3.535,P=0.002).At the same time,IL-6(12.09±2.85 pg/mL vs.15.54±2.45 pg/mL,t=-4.913,P<0.001)and IL-8(63.64±21.69 pg/mL vs.78.97±17.13 pg/mL,t=-2.981,P=0.004)decreased more significantly in the Eos group,and the percentages of inhibition of IL-8 at dexamethasone concentrations 10-8 to 10-6 mol/L were significantly higher in the Eos group than those in the Noneos group(all P<0.05).Conclusions:The induced sputum microbiome richness decreased more significantly following treatment in the Eos patients compared to the Noneos patients.The lower plasma inflammatory factor levels and the higher percentage of inhibition of IL-8 might be due to higher corticosteroid sensitivity in Eos patients.

Macrolides for treatment of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a common disease characterized by continued airflow limitation that is caused by inflammation and autoimmune response. Acute exacerbation of COPD (AECOPD) will increase risk of death, result in a more rapid decline of lung function, and reduce quality of life. COPD inflammation is not only limited to the lungs, but also involves multiple organs, leading to coronary heart disease, depression, skeletal muscle atrophy, and other systemic complications. Clinical study showed that long-term macrolide could reduce the frequency of AECOPD.1 However, there are still some controversies and concerns on side effects such as drug resistance, cardiac toxicity, and hearing impairment caused by long-term macrolide therapy for COPD.