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Antibody deficiency in patients with frequent exacerbations of Chronic
Obstructive Pulmonary Disease (COPD)
#MMPMID28212436
McCullagh BN
; Comellas AP
; Ballas ZK
; Newell JD Jr
; Zimmerman MB
; Azar AE
PLoS One
2017[]; 12
(2
): e0172437
PMID28212436
show ga
Chronic Obstructive Pulmonary Disease is the third leading cause of death in the
US, and is associated with periodic exacerbations, which account for the largest
proportion of health care utilization, and lead to significant morbidity,
mortality, and worsening lung function. A subset of patients with COPD have
frequent exacerbations, occurring 2 or more times per year. Despite many
interventions to reduce COPD exacerbations, there is a significant lack of
knowledge in regards to their mechanisms and predisposing factors. We describe
here an important observation that defines antibody deficiency as a potential
risk factor for frequent COPD exacerbations. We report a case series of patients
who have frequent COPD exacerbations, and who were found to have an underlying
primary antibody deficiency syndrome. We also report on the outcome of COPD
exacerbations following treatment in a subset with of these patients with
antibody deficiency. We identified patients with COPD who had 2 or more moderate
to severe exacerbations per year; immune evaluation including serum
immunoglobulin levels and pneumococcal IgG titers was performed. Patients
diagnosed with an antibody deficiency syndrome were treated with either
immunoglobulin replacement therapy or prophylactic antibiotics, and their COPD
exacerbations were monitored over time. A total of 42 patients were identified
who had 2 or more moderate to severe COPD exacerbations per year. Twenty-nine
patients had an underlying antibody deficiency syndrome: common variable
immunodeficiency (8), specific antibody deficiency (20), and selective IgA
deficiency (1). Twenty-two patients had a follow-up for at least 1 year after
treatment of their antibody deficiency, which resulted in a significant reduction
of COPD exacerbations, courses of oral corticosteroid use and cumulative annual
dose of oral corticosteroid use, rescue antibiotic use, and hospitalizations for
COPD exacerbations. This case series identifies antibody deficiency as a
potentially treatable risk factor for frequent COPD exacerbations; testing for
antibody deficiency should be considered in difficult to manage frequently
exacerbating COPD patients. Further prospective studies are warranted to further
test this hypothesis.
|Adrenal Cortex Hormones/therapeutic use
[MESH]
|Aged
[MESH]
|Anti-Bacterial Agents/therapeutic use
[MESH]
|Female
[MESH]
|Humans
[MESH]
|Immunoglobulin Isotypes/blood/therapeutic use
[MESH]
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