Changes in bronchial inflammation during acute exacerbations of chronic bronchitis

There are little data describing noncellular changes in bronchial inflammat ion during exacerbations of chronic bronchitis, The relationship between sp utum colour and airway inflammation at presentation has been assessed durin g an exacerbation in patients with chronic bronchitis and a primary care di agnosis of chronic obstructive pulmonary disease. Sputum myeloperoxidase, neutrophil elastase, leukotriene B-4 (LTB4), interl eukin-8 (IL-8), sol:serum albumin ratio and serum C-reactive protein were m easured in patients presenting with an exacerbation and mucoid (n = 27) or purulent sputum (n = 42). Mucoid exacerbations were associated with little bronchial or systemic infl ammation at presentation, and sputum bacteriology was similar to that obtai ned in the stable state. Purulent exacerbations were associated with marked bronchial and systemic inflammation (p < 0.025 for all features) and posit ive sputum cultures (90%). Resolution was related to a significant reductio n in LTB4 (p <0.01), but no change in IL-8, suggesting that LTB4 may be mor e important in neutrophil recruitment in these mild, purulent exacerbations . In the stable state, IL-8 remained higher in patients who had experienced a purulent exacerbation (2p < 0.02), The presented results indicate that exacerbations of chronic bronchitis, de fined by sputum colour, differ in the degree of bronchial and systemic infl ammation. Purulent; exacerbations are related to bacterial infection, and a re associated with increased neutrophilic inflammation and increased leukot riene B-4 concentrations.