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Antibody deficiency in patients with frequent exacerbations of Chronic Obstructive Pulmonary Disease (COPD)
Journal article   Open access   Peer reviewed

Antibody deficiency in patients with frequent exacerbations of Chronic Obstructive Pulmonary Disease (COPD)

Brian N McCullagh, Alejandro P Comellas, Zuhair K Ballas, John D Newell Jr, M Bridget Zimmerman and Antoine E Azar
PloS one, Vol.12(2), pp.e0172437-e0172437
2017
DOI: 10.1371/journal.pone.0172437
PMCID: PMC5315316
PMID: 28212436
url
https://doi.org/10.1371/journal.pone.0172437View
Published (Version of record) Open Access

Abstract

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.
 Immunologic Deficiency Syndromes - complications Humans Middle Aged Male Tomography, X-Ray Computed Pulmonary Disease, Chronic Obstructive - etiology Adrenal Cortex Hormones - therapeutic use Anti-Bacterial Agents - therapeutic use Immunoglobulin Isotypes - blood Immunoglobulin Isotypes - therapeutic use Female Pulmonary Disease, Chronic Obstructive - diagnostic imaging Aged Immunologic Deficiency Syndromes - drug therapy Pulmonary Disease, Chronic Obstructive - immunology Pulmonary Disease, Chronic Obstructive - drug therapy

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