Chronic Obstructive Pulmonary Disease (COPD) is a major cause of chronic morbidity and mortality throughout the world. Morbidity and mortality among patients with COPD are for a large part related to acute exacerbations. In this thesis several studies on COPD exacerbations are described. First we tried to identify independent predictors for frequent exacerbations from multiple domains of COPD, so that patients with frequent exacerbations can be identified. Next to this, we determined whether sputum colour and purulence, which both influence the decision to use antibiotic treatment for a COPD exacerbation, correlate with bacterial load in patients admitted for a COPD exacerbation. Furthermore, we performed a randomised placebo controlled study in which the effectiveness of antibiotics, next to prednisolon, in COPD exacerbations was assessed: the ABC-Trial. Also, we performed a study on the antibiotic concentration in the lung, which can influence the effectiveness of antibiotics. We studied the relation of the concentration of amoxicillin in sputum on length of hospitalisation, as a marker for the effectiveness of antibiotic use in patients with a COPD exacerbation. Finally we performed a study on sputa of COPD patients in stable state and during acute exacerbations including the differences between sputum outcomes in adequate and inadequate sputum samples. It seems that although sputum analyses is an important clinical tool in the management of COPD exacerbations, there is a high variability in the quality of sputum samples obtained, which can have profound consequences for clinical decision making.
|Award date||16 Apr 2009|
|Place of Publication||Enschede|
|Publication status||Published - 16 Apr 2009|