Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality throughout the world. C-Reactive protein (CRP) is found in blood plasma, which rises in response to inflammation. A prospective study was conducted in a tertiary care teaching hospital to assess the levels of CRP in stable COPD patients. 100 patients with stable COPD without co-morbidities attending the respiratory OPD were recruited. CRP levels were estimated and patients were followed up for a period of 6 months to check CRP levels serially every 2 months. During exacerbation, CRP was estimated and repeated after 2 weeks of remission, if still positive, again repeated after 2 weeks. Average CRP level was high in a significant number of COPD patients. As the stage of COPD advanced CRP levels were also significantly raised. By applying ANOVA test, average CRP between different stages of COPD was found to be significantly high. Even though current smokers and reformed smokers had high average CRP, statistical significance in mean CRP between them and non smokers were not found. There was a negative correlation between CRP & BMI, but was not statistically significant. There was no significant relationship of CRP with age of the patients. There was negative correlation seen with oxygen saturation, with a significant p value. It was concluded that systemic inflammation is inherent to COPD, independent of smoking status, age & BMI but correlates with disease severity.
Keywords: Stable COPD, CRP, Exacerbation of COPD , systemic Inflammation.
References
- Global initiative for Chronic Obstructive lung diseases. Global strategy for the diagnosis , management & prevention of Chronic Obstructive Pulmonary disease. 2006 [PubMed]
- Barnes P.J Chronic Obstructive Pulmonary disease. N Engl.J Med 2000; 343 : 269-280 [PubMed ]
- Wouters EF. Local & Systemic inflammation in Chronic Obstructive Pulmonary disease Proc Am Throac Soc 2005;2:26-33 [PubMed]
- Gan W Q , Man SF , Senthiselvan A, Sin DD. Association between Chronic Obstructive Pulmonary disease & systemic inflammation: A systematic review & metaanalysis . Thorax 2004 ; 59: 574-580 [PubMed]
- Agusti A Systemic effects of Chronic Obstructive Pulmonary disease : what we know and what we don’t know . Proc Am Throrac Soc 2007 ; 4 – 522 -5 [PubMed]
- Sin DD, Man SF. Biomarkers in COPD: are we there yet? Chest 2008;133:1296-8 [PubMed]
- de Torres JP, Cordoba – Lanus E , Lopez –Aguilar C , et al. C reactive protein levels & clinically important predictive outcomes in stable COPD patients. Eur Respir J 2006 ; 27: 902-7[PubMed]
- Broekhuizen R, Wouters EF, Creutzberg EC, et . Raised CRP levels mark metabolic & functional impairement in advanced COPD. Thorax 2006: 61-17-22 [PubMed]
- Pinto – Plata VM, Mullerova H, Toso JF et al. C Reactive protein in patients with COPD , control smokers & non smokers. Thorax 2006: 61- 23-8 [PubMed]
- Man SF , Cornett JE, Anthonisen NR, et al . C Reactive protein & mortality in mild to moderate COPD. Thorax 2006 ; 61: 849-53 [ PubMed]
- 11) Pepys MB, Hirschfield GM, C reactive protein : a critical update . J Clin Invest 2003 ; 111: 1805-1812. [PubMed]
- Schols AM Burman WA, Stoal Van den Brekel AJ, Dentener MA , Wouters EF. Evidence for a relation between metabolic derangements & increased levels of inflammatory mediators in a subgroup of patients wiyh COPD. Thorax 1996; 51: 819- 824 [PubMed]
- Firouzjahi A , Monadi M, Karimpoor F et al. Serum C Reactive Protein Levels & distribution in COPD vs healthy controls ; a case – control study from Iran. Inflammation 2013; 36:1122-1128[PubMed]
- Karadag F , Kirdar S, Karul AB, Ceylan E . The value of C - Reactive protein as a marker of systemic inflammation in stable COPD. Eur J Intern Med. 2008; 19:104-108 [PubMed]
- Corsonello A, Pedone C, Battaglia S, Paglino G, Bellia V, Incalzi RA , C Reactive protein & ESR as inflammation markers in elderly patients with stable COPD . Arch Gerontol Geriale 2011;53:190-195[PubMed]
- Funda Aku et al - C Reactive Protein levels are raised in stable COPD patients indepe-ndent of smoking behaviour & biomass exposure. J Thorac Dis 2013 Aug 5 (4) 414 -421
- Hassan Ghobadi, Nasrin Fouladi et al – Association of High sensitive CRP level & Assessment Test scores with clinically important predictive outcomes in stable COPD patients. Journal of Respiratory diseases, Thoracic surgery, Intensive Care and Tuberculosis Tanaffos 2015;14(1) ;34-41.
- Dev, E Wallace et all- Value of C reaction protein measurements in exacerbations of chronic obstructive pulmonary diseases, Respiratory Medicine Vol 92, Issue 4, April 1998, pg 664-667.
- Rishu Agarwal, Mohammed Shoaib Zaheer et all- The relationship between C-reactive protein and prognostic factors in Chronic obstructive pulmonary disease. Multidisciplinary Respiratory Medicine 2013; 8(1) 63 Published online 2013 Sep 28.
- Sin DD, Man SF:Why are pts in chronic obstructive pulmonary disease at risk of cardiovascular diseases. The potential role of systemic inflammation in COPD. Circulation 2003;107;1514-9[Pubmed]
- Mannino DM,Ford ES,Redd SC, Obstructive & Restrictivr lung disease & markers of inflammation:data from the Third National HHealth & Nutrition Examination ;Am J Med 2003;114:758-62[PubMed]
- Joppa P, Peteasova D, Stancak B et. Systemic inflammation in patients with COPD & pulmonary hypertension Chest 2006; 130; 326-33 [PubMed].
- Visser M,Bouter LM,Mc QuillanGM Wener MH, Harries TB. Elevated C-reactive protein levels in overweight and obese adults JAMA.1999;282:2131-2135[PubMed]
Corresponding Author
Dr Sophia Philip
31/1179 A-1, Padipparambil House, Sahakarana Road, Ponnurunni, Vyttila, Kochi-19, India
Mob: 9447562941, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i8.03
