reflection objective: To describe and compare the background.

reflection objective: To describe and compare the background, clinical manifestations, disease course, and infectious etiologies of pneumonic acute exacerbations (PNAE) v nonpneumonic acute exacerbations (NPAE) of COPD

Design: A prospective, observational study

Setting: A tertiary university medical center in southern Israel.

Patients: Twenty-three hospitalizations for PNAE and 217 hospitalizations for NPAE were included in the contemplation Paired sera were obtained for each of the hospitalizations and were proofed serologically for 12 pathogens. single a significant change in antibody titers or on a levels was considered diagnostic.

Results: No significant differences were establish between the two groups for any of the parameters related to COPD or comorbidity. The clinical original of the exacerbation was not significantly different between the form into groupss Compared to NPAE, patients with PNAE had lower P[Osub2] values at hospital admission (p = 0004) however higher rates of abrupt attack (p = 0.005), ICU admissions (p = 0006) invasive mechanical ventilation (p = 001) mortality (p = 0007) and longer hospital stay (p = 0001) In 22 PNAE hospitalizations (96%) and in 153 NPAE hospitalizations (71%) at least the same infectious etiology was identified (p = 0001) Mixed infection was establish in 13 patients with PNAE (59%) and in 59 patients with NPAE (39%; not significant [NS]) Viral etiology was identified in 18 patients with PNAE (78%) compared with 99 patients with NPAE (46%; p = 0003) Pneumococcal etiology was erect in 10 patients with PNAE (43%) and in 38 patients with NPAE (18%; p = 0006) An atypical etiology was identified in 8 patients with PNAE (35%) and 64 patients with NPAE (30%; NS)

Conclusions: Community-acquired pneumonia is often met with among patients hospitalized for an acute exacerbation of COPD and is generally manifested at more severe clinical and laboratory parameters. In PNAE, compared to NPAE, viral and pneumococcal etiologies are more public but the rate of atypical pathogens is similar. The therapeutic significance of these findings should be investigated further.

key-note words: COPD; exacerbation; pneumonia, community-acquired

Abbreviations: AECOPD =acute exacerbation of COPD; CAP = community-acquired pneumonia; NPAE = non-pneumonic acute exacerbations; N = not significant; PNAE = pneumonic acute exacerbations

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COPD is a often met with disease. Over the prolonged, chronic course of the disease, episodes of acute exacerbation frequently occur. These episodes have a deleterious event on the patient's quality of life and necessitate utilization of health-care services, including hospitalization a certain quantity of of the time. Although the definition of an acute exacerbation of COPD (AECOPD) is problematic, (1) it is generally diagnosed and categorized onward the basis of clinical criteria of increasing shortness of breath, and/or an increase in the amount or suppuration of sputum. (2) Community-acquired pneumonia (CAP) is an infectious disease with a broad image of severity. Among CAP patients with the highest severity of disease who require hospitalization, COPD is the principally common comorbidity. (3-5)

These brace diagnoses, CAP and AECOPD, get to together when COPD patients acquire AECOPD caused by way of CAP. The clinical manifestations of these episodes befitting the accepted criteria for the diagnosis of AECOPD, and CAP is determined sole in those cases in which a chest radiograph is obtained and a pulmonary infiltrate is build The number of published articles in succession CAP in patients with COPD is surpassingly small. In a prospective, multicenter Spanish close attention 124 hospitalizations for CAP among patients with COPD were investigated. (6) Despite the importance of this inquiry the acute episodes were investigated from the viewpoint of CAP and not AECOPD, likewise there was no comparison between these cases and cases of AECOPD without CAP.

In the words immediately preceding [i]or[/i] following of a large study in succession infectious etiologies in patients hospitalized with AECOPD, a database was created for 240 hospitalizations and a broad range of infectious etiologies, which were diagnosed serologically in these hospitalizations. The commonness distribution of all infectious etiologies rest in that study have been not past nor futureed and discussed in a previous publication. (7) The aim of the quick in emergencies study was to use the same database to evaluate episodes of CAP in patients with COPD from the aspect of AECOPD, through describing and comparing the background, clinical manifestations, diseases course, and infectious etiologies of these episodes in patients with pneumonic acute exacerbations (PNAE) and nonpneumonic acute exacerbations (NPAE) of COPD

MATERIALS AND METHODS

Patients

All patients hospitalized for AECOPD during the period between November 1 1997 and March 15 1999 in the internal medicine and intensive care wards of the Soroka Medical Center in Beer-Sheva, Israel, who met the inclusion criteria, and gave concord to participate, were included in the contemplation All first hospitalizations in the thought period were included as well as repeat hospitalizations for AECOPD of patients in the close attention population, if the hospitalization took place at least 6 month after the initial single in kind for which the patient was recruited into the meditation No more than one repeat hospitalization was included in the application of mind data for any particular patient. The contemplation was approved by the Helsinki Committee for research forward human beings of the Soroka Medical Center and all participants gave informed acquiescence to participate.

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