Serum Surfactant Protein Levels in Patients Admitted to the Hospital with Acute COPD Exacerbation

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From: Lung(Vol. 196, Issue 2)
Publisher: Springer
Document Type: Clinical report
Length: 3,081 words
Lexile Measure: 1530L

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Author(s): Andriana I. Papaioannou 1 , Elisavet Konstantelou 2 , Anastasia Papaporfyriou 2 , Konstantinos Bartziokas 1 , Aris Spathis 3 , Petros Bakakos 2 , Stelios Loukides 1 , Nikolaos Koulouris 2 , Spyros Papiris 1 , Konstantinos Kostikas 1

Author Affiliations:

(Aff1) 0000 0001 2155 0800, grid.5216.0, 2nd Respiratory Medicine Department, University of Athens, Attikon Hospital, , Rimini 1, 12462, Chaidari Athens, Greece

(Aff2) 0000 0001 2155 0800, grid.5216.0, 1st Respiratory Medicine Department, University of Athens, Sotiria Hospital, , Mesogeion 152, 11527, Athens, Greece

(Aff3) 0000 0001 2155 0800, grid.5216.0, Department of Cytology, University of Athens, Attikon Hospital, , Rimini 1, 12462, Chaidari Athens, Greece


Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation and is a leading cause of morbidity and mortality worldwide [1]. Acute exacerbations (AECOPD) are recognized as a basic feature of the disease characterized by a significant change in patients' symptoms and increase in local and systemic inflammation, and have negative impact on the patients' quality of life and survival [1].

Pulmonary surfactant is a highly surface-active mixture of proteins and lipids, that is synthesized and secreted into the alveoli by type II epithelial cells [2]. The protein part of surfactant constitutes four types of proteins (SP), SP-A, SP-B, SP-C, and SP-D. SP-A and SP-D mainly regulate surfactant metabolism and have immunologic functions, whereas SP-B and SP-C play a role in the maintenance of surfactant structure and stabilization of the lipid layers during the respiratory cycle [3, 4]. SPs have been studied in COPD as possible biomarkers of disease severity and progression and as possible predictive factors of unfavorable outcomes [5].

Studies have shown that in COPD patients, circulating levels of SP-D were inversely associated with lung function [6] and symptoms [5], while increased SP-D levels were associated with an increased risk of AECOPD [6-8]. Similar observations have been reported with other SPs which have been found to correlate to COPD development [9, 10], airway obstruction [5, 6, 11], and severity [11].

The aim of the present exploratory study was to evaluate serum levels of SP-A, SP-B, SP-C, and SP-D in COPD patients, both during AECOPD and in stability, and to test their possible associations with disease severity and with the development of new exacerbation events.



Consecutive COPD patients admitted to the hospital for AECOPD according to the GOLD recommendations were included in the study [1]. Patients with concomitant respiratory disease other than COPD, unstable cardiovascular disease, malignancy, and/or inability or unwillingness to collaborate with the study investigators were excluded. All patients received optimal medical treatment according to the GOLD recommendations both during COPD exacerbation and stability [1]. Decisions for both admission and discharge was based on the GOLD recommendations [1] and were made by the attending physicians of the department. The study protocol was approved by the Local Scientific Committee and all patients provided written informed consent.

Study Details

Blood samples were collected at three time-points; at hospital admission, at discharge and 40 days after discharge, when the patient was considered to be in stable condition. On...

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Gale Document Number: GALE|A531222620