Difference in survival between COPD patients with an impaired immune reaction versus an adequate immune reaction to seasonal influenza vaccination: The COMIC study.

AIM: To study the hypothesis that COPD patients who do not achieve seroprotective levels after influenza vaccination, are a less immune-competent group with a higher risk of morbidity and mortality. METHODS: 578 patients included in the COMIC cohort had pre- and post-vaccination stable state blood samples in which influenza-vaccine specific antibodies were measured. Post-vaccination titers of ≥40 were considered protective and indicative of being immuno-competent. Primary outcome was all-cause mortality. Morbidity was defined as time till first severe acute exacerbation in COPD (severe AECOPD) and time till first community acquired pneumonia (CAP). RESULTS: 42% of the patients achieved seroprotective levels to both H1N1 and H3N2 after vaccination. Seroprotective levels to H3N2 were markedly higher (96%) than to H1N1(43%). Having seroprotective levels to both H1N1 and H3N2 was not associated with less morbidity (severe AECOPD HR 0.91 (95% 0.66-1.25; p = 0.564) (CAP HR 1.23 (95% 0.75-2.00; p = 0.412)) or lower mortality (HR 1.10(95% 0.87-1.38; p = 0.433)). CONCLUSION: In a large well-characterized COPD cohort only the minority of patients achieved seroprotective titers to H1N1 and H3N1 after the yearly influenza vaccination. While achieving seroprotection after vaccination can be considered a surrogate marker of being immunocompetent, this was not associated with lower morbidity and mortality. Whether this means that the immune status is not a relevant pheno/endotype in COPD patients for the course of their disease or that seroprotection is not an adequate (surrogate) marker to define the immune status in COPD needs to be further studied.

Comparing the 2007 and 2011 GOLD Classifications as Predictors of all-Cause Mortality and Morbidity in COPD.

To better classify patients with chronic obstructive pulmonary disease (COPD) for prognostic purposes and to tailor treatment, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2007 classification was revised in 2011. The primary aim of the current data analyses was to evaluate the accuracy of the GOLD 2007 and 2011 GOLD classifications to predict all-cause mortality and morbidity in a well-described COPD cohort. The prognostic values of both GOLD classifications, expressed as the C-statistic, were assessed in the Cohort of Mortality and Inflammation in COPD (COMIC) study of 795 COPD patients, with a follow-up of 3 years. Outcomes were all-cause mortality and morbidity. Morbidity was defined as time until first COPD-related hospitalisation and time until first community-acquired pneumonia (CAP). The prognostic value of the GOLD 2011 classification was compared between symptom classification based on the modified Medical Research Council (mMRC) score and the Clinical COPD Questionnaire (CCQ) scores with two different thresholds. Although the GOLD 2011 CCQ classification had the highest accuracy to predict mortality and morbidity in our study, the C-statistics differed only numerically. Furthermore, our study showed that the instrument used to determine the level of symptoms in the GOLD 2011 classification has not only important consequences on the mortality prognosis, but also affects the morbidity prognosis in COPD. Therefore, patients' estimated prognosis could alter when different types of tools are used to evaluate the prognosis.

Double-blind, multicentre analysis of the efficacy of borage oil in patients with atopic eczema.

Although gamma-linolenic acid (GLA) has been shown to correct deficiencies in skin lipids associated with reduced delta-6-desaturase activity which should result in improvement of dysregulation of inflammation and immunity in atopic eczema, clinical studies with evening primrose oil containing 10% GLA have yielded contradictory results. We have therefore examined the effect of a higher percentage (at least 23%) GLA-containing borage oil in adults with stable atopic eczema of moderate severity in a double-blind, multicentre study. One hundred and sixty patients were randomized to take daily either 500 mg of borage oil-containing capsules or the bland lipid miglyol as a placebo over a 24-week period. Use of topical diflucortolone-21-valerate cream was allowed as rescue medication, with the amount used until response being defined as primary, and clinical improvement as secondary efficacy criteria. Although several clinical symptoms improved compared with placebo, the overall response to borage oil did not reach statistical significance. Significant differences in favour of borage oil were, however, observed in a subgroup excluding patients who failed to show increased erythrocyte dihomo-gamma-linolenic acid levels and in whom adherence to inclusion criteria and the study protocol were questionable. GLA metabolites increased in borage oil-treated patients only, and serum IgE showed a trend to decrease on overall and subgroup analysis. No substance-related adverse effects were observed. This study shows no overall efficacy of GLA-containing borage oil in atopic eczema, with steroid use being the primary response parameter, although it suggests that a subgroup of patients may benefit from this well-tolerated treatment.

Infectious typhlitis in chickens caused by spirochetes.

A weakly haemolytic spirochete was detected with an unabsorbed fluorescent antiserum to Treponema hyodysenteriae in smears and cultures of scrapings of caecal mucosa of laying hens with diarrhoea. Two groups of experimental chickens were fed a pure culture of this spirochete or homogenated intestinal contents of affected birds. Both groups showed clinical signs of disease such as increased water content of faecal material and slight retardation of growth. A non-specific typhlitis which histologically resembled milder forms of swine dysentery was seen in the birds from which spirochetes were isolated. The isolate obtained differed in cultural, biochemical, anti-genic and morphological characteristics from T. hyodysenteriae. The pathological significance of intestinal spirochetes and their possible epidemiological relation to swine dysentery are discussed.