1134 CHEST Original Research COPD Original Research C OPD is a growing cause of disease worldwide 1 : according to the Epidemiologic Study of COPD in Spain (EPI-SCAN) study, the prevalence of COPD in Spain is estimated at 10.2%. 2 Acute exacerbation of COPD (AECOPD) is an event that occurs in the natural course of COPD and requires hospitalization. 3 AECOPD accelerates the decline in lung function 4 and increases risk of death. 5 According to the criteria of Anthonisen et al, 6 AECOPD is defined clinically by three symptoms: increased shortness of breath, increased sputum volume, and purulence. Studies have shown that patients with frequent AECOPD compose a specific COPD phenotype. 7 Community-acquired pneumonia (CAP) is an infec- tious disease that is highly prevalent in patients with COPD 8,9 and is probably linked to abnormal host defense mechanisms. 10,11 Elsewhere, we have shown that hospitalized patients with CAP with COPD (CAP 1 COPD) have a different and specific early inflamma- tory response compared with patients without COPD. 12 Clinically, in patients with COPD, CAP is not cur- rently considered an exacerbation, even though several Background: Community-acquired pneumonia (CAP) is a frequent event in patients with COPD, although it is not currently considered an acute exacerbation of COPD (AECOPD). To our knowl- edge, no studies have compared the inflammatory response of patients with COPD who develop CAP or AECOPD. The aim of our study was to compare clinical and evolutive manifestations and biologic signaling of AECOPD and CAP 1 COPD. Methods: Prospective data were collected from 249 consecutively hospitalized patients with COPD. Comparative analyses were performed in patients with AECOPD (n 5 133) and patients with CAP 1 COPD (n 5 116). Measures of clinical characteristics, blood biomarkers, and evolution were recorded on admission, after 3 and 30 days, and in a follow-up period of 30 days, 90 days, and 1 year. Results: Patients with CAP 1 COPD had higher FEV 1 compared with patients with COPD without pneumonia. In-hospital and long-term outcomes (1 year) were similar for both populations. How- ever, patients with AECOPD had more readmissions, and patients with CAP had more prior epi- sodes of pneumonia. At day 1 and day 3, patients with CAP 1 COPD had significantly ( P , .001) higher serum levels of C-reactive protein (CRP), procalcitonin, tumor necrosis factor- a, and IL-6. Repetition of the analyses after stratifying patients based on severity of disease, current inhaled pharmacotherapy, and noninfectious AECOPD cause confirmed higher levels of the same bio- markers in patients with CAP 1 COPD. Chills, pleuritic pain, sputum purulence, and CRP levels at day 1 were independent clinical predictors of CAP 1 COPD. Conclusions: Our study confirms that two different clinical and inflammatory profiles exist in hos- pitalized patients with COPD in response to CAP (stronger response) and AECOPD, although with similar short-term and long-term outcomes. CHEST 2013; 144(4):1134–1142 Abbreviations: AECOPD 5 acute exacerbation of COPD; AUC 5 area under the curve; CAP 5 community-acquired pneumonia; CRP 5 C-reactive protein; GOLD 5 Global Initiative for Chronic Obstructive Lung Disease; ICS 5 inhaled corti- costeroid; LOS 5 length of hospital stay; NIMV 5 noninvasive mechanical ventilation; PCT 5 procalcitonin; TNF- a 5 tumor necrosis factor a Pneumonic and Nonpneumonic Exacerbations of COPD Inflammatory Response and Clinical Characteristics Arturo Huerta, MD; Ernesto Crisafulli, MD, PhD, FCCP; Rosario Menéndez, MD, PhD; Raquel Martínez, MD; Néstor Soler, MD, PhD; Mónica Guerrero, MD; Beatriz Montull, MD; and Antoni Torres, MD, PhD, FCCP Downloaded From: http://journal.publications.chestnet.org/ by a University College London User on 06/24/2014