Single article

DOI: 10.47026/2413-4864-2021-4-1-8

Alekseeva E.P.

Dynamics of Immunological and Functional Indicators in the Course of Treating Exacerbation of Chronic Obstructive Pulmonary Disease

Keywords: chronic obstructive pulmonary disease, exacerbation, innate and adaptive immunity, cytokines, spirometry

Repeated exacerbations of chronic obstructive pulmonary disease cause progression of this disease and result in its unfavorable outcome. Prevention of the first exacerbation of chronic obstructive pulmonary disease and alleviation of exacerbations are key goals in the treatment of the disease. Due to the fact that immune mechanisms occupy the central place in the pathogenesis of chronic obstructive pulmonary disease, the aim of the study was to study immunological parameters in patients with chronic obstructive pulmonary disease at the beginning of exacerbation and in the period of exacerbation termination, as well as the way how changes in immunological indicators affect the dynamics of pulmonary functional parameters in the process of treating patients with exacerbation of chronic obstructive pulmonary disease. The study included 116 patients hospitalized in the pulmonology department due to the first exacerbation of chronic obstructive pulmonary disease. In addition to the standard set of studies, patients underwent lymphocyte phenotyping using CD3, CD4, CD8, CD20 monoclonal antibodies, evaluation of neutrophils' phagocytic activity in a latex test, determination of immunoglobulins – IgG, IgA, IgM concentrations, circulating immune complexes and cytokines (interleukin (IL)-1β, IL-4, IL-8, interferon-γ (IFN-γ) in the serum. The above-described range of studies was carried out on the 2nd day of inpatient treatment and on the 10th–12th days of treatment. The results of the study showed that COPD exacerbation is associated with quantitative insufficiency of the cellular link in adaptive immunity against the background of activation of its humoral link. The features of the cytokine profile in patients with chronic obstructive pulmonary disease in exacerbation stage testified to the activated production of proinflammatory cytokines (IL-1ß, IL-8) and the main cytokines associated with the activation of humoral (IL-4) and cellular (IFN-γ) components of adaptive immunity. At this, the function of the cellular link was activated to a greater extent, as indicated by an increase in the ratio of IFN-γ/ IL-4. Analysis of indicators of external respiration function enabled us to establish that all speed indicators in patients were lower than in healthy ones. The functional parameters of the lungs, as well as immunological parameters, did not undergo significant changes as a result of treatment, which determines further progression of the disease.


  1. Kazakova L.M., Mukhtarova N.D., Borisova L.V., Sungorkina E.P., Muchukova O.M., Sungorkina T.M. Rol’ immunologicheskikh i immunogeneticheskikh faktorov v razvitii khronicheskoi obstruktivnoi bolezni legkikh [The role of immunological and immunogenetic factors in the development of chronic obstructive pulmonary disease]. Healthcare of Chuvashia, 2008, no. 2, pp. 45-50.
  2. Karzakova L.M., Kudryashov S.I., Lutkova T.S, Sokolova E.V, Sidorov I.A. Osnovy obshchei immunologii [Fundamentals of general immunology]. Cheboksary, Chuvash University Publ., 2020, 200 p.
  3. Donaldson G.C., Seemungal T.A., Bhowmik A. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax,2002, vol. 57, no. 10, pp. 847–852. DOI: 10.1136/thorax.57.10.847.
  4. Forsslund H., Yang M., Mikko M., Karimi R., Nyrén S., Engvall B., Grunewald J., Merikallio H., Kaarteenaho R., Wahlström J., Wheelock Å.M., Sköld C.M. Gender differences in the T-cell profiles of the airways in COPD patients associated with clinical phenotypes. International journal of chronic obstructive pulmonary disease, 2016, vol. 12, pp. 35–48.
  5. Gupta N, Malhotra N, Ish P. GOLD 2021 guidelines for COPD – what’s new and why. Adv Respir Med., 2021, 89, no. 3, pp. 344–346. DOI: 10.5603/ARM.a2021.0015.
  6. Jamieson D.B., Matsui E.C., Belli A., McCormack M.C., Peng E., Pierre-Louis S., Curtin-Brosnan J., Breysse P.N., Diette G.B., Hansel N.N. Effects of allergic phenotype on respiratory symptoms and exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med., 2013, vol. 188, no. 2, 187–192. DOI: 10.1164/rccm.201211-2103OC.
  7. Lortet-Tieulent J., Soerjomataram I., López-Campos J.L., Ancochea J., Coebergh J.W., Soriano J.B. “International trends in COPD mortality, 1995–2017,” European Respiratory Journal, 2019, vol. 54, no. 6, pp. 1901791. DOI: 10.1183/13993003.01791-2019.
  8. MacLeod M., Papi A., Contoli M., Beghé B., Celli B.R., Wedzicha J.A., Fabbri L.M. Chronic obstructive pulmonary disease exacerbation fundamentals: Diagnosis, treatment, prevention and disease impact. Respirology, 2021, vol. 26, no. 6, pp. 532–551. DOI: 10.1111/resp.14041.
  9. Mohan A., Chandra S., Agarwal D., Guleria R., Broor S., Gaur B. Prevalence of viral infection detected by PCR and RT-PCR in patients with acute exacerbation of COPD: a systematic review. Respirology, 2010, no. 15, pp. 536–542. DOI: 10.1111/j.1440-1843.2010.01722.x.
  10. Rabe K.F, Watz H. Chronic obstructive pulmonary disease. Lancet,2017, vol. 389, pp. 1931–1940. DOI: 10.1016/S0140-6736(17)31222-9.
  11. Sethi S. Molecular diagnosis of respiratory tract infection in acute exacerbations of chronic obstructive pulmonary disease. Clin Infect Dis., 2011, vol. 52, suppl 4, S290–S295. DOI: 10.1093/cid/cir044.
  12. Sigari N., Moghimi N., Shahraki F.S., Mohammadi S., Roshani D. Anti-cyclic citrullinated peptide (CCP) antibody in patients with wood-smoke-induced chronic obstructive pulmonary disease (COPD) without rheumatoid arthritis. Rheumatol Int., 2015, vol. 35, no. 1, pp. 85–91. DOI: 10.1007/s00296-014-3083-2.
  13. Tam A., Tanabe N., Churg A., Wright J.L., Hogg J.C., Sin D.D. Sex differences in lymphoid follicles in COPD airways. Respiratory research. 2020, vol. 21, no. 1, p. 46. DOI: 10.1186/s12931-020-1311-8.
  14. Varmaghani M., Dehghani M., Heidari E., Sharifi F., Moghaddam S.S., Farzadfar F. Global prevalence of chronic obstructive pulmonary disease: systematic review and meta-analysis. East Mediterr Heal J., 2019, vol. 25, no. 1, pp. 47–57. DOI: 10.26719/emhj.18.014.
  15. Vogelmeier C.F., Criner G.J., Martinez F.J. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary. Am J Respir Crit Care Med.,2017, vol. 195, no. 5, pp. 557–582. DOI: 10.1164/rccm.201701-0218PP.
  16. Waeijen-Smit K., Houben-Wilke S., DiGiandomenico A., Gehrmann U., Franssen F.M.E. Unmet Needs in the Management of Exacerbations of Chronic Obstructive Pulmonary Disease. Emerg. Med., 2021, vol. 16, no. 3, pp. 559–569. DOI: 10.1007/s11739-020-02612-9.
  17. Wedzicha J.A., Brill S.E., Allinson J.P., Donaldson G.C. Mechanisms and impact of the frequent exacerbator phenotype in chronic obstructive pulmonary disease. BMC Med., 2013, vol. 11, pp. 181. DOI: 10.1186/1741-7015-11-181.
  18. Wilkinson T.M., Hurst J.R., Perera W.R., Wilks M., Donaldson G.C., Wedzicha J.A. Effect of interactions between lower airway bacterial and rhinoviral infection in exacerbations of COPD. Chest,2006, vol. 129, pp. 317–324. DOI: 10.1378/chest.129.2.317.

About authors

Alekseeva Evgenia P.
Assistant Lecturer, Department of Internal Diseases, Chuvash State University, Russia, Cheboksary (; ORCID:

Article link

Alekseeva E.P. Dynamics of Immunological and Functional Indicators in the Course of Treating Exacerbation of Chronic Obstructive Pulmonary Disease [Electronic resource] // Acta medica Eurasica. – 2021. – №4. P. 1-8. – URL: DOI: 10.47026/2413-4864-2021-4-1-8.