The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

Oral immunostimulating therapy in preventing respiratory tract infections in COPD patients

Authors:  Mohd Shameem;MD, Rakesh Bhargava;MD, Zuber Ahmad;MD, Naveed Nazir Shah;MBBS MD(student): Department of Tuberculosis and Chest diseases; Jawaherlal Nehru Medical College; AMU; Aligarh (U.P) 202002 INDIA

Introduction Respiratory tract infections (RTI) is the commonest cause of the acute exacerbation of COPD. Thus it is necessary to explore new alternative for prevention of the infection responsible for acute exacerbation. Several interventions have been studied     recently to induce non specific protection against acute respiratory tract infections. On this line, oral immunostimulating therapy (OIST), which is the product of alkaline proteolysis from lysates of the following bacteria- Haemophilus influenzae, Streptococcus pneumoniae, Klebsiella pneumoniae, Klebsiella ozaenae, Staphylococcal aureus, Streptococcus pyogenes, Streptococcus viridans, and Moraxella catarrhalis. OIST reduces the symptomatology of respiratory tract infection and maintains the body's immunological defences at an effective level and reduces the frequency , duration , and severity of recurrent RTI.

Material and Methods:  After approval from ethical committee, initial screening of hospital charts provided the list of potential candidates for the study. Inclusion criteria - history of heavy smoking (>20 pack-years), FEV1 between 20-70% predicated, which improves <15% after salbutamol, history of >3 respiratory tract infections during last 6 months, negative family history of allergy, no seasonal or food related wheezing, no anatomic alterations of the respiratory tract. 200 patients (100 placebo group, 100 OIST group) were followed up outpatient for six months. OIST was given for 10 consecutive days every month for 3 consecutive months in addition to conventional therapy. RTI was defined as at least one of the following signs- fever, increased sputum production during last 48hrs, change in the color of sputum , rales or crepts, respiratory rate  >40/min, cyanosis. Parameters choosen to assess the efficacy were- number of respiratory tract infection, its duration, number of re-infections during 6 months of the study period, treatment outcome in term of consumption of antibiotics, use of reliever medicine (short acting β2 agonist), % change in respiratory symptoms i.e cough, dysponea.  The results were expressed as mean ±SD (95% confidence interval), analysis was done by t-test, p<0.001 were considered as statistically significant.

Result: There was significant reduction in the number of RTI as compared to placebo group(1.35± 1.02, CL-95%Vs 70.0± 3.3; p<0.001), their duration (5.92± 0.84 Vs 13.98; p<0.001). Average number of re-infection was reduced (1.1±0.17 Vs 3.0 ±0.17; p<0.001). Treatment outcome in the OIST group was significantly improved.

Conclusion:  OIST is thus potential preventive as well as curative therapy against acute exacerbation of COPD in addition to conventional therapy.Correspondence: Dr. Mohd Shameem(Assistant Professor); Dept. of TB & Chest Diseases; Jawaherlal Nehru Medical College; Aligarh Muslim University; Aligarh(U.P); India 202002;   +91-9412731835: Fax- +91-571-2702758:

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