Public Health - Environmental Health Science
The airway microbiome in COPD exacerbations of smokers and never-smokers in India
Chronic Obstructive Pulmonary Disease (COPD) is the third-leading cause of death globally. In the developed world, the primary risk factor for COPD is cigarette smoking, while in the developing world (including India), 30-50% of COPD patients are never-smokers. Major risk factors for non-smoking COPD are exposure to high levels of household air pollution and/or ambient air pollution. COPD exacerbations, defined as acute worsening of respiratory symptoms, are the major cause for morbidity and mortality. Due to poor immune defenses, bacterial infections are the predominant cause of exacerbations and prevention and management of exacerbations have been major public health challenges. Current knowledge of the airway microbiome (pathogenic bacteria) associated with exacerbations and treatment regimens to combat these are from smoking COPD patients of developed countries. However, little is known about the airway microbiome that causes exacerbations in the developing world, and more importantly, it is also unclear whether the airway microbiome of non-smoking COPD differs from smoking COPD. The aim of this pilot study is to identify the airway microbiome of Indian smoking COPD and non-smoking COPD during exacerbations, in order to determine i) exacerbation-causing bacterial species amongst Indian COPD patients; ii) whether the causal microbiota in smoking COPD is different from non-smoking COPD; and iii) whether this warrants different preventive/treatment modalities to reduce the severity for smoking or non-smoking COPD subjects. JHSPH has recently partnered with JIPMER, a leading medical institute in India, and the PI’s team is uniquely positioned to conduct this pilot study and forge a relationship for future large studies. The findings of the study may assist physicians in making therapeutic decisions that are most effective and also aid in development of improved methods of diagnosis, prevention (e.g., vaccination) and treatment (e.g. antibiotics) of COPD exacerbations, which can save lives in India and other areas of the world.
Daniel Peterson, JHSOM, Pathology; Alan Scott, JHSPH, Molecular Microbiology and Immunology; Shyam Biswal, JHSPH, Environmental Health Sciences