Nasal swab as an alternative to bronchoscopic lavage for identification of pathogenic organisms in patients with chronic sinusitis concomitant with chronic bronchitis exacerbations

BackgroundCigarette smoke is the most important risk factor for COPD. It has a destructive potential for nasal mucosa. There is a correlation between upper airway inflammation and COPD exacerbation suggesting that the nose may be used to model the lung in COPD, but the relationship between organisms colonizing the upper and lower respiratory tracts is not clear.Aim of workThe aim of this study was to identify the individual bacterial cultures in nasal swab and BAL and to correlate these microbiological data in patients with CRS and concomitant COPD exacerbation.Subjects and methodsSixty-three patients with CRS during exacerbation of COPD and 10 control subjects with CRS and normal lower airways with similar age and sex distribution were recruited for the study. Pulmonary function and paranasal sinuses CT examinations were performed together with endoscopic and clinical assessment. Endoscopic middle meatal swab and BAL were done to all subjects. All the specimens were examined for aerobic and anaerobic bacteria.ResultsNasal swab cultures revealed 49.2% Gram positive organisms, 34.9% Gram negative organisms, and anaerobes 15.9%, BAL cultures resulted in 44.5% Gram positive organisms, 46% Gram negative organisms, and anaerobes 9.5%. Streptococcus pneumoniae was predominant in both nasal swab and BAL (25.3% and 26.9%, respectively) followed by Staphylococcus aureus (23.8% and 17.4%) Moraxella catarrhalis (15.8% and 20.6%), haemophilus influenza (14.2% and 19%) and Pseudomonas aeruginosa (4.3% and 6.3%). Matched organisms between upper and lower respiratory tract cultures were seen in 41 (65%) subjects.ConclusionAerobic bacteria were the predominant organisms cultured from both upper and lower airways in chronic sinusitis patients with acute exacerbation of chronic bronchitis. The matched pattern of microorganisms cultured concomitantly from upper and lower airways, may suggest that nasal swab can be used as a non-invasive tool to predict lower airway pathogens.