Dynamic Changes in Airway Microbiota and Immune Homeostasis in Patients With COPD and the Implications for Nursing...

To investigate changes in airway microbiota and immune markers across Chronic Obstructive Pulmonary Disease (COPD) stages and their associations with clinical phenotypes and nursing factors, providing a basis for precision nursing.

284 stable COPD patients (GOLD 2-3) were enrolled. Sputum and clinical data were collected at baseline (T0), exacerbation (T1), and recovery (T2). Microbiota structure was analyzed via 16S rRNA sequencing, and levels of immune markers such as interleukin-8 (IL-8) and IL-1β were measured by Enzyme-Linked Immunosorbent Assay (ELISA). Statistical analysis was performed by integrating clinical scale scores and nursing adherence data.

At T1, airway microbial α diversity was remarkably lower than at T0 and T2 (p < 0.01). The relative abundances of Haemophilus and Prevotella increased, while those of Veillonella and Lactococcus decreased (p < 0.01). Levels of IL 8, IL 1β, and TNF α were elevated, and Secretory Leukocyte Protease Inhibitor (SLPI) levels were reduced at T1 (p < 0.01). Notable correlations were found between microbiota and immune markers (e.g., Haemophilus abundance with IL 8 levels, r = 0.52, p < 0.01), and these were positively associated with clinical scores such as COPD Assessment Test (CAT) and St. George's Respiratory Questionnaire (SGRQ) (p < 0.05). Patients with >80% inhaler adherence and regular breathing exercises/nutrition had higher microbial diversity and attenuated inflammation (p<0.05).

The airway microbiota-immune axis in COPD patients demonstrates a disease stage-dependent imbalance, characterized by microbial dysbiosis and enhanced pro-inflammatory responses during acute exacerbation. Good nursing adherence can modulate this axis's homeostasis, offering novel targets for precision nursing.