151
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King L, White H, Clifton I, Spoletini G, Ispoglou T, Peckham DG. Nutritional status and intake in patients with non-cystic fibrosis bronchiectasis (NCFB) - a cross sectional study. Clin Nutr 2021; 40:5162-5168. [PMID: 34461590 DOI: 10.1016/j.clnu.2021.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/06/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND & AIMS Bronchiectasis is a heterogeneous, chronic respiratory condition, in which the role of nutrition remains unclear and nutritional guidance is lacking. Few studies have explored the role of nutrition in disease management, and little is known about nutritional requirements during periods of stability or metabolic stress. The aim of this study was to characterise nutritional status and intakes in a cohort of patients and identify potential associations with body composition and functional capacity. METHODS A prospective observational cohort study was undertaken in an adult population (>17 years). Bronchiectasis was confirmed by high-resolution computerised tomography (HRCT). Anthropometric (weight, height, Body Mass Index (BMI), triceps skinfold thickness (TSF), mid upper-arm circumference (MUAC) and mid arm muscle circumference (MAMC)] lung function and nutritional intakes were measured. Results were analysed as a whole and by disease aetiology [primary ciliary dyskinesia (PCD), Idiopathic cause (IC), bronchiectasis in association with asthma and other] and associations tested. RESULTS In total, 128 participants (65.5% female) completed the study. Median handgrip strength (HGS) in the total sample was only 66.5% (IQR 60.5-89.8) of reference population norms and was low for those with PCD [58.0% (IQR 43.5-70.0))]. Univariate regression indicated that BMI was a statistically significant predictor of lung function in the whole population with HGS and weight identified as statistically significant predictors of lung function in PCD. The total population and each sub-group failed to meet estimated average requirements for energy but exceeded the Reference nutrient intake (RNI) for protein. Vitamin D was consistently <35% of the RNI. CONCLUSION BMI lay within normal to overweight ranges within the whole population and sub-groups, but masked important functional, body composition and nutritional deficits. This was particularly so within a younger sub-group with PCD, who had impaired muscle function, when compared to other causal and associative diseases.
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Affiliation(s)
- Linsey King
- University Leeds, Clinical Science Building, Beckett Street, Leeds, LS97TF, UK; Leeds Beckett University, Calverley Street, Leeds, LS1 3HE, UK.
| | - Helen White
- Leeds Beckett University, Calverley Street, Leeds, LS1 3HE, UK.
| | - Ian Clifton
- Leeds Teaching Hospitals Trusts, Beckett Street, Leeds, LS97TF, UK
| | - Giulia Spoletini
- Leeds Teaching Hospitals Trusts, Beckett Street, Leeds, LS97TF, UK
| | | | - Daniel G Peckham
- University Leeds, Clinical Science Building, Beckett Street, Leeds, LS97TF, UK; Leeds Beckett University, Calverley Street, Leeds, LS1 3HE, UK.
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152
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Keir HR, Shoemark A, Huang JTJ, Chalmers JD. SPLUNC1 is a novel marker of disease severity and airway infection in bronchiectasis. Eur Respir J 2021; 58:13993003.01840-2021. [PMID: 34413156 DOI: 10.1183/13993003.01840-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/05/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Holly R Keir
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Amelia Shoemark
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.,Royal Brompton Hospital, Primary Ciliary Dyskinesia Centre, Paediatric Respiratory Medicine, London, UK
| | | | - James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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153
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154
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Chang AB, Boyd J, Bell L, Goyal V, Masters IB, Powell Z, Wilson C, Zacharasiewicz A, Alexopoulou E, Bush A, Chalmers JD, Fortescue R, Hill AT, Karadag B, Midulla F, McCallum GB, Snijders D, Song WJ, Tonia T, Grimwood K, Kantar A. Clinical and research priorities for children and young people with bronchiectasis: an international roadmap. ERJ Open Res 2021; 7:00122-2021. [PMID: 34291113 PMCID: PMC8287136 DOI: 10.1183/23120541.00122-2021] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/20/2021] [Indexed: 12/14/2022] Open
Abstract
The global burden of children and young people (CYP) with bronchiectasis is being recognised increasingly. They experience a poor quality of life and recurrent respiratory exacerbations requiring additional treatment, including hospitalisation. However, there are no published data on patient-driven clinical needs and/or research priorities for paediatric bronchiectasis. Parent/patient-driven views are required to understand the clinical needs and research priorities to inform changes that benefit CYP with bronchiectasis and reduce their disease burden. The European Lung Foundation and the European Respiratory Society Task Force for paediatric bronchiectasis created an international roadmap of clinical and research priorities to guide, and as an extension of, the clinical practice guideline. This roadmap was based on two global web-based surveys. The first survey (10 languages) was completed by 225 respondents (parents of CYP with bronchiectasis and adults with bronchiectasis diagnosed in childhood) from 21 countries. The parent/patient survey encompassed both clinical and research priorities. The second survey, completed by 258 health practitioners from 54 countries, was limited to research priorities. The two highest clinical needs expressed by parents/patients were: having an action management plan for flare-ups/exacerbations and access to physiotherapists. The two highest health practitioners’ research priorities related to eradication of airway pathogens and optimal airway clearance techniques. Based on both surveys, the top 10 research priorities were derived, and unanimous consensus statements were formulated from these priorities. This document addresses parents'/patients' clinical and research priorities from both the parents'/patients' and clinicians' perspectives and will help guide research and clinical efforts to improve the lives of people with bronchiectasis. This document is an international roadmap on parents’/patients’ clinical and research priorities from both the parents’/patients’ and clinicians’ perspectives to help guide research and clinical efforts to improve the lives of people with bronchiectasishttps://bit.ly/3xoonwi
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Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | | | - Leanne Bell
- European Lung Foundation Bronchiectasis Paediatric Patient Advisory Group, Sheffield, UK
| | - Vikas Goyal
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - I Brent Masters
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Zena Powell
- European Lung Foundation Bronchiectasis Paediatric Patient Advisory Group, Sheffield, UK
| | - Christine Wilson
- Dept of Physiotherapy, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Angela Zacharasiewicz
- Dept of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Vienna, Austria
| | - Efthymia Alexopoulou
- 2nd Radiology Dept, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Andrew Bush
- Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial School of Medicine, London, UK
| | - James D Chalmers
- College of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Rebecca Fortescue
- Population Health Research Institute, St George's University of London, London, UK
| | - Adam T Hill
- Dept of Respiratory Medicine, Royal Infirmary and University of Edinburgh, Edinburgh, UK
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Fabio Midulla
- Dept of Maternal Science, Sapienza University of Rome, Rome, Italy
| | - Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | | | - Woo-Jung Song
- Dept of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Keith Grimwood
- Depts of Infectious Disease and Paediatrics, Gold Coast Health, Southport, Queensland, Australia.,School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia.,These authors contributed equally as senior authors
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Ponte San Pietro, Bergamo, Italy.,These authors contributed equally as senior authors
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155
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Abstract
Primary ciliary dyskinesia (PCD) is an inherited cause of bronchiectasis. The estimated PCD prevalence in children with bronchiectasis is up to 26% and in adults with bronchiectasis is 1 to 13%. Due to dysfunction of the multiple motile cilia of the respiratory tract patients suffer from poor mucociliary clearance. Clinical manifestations are heterogeneous; however, a typical patient presents with chronic productive cough and rhinosinusitis from early life. Other symptoms reflect the multiple roles of motile cilia in other organs and can include otitis media and hearing loss, infertility, situs inversus, complex congenital heart disease, and more rarely other syndromic features such as hydrocephalus and retinitis pigmentosa. Awareness, identification, and diagnosis of a patient with PCD are important for multidisciplinary care and genetic counseling. Diagnosis can be pursued through a multitest pathway which includes the measurement of nasal nitric oxide, sampling the nasal epithelium to assess ciliary function and structure, and genotyping. Diagnosis is confirmed by the identification of a hallmark ultrastructural defect or pathogenic mutations in one of > 45 PCD causing genes. When a diagnosis is established management is centered around improving mucociliary clearance through physiotherapy and treatment of infection with antibiotics. The first international randomized controlled trial in PCD has recently been conducted showing azithromycin is effective in reducing exacerbations. It is likely that evidence-based PCD-specific management guidelines and therapies will be developed in the near future. This article examines prevalence, clinical features, diagnosis, and management of PCD highlighting recent advances in basic science and clinical care.
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Affiliation(s)
- Amelia Shoemark
- Scottish Centre for Respiratory Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee DD1 9SY, United Kingdom.,PCD Diagnostic Service, Royal Brompton Hospital, London, United Kingdom
| | - Katharine Harman
- Department of Paediatrics and Child Health, King's College Hospital, London, United Kingdom
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156
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Amati F, Simonetta E, Pilocane T, Gramegna A, Goeminne P, Oriano M, Pascual-Guardia S, Mantero M, Voza A, Santambrogio M, Blasi F, Aliberti S. Diagnosis and Initial Investigation of Bronchiectasis. Semin Respir Crit Care Med 2021; 42:513-524. [PMID: 34261176 DOI: 10.1055/s-0041-1730892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Bronchiectasis refers to both the name of a disease and a single radiological appearance that may, or may not, be associated with disease. As chronic respiratory disease, bronchiectasis is characterized by a variable range of signs and symptoms that may overlap with other chronic respiratory conditions. The proper identification of bronchiectasis as a disease in both primary and secondary care is of paramount importance. However, a standardized definition of radiologically and clinically significant bronchiectasis is still missing. Disease heterogeneity is a hallmark of bronchiectasis and applies not only to radiological features and clinical manifestations but also to other aspects of the disease, including the etiological and microbiological diagnosis as well as the evaluation of pulmonary function. Although the guidelines suggest a "minimum bundle" of tests, the diagnostic approach to bronchiectasis is challenging and may be driven by the "treatable traits" approach based on endotypes and biological characteristics. A broad spectrum of diagnostic tests could be used to investigate the etiology of bronchiectasis as well as other pulmonary, extrapulmonary, and environmental traits. Individualizing bronchiectasis workup according to the site of care (e.g., primary, secondary, and tertiary care) could help optimize patients' management and reduce healthcare costs.
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Affiliation(s)
- Francesco Amati
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Edoardo Simonetta
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Tommaso Pilocane
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Andrea Gramegna
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Pieter Goeminne
- Department of Respiratory Medicine, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Martina Oriano
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Sergi Pascual-Guardia
- Department of Respiratory Medicine, Hospital del Mar (PSMAR)-IMIM, Barcelona, Spain.,School of Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,CIBER, Área de Enfermedades Respiratorias (CIBERES), ISCIII, Spain
| | - Marco Mantero
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Antonio Voza
- Emergency Department, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Martina Santambrogio
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Blasi
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stefano Aliberti
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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157
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Common Variable Immunodeficiency and Other Immunodeficiency Syndromes in Bronchiectasis. Semin Respir Crit Care Med 2021; 42:525-536. [PMID: 34261177 DOI: 10.1055/s-0041-1730893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Immunodeficiency represents a vast number of diseases and syndromes. Both primary and secondary forms of immunodeficiency are important contributors to the development of bronchiectasis. Primary immune deficiencies, in particular, are increasingly identified and defined as contributors. Specific immune deficiencies that are closely associated with bronchiectasis and as discussed in this article are common variable immunodeficiency, specific antibody deficiency, immunodeficiencies involving immunoglobulin E, DOCK8 immunodeficiency, phosphoglucomutase 3 deficiency, activated phosphoinositide 3-kinase delta syndrome, and X-linked agammaglobulinemia. Each of these primary immune deficiencies has unique nuances. Vigilance for these unique signs and symptoms is likely to improve recognition of specific immunodeficiency in the idiopathic bronchiectasis patient. Secondary forms of immunodeficiency occur as a result of a separate disease process. Graft versus host disease, malignancy, and human immunodeficiency virus are three classic examples discussed in this article. An awareness of the potential for these disease settings to lead to bronchiectasis is necessary to optimize patient care. With understanding and mindfulness toward the intricate relationship between bronchiectasis and immunodeficiency, there is an opportunity to elucidate pathophysiologic underpinnings between these two syndromes.
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158
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Abstract
Bronchiectasis is a complex, heterogeneous disorder defined by both a radiological abnormality of permanent bronchial dilatation and a clinical syndrome. There are multiple underlying causes including severe infections, mycobacterial disease, autoimmune conditions, hypersensitivity disorders, and genetic conditions. The pathophysiology of disease is understood in terms of interdependent concepts of chronic infection, inflammation, impaired mucociliary clearance, and structural lung damage. Neutrophilic inflammation is characteristic of the disease, with elevated levels of harmful proteases such as neutrophil elastase associated with worse outcomes. Recent data show that neutrophil extracellular trap formation may be the key mechanism leading to protease release and severe bronchiectasis. Despite the dominant of neutrophilic disease, eosinophilic subtypes are recognized and may require specific treatments. Neutrophilic inflammation is associated with elevated bacterial loads and chronic infection with organisms such as Pseudomonas aeruginosa. Loss of diversity of the normal lung microbiota and dominance of proteobacteria such as Pseudomonas and Haemophilus are features of severe bronchiectasis and link to poor outcomes. Ciliary dysfunction is also a key feature, exemplified by the rare genetic syndrome of primary ciliary dyskinesia. Mucus symptoms arise through goblet cell hyperplasia and metaplasia and reduced ciliary function through dyskinesia and loss of ciliated cells. The contribution of chronic inflammation, infection, and mucus obstruction leads to progressive structural lung damage. The heterogeneity of the disease is the most challenging aspect of management. An understanding of the pathophysiology of disease and their biomarkers can help to guide personalized medicine approaches utilizing the concept of "treatable traits."
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Affiliation(s)
- Holly R Keir
- Scottish Centre for Respiratory Research, University of Dundee, Dundee, United Kingdom
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Dundee, United Kingdom
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159
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Jaggi TK, Ter SK, Mac Aogáin M, Chotirmall SH. Aspergillus-Associated Endophenotypes in Bronchiectasis. Semin Respir Crit Care Med 2021; 42:556-566. [PMID: 34261180 DOI: 10.1055/s-0041-1730947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Bronchiectasis is a chronic condition of global relevance resulting in permanent and irreversible structural airway damage. Bacterial infection in bronchiectasis is well studied; however, recent molecular studies identify fungi as important pathogens, either independently or in association with bacteria. Aspergillus species are established fungal pathogens in cystic fibrosis and their role is now increasingly being recognized in noncystic fibrosis bronchiectasis. While the healthy airway is constantly exposed to ubiquitously present Aspergillus conidia in the environment, anatomically damaged airways appear more prone to colonization and subsequent infection by this fungal group. Aspergilli possess diverse immunopathological mechanistic capabilities and when coupled with innate immune defects in a susceptible host, such as that observed in bronchiectasis, it may promote a range of clinical manifestations including sensitization, allergic bronchopulmonary aspergillosis, Aspergillus bronchitis, and/or invasive aspergillosis. How such clinical states influence "endophenotypes" in bronchiectasis is therefore of importance, as each Aspergillus-associated disease state has overlapping features with bronchiectasis itself, and can evolve, depending on underlying host immunity from one type into another. Concurrent Aspergillus infection complicates the clinical course and exacerbations in bronchiectasis and therefore dedicated research to better understand the Aspergillus-host interaction in the bronchiectasis airway is now warranted.
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Affiliation(s)
- Tavleen Kaur Jaggi
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Soo Kai Ter
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Micheál Mac Aogáin
- Biochemical Genetics Laboratory, Department of Biochemistry, St. James's Hospital, Dublin, Ireland.,Clinical Biochemistry Unit, School of Medicine, Trinity College Dublin, Ireland
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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160
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Suarez-Cuartin G, Hernandez-Argudo M, Perea L, Sibila O. Long-Term Antibiotics in Bronchiectasis. Semin Respir Crit Care Med 2021; 42:606-615. [PMID: 34261184 DOI: 10.1055/s-0041-1730945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A significant proportion of bronchiectasis patients are chronically infected by potentially pathogenic microorganisms which may lead to frequent exacerbations and worse clinical outcomes. Current bronchiectasis guidelines recommend long-term inhaled antibiotics and/or oral macrolides as a part of patient management. In recent years, an increasing amount of evidence assessing the impact of these treatments on patient outcomes has been collected. Inhaled antibiotics have demonstrated significant improvements in sputum bacterial load, but their impact on patient quality of life, lung function, and exacerbation rate has not been consistent across trials. In this regard, recent post hoc analyses of inhaled antibiotics trials in bronchiectasis patients have shown that sputum bacterial load may be a key biomarker to predict treatment response in these patients. Oral macrolides, on the other hand, have proven to reduce exacerbation frequency and improve quality of life, but potential drug-related adverse effects and the increase in bacterial resistance are relevant. This review aims to summarize current important evidence for long-term antibiotic treatment in bronchiectasis patients.
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Affiliation(s)
- Guillermo Suarez-Cuartin
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Hernandez-Argudo
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lidia Perea
- Department of Respiratory Medicine, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERES, Barcelona, Spain
| | - Oriol Sibila
- Department of Respiratory Medicine, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERES, Barcelona, Spain
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161
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Abstract
Bronchiectasis is a heterogenous disease with multiple etiologies and associated comorbidities. As bronchiectasis is a complex disease, it is unsound to think of it as a single disease particularly when the differing etiologies are likely to be driving bronchiectasis through initial divergent molecular pathways, known as endotypes, that phenotypically present as the same disease due to protracted airway inflammation, but revealing potential differing underlying mechanisms that may have disparity of drug responses. Improved understanding of the cellular immune, inflammatory, and microbiological milieu associated with clinical and radiological features of bronchiectasis has resulted in the recognition of important endotypes and phenotypes that will allow for personalized treatments to improve quality of life and outcomes of patients with bronchiectasis. Here we discuss clinical and radiological phenotypes, as well as emerging molecular endotypes that are possible treatable traits in bronchiectasis.
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Affiliation(s)
- Ricardo J José
- Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom.,Centre for Inflammation and Tissue Repair, University College London, London, United Kingdom
| | - Michael R Loebinger
- Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
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162
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Shkeiri R, Saliba W, Stein N, Najjar R, Weber G, Dror SK, Mishan PS, Adir Y, Shteinberg M. Exploring factors associated with acquisition and chronicity of infection in bronchiectasis: A population-based study. Respir Med 2021; 185:106487. [PMID: 34139580 DOI: 10.1016/j.rmed.2021.106487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Chronic infection is associated with adverse outcomes among people with bronchiectasis. However, it is not known which factors are associated with a bacterial infection, and with persistence of an infection after the first episode. We aimed to determine factors associated with a new infection and with chronicity of Pseudomonas aeruginosa (PA) and H. influenzae (HI), the most common organisms in bronchiectasis infection. METHODS Using an Israeli population database, we identified individuals diagnosed with bronchiectasis. Cox proportional hazard models were used to assess risk factors for first isolation and Logistic regression for chronicity of infection after a first isolation of PA and HI. RESULTS We included 1305 people with a median of 5 respiratory samples per individual. PA was initially isolated in 297 people, of whom 97 (33%) developed chronic PA infection. HI was newly identified in 169 people, of whom 39 (23%) developed chronic infection (p = 0.029). Factors associated with increased risk of a new infection with PA were COPD (HR 1.87 [1.52-2.28], previous isolation of HI (HR 1.38 [1.07-1.78]), and alcohol abuse (HR 2.22 [1.13-4.3]). Younger age was associated with increased risk of HI infection, while COPD was associated with a lower risk of HI infection. Prescription of an anti- PA antibiotic was associated with chronic PA after a new infection (OR = 1.8 [1.09-2.9], p = 0.02). A landmark analysis showed that survival was worse in people with chronic PA infection vs. single or intermittent infection (Log rank: p = 0.034) CONCLUSIONS: Younger age and presence of PCD are associated with a new isolation of HI. A new infection with PA is associated with previous HI infection, PCD, COPD, and alcohol abuse. Unexpectedly, treatment with appropriate anti-PA antimicrobials was not associated with a reduced risk of chronicity.
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Affiliation(s)
- Rashed Shkeiri
- Pulmonology Institute Carmel Medical Center, Haifa, Israel
| | - Walid Saliba
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nili Stein
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Ronza Najjar
- Infectious Diseases Unit, Carmel Medical Center, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gabriel Weber
- Infectious Diseases Unit, Carmel Medical Center, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shifra Ken- Dror
- Clinical Microbiological Laboratory, Central Laboratories Haifa & Western Galilee, Clalit Health Services, Haifa, Israel
| | | | - Yochai Adir
- Pulmonology Institute Carmel Medical Center, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Michal Shteinberg
- Pulmonology Institute Carmel Medical Center, Haifa, Israel; CF Center, Carmel Medical Center, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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163
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Barto TL, Maselli DJ, Daignault S, Stiglich J, Porter J, Kraemer C, Hansen G. Real-life experience with high-frequency chest wall oscillation vest therapy in adults with non-cystic fibrosis bronchiectasis. Ther Adv Respir Dis 2021; 14:1753466620932508. [PMID: 32538317 PMCID: PMC7297124 DOI: 10.1177/1753466620932508] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: High frequency chest wall oscillation (HFCWO) has long been used for airway clearance for patients with cystic fibrosis. Only limited research has evaluated this therapy in adult patients with non-cystic fibrosis bronchiectasis (NCFB). Methods: Data from 2596 patients from a registry of adult bronchiectasis patients using HFCWO therapy was used to evaluate hospitalization patterns before and after initiation of HFCWO therapy, as well as antibiotic use and self-reported metrics of quality of life. Self-reported outcomes were also reviewed by cross-checking with sampled patient charts and found to be consistent. Results: The number of patients who had at least one respiratory-related hospitalization decreased from 49.1% (192/391) in the year before to 24.0% (94/391) in the year after starting HFCWO therapy (p-value < 0.001). At the same time, the number of patients who required three or more hospitalizations dropped from 14.3% (56/391) to 5.6% (22/391). Patients currently taking oral antibiotics for respiratory conditions decreased from 57.7% upon initiation of therapy to 29.9% within 1 year (p < 0.001). Patients who subjectively rated their “overall respiratory health” as good to excellent increased from 13.6% upon initiation of therapy to 60.5% in 1 year (p < 0.001) and those who rated their “ability to clear your lungs” as good to excellent increased from 13.9% to 76.6% (p < 0.001). Conclusion: NCFB patients showed improved self-reported outcomes associated with the initiation of HFCWO therapy as measured by number of hospitalizations, antibiotic use, and the subjective experience of airway clearance. The improvement was observed early on after initiation of therapy and sustained for at least 1 year. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Tara Lynn Barto
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, 7200 Cambridge St., 8th Floor, Suite 8A, Houston, TX 77030, USA
| | - Diego Jose Maselli
- Division of Pulmonary Diseases & Critical Care Medicine, UT Health, San Antonio, TX, USA
| | | | | | | | - Carlye Kraemer
- North American Science Associates, Inc., Minneapolis, MN, USA
| | - Gary Hansen
- RespirTech, A Philips Company, St. Paul, MN, USA
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164
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Oriano M, Amati F, Gramegna A, De Soyza A, Mantero M, Sibila O, Chotirmall SH, Voza A, Marchisio P, Blasi F, Aliberti S. Protease-Antiprotease Imbalance in Bronchiectasis. Int J Mol Sci 2021; 22:5996. [PMID: 34206113 PMCID: PMC8199509 DOI: 10.3390/ijms22115996] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/27/2021] [Accepted: 05/29/2021] [Indexed: 12/12/2022] Open
Abstract
Airway inflammation plays a central role in bronchiectasis. Protease-antiprotease balance is crucial in bronchiectasis pathophysiology and increased presence of unopposed proteases activity may contribute to bronchiectasis onset and progression. Proteases' over-reactivity and antiprotease deficiency may have a role in increasing inflammation in bronchiectasis airways and may lead to extracellular matrix degradation and tissue damage. Imbalances in serine proteases and matrix-metallo proteinases (MMPs) have been associated to bronchiectasis. Active neutrophil elastase has been associated with disease severity and poor long-term outcomes in this disease. Moreover, high levels of MMPs have been associated with radiological and disease severity. Finally, severe deficiency of α1-antitrypsin (AAT), as PiSZ and PiZZ (proteinase inhibitor SZ and ZZ) phenotype, have been associated with bronchiectasis development. Several treatments are under study to reduce protease activity in lungs. Molecules to inhibit neutrophil elastase activity have been developed in both oral or inhaled form, along with compounds inhibiting dipeptydil-peptidase 1, enzyme responsible for the activation of serine proteases. Finally, supplementation with AAT is in use for patients with severe deficiency. The identification of different targets of therapy within the protease-antiprotease balance contributes to a precision medicine approach in bronchiectasis and eventually interrupts and disrupts the vicious vortex which characterizes the disease.
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Affiliation(s)
- Martina Oriano
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.O.); (F.A.); (A.G.); (M.M.); (P.M.); (F.B.)
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Francesco Amati
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.O.); (F.A.); (A.G.); (M.M.); (P.M.); (F.B.)
| | - Andrea Gramegna
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.O.); (F.A.); (A.G.); (M.M.); (P.M.); (F.B.)
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Anthony De Soyza
- Population and Health Science Institute, NIHR Biomedical Research Centre for Ageing & Freeman Hospital, Newcastle University, Newcastle NE2 4HH, UK;
| | - Marco Mantero
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.O.); (F.A.); (A.G.); (M.M.); (P.M.); (F.B.)
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Oriol Sibila
- Respiratory Department, Hospital Clinic, IDIBAPS, CIBERES, 08036 Barcelona, Spain;
| | - Sanjay H. Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639798, Singapore;
| | - Antonio Voza
- Emergency Department, IRCCS Humanitas Research Teaching Hospital, 20122 Milan, Italy;
| | - Paola Marchisio
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.O.); (F.A.); (A.G.); (M.M.); (P.M.); (F.B.)
- Paediatric Highly Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Francesco Blasi
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.O.); (F.A.); (A.G.); (M.M.); (P.M.); (F.B.)
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Stefano Aliberti
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.O.); (F.A.); (A.G.); (M.M.); (P.M.); (F.B.)
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
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165
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Ju S, Jeong JH, Heo M, Heo IR, Kim TH, Kim HC, Yoo JW, Cho YJ, Jeong YY, Lee JD, Lee SJ. Serum albumin is a predictor of respiratory hospitalization in patients with bronchiectasis. Chron Respir Dis 2021; 18:14799731211017548. [PMID: 34032131 PMCID: PMC8155784 DOI: 10.1177/14799731211017548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
We evaluated serum albumin as an index for predicting respiratory hospitalization in patients with bronchiectasis. We retrospectively reviewed the medical records of 177 patients with bronchiectasis, categorized them into low and normal albumin groups, and compared their clinical characteristics. The prediction of respiratory hospitalization by factors such as serum albumin level, bronchiectasis severity index (BSI), and FACED score (an acronym derived from five variables of forced expiratory volume in 1 s; FEV1, age, chronic colonization of Pseudomonas aeruginosa, extent of bronchiectasis, and dyspnea) was assessed. There were 15 and 162 patients categorized in the low and normal albumin groups, respectively. The low albumin group had lower body mass index and forced expiratory volume in 1 s, and higher age, frequency of previous respiratory hospitalization, percentage of Pseudomonas colonization, number of affected lobes, BSI and FACED scores, and C-reactive protein (CRP) level, than the normal albumin group. The areas under the receiver operating characteristic curve of serum albumin level and BSI and FACED scores for predicting respiratory hospitalization were 0.732 (95% confidence interval (CI), 0.647-0.816), 0.873 (95% CI, 0.817-0.928), and 0.708 (95% CI, 0.618-0.799), respectively. Albumin level, CRP, modified Medical Research Council score, and chronic Pseudomonas aeruginosa (and other organisms) colonization were independent risk factors for respiratory hospitalization. Low serum albumin level was associated with worse clinical condition, higher severity scores, and respiratory hospitalization in patients with bronchiectasis.
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Affiliation(s)
- Sunmi Ju
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jong Hwan Jeong
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Manbong Heo
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - I Re Heo
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Republic of Korea
| | - Tae Hoon Kim
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Republic of Korea
| | - Ho Cheol Kim
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Republic of Korea
| | - Jung-Wan Yoo
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Yu Ji Cho
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Yi Yeong Jeong
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jong Deog Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Seung Jun Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
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166
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Frent S, Calarasu C, Suska K, Gashynova K, Keir H. ERS International Congress 2020: highlights from the Respiratory Infections assembly. ERJ Open Res 2021; 7:00091-2021. [PMID: 33898612 PMCID: PMC8053904 DOI: 10.1183/23120541.00091-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/25/2021] [Indexed: 11/05/2022] Open
Abstract
In the coronavirus disease 2019 (COVID-19) pandemic year 2020, the 30th European Respiratory Society (ERS) International Congress took place for the first time in a fully virtual format. Despite the challenging nature of the task to create and deliver an online event of this size and scope, it turned out to be a great success, welcoming over 33 000 delegates to the specially designed online platform and offering more than 450 scientific and educational sessions. Somewhat predictably, this year's ERS International Congress dedicated a full day to the topic of COVID-19, highlighting that infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a respiratory disease that is particularly important this year. In this article, the Early Career Members of the Assembly 10 (Respiratory Infections and Tuberculosis) review some of the most interesting sessions including presentations and posters on respiratory infections and tuberculosis that were deemed as important. This is a comprehensive summary of several interesting sessions from #ERSCongress 2020 including presentations and posters on respiratory infections and tuberculosis that were deemed as importanthttps://bit.ly/2OtrYXH
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Affiliation(s)
- Stefan Frent
- Dept of Pulmonology, University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Cristina Calarasu
- Dept of Medical Specialities, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Kseniia Suska
- State Institution "Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine", Dnipro, Ukraine
| | - Kateryna Gashynova
- State Institution "Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine", Dnipro, Ukraine
| | - Holly Keir
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
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167
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Vidaillac C, Chotirmall SH. Pseudomonas aeruginosa in bronchiectasis: infection, inflammation, and therapies. Expert Rev Respir Med 2021; 15:649-662. [PMID: 33736539 DOI: 10.1080/17476348.2021.1906225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Bronchiectasis is a chronic endobronchial suppurative disease characterized by irreversibly dilated bronchi damaged by repeated polymicrobial infections and predominantly, neutrophilic airway inflammation. Some consider bronchiectasis a syndromic consequence of several different causes whilst others view it as an individual disease entity. In most patients, identifying an underlying cause remains challenging. The acquisition and colonization of affected airways by Pseudomonas aeruginosa represent a critical and adverse clinical consequence for its progression and management.Areas covered: In this review, we outline clinical and pre-clinical peer-reviewed research published in the last 5 years, focusing on the pathogenesis of bronchiectasis and the role of P. aeruginosa and its virulence in shaping host inflammatory and immune responses in the airway. We further detail its role in airway infection, the lung microbiome, and address therapeutic options in bronchiectasis.Expert opinion: P. aeruginosa represents a key pulmonary pathogen in bronchiectasis that causes acute and/or chronic airway infection. Eradication can prevent adverse clinical consequence and/or disease progression. Novel therapeutic strategies are emerging and include combination-based approaches. Addressing airway infection caused by P. aeruginosa in bronchiectasis is necessary to prevent airway damage, loss of lung function and exacerbations, all of which contribute to adverse clinical outcome.
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Affiliation(s)
- Celine Vidaillac
- Oxford University Clinical Research Unit, University of Oxford, Ho Chi Minh City, Vietnam.,Center for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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168
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Mac Aogáin M, Narayana JK, Tiew PY, Ali NABM, Yong VFL, Jaggi TK, Lim AYH, Keir HR, Dicker AJ, Thng KX, Tsang A, Ivan FX, Poh ME, Oriano M, Aliberti S, Blasi F, Low TB, Ong TH, Oliver B, Giam YH, Tee A, Koh MS, Abisheganaden JA, Tsaneva-Atanasova K, Chalmers JD, Chotirmall SH. Integrative microbiomics in bronchiectasis exacerbations. Nat Med 2021; 27:688-699. [PMID: 33820995 DOI: 10.1038/s41591-021-01289-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 02/16/2021] [Indexed: 02/01/2023]
Abstract
Bronchiectasis, a progressive chronic airway disease, is characterized by microbial colonization and infection. We present an approach to the multi-biome that integrates bacterial, viral and fungal communities in bronchiectasis through weighted similarity network fusion ( https://integrative-microbiomics.ntu.edu.sg ). Patients at greatest risk of exacerbation have less complex microbial co-occurrence networks, reduced diversity and a higher degree of antagonistic interactions in their airway microbiome. Furthermore, longitudinal interactome dynamics reveals microbial antagonism during exacerbation, which resolves following treatment in an otherwise stable multi-biome. Assessment of the Pseudomonas interactome shows that interaction networks, rather than abundance alone, are associated with exacerbation risk, and that incorporation of microbial interaction data improves clinical prediction models. Shotgun metagenomic sequencing of an independent cohort validated the multi-biome interactions detected in targeted analysis and confirmed the association with exacerbation. Integrative microbiomics captures microbial interactions to determine exacerbation risk, which cannot be appreciated by the study of a single microbial group. Antibiotic strategies probably target the interaction networks rather than individual microbes, providing a fresh approach to the understanding of respiratory infection.
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Affiliation(s)
- Micheál Mac Aogáin
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Jayanth Kumar Narayana
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Pei Yee Tiew
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Valerie Fei Lee Yong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Tavleen Kaur Jaggi
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Albert Yick Hou Lim
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Holly R Keir
- School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Alison J Dicker
- School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Kai Xian Thng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Akina Tsang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | | | - Mau Ern Poh
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Martina Oriano
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stefano Aliberti
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Francesco Blasi
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Teck Boon Low
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore, Singapore
| | - Thun How Ong
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | - Brian Oliver
- Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Yan Hui Giam
- School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Augustine Tee
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore, Singapore
| | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Krasimira Tsaneva-Atanasova
- Department of Mathematics and Living Systems Institute, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - James D Chalmers
- School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
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169
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Wang Y, Mao K, Li Z, Xu W, Shao H, Zhang R. Clinical study of pulmonary CT lesions and associated bronchiectasis in 115 convalescent patients with novel coronavirus pneumonia (COVID-19) in China. Can J Physiol Pharmacol 2021; 99:328-331. [PMID: 33657328 DOI: 10.1139/cjpp-2020-0522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A total of 115 convalescent inpatients with COVID-19 were enrolled. According to the results of scans of lung lesions via computed tomography (CT), the patients were divided into mild, moderate, and severe groups. The clinical data of the patients were collected, including age, gender, finger pulse oxygen pressure, ventricular rate, body temperature, etc. The correlation between the clinical indicators and the lesions of high-resolution CT (HRCT) and bronchiectasis was analyzed. Among the 115 patients, 82 had no bronchiectasis and 33 had bronchiectasis. The bronchodilation-prone layers mainly included the left and right lower lobe of the lung. The probability of branching in the inflamed area was greater than that in the noninflamed area in patients with COVID-19. There were significant differences in gender, CT lesion range, and number of incidents of bronchiectasis between noninflamed and inflamed areas (P < 0.05). Moreover, there were significant differences in age, total proportion of CT lesions, volume of CT lesions, and total number of patients with bronchiectasis among the three groups (P < 0.05). CT lesion range was positively correlated with the total number of patients with bronchiectasis and patient age (respectively, r = 0.186, P < 0.05; r = 0.029, P < 0.05). The lesion range in HRCT images of lungs in patients with COVID-19 is correlated with bronchodilation. The larger the lesion, the higher the probability of bronchiectasis and the more incidents of bronchiectasis.
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Affiliation(s)
- Yuanyuan Wang
- Department of Stomatology, Wuhan No. 1 Hospital (Wuhan Hospital of Traditional Chinese & Western Medicine), Wuhan City, Hubei Province 430022, China
| | - Kaiping Mao
- Department of Stomatology, Wuhan No. 1 Hospital (Wuhan Hospital of Traditional Chinese & Western Medicine), Wuhan City, Hubei Province 430022, China
| | - Zuomin Li
- Department of Cardiovascular Medicine, Wuhan No. 1 Hospital (Wuhan Hospital of Traditional Chinese & Western Medicine), Wuhan City, Hubei Province 430022, China
| | - Wenying Xu
- Department of Stomatology, Wuhan No. 1 Hospital (Wuhan Hospital of Traditional Chinese & Western Medicine), Wuhan City, Hubei Province 430022, China
| | - Hui Shao
- Department of Pediatrics, Wuhan No. 1 Hospital (Wuhan Hospital of Traditional Chinese & Western Medicine), Wuhan City, Hubei Province 430022, China
| | - Rui Zhang
- Department of Thyroid and Breast Surgery, Wuhan No. 1 Hospital (Wuhan Hospital of Traditional Chinese & Western Medicine), Wuhan City, Hubei Province 430022, China
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170
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Girón Moreno RM, Martínez-Vergara A, Martínez-García MÁ. Personalized approaches to bronchiectasis. Expert Rev Respir Med 2021; 15:477-491. [PMID: 33511899 DOI: 10.1080/17476348.2021.1882853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Interest in bronchiectasis is increasing due to its rising prevalence, associated with aging populations and the extended use of high-resolution chest tomography (HRCT), and the resulting high morbidity, mortality, and demand for resources.Areas covered: This article provides an extensive review of bronchiectasis as a complex and heterogeneous disease, as well as examining the difficulty of establishing useful clinical phenotypes. In keeping with the aims of 'precision medicine', we address the disease of bronchiectasis from three specific perspectives: severity, activity, and impact. We used PubMed to search the literature for articles including the following keywords: personalized medicine, bronchiectasis, biomarkers, phenotypes, precision medicine, treatable traits. We reviewed the most relevant articles published over the last 5 years.Expert opinion: This article reflects on the usefulness of these three dimensions in 'control panels' and clinical fingerprinting, as well as approaches to personalized medicine and the treatable features of bronchiectasis non-cystic fibrosis.
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Affiliation(s)
- Rosa Maria Girón Moreno
- Pneumology Department, Hospital Universitario La Princesa. Instituto De Investigación Sanitaria La Princesa, Madrid, Spain
| | - Adrián Martínez-Vergara
- Pneumology Department, Hospital Universitario La Princesa. Instituto De Investigación Sanitaria La Princesa, Madrid, Spain
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171
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Gao J, Li L, Jiang N, Liao Y, Kong L, Song Y, Xu J, Cao J, Li Y, Que C, Pleasants RA. Effect of OM-85 BV on reducing bronchiectasis exacerbation in Chinese patients: the iPROBE study. J Thorac Dis 2021; 13:1641-1651. [PMID: 33841955 PMCID: PMC8024857 DOI: 10.21037/jtd-20-1662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Bronchiectasis is characterized by recurrent infectious exacerbations. No existing data inform preventive strategy for exacerbations beyond chronic macrolides. OM-85 BV, an immunostimulant, has been shown to prevent recurrent respiratory infections. We initiated this 1-year, multi-centered, double-blind, and controlled trial to investigate the PReventive effect of OM-85 BV on Bronchiectasis Exacerbations in Chinese patients (iPROBE). Methods Patients with bronchiectasis aged 18 to 75 years, having at least one exacerbation in the past year, were randomized to receive, in addition to any respiratory medications, two courses of 7 mg of OM-85 BV or matching placebo (one capsule orally per day for 10 days a month) for 3 consecutive months, followed by 3 months without treatment. The primary outcomes included the number of acute infectious exacerbations and the time to first exacerbation. Secondary endpoints included patient-reported respiratory outcomes. Safety measures were also assessed. Results Among the 196 participants, 99 were in the OM-85 BV group and 97 in the placebo group. At week 52, the mean number of acute exacerbations per patient was equal to 0.98 and 0.75, respectively, in the two groups (P=0.14). Difference in the time to first pulmonary exacerbation was not statistically significant (P=0.11). There was no statistically significant difference in any secondary end-points. The safety profile in the two arms was good and the majority of adverse events were mild. Conclusions OM-85 BV did not demonstrate protection in decreasing pulmonary exacerbations of bronchiectasis in this trial performed in Chinese patients. It had good safety profile.
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Affiliation(s)
- Jinming Gao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Lun Li
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Nan Jiang
- Department of Medicine, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Liao
- Department of Medicine, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Lingfei Kong
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yuanlin Song
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jinfu Xu
- Department of Pulmonary and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Jie Cao
- Department of Pulmonary and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuping Li
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chengli Que
- Department of Pulmonary and Critical Care Medicine, First Hospital of Peking University, Beijing, China
| | - Roy A Pleasants
- Division of Pulmonary Medicine and Critical Care, Chapel Hill, NC, USA
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172
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Chang AB, Fortescue R, Grimwood K, Alexopoulou E, Bell L, Boyd J, Bush A, Chalmers JD, Hill AT, Karadag B, Midulla F, McCallum GB, Powell Z, Snijders D, Song WJ, Tonia T, Wilson C, Zacharasiewicz A, Kantar A. Task Force report: European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis. Eur Respir J 2021; 58:13993003.02990-2020. [PMID: 33542057 DOI: 10.1183/13993003.02990-2020] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 12/21/2020] [Indexed: 11/05/2022]
Abstract
There is increasing awareness of bronchiectasis in children and adolescents, a chronic pulmonary disorder associated with poor quality-of-life for the child/adolescent and their parents, recurrent exacerbations and costs to the family and health systems. Optimal treatment improves clinical outcomes. Several national guidelines exist, but there are no international guidelines.The European Respiratory Society (ERS) Task Force for the management of paediatric bronchiectasis sought to identify evidence-based management (investigation and treatment) strategies. It used the ERS standardised process that included a systematic review of the literature and application of the GRADE approach to define the quality of the evidence and level of recommendations.A multidisciplinary team of specialists in paediatric and adult respiratory medicine, infectious disease, physiotherapy, primary care, nursing, radiology, immunology, methodology, patient advocacy and parents of children/adolescents with bronchiectasis considered the most relevant clinical questions (for both clinicians and patients) related to managing paediatric bronchiectasis. Fourteen key clinical questions (7 "Patient, Intervention, Comparison, Outcome" [PICO] and 7 narrative) were generated. The outcomes for each PICO were decided by voting by the panel and parent advisory group.This guideline addresses the definition, diagnostic approach and antibiotic treatment of exacerbations, pathogen eradication, long-term antibiotic therapy, asthma-type therapies (inhaled corticosteroids, bronchodilators), mucoactive drugs, airway clearance, investigation of underlying causes of bronchiectasis, disease monitoring, factors to consider before surgical treatment and the reversibility and prevention of bronchiectasis in children/adolescents. Benchmarking quality of care for children/adolescents with bronchiectasis to improve clinical outcomes and evidence gaps for future research could be based on these recommendations.
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Affiliation(s)
- Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Rebecca Fortescue
- Population Health Research Institute, St George's University of London, London, United Kingdom
| | - Keith Grimwood
- Departments of Infectious Disease and Paediatrics, Gold Coast Health, Southport, Queensland, Australia.,School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast campus, Southport, Queensland, Australia
| | - Efthymia Alexopoulou
- 2nd Radiology Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Leanne Bell
- European Lung Foundation bronchiectasis paediatric patient advisory group, Alnwick, United Kingdom
| | | | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial School of Medicine, London, UK
| | - James D Chalmers
- College of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Adam T Hill
- Dept of Respiratory Medicine, Royal Infirmary and University of Edinburgh, Edinburgh, UK
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Fabio Midulla
- Department of Maternal Science, Sapienza University of Rome, Rome, Italy
| | - Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Zena Powell
- European Lung Foundation bronchiectasis paediatric patient advisory group, Alnwick, United Kingdom
| | - Deborah Snijders
- Dipartimento Salute della Donna e del Bambino, Università degli Studi di Padova, Padova, Italy
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Christine Wilson
- Department of Physiotherapy, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Angela Zacharasiewicz
- Department of Pediatrics, and Adolescent Medicine, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Klinikum Ottakring Vienna, Wien, Austria
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Ponte San Pietro-Bergamo, Bergamo, Italy
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Abstract
Rationale: Although platelets are considered key inflammatory mediators in respiratory diseases, their role in bronchiectasis has not been fully explored. Objectives: We hypothesized that thrombocytosis in stable state may be associated with bronchiectasis severity and worse clinical outcomes. Methods: Patients with bronchiectasis have been enrolled from 10 centers in Europe and Israel, with platelet count recorded during stable state. The primary outcome was 5-year all-cause mortality. Secondary outcomes included exacerbations, hospitalizations, and mortality at 1, 2, and 3-year follow-up. Analyses were conducted using logistic regression after adjustment for confounding variables. Results: Among the 1,771 patients (median age, 67 yr; 63.4% female) included, 136 (7.7%) had thrombocytosis. Patients with thrombocytosis had a significantly higher disease severity, worse quality of life, higher number of exacerbations and hospitalizations, and higher mortality rate at both 3-year (23 [22.8%] vs. 83 [8.5%], respectively; P < 0.01) and 5-year (26 [35.1%] vs. 116 [15.9%], respectively; P < 0.01) in comparison with those with normal platelet count. Thrombocytosis was significantly associated with hospitalizations because of severe exacerbations (odds ratio [OR], 1.83; 95% confidence interval [CI], 1.20-2.79; P = 0.01) after 1-year follow-up, as well as increased 3-year (OR, 3.06; 95% CI, 1.74-5.39; P < 0.01) and 5-year (OR, 2.46; 95% CI, 1.39-4.37; P < 0.01) mortality. Conclusions: Platelets represent a cheap and easy-to-evaluate biomarker, and the presence of thrombocytosis during stable state is associated with disease severity, hospitalizations because of exacerbations, poor quality of life, and mortality in adults with bronchiectasis.
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174
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Giam YH, Shoemark A, Chalmers JD. Neutrophil dysfunction in bronchiectasis: an emerging role for immunometabolism. Eur Respir J 2021; 58:13993003.03157-2020. [DOI: 10.1183/13993003.03157-2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 01/12/2021] [Indexed: 12/22/2022]
Abstract
Bronchiectasis is a heterogenous disease with multiple underlying causes. The pathophysiology is poorly understood but neutrophilic inflammation and dysfunctional killing of pathogens is believed to be key. There are, however, no licensed therapies for bronchiectasis that directly target neutrophilic inflammation. In this review, we discuss our current understanding of neutrophil dysfunction and therapeutic targeting in bronchiectasis. Immunometabolic reprogramming, a process through which inflammation changes inflammatory cell behaviour by altering intracellular metabolic pathways, is increasingly recognised across multiple inflammatory and autoimmune diseases. Here, we show evidence that much of the neutrophil dysfunction observed in bronchiectasis is consistent with immunometabolic reprogramming. Previous attempts at developing therapies targeting neutrophils have focused on reducing neutrophil numbers, resulting in increased frequency of infections. New approaches are needed and we propose that targeting metabolism could theoretically reverse neutrophil dysfunction and dysregulated inflammation. As an exemplar, 5' adenosine monophosphate (AMP)-activated protein kinase (AMPK) activation has already been shown to reverse phagocytic dysfunction and neutrophil extracellular trap (NET) formation in models of pulmonary disease. AMPK modulates multiple metabolic pathways, including glycolysis which is critical for energy generation in neutrophils. AMPK activators can reverse metabolic reprogramming and are already in clinical use and/or development. We propose the need for a new immunomodulatory approach, rather than an anti-inflammatory approach, to enhance bacterial clearance and reduce bronchiectasis disease severity.
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175
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Ardura-Garcia C, Cuevas-Ocaña S, Freitag N, Kampouras A, King JA, Kouis P, Mensink-Bout SM, Whitehouse AL, Williams E, Dassios T, Duijts L, Ersu RH, Gaillard EA, Horsley AR, Proesmans M, Rottier R, Schramm D, Moeller A, Pijnenburg MW. ERS International Congress 2020: highlights from the Paediatric Assembly. ERJ Open Res 2021; 7:00893-2020. [PMID: 33778048 PMCID: PMC7983204 DOI: 10.1183/23120541.00893-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/24/2021] [Indexed: 11/05/2022] Open
Abstract
In this review, the Paediatric Assembly of the European Respiratory Society (ERS) presents a summary of the highlights and most relevant findings in the field of paediatric respiratory medicine presented at the virtual ERS International Congress 2020. Early Career Members of the ERS and Chairs of the different Groups comprising the Paediatric Assembly discuss a selection of the presented research. These cover a wide range of research areas, including respiratory physiology and sleep, asthma and allergy, cystic fibrosis, respiratory infection and immunology, neonatology and intensive care, epidemiology, bronchology and lung and airway development. Specifically, we describe the long-term effect in lung function of premature birth, mode of delivery and chronic respiratory conditions such as cystic fibrosis. In paediatric asthma, we present risk factors, phenotypes and their progression with age, and the challenges in diagnosis. We confirm the value of the lung clearance index to detect early lung changes in cystic fibrosis. For bronchiectasis treatment, we highlight the importance of identifying treatable traits. The use of biomarkers and genotypes to identify infants at risk of long-term respiratory morbidity is also discussed. We present the long-term impact on respiratory health of early life and fetal exposures to maternal obesity and intrauterine hypoxia, mechanical ventilation hyperoxia, aeroallergens, air pollution, vitamin A deficient intake and bronchitis. Moreover, we report on the use of metabolomics and genetic analysis to understand the effect of these exposures on lung growth and alveolar development. Finally, we stress the need to establish multidisciplinary teams to treat complex airway pathologies.
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Affiliation(s)
| | - Sara Cuevas-Ocaña
- Division of Cancer and Stem Cells, Biodiscovery Institute, School of Medicine, University of Nottingham, University Park, Nottingham, UK
| | - Nadine Freitag
- Dept of General Paediatrics, Neonatology and Paediatric Cardiology, University Childreńs Hospital, Heinrich-Heine-University, Duesseldorf, Germany
| | | | - John A. King
- Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Panayiotis Kouis
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Sara M. Mensink-Bout
- Dept of Paediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Abigail L. Whitehouse
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Emma Williams
- Women and Children's Health, School of Life course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Theodore Dassios
- Women and Children's Health, School of Life course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Liesbeth Duijts
- Dept of Paediatrics, Division of Neonatology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Refika H Ersu
- Division of Respirology, University of Ottawa Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Erol A. Gaillard
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Alex R. Horsley
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | | | - Robbert Rottier
- Dept of Paediatric Surgery, Erasmus Medical Centre – Sophia Children's Hospital, Rotterdam, The Netherlands
- Dept of Cell Biology, Erasmus MC, Rotterdam, the Netherlands
| | - Dirk Schramm
- Dept of General Paediatrics, Neonatology and Paediatric Cardiology, University Childreńs Hospital, Heinrich-Heine-University, Duesseldorf, Germany
| | - Alexander Moeller
- Division of Paediatric Pulmonology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marielle W. Pijnenburg
- Department of Paediatrics, Division of Paediatric Respiratory Medicine and Allergology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
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176
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Pérez-Torres Lobato MR, Mejías Trueba M, Rodríguez Ramallo H, Álvarez Del Vayo Benito C, Iglesias Aguilar MDC, Gaboli M. Prolonged Treatment With Inhaled Ampicillin in Children With Non-cystic Fibrosis Bronchiectasis. Arch Bronconeumol 2020; 57:S0300-2896(20)30538-X. [PMID: 33494941 DOI: 10.1016/j.arbres.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/21/2020] [Accepted: 12/02/2020] [Indexed: 11/26/2022]
Affiliation(s)
| | - Marta Mejías Trueba
- Servicio de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | | | | | - Mirella Gaboli
- Unidad de Neumología Pediátrica, Servicio de Pediatría, Hospital Universitario Virgen del Rocío, Sevilla, España.
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177
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Tiew PY, Jaggi TK, Chan LLY, Chotirmall SH. The airway microbiome in COPD, bronchiectasis and bronchiectasis-COPD overlap. CLINICAL RESPIRATORY JOURNAL 2020; 15:123-133. [PMID: 33063421 DOI: 10.1111/crj.13294] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 10/08/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To review the airway microbiome in chronic obstructive pulmonary disease (COPD), bronchiectasis and bronchiectasis-COPD overlap (BCO). DATA SOURCE AND STUDY SELECTION Relevant studies were selected from PubMed, Google scholar, EMBASE and Web of Science. All studies involving human microbiomes, published in the English language, and using the search terms "COPD", "Chronic Obstructive Pulmonary Disease", "Bronchiectasis", "BCO" or "Bronchiectasis and COPD overlap", AND "microbiome", "mycobiome" or "metagenomics" were included. RESULTS Despite variability in sampling methods and specimen types used, microbiome composition remains relatively comparable in COPD and bronchiectasis with prominence of Proteobacteria, Firmicutes and Bacteroidetes. Alterations to airway microbiomes occur in association to disease severity and/or exacerbations in COPD and bronchiectasis. Decreased alpha diversity and Haemophilus-predominant microbiomes are associated with poorer survival in COPD, while, in bronchiectasis, Pseudomonas-predominant microbiomes demonstrate high exacerbation frequency and greater symptom burden while Aspergillus-dominant mycobiome profiles associate with exacerbations. The role of the microbiome in BCO remains understudied. CONCLUSION Use of next-generation sequencing has revolutionised our detection and understanding of the airway microbiome in chronic respiratory diseases such as COPD and bronchiectasis. Targeted amplicon sequencing reveals important associations between the respiratory microbiome and disease outcome while metagenomics may elucidate functional pathways. How best to apply this information into patient care, monitoring and treatment, however, remains challenging and necessitates further study.
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Affiliation(s)
- Pei Yee Tiew
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | - Tavleen K Jaggi
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Louisa L Y Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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178
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He F, Gong HY, Jiang GL, Chen XJ, Yao QJ, Jiang L. Diffuse panbronchiolitis: A case report from a Chinese consanguineous marriage family and literature review. Chron Respir Dis 2020; 17:1479973120961847. [PMID: 33063535 PMCID: PMC7573727 DOI: 10.1177/1479973120961847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Diffuse panbronchiolitis (DPB) is a chronic diffuse airway inflammatory disease, which is strongly associated with the class I human leukocyte antigen (HLA) alleles. Here, we report a pair of sisters who have been suffering from chronic cough, expectoration and wheezing for many years. They were previously misdiagnosed as chronic bronchitis and bronchial asthma, and were recently diagnosed as diffuse panbronchiolitis. The 36-year-old elder sister suffered from diffuse panbronchiolitis complicated with pulmonary tuberculosis. The 30-year-old younger sister suffered from diffuse panbronchiolitis complicated with bronchial asthma and bronchiectasis. We have performed HLA genotyping research on the two sisters, their parents and younger brother. The results showed that all family members were positive for HLA-A24 and HLA-B13. The younger sister and mother were positive for HLA-A2. The younger brother and father were positive for HLA-A11. We suspect that the two sisters’ disease susceptibility may be caused by their parents’ consanguineous marriage. In this study, we reported the clinical characteristics of the two sisters with diffuse panbronchiolitis and shared the associated HLA genotyping results of this family cluster, hoping to provide reference for the etiology, diagnosis and treatment of this disease.
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Affiliation(s)
- Fang He
- Department of Respiratory and Critical Care Medicine, 117913Affiliated Hospital of North Sichuan Medical College, Nanchong, China.,74655North Sichuan Medical College, Nanchong, China
| | - Hai-Ying Gong
- Department of Respiratory and Critical Care Medicine, 117913Affiliated Hospital of North Sichuan Medical College, Nanchong, China.,74655North Sichuan Medical College, Nanchong, China
| | - Guo-Lu Jiang
- Department of Respiratory and Critical Care Medicine, 117913Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiao-Ju Chen
- Department of Respiratory and Critical Care Medicine, 117913Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | | | - Li Jiang
- Department of Respiratory and Critical Care Medicine, 117913Affiliated Hospital of North Sichuan Medical College, Nanchong, China.,74655North Sichuan Medical College, Nanchong, China
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179
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Waters VJ, Kidd TJ, Canton R, Ekkelenkamp MB, Johansen HK, LiPuma JJ, Bell SC, Elborn JS, Flume PA, VanDevanter DR, Gilligan P. Reconciling Antimicrobial Susceptibility Testing and Clinical Response in Antimicrobial Treatment of Chronic Cystic Fibrosis Lung Infections. Clin Infect Dis 2020; 69:1812-1816. [PMID: 31056660 DOI: 10.1093/cid/ciz364] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/29/2019] [Indexed: 01/28/2023] Open
Abstract
Median cystic fibrosis (CF) survival has increased dramatically over time due to several factors, including greater availability and use of antimicrobial therapies. During the progression of CF lung disease, however, the emergence of multidrug antimicrobial resistance can limit treatment effectiveness, threatening patient longevity. Current planktonic-based antimicrobial susceptibility testing lacks the ability to predict clinical response to antimicrobial treatment of chronic CF lung infections. There are numerous reasons for these limitations including bacterial phenotypic and genotypic diversity, polymicrobial interactions, and impaired antibiotic efficacy within the CF lung environment. The parallels to other chronic diseases such as non-CF bronchiectasis are discussed as well as research priorities for moving forward.
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Affiliation(s)
- Valerie J Waters
- Division of Infectious Diseases, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Canada
| | - Timothy J Kidd
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, Australia
| | - Rafael Canton
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Miquel B Ekkelenkamp
- Department of Medical Microbiology, University Medical Center Utrecht, The Netherlands
| | - Helle Krogh Johansen
- Department of Clinical Microbiology, Rigshospitalet, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - John J LiPuma
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor
| | - Scott C Bell
- Department of Thoracic Medicine, Prince Charles Hospital and QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - J Stuart Elborn
- Imperial College Hospital, Queen's University Belfast, Northern Ireland
| | - Patrick A Flume
- Departments of Medicine and Pediatrics, Medical University of South Carolina, Charleston
| | - Donald R VanDevanter
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Peter Gilligan
- Department of Pathology-Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill
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180
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Menéndez R, Méndez R, Amara-Elori I, Reyes S, Montull B, Feced L, Alonso R, Amaro R, Alcaraz V, Fernandez-Barat L, Torres A. Systemic Inflammation during and after Bronchiectasis Exacerbations: Impact of Pseudomonas aeruginosa. J Clin Med 2020; 9:jcm9082631. [PMID: 32823681 PMCID: PMC7463990 DOI: 10.3390/jcm9082631] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/01/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023] Open
Abstract
Bronchiectasis is a chronic structural disease associated with exacerbations that provoke systemic inflammation. We aimed to evaluate the systemic acute proinflammatory cytokine and its biomarker profiles during and after exacerbations and its relationship with the severity of episode, microbiological findings, and the bronchiectasis severity index. This prospective observational study compared exacerbation and stable groups. Cytokine (interleukins (IL)-17a, IL-1β, IL-6, IL 8; tumor necrosis factor-alpha (α)) and high-sensitivity C-reactive protein (hsCRP) levels were determined by multiplex analysis on days 1, 5, 30, and 60 in the exacerbation group and on day 1 in the stable group. We recruited 165 patients with exacerbations, of which 93 were severe (hospitalized). Proinflammatory systemic IL-17a, IL-1β, IL-8, and tumor necrosis factor-α levels increased similarly on days 1 and 5 in severe and non-severe episodes, but on day 30, IL-17a, IL-8, and IL-6 levels were only increased for severe exacerbations. The highest IL-17a level occurred in patients with chronic plus the acute isolation of Pseudomonas aeruginosa. At 30 days, severe exacerbations were independently associated with higher levels of IL-17 (Odds ratio (OR) 4.58), IL-6 (OR 4.89), IL-8 (OR 3.08), and hsCRP (OR 6.7), adjusted for age, the bronchiectasis severity index, and treatment duration. Exacerbations in patients with chronic P. aeruginosa infection were associated with an increase in IL-17 and IL-6 at 30 days (ORs 7.47 and 3.44, respectively). Severe exacerbations elicit a higher systemic proinflammatory response that is sustained to day 30. Patients with chronic P. aeruginosa infection had impaired IL-17a reduction. IL-17a could be a useful target for measuring systemic inflammation.
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Affiliation(s)
- Rosario Menéndez
- Pulmonary Medicine Department, Hospital Universitario y Politécnico La Fe, 46023 Valencia, Spain; (R.M.); (I.A.-E.); (S.R.); (B.M.); (L.F.)
- CIBER Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain; (R.A.); (V.A.); (L.F.-B.); (A.T.)
- Correspondence:
| | - Raúl Méndez
- Pulmonary Medicine Department, Hospital Universitario y Politécnico La Fe, 46023 Valencia, Spain; (R.M.); (I.A.-E.); (S.R.); (B.M.); (L.F.)
| | - Isabel Amara-Elori
- Pulmonary Medicine Department, Hospital Universitario y Politécnico La Fe, 46023 Valencia, Spain; (R.M.); (I.A.-E.); (S.R.); (B.M.); (L.F.)
| | - Soledad Reyes
- Pulmonary Medicine Department, Hospital Universitario y Politécnico La Fe, 46023 Valencia, Spain; (R.M.); (I.A.-E.); (S.R.); (B.M.); (L.F.)
| | - Beatriz Montull
- Pulmonary Medicine Department, Hospital Universitario y Politécnico La Fe, 46023 Valencia, Spain; (R.M.); (I.A.-E.); (S.R.); (B.M.); (L.F.)
| | - Laura Feced
- Pulmonary Medicine Department, Hospital Universitario y Politécnico La Fe, 46023 Valencia, Spain; (R.M.); (I.A.-E.); (S.R.); (B.M.); (L.F.)
| | - Ricardo Alonso
- Laboratory Department, Hospital Universitario y Politécnico La Fe, 46023 Valencia, Spain;
| | - Rosanel Amaro
- CIBER Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain; (R.A.); (V.A.); (L.F.-B.); (A.T.)
- Pulmonary Medicine Department, Hospital Clínico y Provincial, IDIBAPS, 08036 Barcelona, Spain
| | - Victoria Alcaraz
- CIBER Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain; (R.A.); (V.A.); (L.F.-B.); (A.T.)
- Pulmonary Medicine Department, Hospital Clínico y Provincial, IDIBAPS, 08036 Barcelona, Spain
| | - Laia Fernandez-Barat
- CIBER Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain; (R.A.); (V.A.); (L.F.-B.); (A.T.)
- Pulmonary Medicine Department, Hospital Clínico y Provincial, IDIBAPS, 08036 Barcelona, Spain
| | - Antoni Torres
- CIBER Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain; (R.A.); (V.A.); (L.F.-B.); (A.T.)
- Pulmonary Medicine Department, Hospital Clínico y Provincial, IDIBAPS, 08036 Barcelona, Spain
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181
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Kurz SG, Rivas-Santiago B. Time to Expand the Picture of Mycobacterial Lipids: Spotlight on Nontuberculous Mycobacteria. Am J Respir Cell Mol Biol 2020; 62:275-276. [PMID: 31580721 PMCID: PMC7055696 DOI: 10.1165/rcmb.2019-0324ed] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Sebastian G Kurz
- Division of Pulmonary Medicine, Mount-Sinai-National-Jewish Health Respiratory Institute Mount Sinai Medical Center New YorkNew York, New Yorkand
| | - Bruno Rivas-Santiago
- Medical Research Unit ZacatecasMexican Institute of Social Security Delegation ZacatecasZacatecas, Mexico
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182
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Suárez-Cuartín G, Sibila O. Inflamación local y sistémica en bronquiectasias. Endotipos y biomarcadores. OPEN RESPIRATORY ARCHIVES 2020. [DOI: 10.1016/j.opresp.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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183
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de Nucci MCNM, Fernandes FLA, Salge JM, Stelmach R, Cukier A, Athanazio R. Characterization of the severity of dyspnea in patients with bronchiectasis: correlation with clinical, functional, and tomographic aspects. J Bras Pneumol 2020; 46:e20190162. [PMID: 32556031 PMCID: PMC7572272 DOI: 10.36416/1806-3756/e20190162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 02/04/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To characterize a population of patients with bronchiectasis, correlating clinical, radiological, and functional aspects with the severity of dyspnea. METHODS This was a cross-sectional study involving adult patients with HRCT-confirmed bronchiectasis, categorized according to the severity of dyspnea (as being mildly or severely symptomatic, on the basis of the modified Medical Research Council scale). We correlated the severity of dyspnea with clinical parameters, functional parameters (spirometry values, lung volumes, and DLCO), and CT parameters. RESULTS We evaluated 114 patients, 47 (41%) of whom were men. The median age (interquartile range) was 42 years (30-55 years). The most common form was idiopathic bronchiectasis. Of the 114 patients, 20 (17.5%) were colonized with Pseudomonas aeruginosa and 59 (51.8%) were under continuous treatment with macrolides. When we applied the Exacerbation in the previous year, FEV1, Age, Colonization, Extension, and Dyspnea score, the severity of dyspnea was categorized as moderate in 54 patients (47.4%), whereas it was categorized as mild in 50 (43.9%) when we applied the Bronchiectasis Severity Index. The most common lung function pattern was one of obstruction, seen in 95 patients (83.3%), and air trapping was seen in 77 patients (68.7%). The prevalence of an obstructive pattern on spirometry was higher among the patients with dyspnea that was more severe, and most functional parameters showed reasonable accuracy in discriminating between levels of dyspnea severity. CONCLUSIONS Patients with bronchiectasis and dyspnea that was more severe had greater functional impairment. The measurement of lung volumes complemented the spirometry data. Because bronchiectasis is a complex, heterogeneous condition, a single variable does not seem to be sufficient to provide an overall characterization of the clinical condition.
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Affiliation(s)
| | | | - João Marcos Salge
- . Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Rafael Stelmach
- . Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Alberto Cukier
- . Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Rodrigo Athanazio
- . Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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184
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Çolak Y, Nordestgaard BG, Afzal S. Morbidity and mortality in carriers of the cystic fibrosis mutation CFTR Phe508del in the general population. Eur Respir J 2020; 56:13993003.00558-2020. [DOI: 10.1183/13993003.00558-2020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/02/2020] [Indexed: 12/21/2022]
Abstract
Cystic fibrosis (CF) is caused by autosomal-recessive inheritance of a dysfunctional cystic fibrosis transmembrane conductance regulator (CFTR), up to 90% due to Phe508del mutation in the CFTR gene. We tested the hypothesis that CFTR Phe508del carriers have increased morbidity and mortality versus non-carriers in the general population.We genotyped 108 035 randomly selected white Danish individuals from the Copenhagen General Population Study (aged from 20–100 years) for CFTR Phe508del mutation (rs113993960). Risk of chronic bronchitis and airflow limitation was assessed cross-sectionally. Overall survival and risk of bronchiectasis, lung cancer, pneumonia, chronic rhinosinusitis, airway bleeding, spontaneous pneumothorax, respiratory failure, acute and chronic pancreatitis, liver cirrhosis, ileus, gastric and colorectal cancer, and male infertility were assessed prospectively during up to 15 years of follow-up (median: 9 years). A single individual was excluded due to homozygosity for CFTR Phe508del and known CF. No other individuals had diagnosed CF at baseline examination or during follow-up.Among the resulting 108 034 individuals, 105 176 (97%) were non-carriers and 2858 (3%) were carriers (i.e. were heterozygous for CFTR Phe508del). Overall survival was similar between carriers and non-carriers. Compared to non-carriers and with multivariable adjustment, carriers had an odds ratio (OR) of 1.31 (95% CI 1.16–1.48) for chronic bronchitis, a hazard ratio (HR) of 1.88 (95% CI 1.03–3.45) for bronchiectasis and 1.52 (95% CI 1.12–2.08) for lung cancer. Carriers did not differ from non-carriers concerning lung function or any other morbidity outcomes as mentioned above.In the general population, carriers of CFTR Phe508del have a normal lifespan but an increased risk of chronic bronchitis (1.3-fold), bronchiectasis (1.9-fold) and lung cancer (1.5-fold).
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185
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Chin KL, Sarmiento ME, Alvarez-Cabrera N, Norazmi MN, Acosta A. Pulmonary non-tuberculous mycobacterial infections: current state and future management. Eur J Clin Microbiol Infect Dis 2020; 39:799-826. [PMID: 31853742 PMCID: PMC7222044 DOI: 10.1007/s10096-019-03771-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/18/2019] [Indexed: 12/11/2022]
Abstract
Currently, there is a trend of increasing incidence in pulmonary non-tuberculous mycobacterial infections (PNTM) together with a decrease in tuberculosis (TB) incidence, particularly in developed countries. The prevalence of PNTM in underdeveloped and developing countries remains unclear as there is still a lack of detection methods that could clearly diagnose PNTM applicable in these low-resource settings. Since non-tuberculous mycobacteria (NTM) are environmental pathogens, the vicinity favouring host-pathogen interactions is known as important predisposing factor for PNTM. The ongoing changes in world population, as well as socio-political and economic factors, are linked to the rise in the incidence of PNTM. Development is an important factor for the improvement of population well-being, but it has also been linked, in general, to detrimental environmental consequences, including the rise of emergent (usually neglected) infectious diseases, such as PNTM. The rise of neglected PNTM infections requires the expansion of the current efforts on the development of diagnostics, therapies and vaccines for mycobacterial diseases, which at present, are mainly focused on TB. This review discuss the current situation of PNTM and its predisposing factors, as well as the efforts and challenges for their control.
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Affiliation(s)
- Kai Ling Chin
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah (UMS), Kota Kinabalu, Sabah, Malaysia.
| | - Maria E Sarmiento
- School of Health Sciences, Universiti Sains Malaysia (USM), Kubang Kerian, Kelantan, Malaysia
| | - Nadine Alvarez-Cabrera
- Center for Discovery and Innovation (CDI), Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, USA
| | - Mohd Nor Norazmi
- School of Health Sciences, Universiti Sains Malaysia (USM), Kubang Kerian, Kelantan, Malaysia
| | - Armando Acosta
- School of Health Sciences, Universiti Sains Malaysia (USM), Kubang Kerian, Kelantan, Malaysia.
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186
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Martinez-Garcia MA, Aksamit TR, Agusti A. Clinical Fingerprinting: A Way to Address the Complexity and Heterogeneity of Bronchiectasis in Practice. Am J Respir Crit Care Med 2020; 201:14-19. [PMID: 31381866 DOI: 10.1164/rccm.201903-0604pp] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
| | - Timothy R Aksamit
- Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota; and
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, University of Barcelona, Pi i Sunyer Biomedic Reseach Institute (IDIBAPS), Biomedic Reseach Center Network of Respiratory Diseases (CIBERES), Barcelona, Spain
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187
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Shteinberg M, Flume PA, Chalmers JD. Is bronchiectasis really a disease? Eur Respir Rev 2020; 29:29/155/190051. [PMID: 31996354 DOI: 10.1183/16000617.0051-2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/31/2019] [Indexed: 11/05/2022] Open
Abstract
The definition of a disease requires that distinguishing signs and symptoms are present that are common, and that the constellation of signs and symptoms differentiate the condition from other causes. In bronchiectasis, anatomical changes, airways inflammation and airway infection are the distinguishing features that are common to this disease. However, bronchiectasis is a heterogenous disease: signs and symptoms are shared with other airway diseases, there are multiple aetiologies and certain phenotypes of bronchiectasis have distinct clinical and laboratory features that are not common to all people with bronchiectasis. Furthermore, response to therapeutic interventions in clinical trials is not uniform. The concept of bronchiectasis as a treatable trait has been suggested, but this may be too restrictive in view of the heterogeneity of bronchiectasis. It is our opinion that bronchiectasis should be defined as a disease in its own right, but one that shares several pathophysiological features and "treatable traits" with other airway diseases. These traits define the large heterogeneity in the pathogenesis and clinical features and suggest a more targeted approach to therapy.
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Affiliation(s)
- Michal Shteinberg
- Pulmonology Institute and CF Center, Carmel Medical Center, Haifa, Israel .,Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Patrick A Flume
- Dept of Medicine and Dept of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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188
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Non-CF bronchiectasis: Orphan disease no longer. Respir Med 2020; 166:105940. [PMID: 32250872 DOI: 10.1016/j.rmed.2020.105940] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 03/13/2020] [Accepted: 03/18/2020] [Indexed: 02/08/2023]
Abstract
Bronchiectasis is a complex, chronic respiratory condition, characterized by frequent cough and exertional dyspnea due to a range of conditions that include inherited mucociliary defects, inhalational airway injury, immunodeficiency states and prior respiratory infections. For years, bronchiectasis was classified as either being caused by cystic fibrosis or non-cystic fibrosis. Non-cystic fibrosis bronchiectasis, once considered an orphan disease, is more prevalent worldwide in part due to greater availability of chest computed tomographic imaging. Identification of the cause of non-cystic fibrosis bronchiectasis with the use of chest imaging, laboratory testing, and microbiologic assessment of airway secretions can lead to initiation of specific therapies aimed at slowing disease progression. Nonpharmacologic therapies such as airway clearance techniques and pulmonary rehabilitation improve patient symptoms. Inhaled corticosteroids should not be routinely prescribed unless concomitant asthma or COPD is present. Inhaled antibiotics prescribed to individuals with >3 exacerbations per year are well tolerated, reduce airway bacteria load and may reduce the frequency of exacerbations. Likewise, chronic macrolide therapy reduces the frequency of exacerbations. Medical therapies for cystic fibrosis bronchiectasis may not be effective in treatment of non-cystic fibrosis bronchiectasis.
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189
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Alcaraz-Serrano V, Gimeno-Santos E, Scioscia G, Gabarrús A, Navarro A, Herrero-Cortina B, Amaro R, Fernández-Barat L, Torres A. Association between physical activity and risk of hospitalisation in bronchiectasis. Eur Respir J 2020; 55:13993003.02138-2019. [DOI: 10.1183/13993003.02138-2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/03/2020] [Indexed: 01/23/2023]
Abstract
BackgroundPatients with bronchiectasis have a less active lifestyle than healthy peers, but the association with hospital admission has not been explored. The aim of this study was to investigate the association between 1) any physical activity variable; and 2) sedentary time, with hospitalisation due to exacerbation in adults with bronchiectasis.MethodsIn this prospective observational study, baseline lung function, quality of life, exercise tolerance, severity of bronchiectasis and physical activity were recorded. Physical activity was objectively assessed over a week using a SenseWear armband and the results were expressed in steps·day–1 and sedentary time. Number of hospitalisations due to a bronchiectasis exacerbation and time to first event were recorded after 1-year follow-up.ResultsSixty-four patients with bronchiectasis were analysed, of whom 15 (23%) were hospitalised during the follow-up. Hospitalised patients showed poor baseline clinical and severity outcomes, fewer steps walked per day and more sedentary behaviour than the non-hospitalised group. Patients who walked ≤6290 steps·day–1 or spent ≥7.8 h·day–1 in sedentary behaviour had an increased risk of hospital admission due to bronchiectasis exacerbation at 1-year follow-up. Specifically, ≥7.8 h·day–1 of sedentary behaviour was associated with a 5.9-fold higher risk of hospital admission in the following year.ConclusionsLow levels of physical activity and high sedentary time at baseline were associated with a higher risk of hospitalisation due to bronchiectasis exacerbation. If these findings are validated in future studies, it might be appropriate to include physical activity and sedentary behaviour as an item in severity scores.
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Abstract
PURPOSE OF REVIEW Noncystic fibrosis bronchiectasis is a challenging disease which carries a heavy healthcare burden and significant mortality and morbidity. This review highlights the challenges in the diagnosis of bronchiectasis and discusses the management strategies and research opportunities in this field. RECENT FINDINGS The challenges in the management of bronchiectasis appear to be multifactorial, arising from both etiological heterogeneity and disease-specific management. Frequent inflammation and infections not only lead to progressive respiratory failure but also increase the risk of cardiovascular complications. No therapies are approved specifically for adult bronchiectasis, but new guidelines and recent studies outline strategies for control of infection and inflammation and for prevention of frequent exacerbations to improve overall prognosis. SUMMARY Recent studies in the management of bronchiectasis are encouraging. Advances have been made in understanding both disease heterogeneity and best practices for care; interventions such as daily mucociliary clearance, eradication of colonized microbial organisms, and control of inflammation may result in favorable outcomes.
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191
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Duarte AC, Porter J, Leandro MJ. Bronchiectasis in rheumatoid arthritis. A clinical appraisial. Joint Bone Spine 2020; 87:419-424. [PMID: 32007647 DOI: 10.1016/j.jbspin.2019.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/20/2019] [Indexed: 10/25/2022]
Abstract
Bronchiectasis is defined as irreversibly damaged and dilated bronchi and is one of the most common pulmonary manifestations in patients with rheumatoid arthritis (RA). The model of RA-associated autoimmunity induced in some individuals by chronic bacterial infection in bronchiectasis is becoming increasingly acceptable, although a genetic predisposition to RA-associated bronchiectasis has also been demonstrated. Bronchiectasis should be suspected in RA patients with chronic cough and sputum production or frequent respiratory infections and the diagnosis must be confirmed by thoracic high-resolution computed tomography. Management of patients with RA-associated bronchiectasis includes a multimodal treatment approach. Similar to all patients with non-cystic fibrosis bronchiectasis, patients with RA-associated bronchiectasis benefit from a pulmonary rehabilitation program, including an exercise/muscle strengthening program and an education program with a specific session on airway clearance techniques. Prophylactic antibiotics are recommended for patients with frequent (3 or more infective exacerbations per year) or severe infections requiring hospitalization/intravenous antibiotics and inhaled corticosteroids and long-acting β2-agonists should be used in patients with non-cystic fibrosis bronchiectasis and associated airway hyper-responsiveness. In patients with RA-associated bronchiectasis the use of immunomodulatory drugs has to be carefully considered, as they are essential to control disease activity, despite being associated with an increased infectious risk. Pneumococcal and influenza vaccines are advised to all patients with RA-associated bronchiectasis in order to reduce the risk of infection. Patients with RA-associated bronchiectasis have a poorer prognosis than those with either RA or bronchiectasis alone and require regular follow-up, under the joint care of a rheumatologist and a pulmonologist.
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Affiliation(s)
- Ana Catarina Duarte
- Rheumatology department, Hospital Garcia de Orta EPE, Avenida Torrado da Silva, 2805-267 Almada, Portugal.
| | - Joanna Porter
- UCL Respiratory, University College London Hospitals NHS Foundation Trust, 235, Euston Road, Bloomsbury, NW1 2BU London, United Kingdom; Center for Interstitial Lung Disease, University College London Hospitals NHS Foundation Trust, 235, Euston Road, Bloomsbury, NW1 2BU London, United Kingdom
| | - Maria José Leandro
- Center for Rheumatology, University College London Hospitals NHS Foundation Trust, 235, Euston Road, Bloomsbury, NW1 2BU London, United Kingdom
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192
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Lahousse L, Bahmer T, Cuevas-Ocaña S, Flajolet P, Mathioudakis AG, McDonnell M, Uller L, Schleich F, Dortas Junior S, Idzko M, Singh D, Ricciardolo FL, Adcock IM, Usmani O, Spanevello A, Bonvini SJ. ERS International Congress, Madrid, 2019: highlights from the Airway Diseases, Asthma and COPD Assembly. ERJ Open Res 2020; 6:00341-2019. [PMID: 32083111 PMCID: PMC7024762 DOI: 10.1183/23120541.00341-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 01/14/2020] [Indexed: 11/05/2022] Open
Abstract
The European Respiratory Society (ERS) International Congress 2019 in Madrid, Spain, was a platform for scientific discussion of the highest quality scientific research, cutting-edge techniques and innovative new therapies within the respiratory field. This article discusses some of the high-quality research studies presented at that Congress, with a focus on airway diseases, including asthma, COPD, small airways, bronchiectasis and cough, presented through the Airway Diseases, Asthma and COPD Assembly (Assembly 5) of the ERS. The authors establish the key take-home messages of these studies, compare their findings and place them into context of current understanding.
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Affiliation(s)
- Lies Lahousse
- Dept of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Thomas Bahmer
- University Hospital Schleswig-Holstein Campus Kiel, Dept for Internal Medicine I, Kiel, Germany; Member of the German Center for Lung Research (DZL)
| | - Sara Cuevas-Ocaña
- Wolfson Centre for Stem cells, Tissue Engineering and Modelling (STEM), Dept of Stem Cell Biology, Division of Cancer and Stem Cells, School of Medicine, University of Nottingham Biodiscovery Institute, Nottingham, UK
| | - Pauline Flajolet
- Respiratory Pharmacology, National Heart and Lung Institute, Imperial College London, London, UK
| | - Alexander G. Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Melissa McDonnell
- Dept of Respiratory Medicine, Galway University Hospitals, Galway, Ireland
| | - Lena Uller
- Respiratory Immunopharmacology, Dept of Experimental Medical Science, Lund University, Lund, Sweden
| | - Florence Schleich
- Dept of Respiratory Medicine, CHU Sart-Tilman Liege, GIGA I3, Liege, Belgium
| | - Sergio Dortas Junior
- Serviço de Imunologia, Hospital Universitário Clementino Fraga Filho (HUCFF-UFRJ), Rio de Janeiro, Brazil
- Universidade Iguaçu (UNIG), Nova Iguaçu, Brazil
| | - Marco Idzko
- Dept of Pneumology, Medical University of Vienna, Vienna, Austria
| | - Dave Singh
- Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | - Fabio L.M. Ricciardolo
- Dept of Clinical and Biological Sciences, Azienda Ospedaliera Universitaria (AOU) San Luigi Hospital, University of Torino, Turin, Italy
| | - Ian M. Adcock
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Omar Usmani
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Antonio Spanevello
- University of Insubria, Istituti Clinici Scientifici Maugeri, IRCCS, Varese, Italy
| | - Sara J. Bonvini
- Respiratory Pharmacology, National Heart and Lung Institute, Imperial College London, London, UK
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193
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Yeh JJ, Yang YC, Hsu CY, Kao CH. Effect of Bronchodilator and Steroid Use on Heart Disease and Stroke Risks in a Bronchiectasis-Chronic Obstructive Pulmonary Disease Overlap Cohort: A Propensity Score Matching Study. Front Pharmacol 2019; 10:1409. [PMID: 31849665 PMCID: PMC6895570 DOI: 10.3389/fphar.2019.01409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 11/05/2019] [Indexed: 01/14/2023] Open
Abstract
Background: To determine the effects of bronchodilator, steroid, and anti-arrhythmia drug use on the risk of heart disease/stroke (HDS) in patients with bronchiectasis–chronic obstructive pulmonary disease overlap syndrome (BCOS). Methods: We retrospectively enrolled patients with BCOS (BCOS cohort, n = 1,493) and patients without bronchiectasis and chronic obstructive pulmonary disease (COPD) (non-BCOS cohort, n = 5,972). The cumulative incidence of HDS was analyzed through Cox proportional regression. We calculated adjusted hazard ratios (aHRs) and their 95% confidence intervals (CIs) for HDS after adjustments for sex, age, comorbidities, long-acting β2-agonist or long-acting muscarinic antagonist (LABAs/LAMAs) use, short-acting β2-agonist or short-acting muscarinic antagonist (SABAs/SAMAs) use, oral steroid (OSs) or inhaled corticosteroid steroid (ICSs) use, and anti-arrhythmia drugs use. Results: The aHR (95% CI) for HDS was 1.08 (0.28–4.06) for patients using LAMAs compared with those not using drugs. Regarding drug use days, the aHRs (95% CIs) were 32.2 (1.79–773.0), 1.85 (1.01–3.39), and 31.1 (3.25–297.80) for those with recent SABAs use, past ICSs use, and past anti-arrythmia drugs use, respectively. Regarding cumulative drug dose, the aHRs (95% CIs) were 2.12 (1.46–3.10), 3.48 (1.13–10.6), 3.19 (2.04–4.99), 28.1 (1.42–555.7), 2.09 (1.32–3.29), 2.28 (1.53–3.40), and 1.93 (1.36–2.74) for those with a low dose of SABAs, medium dose of SABAs, low dose of SAMAs, low dose of ICSs, medium dose of ICSs, low dose of OSs, and medium dose of OSs, respectively. Conclusions: Compared with patients without bronchiectasis and COPD, BCOS patients with recent SABAs, past ICSs, and past anti-arrhythmia drugs use; a low or medium SABAs ICSs, and OSs dose; and a low SAMAs dose had a higher risk of HDS. LAMAs were not associated with HDS.
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Affiliation(s)
- Jun-Jun Yeh
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.,Department of Early Childhood Education and Nursery, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Yu-Cih Yang
- College of Medicine, China Medical University, Taichung, Taiwan.,Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chung Y Hsu
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Nuclear Medicine, China Medical University Hospital, Taichung, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.,Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan
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194
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Chotirmall SH, Chang AB. Twenty‐five years of
Respirology
: Advances in bronchiectasis. Respirology 2019; 25:14-16. [DOI: 10.1111/resp.13738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/26/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Sanjay H. Chotirmall
- Translational Respiratory Research Laboratory, Lee Kong Chian School of MedicineNanyang Technological University Singapore
| | - Anne B. Chang
- Child Health Division, Menzies School of Health ResearchCharles Darwin University Darwin NT Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Children Centre for Health ResearchQueensland University of Technology Brisbane QLD Australia
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195
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Severiche-Bueno D, Gamboa E, Reyes LF, Chotirmall SH. Hot topics and current controversies in non-cystic fibrosis bronchiectasis. Breathe (Sheff) 2019; 15:286-295. [PMID: 31803263 PMCID: PMC6885332 DOI: 10.1183/20734735.0261-2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Non-cystic fibrosis bronchiectasis (NCFB) is a neglected and orphan disease with poor advances through the 20th century. However, its prevalence is rising and with this come new challenges for physicians. Few guidelines are available to guide clinicians on how to diagnose and manage patients with NCFB. Many areas of debate persist, and there is lack of consensus about research priorities most needed to advance patient care and improve clinical outcomes. In this review, we highlight the current hot topics in NCFB and present updated evidence to inform the critical areas of controversy. Non-cystic fibrosis bronchiectasis (NCFB) is a neglected and orphan disease with poor advances through the 20th century. Physicians should understand available data to provide evidence-based treatments to patients suffering from NCFB.http://bit.ly/2kBGVsx
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Affiliation(s)
| | | | | | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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196
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Amati F, Simonetta E, Gramegna A, Tarsia P, Contarini M, Blasi F, Aliberti S. The biology of pulmonary exacerbations in bronchiectasis. Eur Respir Rev 2019; 28:28/154/190055. [PMID: 31748420 DOI: 10.1183/16000617.0055-2019] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 06/11/2019] [Indexed: 12/21/2022] Open
Abstract
Bronchiectasis is a heterogeneous chronic disease. Heterogeneity characterises bronchiectasis not only in the stable state but also during exacerbations, despite evidence on clinical and biological aspects of bronchiectasis, exacerbations still remain poorly understood.Although the scientific community recognises that bacterial infection is a cornerstone in the development of bronchiectasis, there is a lack of data regarding other trigger factors for exacerbations. In addition, a huge amount of data suggest a primary role of neutrophils in the stable state and exacerbation of bronchiectasis, but the inflammatory reaction involves many other additional pathways. Cole's vicious cycle hypothesis illustrates how airway dysfunction, airway inflammation, infection and structural damage are linked. The introduction of the concept of a "vicious vortex" stresses the complexity of the relationships between the components of the cycle. In this model of disease, exacerbations work as a catalyst, accelerating the progression of disease. The roles of microbiology and inflammation need to be considered as closely linked and will need to be investigated in different ways to collect samples. Clinical and translational research is of paramount importance to achieve a better comprehension of the pathophysiology of bronchiectasis, microbiology and inflammation both in the stable state and during exacerbations.
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Affiliation(s)
- Francesco Amati
- Dept of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Edoardo Simonetta
- Dept of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Gramegna
- Dept of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Tarsia
- Dept of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Martina Contarini
- Dept of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Blasi
- Dept of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Aliberti
- Dept of Pathophysiology and Transplantation, University of Milan, Milan, Italy .,Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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197
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Visser SK, Bye PTP, Fox GJ, Burr LD, Chang AB, Holmes-Liew CL, King P, Middleton PG, Maguire GP, Smith D, Thomson RM, Stroil-Salama E, Britton WJ, Morgan LC. Management of Australian Adults with Bronchiectasis in Tertiary Care: Evidence-Based or Access-Driven? Lung 2019; 197:803-810. [PMID: 31691027 DOI: 10.1007/s00408-019-00280-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/15/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE Australian data regarding the management of patients with bronchiectasis is scarce. We sought to compare the management of adults with bronchiectasis attending tertiary Australian centres with recent national and international guidelines. METHODS The Australian Bronchiectasis Registry is a centralised database of patients with radiologically confirmed bronchiectasis unrelated to cystic fibrosis recruited from 14 tertiary Australian hospitals. We excluded children (<18 years) and those with incomplete data, leaving 589 adults for cross-sectional analyses. We compared the proportion of patients receiving certain therapies, as compared to the proportion eligible for those treatments according to the current guidelines and baseline clinical information available from the registry. RESULTS Pulmonary rehabilitation was attended by 22%, although it was indicated in 67% of the cohort. Airway clearance was undertaken in 52% of patients, although 71% reported chronic productive cough. Sputum bacterial culture results were available for 59%, and mycobacterial culture results were available for 29% of the cohort. Inhaled antibiotics were used in half of potentially eligible patients. Despite guideline recommendations against routine use, inhaled corticosteroids were used in 48% of patients. Long-term macrolides were used in 28% of participants. CONCLUSIONS Discrepancies exist between guideline recommendations and real-world treatment of bronchiectasis in Australia, even in tertiary centres. These findings suggest the need for increased patient referral to pulmonary rehabilitation, increased attention to airway clearance, increased collection of sputum samples (especially for mycobacterial culture) and rationalisation of inhaled corticosteroid use. These findings encourage a review of treatment access and will inform ongoing education to promote evidence-based care for people living with bronchiectasis.
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Affiliation(s)
- Simone K Visser
- Central Clinical School Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia. .,Department of Respiratory Medicine, Royal Prince Alfred Hospital, Level 11, Missenden Rd, Camperdown, NSW, 2050, Australia.
| | - Peter T P Bye
- Central Clinical School Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Department of Respiratory Medicine, Royal Prince Alfred Hospital, Level 11, Missenden Rd, Camperdown, NSW, 2050, Australia
| | - Greg J Fox
- Central Clinical School Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Department of Respiratory Medicine, Royal Prince Alfred Hospital, Level 11, Missenden Rd, Camperdown, NSW, 2050, Australia
| | - Lucy D Burr
- Department of Respiratory and Sleep Medicine, Mater Health, South Brisbane, QLD, Australia.,Mater Research, University of Queensland, St Lucia, QLD, Australia
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Queensland University of Technology, Brisbane, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Chien-Li Holmes-Liew
- Department of Thoracic Medicine, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Paul King
- Monash Respiratory and Sleep Medicine, Monash Medical Centre, Melbourne, VIC, Australia
| | - Peter G Middleton
- Department of Respiratory Medicine, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Graeme P Maguire
- Western Clinical School, University of Melbourne, Melbourne, 3021, Australia.,General Internal Medicine, Western Health, Melbourne, 3011, Australia
| | - Daniel Smith
- The Prince Charles Hospital - Thoracic Medicine, Brisbane, Australia.,QIMR Berghofer Medical Research Institute - Lung Inflammation and Infection Laboratory, Herston, Australia
| | - Rachel M Thomson
- Department of Respiratory Medicine, Greenslopes Private Hospital, Greenslopes, QLD, 4120, Australia
| | | | - Warwick J Britton
- Centenary Institute, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Lucy C Morgan
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia.,Department of Respiratory Medicine, Concord General Repatriation Hospital, Concord, NSW, 2137, Australia
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Smith AH, Chalmers JD. The microbiome in bronchiectasis: Cutting a lung story short. Respirology 2019; 25:43-44. [DOI: 10.1111/resp.13697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 08/28/2019] [Indexed: 01/09/2023]
Affiliation(s)
| | - James D. Chalmers
- Scottish Centre for Respiratory ResearchUniversity of Dundee, Ninewells Hospital and Medical School Dundee UK
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Spinou A, Chalmers JD. Respiratory physiotherapy in the bronchiectasis guidelines: is there a loud voice we are yet to hear? Eur Respir J 2019; 54:54/3/1901610. [PMID: 31563873 DOI: 10.1183/13993003.01610-2019] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/20/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Arietta Spinou
- Population Health Sciences, Life Sciences and Medicine, King's College London, London, UK
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