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Gallucci M, Candela E, Di Palmo E, Miniaci A, Pession A. Non-Cystic Fibrosis Bronchiectasis in Pediatric Age: A Case Series in a Metropolitan Area of Northern Italy. CHILDREN 2022; 9:children9091420. [PMID: 36138729 PMCID: PMC9497485 DOI: 10.3390/children9091420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/12/2022] [Accepted: 09/17/2022] [Indexed: 11/24/2022]
Abstract
Non-cystic fibrosis bronchiectasis is an emergent disease characterized by endobronchial suppuration, dilated airways with neutrophilic inflammation and chronic wet cough due to recurrent lower airway infections. A regular clinical follow-up and adequate management of exacerbations are essential to reduce symptoms and the worsening of lung injury. We report a retrospective study comprising 15 children and adolescents with NCFB followed in our hospital center of pediatric pulmonology. We retrospectively analyzed the main comorbidities associated with the presence of NCFB, the radiological aspect associated with the different etiologies and the therapeutic approach used. We also emphasized the importance of an effective preventive strategy to reduce and prevent pulmonary exacerbations.
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Affiliation(s)
- Marcella Gallucci
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Egidio Candela
- Specialty School of Pediatrics, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
- Correspondence: or ; Tel.: +39-3473878582
| | - Emanuela Di Palmo
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Angela Miniaci
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Andrea Pession
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Abstract
Bronchiectasis is a chronic inflammatory condition with a diverse aetiology including recurrent infections, genetic abnormalities, immunodeficiency and autoimmune disorders. The prevalence has increased over the past few years and this may be due to better imaging and diagnostic techniques. Management remains the emphasis for improving symptoms and reducing exacerbations. This article focuses on highlighting the latest data released since 2014 on new diagnostic techniques as well as potential future pharmacological and non-pharmacological treatment options for patients with bronchiectasis.
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Adetiloye A, Erhabor G, Awopeju O, Adewole O, Onini E, Adewuya O. Challenges of diagnosing and managing bronchiectasis in resource-limited settings: a case study. Pan Afr Med J 2019; 32:82. [PMID: 31223373 PMCID: PMC6560984 DOI: 10.11604/pamj.2019.32.82.18167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/27/2019] [Indexed: 01/24/2023] Open
Abstract
Bronchiectasis, once an orphan disease is now gaining renewed attention as a significant cause of morbidity and mortality. It is a morphologic term used to describe abnormal, irreversibly dilated and thick-walled bronchi, with many etiologies. The management of bronchiectasis can be challenging because its pathogenetic mechanisms is still evolving. Its diagnosis and management is particularly more demanding especially in resource-limited settings like Nigeria because of delayed diagnosis and improper management with devastating consequences, hence this case study.
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Affiliation(s)
- Adebola Adetiloye
- Respiratory Unit, Department of Internal Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-ife, Nigeria
| | - Gregory Erhabor
- Respiratory Unit, Department of Internal Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-ife, Nigeria
| | - Olayemi Awopeju
- Respiratory Unit, Department of Internal Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-ife, Nigeria
| | - Olufemi Adewole
- Respiratory Unit, Department of Internal Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-ife, Nigeria
| | - Ebimobowei Onini
- Respiratory Unit, Department of Internal Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-ife, Nigeria
| | - Oladapo Adewuya
- Cardiology Unit, Department of Internal Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-ife, Nigeria
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Lai K, Shen H, Zhou X, Qiu Z, Cai S, Huang K, Wang Q, Wang C, Lin J, Hao C, Kong L, Zhang S, Chen Y, Luo W, Jiang M, Xie J, Zhong N. Clinical Practice Guidelines for Diagnosis and Management of Cough-Chinese Thoracic Society (CTS) Asthma Consortium. J Thorac Dis 2018; 10:6314-6351. [PMID: 30622806 PMCID: PMC6297434 DOI: 10.21037/jtd.2018.09.153] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 09/10/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Kefang Lai
- State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Huahao Shen
- The Second Hospital Affiliated to Medical College of Zhejiang University, Hangzhou 310009, China
| | - Xin Zhou
- Shanghai Jiaotong University Affiliated Shanghai No. 1 People’s Hospital, Shanghai 200080, China
| | - Zhongmin Qiu
- Tongji Affiliated Tongji Hospital, Shanghai 200065, China
| | - Shaoxi Cai
- Southern Medical University Affiliated Nanfang Hospital, Guangzhou 510515, China
| | - Kewu Huang
- Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing 100020, China
| | | | - Changzheng Wang
- Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Jiangtao Lin
- China-Japan Friendship Hospital, Beijing 100029, China
| | - Chuangli Hao
- Children’s Hospital of Soochow University, Suzhou 215025, China
| | - Lingfei Kong
- The First Hospital of China Medical University, Shenyang 110001, China
| | - Shunan Zhang
- China-Japan Friendship Hospital, Beijing 100029, China
| | - Yaolong Chen
- Evidence-based Medical Center of Lanzhou University, Lanzhou 730000, China
| | - Wei Luo
- State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Mei Jiang
- State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Jiaxing Xie
- State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
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Gallucci M, di Palmo E, Bertelli L, Camela F, Ricci G, Pession A. A pediatric disease to keep in mind: diagnostic tools and management of bronchiectasis in pediatric age. Ital J Pediatr 2017; 43:117. [PMID: 29284507 PMCID: PMC5747121 DOI: 10.1186/s13052-017-0434-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/05/2017] [Indexed: 12/21/2022] Open
Abstract
Bronchiectasis in pediatric age is a heterogeneous disease associated with significant morbidity.The most common medical conditions leading to bronchial damage are previous pneumonia and recurrent lower airway infections followed by underlying diseases such as immune-deficiencies, congenital airway defects, recurrent aspirations and mucociliary clearance disorders.The most frequent symptom is chronic wet cough. The introduction of high-resolution computed tomography (HRCT) has improved the time of diagnosis allowing earlier treatment.However, the term "bronchiectasis" in pediatric age should be used with caution, since some lesions highlighted with HRCT may improve or regress. The use of chest magnetic resonance imaging (MRI) as a radiation-free technique for the assessment and follow-up of lung abnormalities in non-Cystic Fibrosis chronic lung disease is promising.Non-Cystic Fibrosis Bronchiectasis management needs a multi-disciplinary team. Antibiotics and airway clearance techniques (ACT) represent the pillars of treatment even though guidelines in children are lacking. The Azithromycin thanks to its antinflammatory and direct antimicrobial effect could be a new strategy to prevent exacerbations.
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Affiliation(s)
- Marcella Gallucci
- Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola - Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy
| | - Emanuela di Palmo
- Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola - Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy
| | - Luca Bertelli
- Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola - Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy
| | - Federica Camela
- Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola - Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy
| | - Giampaolo Ricci
- Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola - Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy.
| | - Andrea Pession
- Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola - Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy
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Al-Jahdali H, Alshimemeri A, Mobeireek A, Albanna AS, Al Shirawi NN, Wali S, Alkattan K, Alrajhi AA, Mobaireek K, Alorainy HS, Al-Hajjaj MS, Chang AB, Aliberti S. The Saudi Thoracic Society guidelines for diagnosis and management of noncystic fibrosis bronchiectasis. Ann Thorac Med 2017; 12:135-161. [PMID: 28808486 PMCID: PMC5541962 DOI: 10.4103/atm.atm_171_17] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 12/14/2022] Open
Abstract
This is the first guideline developed by the Saudi Thoracic Society for the diagnosis and management of noncystic fibrosis bronchiectasis. Local experts including pulmonologists, infectious disease specialists, thoracic surgeons, respiratory therapists, and others from adult and pediatric departments provided the best practice evidence recommendations based on the available international and local literature. The main objective of this guideline is to utilize the current published evidence to develop recommendations about management of bronchiectasis suitable to our local health-care system and available resources. We aim to provide clinicians with tools to standardize the diagnosis and management of bronchiectasis. This guideline targets primary care physicians, family medicine practitioners, practicing internists and respiratory physicians, and all other health-care providers involved in the care of the patients with bronchiectasis.
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Affiliation(s)
- Hamdan Al-Jahdali
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Department of Medicine, Pulmonary Division, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alshimemeri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Department of Medicine, Pulmonary Division, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdullah Mobeireek
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- King Faisal Specialist Hospital and Research Centre, Department of Medicine, Pulmonary Division, Riyadh, Saudi Arabia
| | - Amr S. Albanna
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Department of Medicine, Pulmonary Division, King Abdulaziz Medical City, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | | | - Siraj Wali
- College of Medicine, King Abdulaziz University, Respiratory Unit, Department of Medicine, Jeddah, Saudi Arabia
| | - Khaled Alkattan
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdulrahman A. Alrajhi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- King Faisal Specialist Hospital and Research Centre, Department of Medicine, Infectious Disease Division, Riyadh, Saudi Arabia
| | - Khalid Mobaireek
- College of Medicine, King Saud University, King Khalid University Hospital, Pediatric Pulmonology Division, Riyadh, Saudi Arabia
| | - Hassan S. Alorainy
- King Faisal Specialist Hospital and Research Centre, Respiratory Therapy Services, Riyadh, Saudi Arabia
| | - Mohamed S. Al-Hajjaj
- Department of Clinical Sciences, College of Medicine. University of Sharjah, Sharjah, UAE
| | - Anne B. Chang
- International Reviewer, Children's Centre of Health Research Queensland University of Technology, Queensland
- International Reviewer, Brisbane and Child Health Division, Menzies School of Health Research, Darwin, Australia
| | - Stefano Aliberti
- International Reviewer, Department of Pathophysiology and Transplantation, University of MilanInternal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Via Francesco Sforza 35, 20122, Milan, Italy
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7
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Abstract
Bronchiectasis is a heterogeneous, chronic condition with many aetiologies. It poses a significant burden on patients and healthcare practitioners and services. Clinical exacerbations often result in reduced quality of life, increased rate of lung function decline, increased hospitalisation, and mortality. Recent focus in respiratory research, guidelines, and future management options has improved this clinical field in evidence-based practice, but further work and phase III clinical trials are required. This article aims to summarise and explore advances in management strategies in recent years and highlight areas of research and future focus.
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Affiliation(s)
- Usma Koser
- Department of Respiratory Medicine, Royal Infirmary and University of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK
| | - Adam Hill
- Department of Respiratory Medicine, Royal Infirmary and University of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK
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Morgan LC, Birman CS. The impact of Primary Ciliary Dyskinesia on the upper respiratory tract. Paediatr Respir Rev 2016; 18:33-8. [PMID: 26898410 DOI: 10.1016/j.prrv.2015.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 09/18/2015] [Indexed: 11/30/2022]
Abstract
Primary Ciliary Dyskinesia (PCD) is an autosomal recessive genetic condition affecting the function of motile cilia. The upper respiratory tract is lined with ciliated epithelium and hence a hallmark of PCD is the development, from the neonatal period onwards, of persisting secretion retention and suppurative infection in the middle ear, nose and facial sinuses [1]. This review aims to remind the clinician involved in the care of a patient with PCD of the complexities of making the diagnosis of chronic rhinosinusitis (CRS) and chronic otitis media with effusion (ChOME), the morbidity associated with CRS and ChOME and of current evidence of best practice for the management of these conditions.
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Affiliation(s)
- Lucy C Morgan
- Sydney Medical School, University of Sydney, NSW; Department of Thoracic Medicine, Concord Hospital, Sydney, NSW; Australian School of Advanced Medicine, Macquarie University, Sydney, NSW.
| | - Catherine S Birman
- Sydney Medical School, University of Sydney, NSW; Australian School of Advanced Medicine, Macquarie University, Sydney, NSW; Department of ENT Surgery, The Children's Hospital at Westmead, Sydney, NSW
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Shapiro AJ, Zariwala MA, Ferkol T, Davis SD, Sagel SD, Dell SD, Rosenfeld M, Olivier KN, Milla C, Daniel SJ, Kimple AJ, Manion M, Knowles MR, Leigh MW. Diagnosis, monitoring, and treatment of primary ciliary dyskinesia: PCD foundation consensus recommendations based on state of the art review. Pediatr Pulmonol 2016; 51:115-32. [PMID: 26418604 PMCID: PMC4912005 DOI: 10.1002/ppul.23304] [Citation(s) in RCA: 240] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/30/2015] [Accepted: 08/21/2015] [Indexed: 01/10/2023]
Abstract
Primary ciliary dyskinesia (PCD) is a genetically heterogeneous, rare lung disease resulting in chronic oto-sino-pulmonary disease in both children and adults. Many physicians incorrectly diagnose PCD or eliminate PCD from their differential diagnosis due to inexperience with diagnostic testing methods. Thus far, all therapies used for PCD are unproven through large clinical trials. This review article outlines consensus recommendations from PCD physicians in North America who have been engaged in a PCD centered research consortium for the last 10 years. These recommendations have been adopted by the governing board of the PCD Foundation to provide guidance for PCD clinical centers for diagnostic testing, monitoring, and appropriate short and long-term therapeutics in PCD patients.
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Affiliation(s)
- Adam J Shapiro
- Department of Pediatrics, Montreal Children's Hospital, McGill University, Quebec, Canada
| | - Maimoona A Zariwala
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Marsico Lung Institute, Chapel Hill, North Carolina
| | - Thomas Ferkol
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Stephanie D Davis
- Department of Pediatrics, Riley Hospital for Children, Indiana University, Indianapolis, Indiana
| | - Scott D Sagel
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
| | - Sharon D Dell
- Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Margaret Rosenfeld
- Department of Pediatrics, Seattle Children's Hospital and University of Washington, Seattle, Washington
| | | | - Carlos Milla
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Sam J Daniel
- Department of Otolaryngology, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Adam J Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Michael R Knowles
- Department of Medicine, University of North Carolina, Marsico Lung Institute, Chapel Hill, North Carolina
| | - Margaret W Leigh
- Department of Pediatrics, University of North Carolina, Marsico Lung Institute, Chapel Hill, North Carolina
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McCullough A, Thomas ET, Ryan C, Bradley JM, O'Neill B, Elborn S, Hughes C. Interventions for enhancing adherence to treatment in adults with bronchiectasis. Cochrane Database Syst Rev 2015; 2015:CD011023. [PMID: 26576499 PMCID: PMC6483476 DOI: 10.1002/14651858.cd011023.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Bronchiectasis is characterised by a widening of the airways, leading to excess mucus production and recurrent infection. It is more prevalent in women and those in middle age. Many patients with bronchiectasis do not adhere to treatments (medications, exercise and airway clearance) prescribed for their condition. The best methods to change these adherence behaviours have not been identified. OBJECTIVES To assess the effects of interventions to enhance adherence to any aspect of treatment in adults with bronchiectasis in terms of adherence and health outcomes, such as pulmonary exacerbations, health-related quality of life and healthcare costs. SEARCH METHODS We searched the Cochrane Airways Group Specialised Register (CAGR), which contains trial reports identified through systematic searches of CENTRAL, MEDLINE, EMBASE, CINAHL, AMED and PsycINFO, from inception to October 2015. SELECTION CRITERIA We planned to include randomised controlled trials (RCTs) of adults with bronchiectasis that compared any intervention aimed at enhancing adherence versus no intervention, usual care or another adherence intervention. We excluded studies of those who had bronchiectasis due to cystic fibrosis. DATA COLLECTION AND ANALYSIS Two review authors (AMcC and ET) independently screened titles, abstracts and full-texts of identified studies. MAIN RESULTS Searches retrieved 36 studies reported in 37 articles; no eligible studies were identified. AUTHORS' CONCLUSIONS We did not identify any studies that assessed the effect of interventions to enhance adherence to treatment in bronchiectasis. Adequately powered, well-designed trials of adherence interventions for bronchiectasis are needed.
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Affiliation(s)
- Amanda McCullough
- Bond UniversityCentre for Research in Evidence‐Based Practice (CREBP)Gold CoastQueenslandAustralia
| | - Elizabeth T Thomas
- Bond UniversityCentre for Research in Evidence‐Based Practice (CREBP)Gold CoastQueenslandAustralia
| | - Cristin Ryan
- Royal College of Surgeons in IrelandSchool of Pharmacy111 St Stephen’s GreenDublin 2Ireland
| | - Judy M Bradley
- Queen's University BelfastThe Wellcome Trust‐Wolfson Northern Ireland Clinical Research Facility U FloorBelfast City HospitalLisburn RoadBelfastNorthern IrelandUKBT9 7AB
- Belfast Health and Social Care TrustDepartment of Respiratory MedicineLisburn RoadBelfastUKBT9 7AB
| | - Brenda O'Neill
- Ulster UniversityCentre for Health and Rehabilitation Technologies (CHaRT), Institute of Nursing and Health ResearchNewtownabbeyNorthern IrelandUK
| | - Stuart Elborn
- Belfast Health and Social Care TrustDepartment of Respiratory MedicineLisburn RoadBelfastUKBT9 7AB
- Queen's University BelfastCentre for Infection and ImmunityHealth Sciences Building97 Lisburn RoadBelfastNorthern IrelandUKBT9 7BL
| | - Carmel Hughes
- Queen's University BelfastSchool of Pharmacy97 Lisburn RoadBelfastNorthern IrelandUKBT9 7BL
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Griffith DE, Adjemian J, Brown-Elliott BA, Philley JV, Prevots DR, Gaston C, Olivier KN, Wallace RJ. Semiquantitative Culture Analysis during Therapy for Mycobacterium avium Complex Lung Disease. Am J Respir Crit Care Med 2015; 192:754-60. [PMID: 26068042 PMCID: PMC4595680 DOI: 10.1164/rccm.201503-0444oc] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/10/2015] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Microbiologically based criteria such as sputum culture conversion to negative have traditionally been used to define treatment success for mycobacterial diseases. There are, however, limited data regarding whether nontuberculous mycobacterial sputum culture conversion or semiquantitative culture analysis correlates with subjective or nonmicrobiologic objective indices of treatment response. OBJECTIVES To determine whether a semiquantitative mycobacterial culture scale correlated with clinical disease status and was predictive of long-term sputum mycobacterial culture conversion to negative in a cohort of patients with nodular/bronchiectatic Mycobacterium avium complex lung disease undergoing therapy. METHODS One hundred and eighty patients undergoing standard macrolide-based therapy for M. avium complex lung disease were monitored at standard frequent intervals with symptomatic, radiographic, and microbiologic data collected, including semiquantitative mycobacterial culture analysis. Analyses were used to evaluate clinical and microbiologic predictors of long-term sputum conversion to culture negative. MEASUREMENTS AND MAIN RESULTS After 12 months of therapy, 148 (82%) patients had sputum conversion to culture negative. Baseline semiquantitative sputum culture scores did not differ between patients with sputum conversion and those without. The change in sputum culture semiquantitative score from baseline to Month 3 was highly predictive of subsequent sputum long-term conversion status indicative of treatment success, as was improvement in cough, and especially early radiographic improvement. CONCLUSIONS Early semiquantitative sputum agar plate culture results can be used to predict symptomatic and radiographic improvement as well as long-term sputum culture conversion to negative in this population. We suggest that semiquantitative sputum culture scores can be a useful tool for evaluating new nontuberculous mycobacterial lung disease therapies.
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Affiliation(s)
| | - Jennifer Adjemian
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
- United States Public Health Service Commissioned Corps, Rockville, Maryland; and
| | | | | | - D. Rebecca Prevots
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Kenneth N. Olivier
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
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12
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Welsh EJ, Evans DJ, Fowler SJ, Spencer S. Interventions for bronchiectasis: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev 2015; 2015:CD010337. [PMID: 26171905 PMCID: PMC7086475 DOI: 10.1002/14651858.cd010337.pub2] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Bronchiectasis is a chronic respiratory disease characterised by abnormal dilatation of the bronchi, and presents typically with a chronic productive cough (or chronic wet cough in children) and recurrent infective exacerbations. It significantly impacts daily activities and quality of life, and can lead to recurrent hospitalisations, severe lung function impairment, respiratory failure and even death. OBJECTIVES To provide an overview of the efficacy and safety of interventions for adults and children with bronchiectasis from Cochrane reviews.To identify gaps in the evidence base that will inform recommendations for new research and reviews, and to summarise information on reported outcomes and make recommendations for the reporting of standard outcomes in future trials and reviews. METHODS We included Cochrane reviews of non-cystic fibrosis (CF) bronchiectasis. We searched the Cochrane Database of Systematic Reviews. The search is current to 11 February 2015. We also identified trials that were potentially eligible for, but not currently included in, published reviews to make recommendations for new Cochrane reviews. We assessed the quality of included reviews using the AMSTAR criteria. We presented an evidence synthesis of data from reviews alongside an evidence map of clinical trials and guideline data. The primary outcomes were exacerbations, lung function and quality of life. MAIN RESULTS We included 21 reviews but extracted data from, and rated the quality of, only nine reviews that reported results for people with bronchiectasis alone. Of the reviews with no usable data, two reviews included studies with mixed clinical populations where data were not reported separately for people with bronchiectasis and 10 reviews did not contain any trials. Of the 40 studies included across the nine reviews, three (number of participants nine to 34) included children. The studies ranged from single session to year-long studies. Each review included from one to 11 trials and 28 (70%) trials in the overview included 40 or fewer participants. The total number of participants included in reviews ranged from 40 to 1040. The age range of adult participants was from 36 to 73 years and children ranged from six to 16 years. The proportion of male participants ranged from 21% to 72%. Where reported, mean baseline forced expiratory volume in one second (FEV1) ranged from 1.17 L to 1.66 L and from 47% to 88% predicted. Most of the reviews had search dates older than two years.We have summarised the published evidence as outlined in Cochrane reviews, but it was not possible to draw definitive conclusions. There was inconclusive evidence on the use of long-term antibiotics and nebulised hypertonic saline for reducing exacerbation frequency and evidence that human deoxyribonuclease (RhDNase) increases exacerbation frequency. Improvements in lung function were reported for inhaled corticosteroids (ICS) though this was small and not clinically relevant. Evidence of benefit for hyperosmolar agents and mucolytics was inconclusive. There was limited evidence of improvements in quality of life with airway clearance techniques and physical therapy but evidence of benefit for hyperosmolar agents was inconclusive. Secondary outcomes were not clearly reported in all trials in the included reviews. Improvements in dyspnoea, wheeze and cough-free days were reported for small trials of ICS and LABA (long-acting beta2-agonsts)/ICS and cough reduction was also reported for a small bromhexine trial. Reduction in sputum production was reported for long-term antibiotics and airway clearance techniques but evidence of benefit for hyperosmolar agents was inconclusive.Adverse events were included as outcomes in seven reviews. The review of long-term (four weeks to one year) prophylactic courses of antibiotics reported significantly more cases of wheeze (Peto odd ratio (OR) 8.56, 95% confidence intervals (CI) 1.63 to 44.93), dyspnoea (12 versus three, P value = 0.01) and chest pain (seven versus zero, P value = 0.01) from the same trial (74 participants) but no differences in occurrence of diarrhoea, rash or number of withdrawals. In the review of mucolytics versus placebo, relevant outcomes were not reported for erdosteine comparisons and no significant adverse effects were reported for bromhexine, though adverse events were associated with RhDNase (OR 28.19, 95% CI 3.77 to 210.85, 1 study). Of the remaining five reviews, adverse events were not reported in the single trials included in the ICS review or the physical therapy review and the impact of adverse events in the single trial included in the inhaled LABA/ICS combination versus ICS review were unclear. The reviews of short-term courses of antibiotics and inhaled hyperosmolar agents reported no significant differences in occurrence of adverse events. Fewer admissions to hospital were reported for long-term antibiotics, but this outcome was not reported in all reviews. No reviews reported differences in mortality, but again this outcome was not included in all reviews.We did not explicitly include antibiotic resistance as an outcome in the review, but this was unclear in the Cochrane reviews and evidence from other trials should be considered.We rated all reviews as high quality (AMSTAR), though opportunities for improved reporting (e.g. summary of findings and GRADE evaluation of the evidence) were identified for inclusion in future updates of the reviews. However, the majority of trials were not high quality and confidence in the effects of treatments, therefore, requires additional evidence from larger and more methodologically robust trials. We evaluated the overall coverage of important topics in bronchiectasis by mapping the quality of the current evidence base against published guidelines and identifying high priority areas for new research on; use of short-course and long-term antibiotics, ICS and oral corticosteroids, inhaled hyperosmolars, mucolytics, and use of airway clearance techniques. AUTHORS' CONCLUSIONS This overview clearly points to significant opportunities for further research aimed at improving outcomes for people with bronchiectasis. We have highlighted important endpoints for studies (particularly exacerbations, quality of life and lung function), and areas of clinical practice that are in most urgent need of evidence-based support (including long-term antibiotics, ICSs and mucolytics).As the evidence is confined to small trials of short duration, it is not currently possible to assess the balance between the benefits and potential harms of treatments for bronchiectasis.
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Affiliation(s)
- Emma J Welsh
- St George's, University of LondonPopulation Health Research InstituteCranmer TerraceLondonUKSW17 0RE
| | - David J Evans
- Hemel Hempstead HospitalThoracic MedicineHillfield RoadHemel HempsteadHertsUKHP2 4AD
- Harefield HospitalHill End RoadHarefieldUKUB9 6JH
| | - Stephen J Fowler
- University Hospital of South ManchesterUniversity of Manchester, NIHR Respiratory and Allergy Clinical Research FacilityManchesterUK
- Lancashire Teaching Hospitals NHS Foundation TrustPrestonUK
| | - Sally Spencer
- Lancaster UniversityFaculty of Health and MedicineBailriggLancasterLancashireUKLA1 4YD
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Daniels MLA, Noone PG. Genetics, diagnosis, and future treatment strategies for primary ciliary dyskinesia. Expert Opin Orphan Drugs 2014; 3:31-44. [PMID: 26998415 DOI: 10.1517/21678707.2015.989212] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Primary ciliary dyskinesia (PCD) is a genetically heterogeneous recessive disorder resulting in chronic oto-sino-pulmonary disease. While PCD is estimated to occur in 1 in 20,000 individuals, fewer than 1,000 patients in the US have a well-established diagnosis. AREAS COVERED We provide an overview of the clinical manifestations of PCD, describe the evolution of diagnostic methods, and critique the literature on management of PCD. EXPERT OPINION Although interest in clinical studies in non-CF bronchiectasis has increased in recent years, some of whom enroll patients with PCD, the literature regarding therapy for PCD as a distinct entity is lacking, as the numbers are small, and there have been no sub-analyses published. However, with improved screening and diagnostic methods, the development of clinical and research consortiums, and actively enrolling registries of PCD patients, the environment is conducive to perform longitudinal studies of disease course and therapeutic studies to alter that course.
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Affiliation(s)
- M Leigh Anne Daniels
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Peadar G Noone
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
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