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Mocelin HT, Fischer GB, Piccini JD, Baú R, Andrade CF, Lukrafka JL. Surgical treatment of non-cystic fibrosis bronchiectasis in children and adolescents: A review. Paediatr Respir Rev 2022:S1526-0542(22)00073-2. [PMID: 36528553 DOI: 10.1016/j.prrv.2022.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To discuss surgery for non-cystic fibrosis [CF] bronchiectasis in children and adolescents. SOURCES Non-systematic review including articles in English, mainly from the last 5 years. SUMMARY OF FINDINGS In this review, we present that in low- and middle-income countries [LMIC] clinical treatment fails in around 20% of cases due to low socioeconomic status and poor adherence. This causes the disease to progress and require surgery. We emphasize that the indications for surgery are not well defined and must be considered on an individual basis. The surgical treatment of bronchiectasis in children may be indicated in selected cases; especially in localized disease with frequent exacerbations despite an optimized clinical approach. Surgery can improve quality of life [QoL] and reduce exacerbations. It has few postoperative complications and low morbidity and mortality. Finally, we propose an algorithm for managing bronchiectasis, which takes into account LMIC settings with limited resources. CONCLUSION We conclude that in LMICs, surgery is a treatment strategy for selected children/adolescents with bronchiectasis.
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Affiliation(s)
- Helena Teresinha Mocelin
- Department of Paediatrics, Federal University of Health Sciences of Porto Alegre (UFCSPA), Brazil; Pediatric Pulmonology Section, Hospital da Criança Santo Antônio, Porto Alegre, Brazil.
| | - Gilberto Bueno Fischer
- Department of Paediatrics, Federal University of Health Sciences of Porto Alegre (UFCSPA), Brazil; Pediatric Pulmonology Section, Hospital da Criança Santo Antônio, Porto Alegre, Brazil.
| | - Júlia Danezi Piccini
- Pediatric Pulmonology Section, Hospital da Criança Santo Antônio, Porto Alegre, Brazil
| | - Renata Baú
- Thoracic Surgeon, Hospital de Clínicas de Porto Alegre, Brazil
| | - Cristiano Feijó Andrade
- Thoracic Surgeon, Hospital de Clínicas de Porto Alegre, Brazil; Thoracic Surgeon, Hospital da Criança Santo Antônio, Porto Alegre, Brazil
| | - Janice Luisa Lukrafka
- Department of Physiotherapy, Federal University of Health Sciences of Porto Alegre (UFCSPA), Brazil.
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SENDON CS, COWLES RA, WORHUNSKY DJ, HODSON D, MOROTTI R, BAZZY-ASAAD A, ESQUIBIES AE. Pediatric unilobar resection in primary ciliary dyskinesia. Minerva Pediatr (Torino) 2022; 74:593-599. [DOI: 10.23736/s2724-5276.20.05802-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Surgical treatment of bronchiectasis in children: An 11-year experience at a central health facility in KwaZulu-Natal, South Africa. SOUTH AFRICAN JOURNAL OF CHILD HEALTH 2022. [DOI: 10.7196/sajch.2022.v16i3.1842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background. The surgical management of children with bronchiectasis has seldom been reported.Objective. To describe the presentation, surgical management and outcomes in children with bronchiectasis presenting for surgery. Methods. We retrospectively reviewed the electronic records of 0 - 13-year-old children who underwent pulmonary resection for bronchiectasis at Inkosi Albert Luthuli Central Hospital, Durban, South Africa, between January 2004 and December 2014. Clinical, radiological and preoperative bronchoscopic findings, as well as surgical and histological outcomes, were analysed.Results. Eighty-eight patients underwent surgical resection. The female/male ratio was 3:2, with a mean age at surgery of 8.2 (range 2 - 13) years; 39 patients were HIV infected and 39 were HIV uninfected. Tuberculosis (TB) (n=68; 77.2%) was the most common cause of bronchiectasis, and recurrent chest infection (n= 45; 51.1%) was the most common clinical finding. Radiological examination confirmed isolated left-sided disease in 40 children (45.4%), isolated right-sided disease in 28 (31.8%) and bilateral disease in 20 (22.7%). Saccular disease with fibrocavitation (n=35; 39.7%) was the most common morphological disease type. Preoperative bronchoalveolar lavage samples confirmed a bacterial cause in 27 patients (30.6%). The most common operative procedures were primary pneumonectomy in 33 patients (37.0%), lobectomy in 30 (34.0%) and bilobectomy in 13 (14.7%). Seventy-five patients were asymptomatic after the operation and complications occurred in 13. Two children (2.2%), one with sepsis and the other with intraoperative hypoxia, died. Seventy patients underwent complete resection. At 1 month after surgery, 89.2% of patients were asymptomatic, while 77.7% of symptomatic patients were HIV positive.Conclusions. Complete pulmonary resection in children with advanced-stage bronchiectasis is safe, with a low morbidity and mortality. Surgery in HIV-positive patients was not associated with worse outcomes and is not contraindicated. HIV- and TB-preventive measures could reduce the burden of childhood bronchiectasis.
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Ullmann N, Porcaro F, Petreschi F, Cammerata M, Allegorico A, Negro V, Cutrera R. Noncystic fibrosis bronchiectasis in children and adolescents: Follow-up over a decade. Pediatr Pulmonol 2021; 56:3026-3034. [PMID: 34265867 DOI: 10.1002/ppul.25553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/28/2021] [Accepted: 06/24/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Noncystic fibrosis bronchiectasis (NCFB) is still considered an "orphan disease" in pediatric age. OBJECTIVE The study describes the clinical and functional features, the instrumental, and microbial findings of a large cohort of patients with NCFB, followed in a single tertiary level hospital. METHODS Children and adolescents diagnosed with NCFB from January 1, 2010 to December 31, 2019 were included. Data from the diagnosis and during the years of follow-up were recorded retrospectively. RESULTS One hundred and thirty-eight patients were enrolled. The most common cause of NCFB was postinfectious (33%), followed by primary ciliary dyskinesia (PCD) (30%), esophageal atresia (EA) (9.5%), and secondary immunodeficiency (9.5%). Chronic cough was the most frequent symptom. The median age of symptoms presentation was 3 years (interquartile age [IQR]: 12-84), with a precocious onset in PCD and EA groups. The median age of CT diagnosis was 9 years for all groups but PCD patients who were diagnosed at older age. Lingula, medium, upper, and lower lobes were more involved in PCD group, while diffuse distribution was observed in the postinfectious one. Microbial exams showed Pseudomonas aeruginosa colonization higher in PCD patients (22%). Despite microbial differences in airways colonization, no difference in respiratory exacerbation rate was recorded among groups. Lung function tests demonstrated the stability of forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) over time, except for the secondary immunodeficiency group. CONCLUSIONS The role of infections in developed countries should not be underestimated and a major effort to obtain an earlier identification of bronchiectasis should be taken. A prompt diagnosis of NFCB could help to reduce the frequency of exacerbations and improve the stability of lung function over time.
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Affiliation(s)
- Nicola Ullmann
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Federica Porcaro
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Petreschi
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Michela Cammerata
- Academic Department of Pediatrics, Tor Vergata University, Rome, Italy
| | - Annalisa Allegorico
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valentina Negro
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Renato Cutrera
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Delayed diagnosis and surgical treatment of bronchial foreign body in children. J Pediatr Surg 2020; 55:1860-1865. [PMID: 31759656 DOI: 10.1016/j.jpedsurg.2019.10.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/15/2019] [Accepted: 10/02/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Delayed diagnosis of children with Bronchial Foreign Body (BFB) leads to significant pulmonary complications and open surgery may not be avoided. However, surgical management for children with BFB is rarely reported. This study aims to describe our experience in the diagnosis and surgical treatment of late-diagnosed BFB during childhood. METHODS Medical records of 8 children who were diagnosed with BFB and underwent open surgery at Children's Hospital of Chongqing Medical University between January 2004 and June 2019 were retrospectively reviewed. RESULTS This group consisted of 8 children, with an average age of 8.1 years. In this group, the typical aspiration history was absent and the diagnosis of BFB was established in delay. The onset of diseases varied from 2 months to over 4 years. Lobectomy was performed in 7 patients and pneumonotomy was performed in 1 patient. No postoperative death was found. The clinical outcomes were satisfactory with an average 33 months follow-up. CONCLUSIONS The diagnosis of BFB should be considered in children who present with repeated pneumonia and agnogenic bronchiectasis and actelectasis despite repeated medical treatment. Surgical treatment is necessary and effective in patients with either unextractable BFB or irreversible damage of lung tissue. LEVELS OF EVIDENCE Level IV. TYPE OF STUDY Retrospective study.
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El Boustany P, Gachelin E, Colomban C, Cernoia J, Sudour P, Carsin A, Dubus JC. A review of non-cystic fibrosis bronchiectasis in children with a focus on the role of long-term treatment with macrolides. Pediatr Pulmonol 2019; 54:487-496. [PMID: 30652424 DOI: 10.1002/ppul.24252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 12/21/2018] [Indexed: 12/23/2022]
Abstract
Bronchiectasis is a rare chronic airway disease arising from several respiratory and systemic diseases. The grade of evidence for specific treatment of childhood bronchiectasis unrelated to cystic fibrosis (CF) is low with very few randomized controlled trials. Treatment has been based mainly on evidence from studies in adults with non-cystic fibrosis bronchiectasis and patients with cystic fibrosis. Recently, long-term treatment with macrolides has been proposed. These molecules offer the advantage of anti-inflammatory and immunomodulatory properties in addition to their antibacterial properties. A total of three randomized double-blind placebo-controlled trials conducted in adults showed that macrolides taken for 6-12 months led to a significant reduction in exacerbation rates. Only one long-term, randomized double-blind placebo-controlled trial was conducted in the pediatric population. It showed that azithromycin administered weekly for up to 24 months reduced pulmonary exacerbations. Further randomized controlled studies are needed to determine the optimal dose and duration of treatment with macrolides. The clinical profile of children who would benefit from this treatment also needs to be determined.
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Affiliation(s)
| | - Elsa Gachelin
- Service de Pédiatrie, CHU Félix Guyon, Saint Denis, France
| | - Cécile Colomban
- Centre d'Investigation Clinique-Centre de Pharmacologie Clinique et d'Evaluations Thérapeutiques (CIC-CPCET), OrphanDev, CHU La Timone, Marseille, France
| | - Julie Cernoia
- Direction de la Recherche Clinique et de l'Innovation, Assistance Publique-hôpitaux de Marseille, Marseille, France
| | - Patrick Sudour
- Direction de la Recherche Clinique et de l'Innovation, Assistance Publique-hôpitaux de Marseille, Marseille, France
| | - Ania Carsin
- Unité de Pneumologie Pédiatrique, CHU Timone Enfants, Marseille, France
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Lee E, Hong SJ. Pharmacotherapeutic strategies for treating bronchiectasis in pediatric patients. Expert Opin Pharmacother 2019; 20:1025-1036. [PMID: 30897021 DOI: 10.1080/14656566.2019.1589453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The social and medical costs of bronchiectasis in children are becoming considerable due to its increasing prevalence. Early identification and intensive treatment of bronchiectasis are needed to decrease the morbidity and mortality associated with bronchiectasis in children. AREAS COVERED This review presents the current pharmacotherapeutic strategies for treating bronchiectasis in children with a focus on non-cystic fibrosis bronchiectasis. EXPERT OPINION Evidence for the effectiveness of diverse treatment strategies in bronchiectasis is lacking, particularly in children, although the disease burden is substantial for bronchiectasis. Most treatment strategies for non-cystic fibrosis bronchiectasis in children have been extrapolated from those in adults with bronchiectasis or children with cystic fibrosis. Antibiotics combined with an active airway clearance therapy via the inhalation of mucoactive agents can stabilize bronchiectasis. The timely and intensive administration of antibiotics during acute exacerbation of bronchiectasis is essential to prevent its progression in children. To suppress the bacterial loads in the airway, systemic or inhaled antibiotics can be administered intermittently or continuously. However, studies on these protocols, including the appropriate duration and effective dosages are lacking. Long-term administration of azithromycin for 12-24 months may reduce the exacerbation frequency with the increased carriage rate of azithromycin-resistant bacteria.
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Affiliation(s)
- Eun Lee
- a Department of Pediatrics , Chonnam National University Hospital, Chonnam National University Medical School , Gwangju , Korea
| | - Soo-Jong Hong
- b Department of Pediatrics , Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine , Seoul , Korea
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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] [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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Chang AB, Redding GJ. Bronchiectasis and Chronic Suppurative Lung Disease. KENDIG'S DISORDERS OF THE RESPIRATORY TRACT IN CHILDREN 2019. [PMCID: PMC7161398 DOI: 10.1016/b978-0-323-44887-1.00026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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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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Amalakuhan B, Maselli DJ, Martinez-Garcia MA. Update in Bronchiectasis 2014. Am J Respir Crit Care Med 2016; 192:1155-61. [PMID: 26568240 DOI: 10.1164/rccm.201505-0926up] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Bravein Amalakuhan
- 1 Division of Pulmonary Diseases/Critical Care Medicine, Department of Medicine, University of Texas Health Science Center and Audie L. Murphy Division, South Texas Veterans Health Care System, San Antonio, Texas; and
| | - Diego J Maselli
- 1 Division of Pulmonary Diseases/Critical Care Medicine, Department of Medicine, University of Texas Health Science Center and Audie L. Murphy Division, South Texas Veterans Health Care System, San Antonio, Texas; and
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Efficiency and safety of surgical intervention to patients with Non-Cystic Fibrosis bronchiectasis: a meta-analysis. Sci Rep 2015; 5:17382. [PMID: 26627202 PMCID: PMC4667173 DOI: 10.1038/srep17382] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 10/29/2015] [Indexed: 12/14/2022] Open
Abstract
No quantitative systematic review was found to report the efficiency and safety of surgical resection in the management of non-cystic fibrosis (non-CF) bronchiectasis. We therefore conducted a meta-analysis to assess the effects of operative intervention to patients with non-CF bronchiectasis. PubMed, the Cochrane library and Web of Science databases were searched up to July 8th, 2015. The pooled mortality from 34 studies recruiting 4788 patients was 1.5% (95% CI, 0.9–2.5%). The pooled morbidity from 33 studies consisting of 4583 patients was 16.7% (95% CI, 14.8–18.6%). The pooled proportion of patients from 35 studies, consisting of 4614 patients who were free of symptoms was 66.5% (95% CI, 61.3–71.7%) after surgery. The summary proportion of patients from 35 articles including 4279 participants who were improved was 27.5% (95% CI, 22.5–32.5%), and 9.1% (95% CI, 7.3–11.5%) showed no clinical improvement. In conclusion, our analysis indicated that lung resection in the management of non-CF bronchiectasis is associated with significant improvements in symptoms, low risk of mortality and acceptable morbidity.
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Yiallouros PK, Kouis P, Middleton N, Nearchou M, Adamidi T, Georgiou A, Eleftheriou A, Ioannou P, Hadjisavvas A, Kyriacou K. Clinical features of primary ciliary dyskinesia in Cyprus with emphasis on lobectomized patients. Respir Med 2015; 109:347-56. [PMID: 25698650 DOI: 10.1016/j.rmed.2015.01.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/24/2014] [Accepted: 01/24/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Despite the manifestations of primary ciliary dyskinesia (PCD) in early life, the diagnosis is often much delayed. Since 1998 in Cyprus, we have established the only national diagnostic and clinical referral center for PCD. OBJECTIVE To review the phenotypic features at presentation of PCD patients in Cyprus in relation to age at diagnosis, with emphasis on previously lobectomised patients. METHODS The medical records of the diagnosed PCD patients were retrospectively reviewed to obtain clinical data on presentation. RESULTS Thirty patients, aged 13.9 years (range 0.1, 58.4 years), were diagnosed with PCD. Twelve of them presented after the age of 18. The most common manifestations were chronic cough (100%), chronic rhinorrhea (96.7%), sputum production (92.9%), laterality defects (63.3%), a history of pneumonia (53.3%) and neonatal respiratory distress (50%). A history of lobectomy in the past was recorded in 16.7% (5 patients). Patients who presented in adulthood had significantly higher frequency of lobectomy (41.7% vs 0%, p-value = 0.006) and had more frequently low FEV1 (58.3% vs 0%, p-value = 0.015) than those who presented before. Serial measurements of FEV1 and FVC indicated significantly lower intercepts in lobectomised compared to the adult non-lobectomised patients both in terms of FEV1 (-4.90 vs -1.80, p-value = 0.022) and FVC (-5.43 vs -1.91, p-value = 0.029) z-score levels. Change in FEV1 and FVC across time was not statistically significant in either group. CONCLUSIONS PCD often remains undiagnosed up to adulthood accompanied by appearance of advanced lung disease. Performance of lobectomies seems to be a poor prognostic factor for PCD in adulthood.
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Affiliation(s)
- Panayiotis K Yiallouros
- Cyprus International Institute for Environmental & Public Health in Association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus; Department of Pediatrics, Hospital "Archbishop Makarios III", Nicosia, Cyprus.
| | - Panayiotis Kouis
- Cyprus International Institute for Environmental & Public Health in Association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus.
| | - Nicos Middleton
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.
| | - Marianna Nearchou
- Department of Electron Microscopy and Molecular Pathology, Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.
| | - Tonia Adamidi
- Department of Pulmonology, Nicosia General Hospital, Nicosia, Cyprus.
| | - Andreas Georgiou
- Department of Pulmonology, Nicosia General Hospital, Nicosia, Cyprus.
| | | | - Phivos Ioannou
- Department of Pediatrics, Hospital "Archbishop Makarios III", Nicosia, Cyprus.
| | - Andreas Hadjisavvas
- Department of Electron Microscopy and Molecular Pathology, Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus; Cyprus School of Molecular Medicine, Nicosia, Cyprus.
| | - Kyriacos Kyriacou
- Department of Electron Microscopy and Molecular Pathology, Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus; Cyprus School of Molecular Medicine, Nicosia, Cyprus.
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