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Do Patients with Bronchiectasis Have an Increased Risk of Developing Lung Cancer? A Systematic Review. Life (Basel) 2023; 13:life13020459. [PMID: 36836816 PMCID: PMC9961135 DOI: 10.3390/life13020459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/23/2023] [Accepted: 01/31/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Initial evidence supports the hypothesis that patients with non-cystic fibrosis bronchiectasis (NCFB) have a higher risk of lung cancer. We systematically reviewed the available literature to define the characteristics of lung malignancies in patients with bronchiectasis and the characteristics of patients who develop bronchiectasis-associated lung cancer. METHOD This study was performed based on the PRISMA guidelines. The review protocol was registered in PROSPERO. RESULTS The frequency rates of lung cancer in patients with NCFB ranged from 0.93% to 8.0%. The incidence rate was 3.96. Cancer more frequently occurred in the elderly and males. Three studies found an overall higher risk of developing lung cancer in the NCFB population compared to the non-bronchiectasis one, and adenocarcinoma was the most frequently reported histological type. The effect of the co-existence of NCFB and COPD was unclear. CONCLUSIONS NCFB is associated with a higher risk of developing lung cancer than individuals without NCFB. This risk is higher for males, the elderly, and smokers, whereas concomitant COPD's effect is unclear.
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Fernández-Barat L, Vázquez Burgos N, Alcaraz V, Bueno-Freire L, López-Aladid R, Cabrera R, Gabarrús A, Palomeque A, Oscanoa P, Ceccato A, Motos A, Amaro R, Bernardi T, Provot C, Soler-Comas A, Muñoz L, Vila J, Torres A. The value of biofilm testing to guide antimicrobial stewardship in chronic respiratory diseases. Front Cell Infect Microbiol 2023; 13:1142274. [PMID: 37201119 PMCID: PMC10187140 DOI: 10.3389/fcimb.2023.1142274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/04/2023] [Indexed: 05/20/2023] Open
Abstract
Introduction Biofilm production is an important yet currently overlooked aspect of diagnostic microbiology that has implications for antimicrobial stewardship. In this study, we aimed to validate and identify additional applications of the BioFilm Ring Test® (BRT) for Pseudomonas aeruginosa (PA) isolates from patients with bronchiectasis (BE). Materials and methods Sputa were collected from BE patients who had at least one PA positive culture in the previous year. We processed the sputa to isolate both mucoid and non-mucoid PA, and determined their susceptibility pattern, mucA gene status, and presence of ciprofloxacin mutations in QRDR genes. The Biofilm production index (BPI) was obtained at 5 and 24 hours. Biofilms were imaged using Gram staining. Results We collected 69 PA isolates, including 33 mucoid and 36 non-mucoid. A BPI value below 14.75 at 5 hours predicted the mucoid PA phenotype with 64% sensitivity and 72% specificity. Conclusion Overall, our findings suggest that the fitness-cost associated with the mucoid phenotype or ciprofloxacin resistance is shown through a time-dependent BPI profile. The BRT has the potential to reveal biofilm features with clinical implications.
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Affiliation(s)
- Laia Fernández-Barat
- Cellex Laboratory, CibeRes (CB06/06/0028)-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
- Pneumology Service, Respiratory Institute, Hospital Clinic, Barcelona, Spain
- *Correspondence: Laia Fernández-Barat, ; Antoni Torres,
| | - Nil Vázquez Burgos
- Cellex Laboratory, CibeRes (CB06/06/0028)-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
- Pneumology Service, Respiratory Institute, Hospital Clinic, Barcelona, Spain
| | - Victoria Alcaraz
- Cellex Laboratory, CibeRes (CB06/06/0028)-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
- Pneumology Service, Respiratory Institute, Hospital Clinic, Barcelona, Spain
| | - Leticia Bueno-Freire
- Cellex Laboratory, CibeRes (CB06/06/0028)-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
- Pneumology Service, Respiratory Institute, Hospital Clinic, Barcelona, Spain
| | - Ruben López-Aladid
- Cellex Laboratory, CibeRes (CB06/06/0028)-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
- Pneumology Service, Respiratory Institute, Hospital Clinic, Barcelona, Spain
| | - Roberto Cabrera
- Cellex Laboratory, CibeRes (CB06/06/0028)-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
- Pneumology Service, Respiratory Institute, Hospital Clinic, Barcelona, Spain
| | - Albert Gabarrús
- Cellex Laboratory, CibeRes (CB06/06/0028)-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
- Pneumology Service, Respiratory Institute, Hospital Clinic, Barcelona, Spain
| | - Andrea Palomeque
- Cellex Laboratory, CibeRes (CB06/06/0028)-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
- Pneumology Service, Respiratory Institute, Hospital Clinic, Barcelona, Spain
| | - Patricia Oscanoa
- Cellex Laboratory, CibeRes (CB06/06/0028)-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
- Pneumology Service, Respiratory Institute, Hospital Clinic, Barcelona, Spain
| | - Adrian Ceccato
- Cellex Laboratory, CibeRes (CB06/06/0028)-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
- Pneumology Service, Respiratory Institute, Hospital Clinic, Barcelona, Spain
| | - Ana Motos
- Cellex Laboratory, CibeRes (CB06/06/0028)-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
- Pneumology Service, Respiratory Institute, Hospital Clinic, Barcelona, Spain
| | - Rosanel Amaro
- Cellex Laboratory, CibeRes (CB06/06/0028)-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
- Pneumology Service, Respiratory Institute, Hospital Clinic, Barcelona, Spain
| | - Thierry Bernardi
- BioFilm Pharma SAS, Lyon, France
- BioFilm Control SAS, Saint Beauzire, France
| | - Christian Provot
- BioFilm Pharma SAS, Lyon, France
- BioFilm Control SAS, Saint Beauzire, France
| | - Alba Soler-Comas
- Cellex Laboratory, CibeRes (CB06/06/0028)-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
- Pneumology Service, Respiratory Institute, Hospital Clinic, Barcelona, Spain
| | - Laura Muñoz
- Microbiology Service, Hospital Clinic, Barcelona, Spain
| | - Jordi Vila
- Microbiology Service, Hospital Clinic, Barcelona, Spain
| | - Antoni Torres
- Cellex Laboratory, CibeRes (CB06/06/0028)-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
- Pneumology Service, Respiratory Institute, Hospital Clinic, Barcelona, Spain
- *Correspondence: Laia Fernández-Barat, ; Antoni Torres,
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Deghdegh K, Boukadoum N, Terra B, Amoura K, Benali R. Characteristics of Bronchiectasis Associated with Chronic Obstructive Pulmonary Disease. Open Respir Med J 2022; 16:e187430642203311. [PMID: 37273954 PMCID: PMC10156028 DOI: 10.2174/18743064-v16-e2203311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/08/2021] [Accepted: 01/17/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction An association between chronic Obstructive Pulmonary Disease (COPD) and bronchiectasis has been observed. However, the incidence of this association is variable. The current use of high-resolution Chest Thoracic (CT) scans in patients with COPD has contributed to its demonstration. It is comorbidity or even an overlap syndrome. The aim of this study is to determine the characteristics of bronchiectasis in patients with COPD at the Annaba University Hospital in Algeria. Subjects and Methods We prospectively included patients hospitalized at the Annaba University Hospital in Algeria between 1st January, 2013 to 31st December, 2015. All patients were hospitalized for an exacerbation of COPD. One hundred and twelve patients (108 men and 04 women) were enrolled in this study. These patients were classified into two groups: G1 (COPD without bronchiectasis) and G2 (COPD with bronchiectasis). The parameters considered for both the groups were the length of hospitalization, comorbidities as per the Charlson index, number of exacerbations in the previous year, quality of life assessed by the Saint Georges questionnaire, a spirométrie, and C. reactive protein (CRP). The diagnosis of exacerbation, bronchiectasis, and COPD was made. The data collected were statistically analyzed using SPSS/version 16. Parametric data were expressed as mean ± SD, and non-parametric data were expressed as the number and percentage of the total. In all tests, a p-value <0.05 was considered significant. Multivariate logistic regression analysis was performed for statistically significant variables. Results and Discussion One hundred and twelve patients (108 men and 04 women) were included in the study. The demographic characteristics of the patients were: age (69.49 years ± 8.15), smoking (53.21 ± 48 p/y), and FEV1(42.55 ± 18.90 l/s). Of the 112 cases included, 21 had COPD associated with bronchiectasis (18.75%). This bronchiectasis was of cylindrical type in the majority of patients, i.e., 17 (80.95%), saccular in 03 cases (14.28%), and mixed in only one case (04.77%). Lesions were bilateral in 16 patients (76.19%) and unilateral in 05 patients (23.81%). FEV1 in the COPD group associated with bronchiectasis was more severe (48.7 ± 6 l/s vs. 40.2 ± 3 l/s) (OR=4.3187; 95% C.I =2.6301 - 6.8740; p <0.017). Furthermore, we noted that the length of hospitalization, the exacerbations during the past year, the CRP rate, the total score of the Saint Georges questionnaire, and the sputum purulence were statistically significant variables with an Odds Ratio significant in the COPD bronchiectasis association. Conclusion The diagnosis of bronchiectasis should be more efficient in patients with COPD with a severe respiratory deficit, purulent sputum, accelerated CRP, and deterioration in the quality of life.
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Affiliation(s)
- Khaled Deghdegh
- Department of Pulmonary Diseases, Faculty of Medicine, Badji Mokhtar University, Annaba, Algeria
| | - Nassim Boukadoum
- Department of Radiology, Faculty of Medicine, Badji Mokhtar University, Annaba, Algeria
| | - Besma Terra
- Department of Pulmonary Diseases, Faculty of Medicine, Badji Mokhtar University, Annaba, Algeria
| | - Kamel Amoura
- Central Biology Laboratory, CAC, Faculty of Medicine, Badji Mokhtar University, Annaba, Algeria
| | - Rachid Benali
- Department of Pulmonary Diseases, Faculty of Medicine, Badji Mokhtar University, Annaba, Algeria
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Maturo F, Rambaud SC. On the Use of Propensity Score Matching in Biomedicine and Pulmonology. Arch Bronconeumol 2022; 58:637-639. [DOI: 10.1016/j.arbres.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 11/25/2022]
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Méndez R, Feced L, Alcaraz-Serrano V, González-Jiménez P, Bouzas L, Alonso R, Martínez-Dolz L, Hervás D, Fernández-Barat L, Torres A, Menéndez R. Cardiovascular Events during and after Bronchiectasis Exacerbations and Long-Term Mortality. Chest 2021; 161:629-636. [PMID: 34656526 DOI: 10.1016/j.chest.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Population-based and retrospective studies have shown that risk for cardiovascular events such as arrythmias, ischemic episodes or heart failure, increase during and after bronchiectasis exacerbations. RESEARCH QUESTION What are the risk factors for cardiovascular events (CVE) during and after bronchiectasis exacerbations and its impact on mortality? STUDY DESIGN AND METHODS This was a post-hoc retrospective analysis of a prospective observational study of 250 patients with bronchiectasis at two tertiary care hospitals. Only the first exacerbation was considered for each patient, collecting demographic, comorbidity, and severity data. The main outcomes were the appearance of CVE and mortality. Risk factors for CVE were analyzed using a semi-competing risks model. RESULTS During a median follow-up of 35 months, 74 (29.6%) patients had a CVE and 93 (37.2%) died. Semi-competing risks analysis indicated that age, arterial hypertension, chronic obstructive pulmonary disease, and potentially the severe exacerbations significantly increased the risk for developing CVE. Compared to patients without CVE, those with CVE had higher mortality. INTERPRETATION Demographic factors and comorbidities are risk factors for the development of CVE after an acute exacerbation of bronchiectasis. The appearance of CVE worsens long-term prognosis.
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Affiliation(s)
- Raúl Méndez
- Pneumology Department. La Fe University and Polytechnic Hospital. Valencia, Spain; Respiratory Infections Research Group. Health Research Institute La Fe. Valencia, Spain.
| | - Laura Feced
- Pneumology Department. La Fe University and Polytechnic Hospital. Valencia, Spain; Respiratory Infections Research Group. Health Research Institute La Fe. Valencia, Spain; University of Valencia. Valencia, Spain
| | - Victoria Alcaraz-Serrano
- Pneumology Department. University Hospital Clínic of Barcelona. August Pi i Sunyer Biomedical Research Institute (IDIBAPS). Barcelona, Spain; Center for Biomedical Research Network in Respiratory Diseases (CIBERES). Madrid, Spain
| | - Paula González-Jiménez
- Pneumology Department. La Fe University and Polytechnic Hospital. Valencia, Spain; Respiratory Infections Research Group. Health Research Institute La Fe. Valencia, Spain; University of Valencia. Valencia, Spain
| | - Leyre Bouzas
- Pneumology Department. La Fe University and Polytechnic Hospital. Valencia, Spain; Respiratory Infections Research Group. Health Research Institute La Fe. Valencia, Spain
| | - Ricardo Alonso
- Laboratory Department. La Fe University and Polytechnic Hospital. Valencia, Spain
| | - Luis Martínez-Dolz
- Cardiology Department. La Fe University and Polytechnic Hospital. Health Research Institute La Fe. Valencia, Spain; Center for Biomedical Research Network in Cardiovascular Diseases (CIBERCV). Madrid, Spain
| | - David Hervás
- Data Science, Biostatistics & Bioinformatics. Health Research Institute La Fe. Valencia, Spain; Department of Applied Statistics and Operational Research and Quality. Universitat Politècnica de València. Valencia, Spain
| | - Laia Fernández-Barat
- Pneumology Department. University Hospital Clínic of Barcelona. August Pi i Sunyer Biomedical Research Institute (IDIBAPS). Barcelona, Spain; Center for Biomedical Research Network in Respiratory Diseases (CIBERES). Madrid, Spain
| | - Antoni Torres
- Pneumology Department. University Hospital Clínic of Barcelona. August Pi i Sunyer Biomedical Research Institute (IDIBAPS). Barcelona, Spain; Center for Biomedical Research Network in Respiratory Diseases (CIBERES). Madrid, Spain
| | - Rosario Menéndez
- Pneumology Department. La Fe University and Polytechnic Hospital. Valencia, Spain; Respiratory Infections Research Group. Health Research Institute La Fe. Valencia, Spain; University of Valencia. Valencia, Spain; Center for Biomedical Research Network in Respiratory Diseases (CIBERES). Madrid, Spain
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Traversi L, Miravitlles M, Martinez-Garcia MA, Shteinberg M, Bossios A, Dimakou K, Jacob J, Hurst JR, Paggiaro PL, Ferri S, Hillas G, Vogel-Claussen J, Dettmer S, Aliberti S, Chalmers JD, Polverino E. ROSE: radiology, obstruction, symptoms and exposure - a Delphi consensus definition of the association of COPD and bronchiectasis by the EMBARC Airways Working Group. ERJ Open Res 2021; 7:00399-2021. [PMID: 34820447 PMCID: PMC8607072 DOI: 10.1183/23120541.00399-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/05/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The coexistence of COPD and bronchiectasis seems to be common and associated with a worse prognosis than for either disease individually. However, no definition of this association exists to guide researchers and clinicians. METHODS We conducted a Delphi survey involving expert pulmonologists and radiologists from Europe, Turkey and Israel in order to define the "COPD- [bronchiectasis] BE association".A panel of 16 experts from EMBARC selected 35 statements for the survey after reviewing scientific literature. Invited participants, selected on the basis of expertise, geographical and sex distribution, were asked to express agreement on the statements. Consensus was defined as a score of ≥6 points (scale 0 to 9) in ≥70% of answers across two scoring rounds. RESULTS 102 (72.3%) out of 141 invited experts participated in the first round. Their response rate in the second round was 81%. The final consensus definition of "COPD-BE association" was: "The coexistence of (1) specific radiological findings (abnormal bronchial dilatation, airways visible within 1 cm of pleura and/or lack of tapering sign in ≥1 pulmonary segment and in >1 lobe) with (2) an obstructive pattern on spirometry ([forced expiratory volume in 1 s] FEV1/[forced vital capacity] FVC <0.7), (3) at least two characteristic symptoms (cough, expectoration, dyspnoea, fatigue, frequent infections) and (4) current or past exposure to smoke (≥10 pack-years) or other toxic agents (biomass, etc.)". These criteria form the acronym "ROSE" (Radiology, Obstruction, Symptoms, Exposure). CONCLUSIONS The Delphi process formulated a European consensus definition of "COPD-BE association". We hope this definition will have broad applicability across clinical practice and research in the future.
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Affiliation(s)
- Letizia Traversi
- Dept of Medicine and Surgery, Respiratory Diseases, Università dell'Insubria, Varese-Como, Italy
- Pneumology Dept, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Marc Miravitlles
- Pneumology Dept, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain
- CIBER de Enfermedades Respiratorias, Barcelona, Spain
| | - Miguel Angel Martinez-Garcia
- CIBER de Enfermedades Respiratorias, Barcelona, Spain
- Respiratory Dept, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Michal Shteinberg
- Pulmonology Institute and Cystic Fibrosis Center, Carmel Medical Center, and the Technion – Israel Institute of Technology, the B. Rappaport Faculty of Medicine, Haifa, Israel
| | - Apostolos Bossios
- Dept of Respiratory Medicine and Allergy, Karolinska University Hospital and Dept of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Katerina Dimakou
- 5th Respiratory Department, “SOTIRIA” Hospital for Chest diseases, Athens, Greece
| | - Joseph Jacob
- Centre for Medical Image Computing, University College London, London, UK
- UCL Respiratory, University College London, London, UK
| | - John R. Hurst
- UCL Respiratory, University College London, London, UK
| | - Pier Luigi Paggiaro
- Dept of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Sebastian Ferri
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
- Dept of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Georgios Hillas
- 5th Respiratory Department, “SOTIRIA” Hospital for Chest diseases, Athens, Greece
| | - Jens Vogel-Claussen
- Institute of Diagnostic and Interventional Radiology, German Center for Lung Research, Breath, Hannover Medical School, Hannover, Germany
| | - Sabine Dettmer
- Institute of Diagnostic and Interventional Radiology, German Center for Lung Research, Breath, Hannover Medical School, Hannover, Germany
| | - Stefano Aliberti
- Dept of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - James D. Chalmers
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Eva Polverino
- Pneumology Dept, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain
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Park Y, Yong SH, Leem AY, Kim SY, Lee SH, Chung K, Kim EY, Jung JY, Kang YA, Park MS, Kim YS, Lee SH. Impact of non-cystic fibrosis bronchiectasis on critically ill patients in Korea: a retrospective observational study. Sci Rep 2021; 11:15757. [PMID: 34345008 PMCID: PMC8333349 DOI: 10.1038/s41598-021-95366-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/26/2021] [Indexed: 11/26/2022] Open
Abstract
This study investigated the impact of bronchiectasis on patients admitted to the intensive care unit (ICU) at a hospital in Korea. Patients with bronchiectasis were diagnosed using results of chest computed tomography performed before ICU admission. The severity of bronchiectasis was based on the number of affected lobes, and patients with ≥ 3 bronchiectatic lobes were classified into the severe bronchiectasis group. Overall, 823 patients were enrolled. The mean age was 66.0 ± 13.9 years, and 63.4% were men. Bronchiectasis and severe bronchiectasis were present in 148 (18.0%) and 108 (13.1%) patients, respectively. The increase in the number of bronchiectatic lobes was related to the rise in ICU mortality (P for trend = 0.012) and in-hospital mortality (P for trend = 0.004). Patients with severe bronchiectasis had higher odds for 28-day mortality [odds ratio (OR) 1.122, 95% confidence interval (CI) 1.024–1.230], ICU mortality (OR 1.119, 95% CI 1.023–1.223), and in-hospital mortality (OR 1.208, 95% CI 1.092–1.337). The severe bronchiectasis group showed lower overall survival (log-rank P < 0.001), and the adjusted hazard ratio was 1.535 (95% CI 1.178–2.001). Severe bronchiectasis had a negative impact on all-cause mortality during ICU and hospital stays, resulting in a lower survival rate.
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Affiliation(s)
- Youngmok Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Seung Hyun Yong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Ah Young Leem
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Song Yee Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Sang Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyungsoo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Eun Young Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Ji Ye Jung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Young Ae Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Moo Suk Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Young Sam Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Su Hwan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Detailleur S, Vos R, Goeminne P. The Deteriorating Patient: Therapies Including Lung Transplantation. Semin Respir Crit Care Med 2021; 42:623-638. [PMID: 34261186 DOI: 10.1055/s-0041-1730946] [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
In this review paper, we discuss the characteristics that define severe bronchiectasis and which may lead to deterioration of noncystic fibrosis bronchiectasis. These characteristics were used to establish the current severity scores: bronchiectasis severity index (BSI), FACED, and E-FACED (exacerbation frequency, forced expiratory volume in 1 second, age, colonization, extension and dyspnea score). They can be used to predict mortality, exacerbation rate, hospital admission, and quality of life. Furthermore, there are different treatable traits that contribute to severe bronchiectasis and clinical deterioration. When present, they can be a target of the treatment to stabilize bronchiectasis.One of the first steps in treatment management of bronchiectasis is evaluation of compliance to already prescribed therapy. Several factors can contribute to treatment adherence, but to date no real interventions have been published to ameliorate this phenomenon. In the second step, treatment in deteriorating patients with bronchiectasis should be guided by the predominant symptoms, for example, cough, sputum, difficulty expectoration, exacerbation rate, or physical impairment. In the third step, we evaluate treatable traits that could influence disease severity in the deteriorating patient. Finally, in patients who are difficult to treat despite maximum medical treatment, eligibility for surgery (when disease is localized), should be considered. In case of end-stage disease, the evaluation for lung transplantation should be performed. Noninvasive ventilation can serve as a bridge to lung transplantation in patients with respiratory failure.
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Affiliation(s)
- Stephanie Detailleur
- Department of Respiratory Diseases, University Hospital Gasthuisberg, Leuven, Belgium
| | - Robin Vos
- Department of Respiratory Diseases, University Hospital Gasthuisberg, Leuven, Belgium
| | - Pieter Goeminne
- Department of Respiratory Diseases, AZ Nikolaas, Sint-Niklaas, Belgium
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Saad AB, Migaou A, Mhamed SC, Fahem N, Rouatbi N, Joobeur S. [Bronchial dilatations in patients with chronic obstructive pulmonary disease in a Tunisian center: effect on disease progression and prognosis]. Pan Afr Med J 2020; 37:200. [PMID: 33505569 PMCID: PMC7813652 DOI: 10.11604/pamj.2020.37.200.24448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/12/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION bronchial dilations (BDs) seem to have a major role in the natural history of chronic obstructive pulmonary disease (COPD). The purpose of our study was to evaluate the impact of BDs on the severity and progression of COPD as well as on patients' prognosis. METHODS we conducted a retrospective, single-center, analytical study over the period 1995- 2017. The study was based on data from the medical records of patients with COPD who had undergone chest CT scan during the follow-up period. We compared two groups (G) of patients: G1: COPD with BDs; G2: COPD without BDs. RESULTS our study included 466 patients with COPD. Among them 101 (21.6%) had BDs associated with COPD. G1 patients had lower maximum expiratory volume in the first second (FEV1) (G1: 1.21 L, G2: 1.37 L, p = 0.015), lower forced vital capacity (FVC) (p = 0.014), a lower PaO2 at steady state (p = 0.049), a higher rate of acute exacerbations (AE) per year (G1: 3.31, G2: 2.44, p = 0.001) and a higher rate of hospitalizations in the Intensive Care Unit per year (p = 0.02). G1 patients with AE receiving treatment in hospital had lower PaO2 3) on admission (G1: 60 mmHg, G2: 63.7 mmHg, p = 0.02 G2: 63.7 mmHg, p = 0.023), more elevated carbon dioxide (CO2) levels (p = 0.001) and were characterized by a higher use of non-invasive ventilation (NIV) (p = 0.044) and invasive mechanical ventilation (p = 0.011). G2 patients had better overall survival (p = 0.002). CONCLUSION bronchial dilatations are an indicator of poor prognosis in patients with chronic obstructive pulmonary disease, expecially because of the higher rate and severity of exacerbations, airway obstructions and mortality.
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Affiliation(s)
- Ahmed Ben Saad
- Service de Pneumologie et d´Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, 5000 Monastir, Monastir, Tunisie
| | - Asma Migaou
- Service de Pneumologie et d´Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, 5000 Monastir, Monastir, Tunisie
| | - Saousen Cheikh Mhamed
- Service de Pneumologie et d´Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, 5000 Monastir, Monastir, Tunisie
| | - Nesrine Fahem
- Service de Pneumologie et d´Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, 5000 Monastir, Monastir, Tunisie
| | - Naceur Rouatbi
- Service de Pneumologie et d´Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, 5000 Monastir, Monastir, Tunisie
| | - Samah Joobeur
- Service de Pneumologie et d´Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, 5000 Monastir, Monastir, Tunisie
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10
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Consensus document on the diagnosis and treatment of chronic bronchial infection in chronic obstructive pulmonary disease. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.arbr.2020.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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11
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de la Rosa Carrillo D, López-Campos JL, Alcázar Navarrete B, Calle Rubio M, Cantón Moreno R, García-Rivero JL, Máiz Carro L, Olveira Fuster C, Martínez-García MÁ. Consensus Document on the Diagnosis and Treatment of Chronic Bronchial Infection in Chronic Obstructive Pulmonary Disease. Arch Bronconeumol 2020; 56:651-664. [PMID: 32540279 DOI: 10.1016/j.arbres.2020.04.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/22/2020] [Accepted: 04/01/2020] [Indexed: 02/07/2023]
Abstract
Although the chronic presence of microorganisms in the airways of patients with stable chronic obstructive pulmonary disease (COPD) confers a poor outcome, no recommendations have been established in disease management guidelines on how to diagnose and treat these cases. In order to guide professionals, the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) has prepared a document which aims to answer questions on the clinical management of COPD patients in whom microorganisms are occasionally or habitually isolated. Since the available scientific evidence is too heterogeneous to use in the creation of a clinical practice guideline, we have drawn up a document based on existing scientific literature and clinical experience, addressing the definition of different clinical situations and their diagnosis and management. The text was drawn up by consensus and approved by a large group of respiratory medicine experts with extensive clinical and scientific experience in the field, and has been endorsed by the SEPAR Scientific Committee.
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Affiliation(s)
| | - José Luís López-Campos
- Servicio de Neumología, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
| | - Bernardino Alcázar Navarrete
- Servicio de Neumología, Hospital Regional Universitario de Málaga. Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, España
| | - Myriam Calle Rubio
- Servicio de Neumología, Hospital de Alta Resolución de Loja, Loja, Granada, España
| | - Rafael Cantón Moreno
- Servicio de Neumología, Unidad de Infección Bronquial Crónica, Fibrosis Quística y Bronquiectasias, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Juan Luis García-Rivero
- Servicio de Neumología, Hospital Clínico San Carlos. Departamento de Medicina, Facultad de Medicina, UCM, Madrid, España
| | - Luís Máiz Carro
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España
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12
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Ielpo A, Crisafulli E, Alcaraz-Serrano V, Gabarrús A, Oscanoa P, Scioscia G, Fernandez-Barat L, Cilloniz C, Amaro R, Torres A. Aetiological diagnosis in new adult outpatients with bronchiectasis:role of predictors derived from real life experience. Respir Med 2020; 172:106090. [PMID: 32916445 DOI: 10.1016/j.rmed.2020.106090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In adult patients with bronchiectasis (BE) the identification of the underlying aetiology may be difficult. In a new patient with BE the performance of a panel of tests is recommended, even though this practice may be expensive and the level of evidence supporting is low. We aimed to identify a panel of variables able to predict the aetiological diagnosis of BE. METHODS Our prospective study derived from our real-life experience on the management of adult stable BE outpatients. We recorded variables concerning clinical, radiological, microbiological and laboratory features. We identified five groups of aetiological diagnosis of BE (idiopathic, post-infective, COPD, asthma and non-common diseases [immunodeficiency or other rare conditions]). Multivariate models were used to identify predictors of each aetiological diagnosis. The suitability of performing a specific test for the diagnosis was also considered. RESULTS We enrolled 354 patients with a new diagnosis of BE. Patients with different aetiological causes differed significantly with regard to age, sex, smoking habit, comorbidities, dyspnoea perception, airflow obstruction and severity scores. Various predictors were assessed, including sex, previous respiratory infections, diffuse localization of BE, risk scores, and laboratory variables (sodium and eosinophils). The levels of autoantibodies or immunoglobulins were reserved for the diagnosis of non-common disease. CONCLUSION Our research confirms that some predictors are specific for the aetiological diagnosis of BE. The possibility of integrating this information may represent a useful tool for the diagnosis. The execution of certain specific tests should be reserved for patients with a non-common disease.
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Affiliation(s)
- Antonella Ielpo
- Pulmonary Division and Pulmonary Rehabilitation Unit, Villa Pineta Hospital, Pavullo, Modena, Italy.
| | - Ernesto Crisafulli
- Department of Medicine, Respiratory Medicine Unit and Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
| | - Victoria Alcaraz-Serrano
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Albert Gabarrús
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Patricia Oscanoa
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Giulia Scioscia
- Department of Medicine and Surgery Science, University of Foggia, Italy.
| | - Laia Fernandez-Barat
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Catia Cilloniz
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Rosanel Amaro
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Antoni Torres
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
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13
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Crisafulli E, Manco A, Ferrer M, Huerta A, Micheletto C, Girelli D, Clini E, Torres A. Pneumonic versus Nonpneumonic Exacerbations of Chronic Obstructive Pulmonary Disease. Semin Respir Crit Care Med 2020; 41:817-829. [PMID: 32726837 DOI: 10.1055/s-0040-1702196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) often suffer acute exacerbations (AECOPD) and community-acquired pneumonia (CAP), named nonpneumonic and pneumonic exacerbations of COPD, respectively. Abnormal host defense mechanisms may play a role in the specificity of the systemic inflammatory response. Given the association of this aspect to some biomarkers at admission (e.g., C-reactive protein), it can be used to help to discriminate AECOPD and CAP, especially in cases with doubtful infiltrates and advanced lung impairment. Fever, sputum purulence, chills, and pleuritic pain are typical clinical features of CAP in a patient with COPD, whereas isolated dyspnea at admission has been reported to predict AECOPD. Although CAP may have a worse outcome in terms of mortality (in hospital and short term), length of hospitalization, and early readmission rates, this has only been confirmed in a few prospective studies. There is a lack of methodologically sound research confirming the impact of severe AECOPD and COPD + CAP. Here, we review studies reporting head-to-head comparisons between AECOPD and CAP + COPD in hospitalized patients. We focus on the epidemiology, risk factors, systemic inflammatory response, clinical and microbiological characteristics, outcomes, and treatment approaches. Finally, we briefly discuss some proposals on how we should orient research in the future.
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Affiliation(s)
- Ernesto Crisafulli
- Department of Medicine, Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.,Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Alessandra Manco
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Miquel Ferrer
- Department of Pneumology, Respiratory Institute, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERES (CB06/06/0028), University of Barcelona, Barcelona, Spain
| | - Arturo Huerta
- Department of Pneumology, Respiratory Institute, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERES (CB06/06/0028), University of Barcelona, Barcelona, Spain
| | - Claudio Micheletto
- Department of Cardiovascular and Thoracic, Pneumology Unit, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Domenico Girelli
- Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Enrico Clini
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia and University Hospital of Modena Policlinico, Modena, Italy
| | - Antoni Torres
- Department of Pneumology, Respiratory Institute, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERES (CB06/06/0028), University of Barcelona, Barcelona, Spain
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Doña E, Olveira C, Padilla-Galo A. Las bronquiectasias en el reino de la vía aérea. Enfermedad pulmonar obstructiva crónica y asma. Nuevos datos. OPEN RESPIRATORY ARCHIVES 2020. [DOI: 10.1016/j.opresp.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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15
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Sahin H, Naz I, Susam S, Erbaycu AE, Olcay S. The effect of the presence and severity of bronchiectasis on the respiratory functions, exercise capacity, dyspnea perception, and quality of life in patients with chronic obstructive pulmonary disease. Ann Thorac Med 2020; 15:26-32. [PMID: 32002044 PMCID: PMC6967141 DOI: 10.4103/atm.atm_198_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/17/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND: Bronchiectasis is common in patients with advanced chronic obstructive pulmonary disease (COPD) and adversely affects the patients' clinical condition. This study aimed to investigate the effects of bronchiectasis on exercise capacity, dyspnea perception, disease-specific quality of life, and psychological status in patients with COPD and determine the extent of these adverse effects by the severity of bronchiectasis. METHODS: A total of 387 COPD patients (245 patients with only COPD [Group 1] and 142 COPD patients with accompanying bronchiectasis [Group 2]) were included in the study. The patients in Group 2 were divided into three subgroups as mild, moderate, and severe using the Bronchiectasis Severity Index. Six-minute walk distance, dyspnea perception, St. George's Respiratory Questionnaire (SGRQ), and hospital anxiety and depression scores were compared between the groups. RESULTS: In Group 2, dyspnea perception, SGRQ total scores, depression score were higher, and walking distance was lower (P = 0.001, P = 0.007, P = 0.001, and P = 0.011, respectively). Group 2 had significantly worse arterial blood gas values. Dyspnea perception increased with the increasing severity in Group 2 (P < 0.001). Walking distance was lower in patients with severe bronchiectasis (P < 0.001). SGRQ total score, anxiety, and depression scores were significantly higher in the severe subgroup (P < 0.001, P = 0.003, and P = 0.002, respectively). CONCLUSIONS: In patients with Stage 3 and 4 COPD, the presence of bronchiectasis adversely affects the clinical status of the patients, decreases their exercise capacity, deteriorates their quality of life, and disrupts their psychological status. Investigating the presence of bronchiectasis in COPD patients is crucial for early diagnosis and proper treatment.
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Affiliation(s)
- Hulya Sahin
- Pulmonary Rehabilitation Unit, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
| | - Ilknur Naz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Katip Celebi University, Izmir, Turkey
| | - Seher Susam
- Department of Radiology, Radiology Unit, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
| | - Ahmet Emin Erbaycu
- Department of Chest Diseases, Radiology Unit, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
| | - Serhan Olcay
- Department of Chest Diseases, Burdur State Hospital, Burdur, Turkey
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Crisafulli E, Torres A. Hospitalized acute exacerbations of chronic obstructive pulmonary disease: which patients may have a negative clinical outcome? Expert Rev Respir Med 2019; 13:691-693. [DOI: 10.1080/17476348.2019.1635459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Ernesto Crisafulli
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Antoni Torres
- Pneumology Department, Clinic Thorax Institute, Hospital Clinic of Barcelona - Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, CIBERES, Barcelona, Spain
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