1
|
EVALUATING THE EFFICACY OF HUMAN BRONCHIECTASISBASED ANTIBIOTIC THERAPY IN THE TREATMENT OF ORANGUTAN RESPIRATORY DISEASE SYNDROME. J Zoo Wildl Med 2022; 52:1205-1216. [PMID: 34998290 DOI: 10.1638/2020-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/21/2022] Open
Abstract
Unique among apes, orangutans (Pongo spp.) develop a chronic respiratory disease called orangutan respiratory disease syndrome (ORDS). The authors define ORDS as intermittent bacterial infection and chronic inflammation of any region or combination of regions of the respiratory tract, including the sinuses, air sacs, cranial bones, airways, and lung parenchyma. Infection in any of these areas can present acutely but then becomes recurrent, chronic, progressive, and ultimately fatal. The closest model to this disease is cystic fibrosis (CF) in people. We hypothesized that use of a 4-8-wk course of combined oral antibiotics used in the treatment of bronchiectasis in CF patients would lead to prolonged symptomatic and computed tomography (CT) scan improvement in orangutans experiencing early signs of ORDS. Nine adult Bornean orangutans (Pongo pygmaeus, eight males, one female, 18-29 yr of age) diagnosed with early ORDS-like respiratory disease underwent CT scan before initiation of treatment. Each animal received a combined course of azithromycin (400 mg 3/wk, mean 7 mg/kg) and levofloxacin (500 mg PO q24h, mean 8.75 mg/kg) for a period of 4-8 wk. CT scan was repeated 6-14 mon after completion of antibiotic treatment. Pretreatment CT showed that six of nine animals had lower respiratory pathology (airway disease, pneumonia, or both). All six orangutans had concurrent sinusitis, mastoiditis, airsacculitis, or a combination of these conditions. Upper respiratory disease alone was observed in three animals. CT showed improvement or resolution in four of five sinusitis cases, improvement in one of two instances of mastoiditis, resolution in five of six instances of airsacculitis, improvement or resolution in six of six instance of lower airway disease (P = 0.03, 95% CI 0.54-1.0], and resolution in five of five cases of pneumonia. Resolution of pretreatment clinical signs was observed in all nine animals. Two developed signs not present at pretreatment. These results show that combination antibiotic therapy with azithromycin and levofloxacin provides improvement in clinical signs and CT evidence of ORDS-related pathology, resulting in symptom-free status in some animals for up to 33 mon.
Collapse
|
2
|
Singh P, Katoch CDS, Vardhan V, Chopra M, Singh S, Ahuja N. Functional impairment in bronchiectasis: Spirometry parameters versus St. George's Respiratory Questionnaire scores: Any co-relation? Lung India 2021; 38:545-551. [PMID: 34747737 PMCID: PMC8614608 DOI: 10.4103/lungindia.lungindia_707_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/11/2020] [Accepted: 07/10/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Bronchiectasis is a common respiratory disease which has significant morbidity and mortality. Health-related quality of life scores are not routinely used for the assessment of bronchiectasis. The present study was undertaken with an aim to assess the clinical profile and functional impairment using spirometry in patients with bronchiectasis and to co-relate functional impairment with their St. George's Respiratory Questionnaire (SGRQ) score. METHODOLOGY This was a cross-sectional study carried out on 102 patients of bronchiectasis. All patients were assessed for clinical profile, spirometry, and SGRQ scores. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC were measured and compared with SGRQ scores. Data analysis was done using SPSS version 20.0 and MS-Excel. RESULTS Obstruction was found in 62.7% and significant bronchodilator reversibility was observed in 30.4%. All spirometry parameters individually and combined showed a negative co-relation which was stastically significant (P < 0.001). Best co-relation was with FEV1 r = -0.809; symptom score, r = -0.821; activity score, r= -0.849; impact score and r = -0.873 total score. FVC% versus symptoms score r = -0.735; activity score r = -0.729, impacts score r = -0.778; total score r = -0.792. FEV1/FVC versus symptoms score r = -0.227, activity score r = -0.278, impacts score r = -0.263, total score r = -0.274. CONCLUSION SGRQ scores have shown good correlation with functional impairment. It can be used as a modality to evaluate health status of patient in resource constraint settings.
Collapse
Affiliation(s)
- Priyanka Singh
- Department of Pulmonary Medicine, Army Hospital (Research and Referral), New Delhi, India
| | - C. D. S. Katoch
- Department of Pulmonary Medicine, Army Institute of Cardio-Thoracic Sciences, Pune, Maharashtra, India
| | - Vasu Vardhan
- Department of Pulmonary Medicine, Army College of Medical Sciences, New Delhi, India
| | - Manu Chopra
- Department of Pulmonary Medicine, Army Hospital (Research and Referral), New Delhi, India
| | - Sarvinder Singh
- Department of Pulmonary Medicine, Army Hospital (Research and Referral), New Delhi, India
| | - Nitin Ahuja
- Department of Hospital Administration, Army Hospital (Research and Referral), New Delhi, India
| |
Collapse
|
3
|
Schweitzer MD, Salamo O, Campos M, Schraufnagel DE, Sadikot R, Mirsaeidi M. Body habitus in patients with and without bronchiectasis and non-tuberculous mycobacteria. PLoS One 2017; 12:e0185095. [PMID: 28957340 PMCID: PMC5619759 DOI: 10.1371/journal.pone.0185095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/06/2017] [Indexed: 11/18/2022] Open
Abstract
Background Female gender, tall stature, presence of bronchiectasis are associated with pulmonary nontuberculous mycobacterial (NTM) infections. The biologic relationship between the body habitus and NTM infection is not well defined and the body habitus profile of the patients with NTM and concurrent bronchiectasis is completely unknown. Methods We conducted a case control study at the Miami VA Healthcare System and the University of Illinois Medical Center on patients with pulmonary NTM infections between 2010 and 2015. We compared pulmonary NTM subjects with and without bronchiectasis. NTM infection was confirmed by using the American Thoracic Society/ Infectious Disease Society of America criteria. Standard radiological criteria were used to define bronchiectasis in chest CT-scan. Results Two hundred twenty subjects with pulmonary NTM were enrolled in the study. Sixty six subjects (30%) had bronchiectasis on CT scan of the chest. Subjects in the bronchiectasis group included more women (p = 0.002) and were significantly older (p = 0.005). Those patients who had bronchiectasis tended to have a significantly lower weight (less than 50kg) and height ≤155 cm (p <0.0001 and p = 0.018, respectively). Kaplan–Meier analysis confirmed that subjects who had bronchiectasis were shorter and weighed less, after adjusting for gender. Conclusions This study defines a new sub-phenotype of NTM subjects with bronchiectasis who tend to be short with lower body weight. Further studies are needed to better understand and define the body habitus profiles of this new sub-phenotype and their clinical implications.
Collapse
Affiliation(s)
- Michael D. Schweitzer
- Section of Pulmonary, Department of Medicine, Miami VA Medical Center, Miami, FL, United States of America
| | - Oriana Salamo
- Section of Pulmonary, Department of Medicine, Miami VA Medical Center, Miami, FL, United States of America
| | - Michael Campos
- Section of Pulmonary, Department of Medicine, Miami VA Medical Center, Miami, FL, United States of America
- Division of Pulmonary and Critical Care, Department of Medicine, University of Miami, Miami, FL, United States of America
| | - Dean E. Schraufnagel
- Division of Pulmonary and Critical Care, Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Ruxana Sadikot
- Division of Pulmonary and Critical Care, Department of Medicine, University of Emory, Atlanta, GA, United States of America
| | - Mehdi Mirsaeidi
- Section of Pulmonary, Department of Medicine, Miami VA Medical Center, Miami, FL, United States of America
- Division of Pulmonary and Critical Care, Department of Medicine, University of Miami, Miami, FL, United States of America
- * E-mail:
| |
Collapse
|
4
|
Poh TY, Mac Aogáin M, Chan AKW, Yii ACA, Yong VFL, Tiew PY, Koh MS, Chotirmall SH. Understanding COPD-overlap syndromes. Expert Rev Respir Med 2017; 11:285-298. [PMID: 28282995 DOI: 10.1080/17476348.2017.1305895] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease accounts for a large burden of lung disease. It can 'overlap' with other respiratory diseases including bronchiectasis, fibrosis and obstructive sleep apnea (OSA). While COPD alone confers morbidity and mortality, common features with contrasting clinical outcomes can occur in COPD 'overlap syndromes'. Areas covered: Given the large degree of heterogeneity in COPD, individual variation to treatment is adopted based on its observed phenotype, which in turn overlaps with features of other respiratory disease states such as asthma. This is coined asthma-COPD overlap syndrome ('ACOS'). Other examples of such overlapping clinical states include bronchiectasis-COPD ('BCOS'), fibrosis-COPD ('FCOS') and OSA-COPD ('OCOS'). The objective of this review is to highlight similarities and differences between the COPD-overlap syndromes in terms of risk factors, pathophysiology, diagnosis and potential treatment differences. Expert commentary: As a consequence of COPD overlap syndromes, a transition from the traditional 'one size fits all' treatment approach is necessary. Greater treatment stratification according to clinical phenotype using a precision medicine approach is now required. In this light, it is important to recognize and differentiate COPD overlap syndromes as distinct disease states compared to individual diseases such as asthma, COPD, fibrosis or bronchiectasis.
Collapse
Affiliation(s)
- Tuang Yeow Poh
- a Lee Kong Chian School of Medicine, Translational Respiratory Research Laboratory , Nanyang Technological University , Singapore , Singapore
| | - Micheál Mac Aogáin
- a Lee Kong Chian School of Medicine, Translational Respiratory Research Laboratory , Nanyang Technological University , Singapore , Singapore
| | - Adrian Kwok Wai Chan
- b Department of Respiratory & Critical Care Medicine , Singapore General Hospital , Singapore , Singapore
| | - Anthony Chau Ang Yii
- b Department of Respiratory & Critical Care Medicine , Singapore General Hospital , Singapore , Singapore
| | - Valerie Fei Lee Yong
- a Lee Kong Chian School of Medicine, Translational Respiratory Research Laboratory , Nanyang Technological University , Singapore , Singapore
| | - Pei Yee Tiew
- b Department of Respiratory & Critical Care Medicine , Singapore General Hospital , Singapore , Singapore
| | - Mariko Siyue Koh
- b Department of Respiratory & Critical Care Medicine , Singapore General Hospital , Singapore , Singapore
| | - Sanjay Haresh Chotirmall
- a Lee Kong Chian School of Medicine, Translational Respiratory Research Laboratory , Nanyang Technological University , Singapore , Singapore
| |
Collapse
|
5
|
Moore LSP, Cunningham J, Donaldson H. A clinical approach to managingPseudomonas aeruginosainfections. Br J Hosp Med (Lond) 2016; 77:C50-4. [DOI: 10.12968/hmed.2016.77.4.c50] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Luke SP Moore
- Clinical Research Fellow in the NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London W12 0HS
| | - Joel Cunningham
- Core Medical Trainee, Imperial College Healthcare NHS Trust, London
| | - Hugo Donaldson
- Consultant Microbiologist in the Department of Microbiology, Imperial College Healthcare NHS Trust, London
| |
Collapse
|
6
|
Hoppentocht M, Akkerman OW, Hagedoorn P, Alffenaar JWC, van der Werf TS, Kerstjens HAM, Frijlink HW, de Boer AH. Tolerability and Pharmacokinetic Evaluation of Inhaled Dry Powder Tobramycin Free Base in Non-Cystic Fibrosis Bronchiectasis Patients. PLoS One 2016; 11:e0149768. [PMID: 26959239 PMCID: PMC4784940 DOI: 10.1371/journal.pone.0149768] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 02/03/2016] [Indexed: 12/01/2022] Open
Abstract
Rationale Bronchiectasis is a condition characterised by dilated and thick-walled bronchi. The presence of Pseudomonas aeruginosa in bronchiectasis is associated with a higher hospitalisation frequency and a reduced quality of life, requiring frequent and adequate treatment with antibiotics. Objectives To assess local tolerability and the pharmacokinetic parameters of inhaled excipient free dry powder tobramycin as free base administered with the Cyclops dry powder inhaler to participants with non-cystic fibrosis bronchiectasis. The free base and absence of excipients reduces the inhaled powder dose. Methods Eight participants in the study were trained in handling the device and inhaling correctly. During drug administration the inspiratory flow curve was recorded. Local tolerability was assessed by spirometry and recording adverse events. Serum samples were collected before, and 15, 30, 45, 60, 75, 90, 105, 120 min; 4, 8 and 12 h after inhalation. Results and Discussion Dry powder tobramycin base was well tolerated and mild tobramycin-related cough was reported only once. A good drug dose-serum concentration correlation was obtained. Relatively small inhaled volumes were computed from the recorded flow curves, resulting in presumably substantial deposition in the central airways—i.e., at the site of infection. Conclusions In this first study of inhaled dry powder tobramycin free base in non-cystic fibrosis bronchiectasis patients, the free base of tobramycin and the administration with the Cyclops dry powder device were well tolerated. Our data support further clinical studies to evaluate safety and efficacy of this compound in this population.
Collapse
Affiliation(s)
- Marcel Hoppentocht
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, the Netherlands
- * E-mail:
| | - Onno W. Akkerman
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Paul Hagedoorn
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, the Netherlands
| | - Jan-Willem C. Alffenaar
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Tjip S. van der Werf
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Huib A. M. Kerstjens
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Henderik W. Frijlink
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, the Netherlands
| | - Anne H. de Boer
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, the Netherlands
| |
Collapse
|
7
|
Scaglione M, Linsenmaier U, Schueller G, Berger F, Wirth S. Airway Disease. EMERGENCY RADIOLOGY OF THE CHEST AND CARDIOVASCULAR SYSTEM 2016. [PMCID: PMC7119984 DOI: 10.1007/174_2016_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Mariano Scaglione
- Dept of Radiology, Pineta Grande Medical Center, Castel Volturno, Caserta, Italy
| | | | | | - Ferco Berger
- VU University Medical Center, Amsterdam, The Netherlands
| | | |
Collapse
|
8
|
Chu H, Zhao L, Xiao H, Zhang Z, Zhang J, Gui T, Gong S, Xu L, Sun X. Prevalence of nontuberculous mycobacteria in patients with bronchiectasis: a meta-analysis. Arch Med Sci 2014; 10:661-8. [PMID: 25276148 PMCID: PMC4175767 DOI: 10.5114/aoms.2014.44857] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 05/18/2013] [Accepted: 05/24/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Nontuberculous mycobacteria (NTM) have emerged as critical opportunistic pathogens of lung diseases recently. Patients with preexisting bronchiectasis are susceptible to NTM. Nevertheless, patients with preexisting bronchiectasis are susceptible to NTM but the prevalence of NTM pulmonary infection in different species and geographical areas is still not fully understood. MATERIAL AND METHODS The relevant data of the prevalence of NTM in patients with bronchiectasis were retrieved by searching the main databases such as PubMed, MEDLINE, Cochrane Library, and EMBASE. This meta-analysis was performed using Rev. Man 5.1 and Stata 11.0 software. The collected information of NTM prevalence was chosen as the effect size. RESULTS The results of the meta-analysis showed that the overall prevalence of NTM was 9.3% in patients with bronchiectasis. The further stratification of subgroup analysis indicated that the combined prevalence of NTM was higher in studies whose "sample size" was more than or equal to 100 (p = 0.002), in studies in which "time of study" was after or equal to 2002 (p < 0.001), in studies in which "participants' geographic location" was Asian (p < 0.001) and in studies whose "method of study" was retrospective (p = 0.002) as well, compared with corresponding groups. CONCLUSIONS Our findings suggested that the prevalence NTM infection is high in patients with bronchiectasis. A larger number of definitive randomized trials are still required to assess this research issue.
Collapse
Affiliation(s)
- Haiqing Chu
- Department of Respiratory Disease, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lan Zhao
- Department of Respiratory Disease, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Heping Xiao
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhemin Zhang
- Department of Respiratory Disease, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jinbo Zhang
- Department of Respiratory Disease, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tao Gui
- Department of Respiratory Disease, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Sugang Gong
- Department of Respiratory Disease, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Liyun Xu
- Department of Respiratory Disease, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiwen Sun
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
9
|
Feldman C. The Use of Antiinflammatory Therapy and Macrolides in Bronchiectasis. Clin Chest Med 2012; 33:371-80. [DOI: 10.1016/j.ccm.2012.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
10
|
Goeminne PC, Scheers H, Decraene A, Seys S, Dupont LJ. Risk factors for morbidity and death in non-cystic fibrosis bronchiectasis: a retrospective cross-sectional analysis of CT diagnosed bronchiectatic patients. Respir Res 2012; 13:21. [PMID: 22423975 PMCID: PMC3379934 DOI: 10.1186/1465-9921-13-21] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 03/16/2012] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION There is a relative lack of information about the death rate and morbidity of non-cystic fibrosis bronchiectasis and most studies are limited due to referral bias. We wanted to assess death rate and morbidity in those patients at our hospital. METHODS Adult patients seen at our department between June 2006 and November 2009 were recruited if the key string "bronchiect-" was mentioned in electronic clinical records and if chest CT imaging was available. Clinical records of all patients with confirmed radiologic diagnosis of bronchiectasis were reviewed and clinical characteristics were analyzed. RESULTS 539 patients with a radiographic diagnosis of non-cystic fibrosis bronchiectasis were identified in a retrospective cross-sectional analysis giving a prevalence of 2.6% in our hospital population. A wide range of etiologies was found with idiopathic bronchiectasis in 26%. In the 41 months interval, 57 patients (10.6%) died. We found a median exacerbation rate of 1.94 per year. Bacterial colonization status was associated with more deaths, exacerbation rate, symptoms and reduced pulmonary function. Pulmonary hypertension was found in 48% of our patients. CONCLUSIONS We evaluated a large non-cystic fibrosis bronchiectasis population, and provided new epidemiological data on associations between clinical characteristics and deaths and morbidity in these patients.
Collapse
|
11
|
Abstract
Non-cystic fibrosis (CF) bronchiectasis is a common, potentially serious, condition. Further investigations should be performed in an attempt to identify the underlying cause because it may lead to a change in therapy and have significant prognostic implications. MRI is being investigated as a radiation free alternative to high-resolution CT scan of the chest. Many of the treatment recommendations for non-CF bronchiectasis have not been studied in randomized controlled trials but have been extrapolated from the management recommendations for CF. Studies are beginning to inform decisions regarding the management of non-CF bronchiectasis, and an understanding of the best treatment options is beginning to emerge.
Collapse
Affiliation(s)
- Charles Feldman
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Parktown, Johannesburg, South Africa.
| |
Collapse
|
12
|
|
13
|
Permin H. Bronchiectasis--a complex multifactorial disease. THE CLINICAL RESPIRATORY JOURNAL 2009; 3:125. [PMID: 20298394 DOI: 10.1111/j.1752-699x.2009.00148.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|