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Jankovic J, Jandric A, Djurdjevic N, Vukosavljevic D, Bojic Z, Zecevic A, Stjepanovic M. Phenotype and Clinicoradiological Differences in Multifocal and Focal Bronchiectasis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:795. [PMID: 38792978 PMCID: PMC11122736 DOI: 10.3390/medicina60050795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024]
Abstract
Introduction: Bronchiectasis is a chronic progressive respiratory disease characterized by permanent dilatation of the bronchi. It is a complex condition with numerous different etiologies, co-morbidities, and a heterogeneous presentation. As we know, there is a lack of studies that describe the differences and compare the characteristics between focal and multifocal bronchiectasis. The aim of this study is to identify differences in clinical characteristics presentation, severity or distribution in focal and multifocal bronchiectasis, and prognostic implications. Methods: 126 patients with computed tomography (CT)-verified bronchiectasis were enrolled. Baseline characteristics that included age, sex, smoking history, and respiratory symptoms were recorded, with special attention paid to hemoptysis appearance, body mass index, and comorbidities. The type of bronchiectasis determined by CT scan and the modified Reiff scores indicating radiological severity were recorded. Patients were divided in two groups (I is focal and II is multifocal). Results: There were no statistically significant differences in age, smoking status, comorbidity, and BMI between the two groups. Multifocality was associated with a significantly higher proportion of females (p = 0.014), the rate of hemoptysis (p = 0.023), and the number of hospitalizations, but not of exacerbations and prevalence of immunodeficiency (p = 0.049). Significantly, a high number of subjects with multifocality had bronchiectasis of moderate severity, and post-infective and asthma-associated phenotypes were the dominant in this group. Unexpectedly, the cystic and varicose radiological phenotype (which need more time to develop) were more dominant in the focal group. The cylindrical phenotype was equally observed in the multifocal and focal groups. Conclusions: Our study suggests that multifocality is not related to age, number of exacerbations, or radiological phenotype, but it seems to be associated with the clinical post-infective phenotype, immunodeficiency, frequent hospitalizations, and severity. Thus, the presence of multifocal bronchiectasis may act as a biomarker of severity and poor outcomes in these patients.
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Affiliation(s)
- Jelena Jankovic
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (A.J.); (N.D.); (D.V.); (Z.B.); (A.Z.)
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Aleksandar Jandric
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (A.J.); (N.D.); (D.V.); (Z.B.); (A.Z.)
| | - Natasa Djurdjevic
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (A.J.); (N.D.); (D.V.); (Z.B.); (A.Z.)
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Dragan Vukosavljevic
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (A.J.); (N.D.); (D.V.); (Z.B.); (A.Z.)
| | - Zlatan Bojic
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (A.J.); (N.D.); (D.V.); (Z.B.); (A.Z.)
| | - Andrej Zecevic
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (A.J.); (N.D.); (D.V.); (Z.B.); (A.Z.)
| | - Mihailo Stjepanovic
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (A.J.); (N.D.); (D.V.); (Z.B.); (A.Z.)
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
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Seo W, Kim HW, Kim JS, Min J. Long term management of people with post-tuberculosis lung disease. Korean J Intern Med 2024; 39:7-24. [PMID: 38225822 PMCID: PMC10790047 DOI: 10.3904/kjim.2023.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/24/2023] [Accepted: 11/08/2023] [Indexed: 01/17/2024] Open
Abstract
Post-tuberculosis lung disease (PTLD) is emerging as a significant area of global interest. As the number of patients surviving tuberculosis (TB) increases, the subsequent long-term repercussions have drawn increased attention due to their profound clinical and socioeconomic impacts. A primary obstacle to its comprehensive study has been its marked heterogeneity. The disease presents a spectrum of clinical manifestations which encompass tracheobronchial stenosis, bronchiectasis, granulomas with fibrosis, cavitation with associated aspergillosis, chronic pleural diseases, and small airway diseases-all persistent consequences of PTLD. The spectrum of symptoms a patient may experience varies based on the severity of the initial infection and the efficacy of the treatment received. As a result, the long-term management of PTLD necessitates a detailed and specific approach, addressing each manifestation individually-a tailored strategy. In the immediate aftermath (0-12 months after anti-TB chemotherapy), there should be an emphasis on monitoring for relapse, tracheobronchial stenosis, and smoking cessation. Subsequent management should focus on addressing hemoptysis, managing infection including aspergillosis, and TB-associated chronic obstructive pulmonary disease or restrictive lung function. There remains a vast expanse of knowledge to be discovered in PTLD. This review emphasizes the pressing need for comprehensive, consolidated guidelines for management of patients with PTLD.
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Affiliation(s)
- Wan Seo
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Hyung Woo Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Ju Sang Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Jinsoo Min
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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Elhussini MSH, Mohammed AM, Eid HA, Gharib A. Bronchiectasis as co morbidity with COPD or ILD: complex interactions and severe consequences. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2023. [DOI: 10.1186/s43168-023-00192-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Abstract
Background
Bronchiectasis is a chronic pulmonary disease characterized by widened, malformed bronchi, with profuse expectoration and impaired quality of life. COPD and ILD are common co-morbidities with bronchiectasis.
Methods
The present study evaluated the clinical, laboratory& radiological characteristics of COPD and ILD with/without bronchiectasis. A hospital-based, retrospective study was conducted for 1 year.
Results
A total of 101 patients were analyzed, 60 patients had COPD, 34 had ILD and 7 patients had bronchiectasis without COPD or ILD. It was noticed that, out of the analyzed 60 COPD patients, 10 patients developed bronchiectasis (16.7%) versus10 patients of 34 ILD patients (29.4%). In COPD and ILD accompanied by bronchiectasis, the incidence of hemoptysis was significantly higher in comparison to those without bronchiectasis. Moreover, they showed a significant increase in partial pressure of carbon dioxide (PCO2) in comparison to those without bronchiectasis, as well as in comparison to bronchiectasis only. Sputum culture revealed that COPD with bronchiectasis were significantly associated with Staphlococcus aureus (77.8%), more than ILD with Bronchiectasis (33.3%). While S. pneumoniae were more evident in cases of ILD with bronchiectasis (22.2%). The bilateral, peripheral bronchiectasis was more common than the unilateral, central bronchiectasis among cases of COPD with bronchiectasis followed by ILD with bronchiectasis more than bronchiectasis only.
Conclusion
Patients with COPD /ILD with bronchiectasis can be associated with serious clinical manifestations as hemoptysis. Their sputum cultures detected more positive organisms than negative in comparison to cases of bronchiectasis only. Screening of COPD and ILD patients using HRCT Scanning is a recommended preventive measure for early detection of bronchiectasis.
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4
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Zhou Y, Mu W, Zhang J, Wen SW, Pakhale S. Global prevalence of non-tuberculous mycobacteria in adults with non-cystic fibrosis bronchiectasis 2006-2021: a systematic review and meta-analysis. BMJ Open 2022; 12:e055672. [PMID: 35914904 PMCID: PMC9345037 DOI: 10.1136/bmjopen-2021-055672] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To accurately estimate the global prevalence of non-tuberculous mycobacteria (NTM) in adults with non-cystic fibrosis (non-CF) bronchiectasis and to determine the proportion of NTM species and subspecies in clinical patients from 2006 to 2021. DESIGN Systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Medline, Embase, Cochrane Library and Web of Science were searched for articles published between 2006 and 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included all the prospective or retrospective studies without language restrictions and all patients were adults (≥18 years of age) with non-CF bronchiectasis. The studies estimated the effect size of the prevalence of NTM with a sample size ≥40, and patients were registered in and after 2006. DATA EXTRACTION AND SYNTHESIS Two reviewers screened the titles, abstracts and full texts independently. Relevant information was extracted and curated into tables. Risk of bias was evaluated following the Cochrane Collaboration's tool. Meta-analysis was performed with software R Statistics V.3.6.3 using random effect model with 95% CI. I2 index and Q statistics were calculated to assess the heterogeneity, and mixed-effects meta-regression analyses were performed to identify the sources of heterogeneity. The proportions of NTM subspecies were examined using Shapiro-Wilk normality test in R. RESULTS Of all the 2014 studies yielded, 24 met the inclusion criteria. Of these, 14 were identified to be randomised controlled studies and included for an accurate estimation. The global prevalence of NTM in adults with non-CF bronchiectasis from 2006 to 2021 was estimated to be approximately 10%, with great variations primarily due to geographical location. Mycobacterium avium complex was the most common subspecies, followed by Mycobacterium simiae and Mycobacterium gordonae. CONCLUSIONS The prevalence of NTM in adults with non-CF bronchiectasis has been on the rise and the most common subspecies changed greatly in recent years. More cohort studies should be done in many countries and regions for future estimates. PROSPERO REGISTRATION NUMBER CRD42020168473.
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Affiliation(s)
- Yunchun Zhou
- Department of Pulmonary and Critical Care Medicine, People's Hospital of Yuxi City, Yuxi, Yunnan, China
- The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, China
| | - Wei Mu
- Department of Clinical Pharmacology, The Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jihua Zhang
- Department of Pulmonary and Critical Care Medicine, People's Hospital of Yuxi City, Yuxi, Yunnan, China
- The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, China
| | - Shi Wu Wen
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Smita Pakhale
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Respiratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
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5
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Aliberti S, Amati F, Gramegna A, Vigone B, Oriano M, Sotgiu G, Mantero M, Simonetta E, Saderi L, Stainer A, Tammaro S, Marchisio P, Polverino E, Chalmers JD, Blasi F. Comparison of different sets of immunological tests to identify treatable immunodeficiencies in adult bronchiectasis patients. ERJ Open Res 2022; 8:00388-2021. [PMID: 35350277 PMCID: PMC8958217 DOI: 10.1183/23120541.00388-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/27/2021] [Indexed: 11/05/2022] Open
Abstract
Background The reported prevalence of immunodeficiencies in bronchiectasis patients is variable depending on the frequency and extent of immunological tests performed. European Respiratory Society guidelines recommend a minimum bundle of tests. Broadening the spectrum of immunological tests could increase the number of patients diagnosed with an immunodeficiency and those who could receive specific therapy. The primary objective of the present study was to assess the performance of different sets of immunological tests in diagnosing any, primary, secondary or treatable immunodeficiencies in adults with bronchiectasis. Methods An observational, cross-sectional study was conducted at the Bronchiectasis Program of the Policlinico University Hospital in Milan, Italy, from September 2016 to June 2019. Adult outpatients with a clinical and radiological diagnosis of bronchiectasis underwent the same immunological screening during the first visit when clinically stable consisting of: complete blood count; immunoglobulin (Ig) subclass tests for IgA, IgG, IgM and IgG; total IgE; lymphocyte subsets; and HIV antibodies. The primary endpoint was the prevalence of patients with any immunodeficiencies using five different sets of immunological tests. Results A total of 401 bronchiectasis patients underwent the immunological screening. A significantly different prevalence of bronchiectasis patients diagnosed with any, primary or secondary immunodeficiencies was found across different bundles. 44.6% of bronchiectasis patients had a diagnosis of immunodeficiency when IgG subclasses and lymphocyte subsets were added to the minimum bundle suggested by the guidelines. Conclusion A four-fold increase in the diagnosis of immunodeficiencies can be found in adults with bronchiectasis when IgG subclasses and lymphocyte subsets are added to the bundle of tests recommended by guidelines.
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Affiliation(s)
- Stefano Aliberti
- Dept of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Respiratory Unit, Rozzano, Italy.,These authors contributed equally
| | - Francesco Amati
- Dept of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Respiratory Unit, Rozzano, Italy.,These authors contributed equally
| | - Andrea Gramegna
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy.,Dept of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Barbara Vigone
- Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Martina Oriano
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy.,Dept of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Marco Mantero
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy.,Dept of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Edoardo Simonetta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy.,Dept of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Anna Stainer
- Dept of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Respiratory Unit, Rozzano, Italy
| | - Serena Tammaro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy
| | - Paola Marchisio
- Dept of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eva Polverino
- Pneumology Dept, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | | | - Francesco Blasi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy.,Dept of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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6
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Lynch JP, Zhanel GG. Pseudomonas aeruginosa Pneumonia: Evolution of Antimicrobial Resistance and Implications for Therapy. Semin Respir Crit Care Med 2022; 43:191-218. [PMID: 35062038 DOI: 10.1055/s-0041-1740109] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Pseudomonas aeruginosa (PA), a non-lactose-fermenting gram-negative bacillus, is a common cause of nosocomial infections in critically ill or debilitated patients, particularly ventilator-associated pneumonia (VAP), and infections of urinary tract, intra-abdominal, wounds, skin/soft tissue, and bloodstream. PA rarely affects healthy individuals, but may cause serious infections in patients with chronic structural lung disease, comorbidities, advanced age, impaired immune defenses, or with medical devices (e.g., urinary or intravascular catheters, foreign bodies). Treatment of pseudomonal infections is difficult, as PA is intrinsically resistant to multiple antimicrobials, and may acquire new resistance determinants even while on antimicrobial therapy. Mortality associated with pseudomonal VAP or bacteremias is high (> 35%) and optimal therapy is controversial. Over the past three decades, antimicrobial resistance (AMR) among PA has escalated globally, via dissemination of several international multidrug resistant "epidemic" clones. We discuss the importance of PA as a cause of pneumonia including health care-associated pneumonia, hospital-acquired pneumonia, VAP, the emergence of AMR to this pathogen, and approaches to therapy (both empirical and definitive).
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Affiliation(s)
- Joseph P Lynch
- Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California
| | - George G Zhanel
- Department of Medical Microbiology/Infectious Diseases, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
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Zhang K, Zou X, Ma Z, Liu X, Qiu C, Xie L, Lin Z, Li S, Wu Y. Risk Factors Associated with Impairment in Pulmonary Diffusing Capacity among Patients with Noncystic Fibrosis Bronchiectasis. Can Respir J 2022; 2022:8175508. [PMID: 35308822 PMCID: PMC8926517 DOI: 10.1155/2022/8175508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/11/2022] [Indexed: 11/17/2022] Open
Abstract
This study aims to investigate the risk factors associated with impaired pulmonary diffusing capacity among patients with noncystic fibrosis bronchiectasis (NCFB) and compare the predictive value of several scoring systems for the impairment in these patients. Between July 2019 and June 2021, patients who were admitted to the hospital and diagnosed with NCFB were included in this study. Clinical data were collected and analyzed retrospectively. A total of 175 NCFB patients were included in the analysis. Multivariate logistic regression analysis revealed that impaired pulmonary diffusing capacity diagnosed by carbon monoxide diffusing capacity (DLCO) <80% prediction was associated with age, Reiff score, body mass index (BMI), comorbid chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD). Disease duration, frequency of exacerbation, hemoglobin level, and COPD were independent risk factors for impaired pulmonary diffusing capacity diagnosed by DLCO/alveolar volume (VA) <80% prediction. Age, Reiff score, and smoking status were independent risk factors for decreased VA diagnosed by VA <80% prediction. The areas under the curve (AUC) for discrimination of DLCO <80% prediction were 0.822 (0.760-0.885) for Bronchiectasis Severity Index (BSI), 0.787 (0.718-0.856) for FACED, 0.795 (0.729-0.863) for E-FACED, and 0.767 (0.694-0.839) for modified Medical Research Council (mMRC) scores; the AUC for discrimination of DLCO/VA <80% prediction was 0.803 (0.727-0.880) for BSI, 0.752 (0.669-0.835) for FACED, 0.757 (0.676-0.839) for E-FACED, and 0.762 (0.679-0.845) for mMRC, respectively. The BSI had the largest AUC, but the differences between those scoring systems had no statistical significance (P=0.181 for DLCO <80% prediction and P=0.105 for DLCO/VA <80% prediction). The mMRC score (up to 2 grades) showed a high specificity for discriminating diffusing dysfunction (88.3% for DLCO <80% prediction and 76.1% for DLCO/VA <80% prediction). In NCFB patients, several factors such as age, Reiff score, BMI, exacerbation frequency, disease duration, and comorbid COPD and ILD were associated with impaired pulmonary diffusing capacity, which requires more attention in managing those patients. In addition, several scoring methods, including a simple index of mMRC, showed a comparable and moderate performance for predicting pulmonary diffusing impairment and would facilitate the systematic evaluation of the diffusing capacity of NCFB patients.
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Affiliation(s)
- Kaijun Zhang
- Department of Pulmonary and Critical Care Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Xin Zou
- Department of Pulmonary and Critical Care Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Zhiyi Ma
- Department of Pulmonary and Critical Care Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Xiaohong Liu
- Department of Pulmonary and Critical Care Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Chencheng Qiu
- Department of Respiratory Medicine, Shanghang County Hospital, Longyan 364200, China
| | - Lingyan Xie
- Department of Pulmonary and Critical Care Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Zhaosheng Lin
- Department of Pulmonary and Critical Care Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Saiyu Li
- Department of Pulmonary and Critical Care Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Yongming Wu
- Department of Pulmonary and Critical Care Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
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8
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Lim RK, Tremblay A, Lu S, Somayaji R. Evaluating hemoptysis hospitalizations among patients with bronchiectasis in the United States: a population-based cohort study. BMC Pulm Med 2021; 21:392. [PMID: 34852812 PMCID: PMC8638373 DOI: 10.1186/s12890-021-01762-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 11/19/2021] [Indexed: 12/04/2022] Open
Abstract
Background The burden of hospitalizations and mortality for hemoptysis due to bronchiectasis is not well characterized. The primary outcome of our study was to evaluate in-hospital mortality in patients admitted with hemoptysis and bronchiectasis, as well as the rates of bronchial artery embolization, length of stay, and hospitalization costs. Methods The authors queried the Nationwide Inpatient Sample (NIS) claims database for hospitalizations between 2016 and 2017 using the ICD-10-CM codes for hemoptysis and bronchiectasis in the United States. Multivariable regression was used to evaluate predictors of in-hospital mortality, embolization, length of stay, and hospital costs. Results There were 8240 hospitalizations (weighted) for hemoptysis in the United States from 2016 to 2017. The overall in-hospital mortality was 4.5%, but higher in males compared to females. Predictors of in-hospital mortality included undergoing three or more procedures, age, and congestive heart failure. Bronchial artery embolization (BAE) was utilized during 2.1% of hospitalizations and was more frequently used in those with nontuberculous mycobacteria and aspergillus infections, but not pseudomonal infections. The mean length of stay was 6 days and the median hospitalization cost per patient was USD $9,610. Having comorbidities and procedures was significantly associated with increased length of stay and costs. Conclusion Hemoptysis is a frequent indication for hospitalization among the bronchiectasis population. In-hospital death occurred in approximately 4.5% of hospitalizations. The effectiveness of BAE in treating and preventing recurrent hemoptysis from bronchiectasis needs to be explored.
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Affiliation(s)
- Rachel K Lim
- Department of Medicine, University of Calgary, Calgary, Canada. .,Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Alain Tremblay
- Department of Medicine, University of Calgary, Calgary, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Shengjie Lu
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ranjani Somayaji
- Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Microbiology, Immunology and Infectious Disease, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada
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9
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Zhu YN, Xie JQ, He XW, Peng B, Wang CC, Zhang GJ, Xu JF, Gao YH. Prevalence and Clinical Characteristics of Nontuberculous Mycobacteria in Patients with Bronchiectasis: A Systematic Review and Meta-Analysis. Respiration 2021; 100:1218-1229. [PMID: 34515207 DOI: 10.1159/000518328] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/20/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although international bronchiectasis guidelines recommended screening of nontuberculous mycobacteria (NTM) both at initial evaluation and prior to administration of macrolide treatment, data regarding NTM in bronchiectasis remain elusive. OBJECTIVE To establish the prevalence, species, and clinical features of NTM in adults with bronchiectasis. METHODS We searched PubMed, Embase, and Web of Science for studies published before April 2020 reporting the prevalence of NTM in adults with bronchiectasis. We only included studies with bronchiectasis confirmed by computed tomography and NTM identified by mycobacteria culture or molecular methods. Random-effects meta-analysis was employed. RESULTS Of the 2,229 citations identified, 21 studies, including 12,454 bronchiectasis patients were included in the final meta-analysis. The overall pooled prevalence of NTM isolation and pulmonary NTM disease were 7.7% (5.0%-11.7%) (n/N = 2,677/12,454) and 4.1% (1.4%-11.4%) (n/N = 30/559), respectively, with significant heterogeneity (I2 = 97.7%, p < 0.001 and I2 = 79.9%, p = 0.007; respectively). The prevalence of NTM isolation varied significantly among different geographical regions with the highest isolation at 50.0% (47.3%-52.7%) reported in the United States. Mycobacterium avium complex and Mycobacterium abscessus complex accounted for 66 and 16.6% of all species, respectively. Some clinical and radiological differences were noted between patients with and without the presence of NTM isolation although the results are inconsistent. CONCLUSIONS Heterogeneity in prevalence estimates of NTM isolation indicated that both local surveys to inform development of clinical services tailored to patients with bronchiectasis and population-based studies are needed. The clinical features associated with NTM in bronchiectasis and their incremental utility in studying the association is unknown and merits further investigation.
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Affiliation(s)
- Ya-Nan Zhu
- Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Internal Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jia-Qi Xie
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao-Wen He
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bo Peng
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Cong-Cong Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guo-Jun Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jin-Fu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yong-Hua Gao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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10
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Common Variable Immunodeficiency and Other Immunodeficiency Syndromes in Bronchiectasis. Semin Respir Crit Care Med 2021; 42:525-536. [PMID: 34261177 DOI: 10.1055/s-0041-1730893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Immunodeficiency represents a vast number of diseases and syndromes. Both primary and secondary forms of immunodeficiency are important contributors to the development of bronchiectasis. Primary immune deficiencies, in particular, are increasingly identified and defined as contributors. Specific immune deficiencies that are closely associated with bronchiectasis and as discussed in this article are common variable immunodeficiency, specific antibody deficiency, immunodeficiencies involving immunoglobulin E, DOCK8 immunodeficiency, phosphoglucomutase 3 deficiency, activated phosphoinositide 3-kinase delta syndrome, and X-linked agammaglobulinemia. Each of these primary immune deficiencies has unique nuances. Vigilance for these unique signs and symptoms is likely to improve recognition of specific immunodeficiency in the idiopathic bronchiectasis patient. Secondary forms of immunodeficiency occur as a result of a separate disease process. Graft versus host disease, malignancy, and human immunodeficiency virus are three classic examples discussed in this article. An awareness of the potential for these disease settings to lead to bronchiectasis is necessary to optimize patient care. With understanding and mindfulness toward the intricate relationship between bronchiectasis and immunodeficiency, there is an opportunity to elucidate pathophysiologic underpinnings between these two syndromes.
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11
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Girón Moreno RM, Martínez-Vergara A, Martínez-García MÁ. Personalized approaches to bronchiectasis. Expert Rev Respir Med 2021; 15:477-491. [PMID: 33511899 DOI: 10.1080/17476348.2021.1882853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Interest in bronchiectasis is increasing due to its rising prevalence, associated with aging populations and the extended use of high-resolution chest tomography (HRCT), and the resulting high morbidity, mortality, and demand for resources.Areas covered: This article provides an extensive review of bronchiectasis as a complex and heterogeneous disease, as well as examining the difficulty of establishing useful clinical phenotypes. In keeping with the aims of 'precision medicine', we address the disease of bronchiectasis from three specific perspectives: severity, activity, and impact. We used PubMed to search the literature for articles including the following keywords: personalized medicine, bronchiectasis, biomarkers, phenotypes, precision medicine, treatable traits. We reviewed the most relevant articles published over the last 5 years.Expert opinion: This article reflects on the usefulness of these three dimensions in 'control panels' and clinical fingerprinting, as well as approaches to personalized medicine and the treatable features of bronchiectasis non-cystic fibrosis.
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Affiliation(s)
- Rosa Maria Girón Moreno
- Pneumology Department, Hospital Universitario La Princesa. Instituto De Investigación Sanitaria La Princesa, Madrid, Spain
| | - Adrián Martínez-Vergara
- Pneumology Department, Hospital Universitario La Princesa. Instituto De Investigación Sanitaria La Princesa, Madrid, Spain
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12
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Gao L, Qin KR, Li T, Wang HL, Pang M. The clinical phenotype of bronchiectasis and its clinical guiding implications. Exp Biol Med (Maywood) 2020; 246:275-280. [PMID: 33241711 DOI: 10.1177/1535370220972324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Bronchiectasis is a chronic airway disease with abnormal and persistent bronchial dilatation caused by a variety of reasons. In recent years, numerous reports have shown that bronchiectasis is heterogeneous, the clinical characteristics of patients with different phenotypes are different, and the efficacy of a treatment regimen may vary greatly in patients with different bronchiectasis phenotypes. This paper summarizes the current clinical phenotypic classification of bronchiectasis from the perspective of etiology, microbiology, and the frequency of acute exacerbation, and cluster analysis was used to determine new clinical phenotypes and their statistical and clinical significance. Different tools for assessing disease severity yield different outcomes. This article summarizes the research progress in the above areas, hoping to provide a more comprehensive understanding of the disease.
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Affiliation(s)
- Li Gao
- Department of Pulmonary and Critical Care Medicine, the First Hospital, 74648Shanxi Medical University, Shanxi 030001, China
| | - Ke-Ru Qin
- School of Basic Medicine, Basic Medical Science Center, 74648Shanxi Medical University, Shanxi 030600, China
| | - Ting Li
- Department of Pulmonary and Critical Care Medicine, the First Hospital, 74648Shanxi Medical University, Shanxi 030001, China
| | - Hai-Long Wang
- School of Basic Medicine, Basic Medical Science Center, 74648Shanxi Medical University, Shanxi 030600, China
| | - Min Pang
- Department of Pulmonary and Critical Care Medicine, the First Hospital, 74648Shanxi Medical University, Shanxi 030001, China
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13
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Malipiero G, Paoletti G, Blasi F, Paggiaro P, Senna G, Latorre M, Caminati M, Carpagnano GE, Crimi N, Spanevello A, Aliberti S, Canonica GW, Heffler E. Clinical features associated with a doctor-diagnosis of bronchiectasis in the Severe Asthma Network in Italy (SANI) registry. Expert Rev Respir Med 2020; 15:419-424. [PMID: 33100041 DOI: 10.1080/17476348.2021.1840983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Several severe asthma comorbidities have been identified: an emerging one is bronchiectasis. We evaluated the frequency of bronchiectasis on severe asthma in a real-life setting, through the 'Severe Asthma Network Italy' (SANI) registry. METHODS SANI registry encompasses demographic, clinical, functional and inflammatory data of Italian severe asthmatics. Data obtained by the enrolled patients were analyzed, focusing the attention on those patients with concomitant clinically relevant bronchiectasis. RESULTS About 15.5% patients have bronchiectasis. Bronchiectasis diagnosis was associated with a higher prevalence of chronic rhinosinusitis with nasal polyps (54.6% vs. 38%, p = 0.001) and higher serum IgE levels (673.4 vs. 412.1 kUI/L, p = 0.013). Patients with bronchiectasis had worse asthma control (ACT: 16.7 vs 18.2, p = 0.013), worse quality of life (AQLQ: 4.08 vs. 4.60, p = 0.02) and lower lung function (FEV1% predicted 67.3 vs. 75.0, p = 0.002). A higher rate of severe asthma exacerbations in the previous 12 months (85.2% vs. 61.5%, p < 0.001) was found in patients with bronchiectasis. CONCLUSION severe asthma associated with bronchiectasis represents a particularly severe asthma variant, possibly driven by an eosinophilic endotype. We, therefore, suggest that bronchiectasis should necessarily be assessed in severe asthmatic patients.
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Affiliation(s)
- Giacomo Malipiero
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Francesco Blasi
- Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy.,Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milano, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Marco Caminati
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
| | - Giovanna Elisiana Carpagnano
- Respiratory Medicine Section, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Nunzio Crimi
- Respiratory Medicine Unit, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy.,Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Antonio Spanevello
- Faculty of Medicine and Surgery, University of Insubria, Varese, Italy.,Division of Pulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS, Tradate, Italy 3
| | - Stefano Aliberti
- Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy.,Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milano, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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14
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de la Rosa Carrillo D, Prados Sánchez C. Epidemiología y diversidad geográfica de las bronquiectasias. OPEN RESPIRATORY ARCHIVES 2020. [DOI: 10.1016/j.opresp.2020.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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15
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Abstract
PURPOSE OF REVIEW Bronchiectasis is a chronic respiratory disease with heterogeneous clinical manifestations and outcomes. Identifying clinical phenotypes could help in managing bronchiectasis patients and hopefully improve disease prognosis by adopting personalized treatment. We review the current literature on clinical phenotypes of bronchiectasis and try to highlight priorities for future research. RECENT FINDINGS Different studies have tried to stratify bronchiectasis patients according to cause, microbiology, or associated conditions. In consideration of the huge heterogeneity of bronchiectasis different cluster analyses in bronchiectasis have also been performed. Unfortunately classification by cause is clinically meaningful only in a few conditions in which specific treatment is available or a specific management is recommended. This is the case, for instance, of allergic bronchopulmonary aspergillosis, immunodeficiencies or chronic airways comorbidities of bronchiectasis, such as chronic obstructive pulmonary disease and asthma. From a clinical perspective, the microbiological cluster stratification proposed by Aliberti et al. seems the most profitable one but still so a number of host-related factors have an unpredictable effect on clinical manifestations and outcomes of bronchiectasis. SUMMARY Although numerous attempts to identify clinical phenotypes in bronchiectasis have been performed, currently there is need to further investigate the host-related factors (endotypes) that surely play a determinant role in disease severity.
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16
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Huang HY, Chung FT, Lo CY, Lin HC, Huang YT, Yeh CH, Lin CW, Huang YC, Wang CH. Etiology and characteristics of patients with bronchiectasis in Taiwan: a cohort study from 2002 to 2016. BMC Pulm Med 2020; 20:45. [PMID: 32070324 PMCID: PMC7029505 DOI: 10.1186/s12890-020-1080-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/07/2020] [Indexed: 12/15/2022] Open
Abstract
Background Bronchiectasis is a chronic infectious respiratory disease with diverse causes and ethnic or geographic differences. However, few large-scale studies of its etiology have been conducted in Asia. This study aimed to determine the etiology and clinical features of bronchiectasis in Taiwan. Methods This longitudinal cohort study investigated the etiology and clinical features of newly diagnosed non-cystic fibrosis bronchiectasis patients from January 2002 to December 2016. The clinical, functional and microbiological data of patients were retrieved from the Chang Gung Research Database, which includes seven medical facilities throughout Taiwan. The index date was the date of the first bronchiectasis diagnosis. Known diseases that were diagnosed before the index date were regarded as etiologies of bronchiectasis. Results The cohort comprised 15,729 adult patients with bronchiectasis. Idiopathic (32%) was the most common cause, followed by post-pneumonia (24%). Other causes included post-tuberculosis (12%), chronic obstructive pulmonary disease (14%), asthma (10%), gastroesophageal reflux disease (2%) and rheumatic diseases (2%). At diagnosis, 8487 patients had sputum culture. Pseudomonas aeruginosa (5.3%) was the most common bacteria, followed by non-tuberculosis mycobacteria (3.6%), Haemophilus influenzae (3.4%) and Klebsiella pneumoniae (3.1%), but 6155 (72.1%) had negative sputum cultures. Patients with post-tuberculosis had a higher sputum isolation rate of non-tuberculosis mycobacteria than P. aeruginosa. Patients with post-tuberculosis and post-pneumonia bronchiectasis had a higher frequency of chronic lung infection than other groups (p < 0.05). Clinical characteristics, such as gender, lung function, comorbidities and microbiology, were significantly different between idiopathic and known etiologies. Conclusions Idiopathic, post-infection and tuberculosis constitute major bronchiectasis etiologies in Taiwan. Clinical characteristics and sputum microbiology were distinct among separate etiology phenotypes.
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Affiliation(s)
- Hung-Yu Huang
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Saint Paul's Hospital, Taoyuan, Taiwan.,Department of Thoracic Medicine, Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, 199 Tun-Hwa North Road, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Fu-Tsai Chung
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, 199 Tun-Hwa North Road, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Yu Lo
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, 199 Tun-Hwa North Road, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Horng-Chyuan Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, 199 Tun-Hwa North Road, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Hsin Yeh
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chang-Wei Lin
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Saint Paul's Hospital, Taoyuan, Taiwan.,Department of Thoracic Medicine, Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, 199 Tun-Hwa North Road, Taipei, Taiwan
| | - Yu-Chen Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, 199 Tun-Hwa North Road, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Hua Wang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, 199 Tun-Hwa North Road, Taipei, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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17
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Stratev V, Dimitrova V, Petkova D. COPD and Comorbidities: Relating Mechanisms and Treatment. CURRENT RESPIRATORY MEDICINE REVIEWS 2019. [DOI: 10.2174/1573398x14666181018101021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Despite being a disease with the constantly rising social burden and mortality, COPD is
also associated with a number of other conditions known as comorbidities. COPD and other diseases
often share similar risk factors, such as smoking and aging, which leads to increased prevalence of
comorbidities. The key pathogenic mechanisms of COPD are chronic inflammation and oxidative
stress and they also contribute significantly to the development of accompanying diseases. Through
complex interactions, COPD increases the risk for certain comorbidities and they, in turn, have a
negative impact on health status and contribute to mortality in COPD patients. Proper treatment of
comorbidities may have a beneficial effect on COPD natural course and progression. Here we review
the prevalence of the most common comorbidities of COPD; their interrelating mechanism and the
current advances of the treatment in terms of co-existence.
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Affiliation(s)
- Velin Stratev
- Clinic of Pulmonary Diseases, University Hospital “St. Marina”, Varna, Bulgaria
| | - Valentina Dimitrova
- Clinic of Pulmonary Diseases, University Hospital “St. Marina”, Varna, Bulgaria
| | - Diana Petkova
- Clinic of Pulmonary Diseases, University Hospital “St. Marina”, Varna, Bulgaria
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18
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Goussault H, Salvator H, Catherinot E, Chabi ML, Tcherakian C, Chabrol A, Didier M, Rivaud E, Fischer A, Suarez F, Hermine O, Lanternier F, Lortholary O, Mahlaoui N, Devillier P, Couderc LJ. Primary immunodeficiency-related bronchiectasis in adults: comparison with bronchiectasis of other etiologies in a French reference center. Respir Res 2019; 20:275. [PMID: 31801528 PMCID: PMC6894192 DOI: 10.1186/s12931-019-1242-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/14/2019] [Indexed: 12/18/2022] Open
Abstract
Background Bronchiectasis is a heterogeneous disease depending on etiology. It represents the most frequent non-infectious pulmonary complication of primary immunodeficiencies (PID). We investigated whether bronchiectasis associated with PID had a distinct course in comparison to bronchiectasis of other causes. Methods Retrospective single-center study of adult patients diagnosed with non-cystic fibrosis bronchiectasis with more than 5 years of follow-up and at least 4 pulmonary functional tests available at one year apart. They were divided into three groups: PID- related bronchiectasis, idiopathic/post infectious-related bronchiectasis and other causes of bronchiectasis. Respiratory functional data and clinical outcomes were compared. Results Of 329 patients with bronchiectasis diagnosed in Foch Hospital (Suresnes, France), 98 patients fulfilled the selected criteria (20 PID-related cases, 39 idiopathic or post-infectious cases, and 39 cases with other causes). Median time of follow-up was 9.5 years. Groups were similar concerning initial characteristics (female 70.4%, never smokers 59.2%, mild severity bronchiectasis according to the FACED score and median FEV1 at diagnosis 73.5% predicted values [Q1–Q3: 53.75–90.5]), except PID patients who were younger (median age of 51.5 vs 62 years, p = 0.02). Eighty-five percent of PID patients received immunoglobulin substitution (median trough level was measured at 10.5 g/dl [10;10.92]). Global median FEV1 annual decline was 25.03 ml/year [8.16;43.9] and 19.82 ml/year [16.08;48.02] in the PID patients group. Forty-five percent of patients had bacterial colonization, pneumoniae occurred in 56% of patients and median exacerbation annual rate was 0.8 [0.3–1.4]. Hemoptysis occurred in 31.6% of patients. Global mortality rate was 11.2%. We did not record any significant difference for all clinical and functional outcomes between patients with PID and other etiologies. The median decline in FEV1 was similar in the three groups. Conclusions The course of PID-related bronchiectasis was similar to bronchiectasis of other causes. Provided that patients receive immunoglobulin replacement, the course of PID-related bronchiectasis seems to be independent of the underlying immune disorder.
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Affiliation(s)
| | - Hélène Salvator
- Service de Pneumologie, Hôpital Foch, Suresnes, France. .,Laboratoire de Pharmacologie Respiratoire UPRES EA 220, Universite Paris Saclay, Versailles, France. .,Faculté des Sciences de la Santé Simone Veil, Université Versailles-Saint-Quentin-en-Yvelines, Université Paris Saclay, Versailles, France.
| | | | | | | | | | | | | | - Alain Fischer
- CEREDIH, Centre de Référence des Déficits Immunitaires Héréditaires, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris, France.,Service d'Immunologie-Hématologie et Rhumatologie Pédiatrique, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris, France.,Institut Imagine, INSERM U1163, Université Paris Descartes-Sorbonne Paris Cité, Paris, France.,Collège de France, Paris, France
| | - Felipe Suarez
- CEREDIH, Centre de Référence des Déficits Immunitaires Héréditaires, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris, France.,Institut Imagine, INSERM U1163, Université Paris Descartes-Sorbonne Paris Cité, Paris, France.,Service d'Hématologie Adulte, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Hermine
- CEREDIH, Centre de Référence des Déficits Immunitaires Héréditaires, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris, France.,Institut Imagine, INSERM U1163, Université Paris Descartes-Sorbonne Paris Cité, Paris, France.,Service d'Hématologie Adulte, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fanny Lanternier
- Service des Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker Pasteur, Hôpital Necker-Enfants Malades, APHP, Université de Paris, Paris, France
| | - Olivier Lortholary
- CEREDIH, Centre de Référence des Déficits Immunitaires Héréditaires, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris, France.,Institut Imagine, INSERM U1163, Université Paris Descartes-Sorbonne Paris Cité, Paris, France.,Service des Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker Pasteur, Hôpital Necker-Enfants Malades, APHP, Université de Paris, Paris, France
| | - Nizar Mahlaoui
- CEREDIH, Centre de Référence des Déficits Immunitaires Héréditaires, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris, France.,Service d'Immunologie-Hématologie et Rhumatologie Pédiatrique, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris, France
| | - Philippe Devillier
- Service de Pneumologie, Hôpital Foch, Suresnes, France.,Laboratoire de Pharmacologie Respiratoire UPRES EA 220, Universite Paris Saclay, Versailles, France.,Faculté des Sciences de la Santé Simone Veil, Université Versailles-Saint-Quentin-en-Yvelines, Université Paris Saclay, Versailles, France
| | - Louis-Jean Couderc
- Service de Pneumologie, Hôpital Foch, Suresnes, France.,Laboratoire de Pharmacologie Respiratoire UPRES EA 220, Universite Paris Saclay, Versailles, France.,Faculté des Sciences de la Santé Simone Veil, Université Versailles-Saint-Quentin-en-Yvelines, Université Paris Saclay, Versailles, France
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19
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Mäntylä J, Mazur W, Törölä T, Bergman P, Saarinen T, Kauppi P. Asthma as aetiology of bronchiectasis in Finland. Respir Med 2019; 152:105-111. [PMID: 31128603 DOI: 10.1016/j.rmed.2019.04.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/26/2019] [Accepted: 04/29/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND By definition bronchiectasis (BE) means destructed structure of normal bronchus as a consequence of frequent bacterial infections and inflammation. In many senses, BE is a neglected orphan disease. A recent pan-European registry study, EMBARC, has been set up in order to better understand its pathophysiology, better phenotype patients, and to individualize their management. AIM To examine the aetiology and co-morbidity of BE in the capital area in Finland. METHODS Two hundred five patients with BE diagnosis and follow up visits between 2016 and 2017 in Helsinki University Hospital were invited to participate in the study. Baseline demographics, lung functions, imaging, microbiological, and therapeutic data, together with co-morbidities were entered into EMBARC database. Clinical characteristics, aetiologic factors, co-morbidities, and risk factors for extensive BE were explored. RESULTS To the study included 95 adult patients and seventy nine percent of the BE patients were women. The mean age was 69 years (SD ± 13). Asthma was a comorbid condition in 68% of the patients but in 26% it was estimated to be the cause of BE. Asthma was aetiological factor for BE if it had been diagnosed earlier than BE. As 41% BE were idiopathic, in 11% the disorder was postinfectious and others were associated to rheumatic disease, Alpha-1-antitrypsin deficiency, IgG deficiency and Kartagener syndrome. The most common co-morbidities in addition to asthma were cardiovascular disease (30%), gastroesophageal reflux disease (26%), overweight (22%), diabetes (16%), inactive neoplasia (15%), and immunodeficiency (12%). Extensive BE was found in 68% of BE patients in whom four or more lobes were affected. Risk factors for extensive BE were asthma (OR 2.7), asthma as aetiology for BE (OR 4.3), and rhinosinusitis (OR 3.1). CONCLUSIONS Asthma was associated to BE in 68% and it was estimated as aetiology in every fourth patient. However, retrospectively, it is difficult to exclude asthma as a background cause in patients with asthma-like symptoms and respiratory infections. We propose asthma as an aetiology factor for BE if it is diagnosed earlier than BE. Asthma and rhinosinusitis were predictive for extensive BE.
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Affiliation(s)
- Jarkko Mäntylä
- University of Helsinki and Helsinki University Hospital, Respiratory Diseases and Allergology, Helsinki, Finland; University of Helsinki and Helsinki University Hospital, Respiratory Diseases, Helsinki, Finland.
| | - Witold Mazur
- University of Helsinki and Helsinki University Hospital, Respiratory Diseases, Helsinki, Finland
| | - Tanja Törölä
- University of Helsinki and Helsinki University Hospital, Respiratory Diseases, Helsinki, Finland
| | - Paula Bergman
- University of Helsinki, Biostatistics Consulting, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Tuomas Saarinen
- (d)Tampere University Hospital, Radiology Department, Tampere, Finland
| | - Paula Kauppi
- University of Helsinki and Helsinki University Hospital, Respiratory Diseases and Allergology, Helsinki, Finland
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20
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Vidaillac C, Yong VFL, Jaggi TK, Soh MM, Chotirmall SH. Gender differences in bronchiectasis: a real issue? Breathe (Sheff) 2018; 14:108-121. [PMID: 29875830 PMCID: PMC5980467 DOI: 10.1183/20734735.000218] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Gender differences in chronic respiratory disease, including cystic fibrosis and non-cystic fibrosis bronchiectasis are clinically apparent and of increasing importance. Differences in disease prevalence, severity and outcome are all described, however, the precise cause of the gender dichotomy and their associated underlying mechanisms have been poorly characterised. A lack of dedicated clinical and epidemiological research focused in this area has led to a paucity of data and therefore a lack of understanding of its key drivers. Diagnosis, disease pathogenesis and treatment response are all complex but important aspects of bronchiectasis with an evident gender bias. Broadening our understanding of the interplay between microbiology, host physiology and the environment in the context of chronic lung diseases, such as bronchiectasis, is critical to unravelling mechanisms driving the observed gender differences. In this review, epidemiological, biological and environmental evidence related to gender in bronchiectasis is summarised. This illustrates gender differences as a “real issue” with the objective of mapping out a future framework upon which a gender-tailored medical approach may be incorporated into the diagnosis, monitoring and treatment of bronchiectasis. CF and non-CF bronchiectasis are complex multifactorial chronic pulmonary diseases demonstrating gender differences in their prevalence, severity and infections, some of which are attributable to sex hormoneshttp://ow.ly/beDf30jseK4
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Affiliation(s)
- Celine Vidaillac
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Valerie F L Yong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Tavleen K Jaggi
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Min-Min Soh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Chandrasekaran R, Mac Aogáin M, Chalmers JD, Elborn SJ, Chotirmall SH. Geographic variation in the aetiology, epidemiology and microbiology of bronchiectasis. BMC Pulm Med 2018; 18:83. [PMID: 29788932 PMCID: PMC5964678 DOI: 10.1186/s12890-018-0638-0] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 04/25/2018] [Indexed: 12/16/2022] Open
Abstract
Bronchiectasis is a disease associated with chronic progressive and irreversible dilatation of the bronchi and is characterised by chronic infection and associated inflammation. The prevalence of bronchiectasis is age-related and there is some geographical variation in incidence, prevalence and clinical features. Most bronchiectasis is reported to be idiopathic however post-infectious aetiologies dominate across Asia especially secondary to tuberculosis. Most focus to date has been on the study of airway bacteria, both as colonisers and causes of exacerbations. Modern molecular technologies including next generation sequencing (NGS) have become invaluable tools to identify microorganisms directly from sputum and which are difficult to culture using traditional agar based methods. These have provided important insight into our understanding of emerging pathogens in the airways of people with bronchiectasis and the geographical differences that occur. The contribution of the lung microbiome, its ethnic variation, and subsequent roles in disease progression and response to therapy across geographic regions warrant further investigation. This review summarises the known geographical differences in the aetiology, epidemiology and microbiology of bronchiectasis. Further, we highlight the opportunities offered by emerging molecular technologies such as -omics to further dissect out important ethnic differences in the prognosis and management of bronchiectasis.
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Affiliation(s)
- Ravishankar Chandrasekaran
- Lee Kong Chian School of Medicine, Nanyang Technological University, Clinical Sciences Building, 11 Mandalay Road, Singapore, 308232, Singapore
| | - Micheál Mac Aogáin
- Lee Kong Chian School of Medicine, Nanyang Technological University, Clinical Sciences Building, 11 Mandalay Road, Singapore, 308232, Singapore
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - Stuart J Elborn
- Imperial College and Royal Brompton Hospital, London, UK.,Queen's University Belfast, Belfast, UK
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Clinical Sciences Building, 11 Mandalay Road, Singapore, 308232, Singapore.
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Olveira C, Padilla A, Martínez-García MÁ, de la Rosa D, Girón RM, Vendrell M, Máiz L, Borderías L, Polverino E, Martínez-Moragón E, Rajas O, Casas F, Cordovilla R, de Gracia J. Etiology of Bronchiectasis in a Cohort of 2047 Patients. An Analysis of the Spanish Historical Bronchiectasis Registry. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.arbr.2017.05.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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De la Rosa D, Martínez-Garcia MA, Giron RM, Vendrell M, Olveira C, Borderias L, Maiz L, Torres A, Martinez-Moragon E, Rajas O, Casas F, Cordovilla R, de Gracia J. Clinical impact of chronic obstructive pulmonary disease on non-cystic fibrosis bronchiectasis. A study on 1,790 patients from the Spanish Bronchiectasis Historical Registry. PLoS One 2017; 12:e0177931. [PMID: 28542286 PMCID: PMC5436841 DOI: 10.1371/journal.pone.0177931] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 05/05/2017] [Indexed: 11/24/2022] Open
Abstract
Background Few studies have evaluated the coexistence of bronchiectasis (BE) and chronic obstructive pulmonary disease (COPD) in series of patients diagnosed primarily with BE. The aim of this study was to analyse the characteristics of patients with BE associated with COPD included in the Spanish Bronchiectasis Historical Registry and compare them to the remaining patients with non-cystic fibrosis BE. Methods We conducted a multicentre observational study of historical cohorts, analysing the characteristics of 1,790 patients who had been included in the registry between 2002 and 2011. Of these, 158 (8.8%) were registered as BE related to COPD and were compared to the remaining patients with BE of other aetiologies. Results Patients with COPD were mostly male, older, had a poorer respiratory function and more frequent exacerbations. There were no differences in the proportion of patients with chronic bronchial colonisation or in the isolated microorganisms. A significantly larger proportion of patients with COPD received treatment with bronchodilators, inhaled steroids and intravenous antibiotics, but there was no difference in the use of long term oral or inhaled antibiotherapy. During a follow-up period of 3.36 years, the overall proportion of deaths was 13.8%. When compared to the remaining aetiologies, patients with BE associated with COPD presented the highest mortality rate. The multivariate analysis showed that the diagnosis of COPD in a patient with BE as a primary diagnosis increased the risk of death by 1.77. Conclusion Patients with BE related to COPD have the same microbiological characteristics as patients with BE due to other aetiologies. They receive treatment with long term oral and inhaled antibiotics aimed at controlling chronic bronchial colonisation, even though the current COPD treatment guidelines do not envisage this type of therapy. These patients’ mortality is notably higher than that of remaining patients with non-cystic fibrosis BE.
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Affiliation(s)
- David De la Rosa
- Department of Pneumology, Hospital Plató, Barcelona, Spain
- * E-mail:
| | | | - Rosa Maria Giron
- Departament of Pneumology, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
| | - Montserrat Vendrell
- Department of Pneumology, Hospital Josep Trueta Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Casilda Olveira
- Department of Pneumology, Hospital Regional Universitario de Málaga, Instituto de Biomedicina de Málaga (IBIMA), Facultad de Medicina de Málaga, Spain
| | - Luis Borderias
- Department of Pneumology, Hospital General San Jorge, Huesca, Spain
| | - Luis Maiz
- Department of Pneumology, Hospital Ramón y Cajal, Madrid, Spain
| | - Antoni Torres
- Respiratory Institute, Hospital Clinic i Provincial, Barcelona, Spain
| | | | - Olga Rajas
- Departament of Pneumology, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
| | - Francisco Casas
- Department of Pneumology, Hospital Universitario San Cecilio, Granada, Spain
| | - Rosa Cordovilla
- Department of Pneumology, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Javier de Gracia
- Department of Pneumology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
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Olveira C, Padilla A, Martínez-García MÁ, de la Rosa D, Girón RM, Vendrell M, Máiz L, Borderías L, Polverino E, Martínez-Moragón E, Rajas O, Casas F, Cordovilla R, de Gracia J. Etiology of Bronchiectasis in a Cohort of 2047 Patients. An Analysis of the Spanish Historical Bronchiectasis Registry. Arch Bronconeumol 2017; 53:366-374. [PMID: 28118936 DOI: 10.1016/j.arbres.2016.12.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/14/2016] [Accepted: 12/04/2016] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Bronchiectasis is caused by many diseases. Establishing its etiology is important for clinical and prognostic reasons. The aim of this study was to evaluate the etiology of bronchiectasis in a large patient sample and its possible relationship with demographic, clinical or severity factors, and to analyze differences between idiopathic disease, post-infectious disease, and disease caused by other factors. METHODS Multicenter, cross-sectional study of the SEPAR Spanish Historical Registry (RHEBQ-SEPAR). Adult patients with bronchiectasis followed by pulmonologists were included prospectively. Etiological studies were based on guidelines and standardized diagnostic tests included in the register, which were later included in the SEPAR guidelines on bronchiectasis. RESULTS A total of 2,047 patients from 36 Spanish hospitals were analyzed. Mean age was 64.9years and 54.9% were women. Etiology was identified in 75.8% of cases (post-Infection: 30%; cystic fibrosis: 12.5%; immunodeficiencies: 9.4%; COPD: 7.8%; asthma: 5.4%; ciliary dyskinesia: 2.9%, and systemic diseases: 1.4%). The different etiologies presented different demographic, clinical, and microbiological factors. Post-infectious bronchiectasis and bronchiectasis caused by COPD and asthma were associated with an increased risk of poorer lung function. Patients with post-infectious bronchiectasis were older and were diagnosed later. Idiopathic bronchiectasis was more common in female non-smokers and was associated with better lung function, a higher body mass index, and a lower rate of Pseudomonas aeruginosa than bronchiectasis of known etiology. CONCLUSIONS The etiology of bronchiectasis was identified in a large proportion of patients included in the RHEBQ-SEPAR registry. Different phenotypes associated with different causes could be identified.
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Affiliation(s)
- Casilda Olveira
- Servicio de Neumología, Hospital Regional Universitario de Málaga, Instituto de Biomedicina de Málaga (IBIMA), Facultad de Medicina, Universidad de Málaga, Málaga, España.
| | - Alicia Padilla
- Unidad de Neumología, Agencia Sanitaria Costa del Sol, Marbella, Málaga, España
| | - Miguel-Ángel Martínez-García
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe⋅ CIBER de enfermedades respiratorias (CIBERes), Valencia, España
| | | | - Rosa-María Girón
- Servicio de Neumología, Instituto de Investigación Sanitaria Hospital Universitario de la Princesa, Madrid, España
| | - Montserrat Vendrell
- Servicio de Neumología, Hospital Josep Trueta⋅ Biomedical Research Institute (IDIBGI), Girona, España
| | - Luis Máiz
- Servicio de Neumología, Hospital Ramón y Cajal, Madrid, España
| | - Luis Borderías
- Servicio de Neumología, Hospital General San Jorge, Huesca, España
| | - Eva Polverino
- Servicio de Neumología, Hospital Clínic i Provincial, Barcelona, España
| | | | - Olga Rajas
- Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, España
| | - Francisco Casas
- Complejo Hospitalario Universitario de Granada, Granada, España
| | - Rosa Cordovilla
- Servicio de Neumología, Hospital Universitario de Salamanca, Salamanca, España
| | - Javier de Gracia
- Servicio de Neumología, Hospital Vall d'Hebron, Barcelona, España
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Amati F, Franceschi E, Gramegna A, Chalmers JD, Aliberti S. Investigating the Etiology of Bronchiectasis: You Do Not Find What You Do Not Look For. Respiration 2017; 93:228-229. [PMID: 28110337 DOI: 10.1159/000455880] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Francesco Amati
- Department of Pathophysiology and Transplantation, University of Milan, Cardio-Thoracic Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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Battaglia S, Torres A, Polverino E. The Importance of Phenotyping Bronchiectasis. Respiration 2016; 92:134-5. [DOI: 10.1159/000448557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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