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Heraganahally SS, Gibbs C, Ravichandran SJ, Erdenebayar D, Abeyaratne A, Howarth T. Factors influencing survival and mortality among adult Aboriginal Australians with bronchiectasis-A 10-year retrospective study. Front Med (Lausanne) 2024; 11:1366037. [PMID: 38774399 PMCID: PMC11106411 DOI: 10.3389/fmed.2024.1366037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/23/2024] [Indexed: 05/24/2024] Open
Abstract
Background The prevalence of bronchiectasis among adult Aboriginal Australians is higher than that of non-Aboriginal Australians. However, despite evidence to suggest higher prevalence of bronchiectasis among Aboriginal people in Australia, there is sparce evidence in the literature assessing clinical parameters that may predict survival or mortality in this population. Methods Aboriginal Australians residing in the Top End Health Service region of the Northern Territory of Australia aged >18 years with chest computed tomography (CT) confirmed bronchiectasis between 2011 and 2020 were included. Demographics, body mass index (BMI), medical co-morbidities, lung function data, sputum microbiology, chest CT scan results, hospital admissions restricted to respiratory conditions and all-cause mortality were assessed. Results A total of 459 patients were included, of whom 146 were recorded deceased (median age at death 59 years). Among the deceased cohort, patients were older (median age 52 vs. 45 years, p = 0.023), had a higher prevalence of chronic obstructive pulmonary disease (91 vs. 79%, p = 0.126), lower lung function parameters (median percentage predicted forced expiratory volume in 1 s 29 vs. 40%, p = 0.149), a significantly greater proportion cultured non-Aspergillus fungi (65 vs. 46%, p = 0.007) and pseudomonas (46 vs. 28%, p = 0.007) on sputum microbiology and demonstrated bilateral involvement on radiology. In multivariate models advancing age, prior pseudomonas culture and Intensive care unit (ICU) visits were associated with increased odds of mortality. Higher BMI, better lung function on spirometry, prior positive sputum microbiology for Haemophilus and use of inhaled long-acting beta antagonist/muscarinic agents may have a favourable effect. Conclusion The results of this study may be of use to stratify high risk adult Aboriginal patients with bronchiectasis and to develop strategies to prevent future mortality.
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Affiliation(s)
- Subash S. Heraganahally
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, NT, Australia
- College of Medicine and Public Health, Flinders University, Darwin, NT, Australia
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, NT, Australia
| | - Claire Gibbs
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, NT, Australia
- College of Medicine and Public Health, Flinders University, Darwin, NT, Australia
| | | | | | | | - Timothy Howarth
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, NT, Australia
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
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Abed H, Gogandi H, Almutawwif M, Aloufi A, Tashkandi M, Alqarni A, Aladwani F, Sadek HS. Dental management of Kartagener syndrome: A case report. SPECIAL CARE IN DENTISTRY 2024; 44:729-736. [PMID: 37612790 DOI: 10.1111/scd.12917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/07/2023] [Accepted: 08/12/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Kartagener syndrome (KS) is recognized as an inherited, autosomal recessive disorder characterized by a combination of chronic sinusitis, bronchiectasis, and situs inversus. It affects one in 12,500-50,000 live births worldwide. AIM This paper aims to discuss the dental management of patients diagnosed with KS. CASE REPORT A 31-year-old male with KS manifests by impaired cilia motility which increases the risk of a frequent lung infection. The dental examination revealed that the patient required comprehensive oral hygiene care which included patient education and nonsurgical periodontal therapy under local anesthesia. CONCLUSIONS Dental care providers should ask affected patients with KS about their signs and symptoms of cardiac and pulmonary disease and seek consultation with their attending physician regarding these health concerns before the initiation of general anesthesia and perhaps conscious sedation administration. Patients with KS with emerging cardiac and/or respiratory impairment should be referred promptly for medical assessment.
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Affiliation(s)
- Hassan Abed
- Department of Basic and Clinical Oral Sciences, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
- Dental Unit, Division of Special Care Dentistry, My Clinic Polyclinic, Jeddah, Saudi Arabia
| | - Huda Gogandi
- Department of Basic and Clinical Oral Sciences, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Mustafa Almutawwif
- Department of Basic and Clinical Oral Sciences, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdullah Aloufi
- Special Care Dentistry Clinic, Tabuk Specialist Dental Centre, Tabuk, Saudi Arabia
| | - Mustafa Tashkandi
- Department of Basic and Clinical Oral Sciences, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ali Alqarni
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
| | - Fahad Aladwani
- Dental Unit, Division of Periodontics, My Clinic Polyclinic, Jeddah, Saudi Arabia
| | - Hisham S Sadek
- Department of Oral Medicine, Oral Diagnosis and Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt
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Ng SHX, Chai GT, George PP, Kaur P, Yip WF, Chiam ZY, Neo HY, Tan WS, Hum A. Prognostic Factors of Mortality in Nonchronic Obstructive Pulmonary Disease Chronic Lung Disease: A Scoping Review. J Palliat Med 2024; 27:411-420. [PMID: 37702606 DOI: 10.1089/jpm.2023.0263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Introduction: Patients with chronic lung disease (CLD) experience a heavy symptom burden at the end of life, but their uptake of palliative care is notably low. Having an understanding of a patient's prognosis would facilitate shared decision making on treatment options and care planning between patients, families, and their clinicians, and complement clinicians' assessments of patients' unmet palliative needs. While literature on prognostication in patients with chronic obstructive pulmonary disease (COPD) has been established and summarized, information for other CLDs remains less consolidated. Summarizing the mortality risk factors for non-COPD CLDs would be a novel contribution to literature. Hence, we aimed to identify and summarize the prognostic factors associated with non-COPD CLDs from the literature. Methods: We conducted a scoping review following published guidelines. We searched MEDLINE, Embase, PubMed, CINAHL, Cochrane Library, and Web of Science for studies published between 2000 and 2020 that described non-COPD CLD populations with an all-cause mortality risk period of up to three years. Only primary studies which reported associations with mortality adjusted through multivariable analysis were included. Results: Fifty-five studies were reviewed, with 53 based on interstitial lung disease (ILD) or connective tissue disease-associated ILD populations and two in bronchiectasis populations. Prognostic factors were classified into 10 domains, with pulmonary function and disease being the largest. Older age, lower forced vital capacity, and lower carbon monoxide diffusing capacity were most commonly investigated and associated with statistically significant increases in mortality risks. Conclusions: This comprehensive overview of prognostic factors for patients with non-COPD CLDs would facilitate the identification and prioritization of candidate factors to predict short-term mortality, supporting tool development for decision making and to identify high-risk patients for palliative needs assessments. Literature focused on patients with ILDs, and more studies should be conducted on other CLDs to bridge the knowledge gap.
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Affiliation(s)
- Sheryl Hui Xian Ng
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
| | - Gin Tsen Chai
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Pradeep Paul George
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
| | - Palvinder Kaur
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
| | - Wan Fen Yip
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
| | - Zi Yan Chiam
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Han Yee Neo
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Woan Shin Tan
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
| | - Allyn Hum
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore, Singapore
- The Palliative Care Centre for Excellence in Research and Education, Dover Park Hospice, Singapore, Singapore
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Blamires J, Dickinson A, Byrnes CA, Tautolo ES. Sore and tired. A qualitative study exploring the symptom experience of youth with bronchiectasis. J Child Health Care 2023; 27:587-598. [PMID: 35379016 DOI: 10.1177/13674935221082437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This qualitative study was conducted to explore the experiences of youth living with bronchiectasis in New Zealand (NZ). Semi-structured interviews were conducted with youth with bronchiectasis. Key themes were identified using an inductive approach through constant comparative analysis and guided by Thorne's interpretive description (ID). Fifteen young people of mixed ethnicity (nine females and six males) aged between 13 and 23 years participated. Three key themes 'sore and tired', 'life interrupted and 'looking after self' were identified. This paper will focus on 'sore and tired' and its three subthemes which describe the participants symptom experience. While there was variability in physical symptom patterns, cough, soreness and fatigue were prominent features impacting physical, emotional and social aspects of day-to-day life. All identified pervasive and profound fatigue as significant. The identification of prodromal symptoms provides opportunity for greater appreciation of the varied and personal symptom experience of young people with bronchiectasis. Early identification of these symptoms and inclusion within management plans for escalating treatment has the potential to improve outcomes, reducing delays in seeking additional medical management and preventing further exacerbation.
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Affiliation(s)
- Julie Blamires
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Annette Dickinson
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Catherine A Byrnes
- Department of Paediatrics, Child and Youth Health, Faculty of Health & Medical Sciences, University of Auckland, Auckland, New Zealand
| | - El Shadan Tautolo
- School of Public Health & Interdisciplinary Studies. Director - AUT Pacific Health Research Centre, Auckland University of Technology, Auckland, New Zealand
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Titus G, Hassanali S, Feldman C. Non-cystic fibrosis bronchiectasis: A single-centre retrospective study in Johannesburg, South Africa. Afr J Thorac Crit Care Med 2023; 29:e1017. [PMID: 38239779 PMCID: PMC10795020 DOI: 10.7196/ajtccm.2023.v29i4.1017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/17/2023] [Indexed: 01/22/2024] Open
Abstract
Background Bronchiectasis, once rarely encountered, appears to be increasing in prevalence in South Africa (SA) and globally. There is a lack of published data on non-cystic fibrosis (CF) bronchiectasis, specifically in low- to middle-income countries, despite the high rates of risk factors such as HIV, pulmonary tuberculosis, and other infections. Objectives Given this lack of data, to review the characteristics of adult patients with non-CF bronchiectasis at a tertiary academic hospital in Johannesburg, SA. Methods This was a single-centre, retrospective record review, including all cases of non-CF bronchiectasis that were in the records of the adult pulmonology clinic at Charlotte Maxeke Johannesburg Academic Hospital as of April 2017. Results There were 197 patients, with a slight predominance of males, and the patients were generally young. The HIV rate was higher than the national average (34.8% v. 13.7%), and the HIV-positive patients had a high TB prevalence (86.9%). Pseudomonas spp. were cultured from sputum in 15.3% of cases. Fewer than half of the cohort had the diagnosis of bronchiectasis confirmed by high-resolution chest tomography. Airway obstruction (forced expiratory volume in 1 second/forced vital capacity ratio <70%) was observed in 47.0% of patients. Treatment with a short-acting beta-2-agonist was prescribed in 62.9%, a long-acting beta-2-agonist in 43.6% and inhaled corticosteroids in 51.3%. Antibiotic therapy during exacerbations was used in 44.2%, mainly amoxycillin-clavulanate (66.7%). Conclusion While single centre and retrospective, this study adds to the data on non-CF bronchiectasis in sub-Saharan Africa and should encourage further research to increase our understanding of adult non-CF bronchiectasis in SA. Study synopsis What the study adds. This study adds to published data detailing the clinical characteristics of adult non-cystic fibrosis (CF) bronchiectasis in low- and middle-income countries (LMICs).Implications of the findings. As a retrospective descriptive study, the findings summarise the characteristics of adults with non-CF bronchiectasis in a cohort from Johannesburg, South Africa. The findings suggest that the characteristics of bronchiectasis in this region appear to be similar in several ways to those in other LMICs, but quite different from those in the developed world.
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Affiliation(s)
- G Titus
- Division of Pulmonology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S Hassanali
- Section of Pulmonology Medicine, Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya
| | - C Feldman
- Division of Pulmonology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Wagner MJ, Dimitrov M, Lam GY, Leung W, Tyrrell GJ, Vethanayagam D. Microbiology sampling in non-cystic fibrosis bronchiectasis cases from northern Alberta. PLoS One 2023; 18:e0288704. [PMID: 37450508 PMCID: PMC10348526 DOI: 10.1371/journal.pone.0288704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
Non-cystic fibrosis bronchiectasis (NCFB) is a chronic respiratory disease resulting in chronic cough, thick sputum, and lower airway microbial colonization, akin to patients with cystic fibrosis (CF). NCFB is a common, yet under recognized entity which inflicts significant morbidity and mortality particularly to older individuals, with a rising prevalence in the developed world. Given that sputum cultures are a non-invasive method to characterize the lower airway microbiota in NCFB patients, for which pathogenic organisms are associated with worsened outcomes, we sought to characterize the microbiological pattern and clinical outcomes associated with sputum culture in a cohort of NCFB patients from Western Canada. A total of 20 subjects were prospectively recruited from various bronchiectasis clinics across the Greater Edmonton area. A retrospective chart review and a symptoms questionnaire was performed, gathering information not limited to symptoms, comorbidities, exacerbations, hospitalizations, sputum production, and sputum culture results over the prior 5 years. Subjects reported frequent hospitalization alongside a significant burden of symptoms. A large majority of sputum cultures grew pathogenic organisms such as Haemophilus influenzae and Pseudomonas aeruginosa. We also note the considerable waste and inefficiency associated with sputum cultures, outlining areas for which this important diagnostic modality can be improved. Accurate characterization of the airway microbiota alongside efficient delivery of health services are key to ensuring the proper treatment of individuals with NCFB, given their high disease burden and frequent hospitalization.
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Affiliation(s)
- Mitchell J. Wagner
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Monette Dimitrov
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Grace Y. Lam
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Winnie Leung
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Gregory J. Tyrrell
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Provincial Laboratory for Public Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - Dilini Vethanayagam
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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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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8
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Flume PA, Basavaraj A, Garcia B, Winthrop K, Di Mango E, Daley CL, Philley JV, Henkle E, O'Donnell AE, Metersky M. Towards development of evidence to inform recommendations for the evaluation and management of bronchiectasis. Respir Med 2023; 211:107217. [PMID: 36931575 DOI: 10.1016/j.rmed.2023.107217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/17/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Abstract
Bronchiectasis (BE) is a chronic condition characterized by airway dilation as a consequence of a variety of pathogenic processes. It is often associated with persistent airway infection and an inflammatory response resulting in cough productive of purulent sputum, which has an adverse impact on quality of life. The prevalence of BE is increasing worldwide. Treatment guidelines exist for managing BE, but they are generally informed by a paucity of high-quality evidence. This review presents the findings of a scientific advisory board of experts held in the United States in November 2020. The main focus of the meeting was to identify unmet needs in BE and propose ways to identify research priorities for the management of BE, with a view to developing evidence-based treatment recommendations. Key issues identified include diagnosis, patient evaluation, promoting airway clearance and appropriate use of antimicrobials. Unmet needs include effective pharmacological agents to promote airway clearance and reduce inflammation, control of chronic infection, clinical endpoints to be used in the design of BE clinical trials, and more accurate classification of patients using phenotypes and endotypes to better guide treatment decisions and improve outcomes.
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Affiliation(s)
- Patrick A Flume
- Department of Medicine and Pediatrics, Medical University of South Carolina, 96 Jonathan Lucas Street, Room 816-CSB, Charleston, SC, USA.
| | - Ashwin Basavaraj
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine, 462 First Avenue, Administration Building OBV, A601, New York, NY, 10016, USA.
| | - Bryan Garcia
- University of Alabama at Birmingham, 1900 University Blvd, THT Suite 541A, Birmingham, AL, 35233, USA.
| | - Kevin Winthrop
- Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, 97239, Portland, OR, USA.
| | - Emily Di Mango
- Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, USA.
| | - Charles L Daley
- Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA.
| | - Julie V Philley
- Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center at Tyler, 11937 US Hwy 271, 75708, Tyler, USA.
| | - Emily Henkle
- Oregon Health and Science University, OHSU-PSU School of Public Health, 3181 SW Sam Jackson Park Rd, Mailcode VPT, Portland, OR, 97239, USA.
| | - Anne E O'Donnell
- Division of Pulmonary, Critical Care and Sleep Medicine, Georgetown University Medical Center, Washington, DC, USA.
| | - Mark Metersky
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030-1321, USA.
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Mao Y, Chen L, He T, Li J, Zou A, Li F, Chen F, Fan B, Ni W, Xiao W, You H, Fu W. Daily versus three-times-weekly azithromycin in Chinese patients with non-cystic fibrosis bronchiectasis: protocol for a prospective, open-label and randomised controlled trial. BMJ Open 2022; 12:e059186. [PMID: 35803624 PMCID: PMC9272127 DOI: 10.1136/bmjopen-2021-059186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Non-cystic fibrosis bronchiectasis (NCFB) brought a heavy healthcare burden worldwide. Macrolide maintenance therapy was proved to be helpful in reducing exacerbation of NCFB. However, the optimal dosing regimens of macrolides have not been determined, and its efficacy in Chinese NCFB population has not been validated. This protocol describes a head-to-head clinical trial designed to compare the efficacy of two dosing regimens of azithromycin in Chinese NCFB population. METHODS AND ANALYSIS This prospective, open-label and randomised controlled trial will be conducted in the First People's Hospital of Jiashan, China. Eligible patients with high-resolution CT defined NCFB will be randomly divided into three groups, which will receive either 250 mg daily azithromycin, or 500 mg three-times-weekly azithromycin or no treatment for 6 months. They will be followed up for another 6 months without treatment. The primary outcome is the mean rate of protocol-defined pulmonary exacerbation at 6 months. ETHICS AND DISSEMINATION Ethical approval was obtained from the First People's Hospital of Jiashan Ethics Committee. The findings will be disseminated in peer-reviewed publications. TRIAL REGISTRATION NUMBER ChiCTR2100052906.
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Affiliation(s)
- Yanxiong Mao
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Lan Chen
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Ting He
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Jing Li
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Aiping Zou
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Feng Li
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Fei Chen
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Bo Fan
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Weihao Ni
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Wei Xiao
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Huimin You
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Wenjiang Fu
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
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10
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Coppolo DP, Schloss J, Suggett JA, Mitchell JP. Non-Pharmaceutical Techniques for Obstructive Airway Clearance Focusing on the Role of Oscillating Positive Expiratory Pressure (OPEP): A Narrative Review. Pulm Ther 2021; 8:1-41. [PMID: 34860355 PMCID: PMC8640712 DOI: 10.1007/s41030-021-00178-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/29/2021] [Indexed: 11/26/2022] Open
Abstract
Mucus secretion in the lungs is a natural process that protects the airways from inhaled insoluble particle accumulation by capture and removal via the mucociliary escalator. Diseases such as cystic fibrosis (CF) and associated bronchiectasis, as well as chronic obstructive pulmonary disease (COPD), result in mucus layer thickening, associated with high viscosity in CF, which can eventually lead to complete airway obstruction. These processes severely impair the delivery of inhaled medications to obstructed regions of the lungs, resulting in poorly controlled disease with associated increased morbidity and mortality. This narrative review article focuses on the use of non-pharmacological airway clearance therapies (ACTs) that promote mechanical movement from the obstructed airway. Particular attention is given to the evolving application of oscillating positive expiratory pressure (OPEP) therapy via a variety of devices. Advice is provided as to the features that appear to be the most effective at mucus mobilization.
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Affiliation(s)
| | | | | | - Jolyon P Mitchell
- Jolyon Mitchell Inhaler Consulting Services Inc., 1154 St. Anthony Road, London, ON, N6H 2R1, Canada.
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11
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Wang Y. Effects of Doxofylline Combined with Ceftazidime on Clinical Efficacy, Drug Safety, and Prognosis in Patients with Chronic Obstructive Pulmonary Disease Complicated with Infection. Med Sci Monit 2021; 27:e930494. [PMID: 34404757 PMCID: PMC8381755 DOI: 10.12659/msm.930494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The aim of this study was to investigate the effects of doxofylline combined with ceftazidime on clinical efficacy, drug safety, and prognosis in patients with COPD complicated with infection. Material/Methods A total of 450 patients admitted to the Inner Mongolia BaoGang Hospital for treatment of COPD from January 2017 to December 2019 were selected to participate. All patients were randomly divided into control and observation groups, with 225 patients in each group. In addition, patients with COPD in the remission stage were matched by sex and age for a blank control group. The control group was treated with doxofylline, and the observation group was treated with ceftazidime and doxofylline. No drug intervention was given to the blank control group. Short-term efficacy, pulmonary ventilation function, patient quality of life, peripheral blood TNF-α and PGDF-B levels, and adverse drug reactions were observed. Results The effective treatment rate in the observation group was 96.89%, which was significantly higher than that in the control group (84.00%). Measures of pulmonary ventilation function and patient quality of life in the observation group were significantly higher than those in the control group. Levels of TNF-α and PDGF-B in the observation group were significantly lower than those in the control group. There were no significant differences in the above indicators between the blank control group and the observation group. Conclusions Doxofylline combined with ceftazidime effectively treated patients with COPD complicated with infection. These results provide a reference for clinical treatment.
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Affiliation(s)
- Ying Wang
- Department of Geriatric, Inner Mongolia BaoGang Hospital, Baotou, Inner Mongolia, China (mainland)
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12
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Vidaillac C, Chotirmall SH. Pseudomonas aeruginosa in bronchiectasis: infection, inflammation, and therapies. Expert Rev Respir Med 2021; 15:649-662. [PMID: 33736539 DOI: 10.1080/17476348.2021.1906225] [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] [Indexed: 12/27/2022]
Abstract
Introduction: Bronchiectasis is a chronic endobronchial suppurative disease characterized by irreversibly dilated bronchi damaged by repeated polymicrobial infections and predominantly, neutrophilic airway inflammation. Some consider bronchiectasis a syndromic consequence of several different causes whilst others view it as an individual disease entity. In most patients, identifying an underlying cause remains challenging. The acquisition and colonization of affected airways by Pseudomonas aeruginosa represent a critical and adverse clinical consequence for its progression and management.Areas covered: In this review, we outline clinical and pre-clinical peer-reviewed research published in the last 5 years, focusing on the pathogenesis of bronchiectasis and the role of P. aeruginosa and its virulence in shaping host inflammatory and immune responses in the airway. We further detail its role in airway infection, the lung microbiome, and address therapeutic options in bronchiectasis.Expert opinion: P. aeruginosa represents a key pulmonary pathogen in bronchiectasis that causes acute and/or chronic airway infection. Eradication can prevent adverse clinical consequence and/or disease progression. Novel therapeutic strategies are emerging and include combination-based approaches. Addressing airway infection caused by P. aeruginosa in bronchiectasis is necessary to prevent airway damage, loss of lung function and exacerbations, all of which contribute to adverse clinical outcome.
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Affiliation(s)
- Celine Vidaillac
- Oxford University Clinical Research Unit, University of Oxford, Ho Chi Minh City, Vietnam.,Center for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Chaurasia S, Haran A, Reddy A, Chawla P. Association Between Non-Cystic Fibrosis Bronchiectasis and Quality of Life: A Single-Center Cross-Sectional Study. Cureus 2021; 13:e14231. [PMID: 33959430 PMCID: PMC8093104 DOI: 10.7759/cureus.14231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Bronchiectasis is a chronic respiratory disease that can affect patients of all ages and significantly impact the quality of life (QOL) in patients who suffer from it. In spite of its widespread prevalence, and the significant impact on QOL, data on the quantitative impact of bronchiectasis on QOL is lacking. The Quality of Life-Bronchiectasis (QOL-B) is a self-administered patient-reported outcome measure, that was recently developed as a response to the emergent need for such measurement tools to study the impact of bronchiectasis on QOL. Methods We conducted a single-center cross-sectional study to study the correlation between QOL and various other outcome parameters such as exercise capacity, lung functions, co-morbidities, inflammatory markers, and body mass index (BMI). The secondary outcome was to find out various determinants of quality of life in non-cystic fibrosis bronchiectasis (NCFB). Results Forty-four patients who determined the pre-determined criteria for NCFB were enrolled in this study. This study demonstrated a significant impact on the QOL of NCFB patients based on the QOL-B scoring system. Almost all domains of QOL-B were found to be adversely impacted as measured by one or more of the outcome parameters but the FEV1, age, colonization, extension, dyspnea (FACED) score, bronchiectasis severity index (BSI) score, six-minute walk test (6MWD), and FEV1 showed associations across most scales while the other outcome parameters showed varying associations. Conclusions The QOL is significantly reduced in NCFB and it may be quantified using the QOL-B questionnaire. The impact on QOL in NCFB may be assessed using validated tools such as the FACED and BSI scoring systems, as well as other well-established outcome parameters like 6MWD and FEV1 predicted.
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Affiliation(s)
| | - Alamelu Haran
- Pulmonary Medicine, Vydehi Institute of Medical Sciences and Research Center, Bangalore, IND
| | - Anish Reddy
- Pulmonary Medicine, Vydehi Institute of Medical Sciences and Research Center, Bangalore, IND
| | - Pavny Chawla
- Respiratory Diseases and Sleep Disorders, Artemis Hospital, Gurgaon, IND
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14
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Ielpo A, Crisafulli E, Alcaraz-Serrano V, Gabarrús A, Oscanoa P, Scioscia G, Fernandez-Barat L, Cilloniz C, Amaro R, Torres A. Aetiological diagnosis in new adult outpatients with bronchiectasis:role of predictors derived from real life experience. Respir Med 2020; 172:106090. [PMID: 32916445 DOI: 10.1016/j.rmed.2020.106090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In adult patients with bronchiectasis (BE) the identification of the underlying aetiology may be difficult. In a new patient with BE the performance of a panel of tests is recommended, even though this practice may be expensive and the level of evidence supporting is low. We aimed to identify a panel of variables able to predict the aetiological diagnosis of BE. METHODS Our prospective study derived from our real-life experience on the management of adult stable BE outpatients. We recorded variables concerning clinical, radiological, microbiological and laboratory features. We identified five groups of aetiological diagnosis of BE (idiopathic, post-infective, COPD, asthma and non-common diseases [immunodeficiency or other rare conditions]). Multivariate models were used to identify predictors of each aetiological diagnosis. The suitability of performing a specific test for the diagnosis was also considered. RESULTS We enrolled 354 patients with a new diagnosis of BE. Patients with different aetiological causes differed significantly with regard to age, sex, smoking habit, comorbidities, dyspnoea perception, airflow obstruction and severity scores. Various predictors were assessed, including sex, previous respiratory infections, diffuse localization of BE, risk scores, and laboratory variables (sodium and eosinophils). The levels of autoantibodies or immunoglobulins were reserved for the diagnosis of non-common disease. CONCLUSION Our research confirms that some predictors are specific for the aetiological diagnosis of BE. The possibility of integrating this information may represent a useful tool for the diagnosis. The execution of certain specific tests should be reserved for patients with a non-common disease.
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Affiliation(s)
- Antonella Ielpo
- Pulmonary Division and Pulmonary Rehabilitation Unit, Villa Pineta Hospital, Pavullo, Modena, Italy.
| | - Ernesto Crisafulli
- Department of Medicine, Respiratory Medicine Unit and Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
| | - Victoria Alcaraz-Serrano
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Albert Gabarrús
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Patricia Oscanoa
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Giulia Scioscia
- Department of Medicine and Surgery Science, University of Foggia, Italy.
| | - Laia Fernandez-Barat
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Catia Cilloniz
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Rosanel Amaro
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Antoni Torres
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona - Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) - University of Barcelona - Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
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15
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Xue T, Ma Z, Liu F, Du W, He L, Wang J, An C. Pneumocystis jirovecii colonization and its association with pulmonary diseases: a multicenter study based on a modified loop-mediated isothermal amplification assay. BMC Pulm Med 2020; 20:70. [PMID: 32197601 PMCID: PMC7085144 DOI: 10.1186/s12890-020-1111-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 03/12/2020] [Indexed: 02/07/2023] Open
Abstract
Background Pneumocystis jirovecii (P. jirovecii) is an opportunistic fungal pathogen and the role of its colonization in pulmonary diseases has become a popular focus in recent years. The aim of this study was to develop a modified loop-mediated isothermal amplification (LAMP) assay for detection of Pneumocystis jirovecii (P. jirovecii) DNA amongst non-HIV patients with various pulmonary diseases and use it to examine the prevalence and assess the association of P. jirovecii colonization with clinical characteristics of these diseases. Methods We modified the previously reported LAMP assay for P. jirovecii by adding real-time detection. This method was used to detect P. jirovecii colonization in pulmonary samples collected from 403 non-HIV patients with various pulmonary diseases enrolled from 5 hospitals in China. We determined the prevalence of P. jirovecii colonization in 7 types of pulmonary diseases and assessed the association of P. jirovecii colonization with clinical characteristics of these diseases. Results The modified LAMP assay showed no cross-reactivity with other common pulmonary microbes and was 1000 times more sensitive than that of conventional PCR. Using the modified LAMP assay, we detected P. jirovecii colonization in 281 (69.7%) of the 403 patients enrolled. P. jirovecii colonization was more common in interstitial lung diseases than in chronic obstructive pulmonary disease (COPD) (84.6% vs 64.5%, P < 0.05). Patients with acute exacerbation of COPD had a higher prevalence of P. jirovecii colonization compared to patients with stabilized COPD (67.4% vs 43.3%, P < 0.05). P. jirovecii colonization was associated with decreased pulmonary function, increased levels of 1,3-β-D-glucan and C-reactive protein, and decreased levels of CD4+ T-cell counts (P < 0.05 for each). Approximately 70% of P. jirovecii colonized patients had confections with other fungi or bacteria. Conclusions We developed a modified LAMP assay for detecting P. jirovecii. Our multi-center study of 403 patients supports that P. jirovecii colonization is a risk factor for the development of pulmonary diseases and highlights the need to further study the pathogenesis and transmission of P. jirovecii colonization in pulmonary diseases.
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Affiliation(s)
- Ting Xue
- Department of Microbiology and Parasitology, College of Basic Medical Science, China Medical University, 77 Puhe Road, Shenyang, People's Republic of China.,Department of Respiratory and Critical Care Medicine, First Hospital of Shanxi Medical University, Taiyuan, People's Republic of China
| | - Zhuang Ma
- Department of Respiratory Medicine, General Hospital of Shenyang Military Command, Shenyang, People's Republic of China
| | - Fan Liu
- Department of Respiratory Internal Medicine, the First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Weiqin Du
- Department of Medical Laboratory, the Eleventh Affiliated Hospital of Shanxi Medical University, Lvliang, People's Republic of China
| | - Li He
- Department of Microbiology and Parasitology, College of Basic Medical Science, China Medical University, 77 Puhe Road, Shenyang, People's Republic of China
| | - Jinyan Wang
- Department of Immunology, College of Basic Medical Science, China Medical University, Shenyang, People's Republic of China
| | - Chunli An
- Department of Microbiology and Parasitology, College of Basic Medical Science, China Medical University, 77 Puhe Road, Shenyang, People's Republic of China.
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Hsu D, Irfan M, Jabeen K, Iqbal N, Hasan R, Migliori GB, Zumla A, Visca D, Centis R, Tiberi S. Post tuberculosis treatment infectious complications. Int J Infect Dis 2020; 92S:S41-S45. [PMID: 32114203 DOI: 10.1016/j.ijid.2020.02.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/14/2020] [Accepted: 02/14/2020] [Indexed: 12/16/2022] Open
Abstract
Following greater attention and follow-up of patients with treated pulmonary tuberculosis (TB), it has emerged that infections are more likely to occur in this cohort of patients. This comes as no surprise, as pulmonary TB is a destructive process that leads to cicatrization, alteration of parenchyma, bronchiectasis, and scarring of the lung, with reduction of lung volumes and an impact on pulmonary function. In addition to relapse and re-infection with TB, other pathogens are increasingly recognized in post-TB patients. This paper serves as a summary and guide on how to approach the post-TB patient with new signs and symptoms of pulmonary infection in order to ensure optimal management and rehabilitation.
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Affiliation(s)
- Desmond Hsu
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK.
| | - Muhammad Irfan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan.
| | - Kauser Jabeen
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan.
| | - Nousheen Iqbal
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan.
| | - Rumina Hasan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan.
| | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy.
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK.
| | - Dina Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy; Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese, Italy.
| | - Rosella Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy.
| | - Simon Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK.
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Oxidative and inflammatory effects of pulmonary rehabilitation in patients with bronchiectasis. A prospective, randomized study. NUTR HOSP 2020; 37:6-13. [PMID: 31960695 DOI: 10.20960/nh.02763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Background: systemic inflammation and oxidative stress are important factors in the pathogenesis of bronchiectasis. Pulmonary rehabilitation (PR) is recommended for bronchiectasis, but there is no data about its effect on the inflammatory and REDOX status of these patients. Aims: to investigate the effect of PR in non-cystic-fibrosis bronchiectasis (NCFB) patients, and to compare it with the effect of PR plus a hyperproteic oral nutritional supplement (PRS) enriched with beta-hydroxy-beta-methylbutyrate (HMB) on serum inflammatory and oxidative biomarkers. Materials and methods: this was an open randomized, controlled trial. Thirty individuals (65 years old or younger with a body mass index over 18.5, older than 65 years with a body mass index over 20) were recruited from September 2013 to September 2014, and randomly assigned to receive PR or PRS. Total neutrophils, and inflammatory and oxidative biomarker levels were measured at baseline, and then at 3 and 6 months. Results: in the PRS group neutrophil levels were decreased from baseline at 6 months. A significantly different fold change was found between the PR and PRS groups. In the PR group, IL-6 and adiponectin were increased by the end of the study while TNFα levels were decreased from baseline at 6 months. REDOX biomarkers remained stable throughout the study except for 8-isoprostane levels, which were increased from baseline at 6 months in both groups of patients. Conclusions: a PR program induced a pro-oxidative effect accompanied by changes in circulating inflammatory cytokine levels in NCFB patients. Our results would also suggest a possible beneficial effect of the HMB enriched supplement on neutrophil level regulation in these patients. The information provided in this study could be useful for choosing the right therapeutic approach in the management of bronchiectasis.
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Sahin H, Naz I, Susam S, Erbaycu AE, Olcay S. The effect of the presence and severity of bronchiectasis on the respiratory functions, exercise capacity, dyspnea perception, and quality of life in patients with chronic obstructive pulmonary disease. Ann Thorac Med 2020; 15:26-32. [PMID: 32002044 PMCID: PMC6967141 DOI: 10.4103/atm.atm_198_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/17/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND: Bronchiectasis is common in patients with advanced chronic obstructive pulmonary disease (COPD) and adversely affects the patients' clinical condition. This study aimed to investigate the effects of bronchiectasis on exercise capacity, dyspnea perception, disease-specific quality of life, and psychological status in patients with COPD and determine the extent of these adverse effects by the severity of bronchiectasis. METHODS: A total of 387 COPD patients (245 patients with only COPD [Group 1] and 142 COPD patients with accompanying bronchiectasis [Group 2]) were included in the study. The patients in Group 2 were divided into three subgroups as mild, moderate, and severe using the Bronchiectasis Severity Index. Six-minute walk distance, dyspnea perception, St. George's Respiratory Questionnaire (SGRQ), and hospital anxiety and depression scores were compared between the groups. RESULTS: In Group 2, dyspnea perception, SGRQ total scores, depression score were higher, and walking distance was lower (P = 0.001, P = 0.007, P = 0.001, and P = 0.011, respectively). Group 2 had significantly worse arterial blood gas values. Dyspnea perception increased with the increasing severity in Group 2 (P < 0.001). Walking distance was lower in patients with severe bronchiectasis (P < 0.001). SGRQ total score, anxiety, and depression scores were significantly higher in the severe subgroup (P < 0.001, P = 0.003, and P = 0.002, respectively). CONCLUSIONS: In patients with Stage 3 and 4 COPD, the presence of bronchiectasis adversely affects the clinical status of the patients, decreases their exercise capacity, deteriorates their quality of life, and disrupts their psychological status. Investigating the presence of bronchiectasis in COPD patients is crucial for early diagnosis and proper treatment.
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Affiliation(s)
- Hulya Sahin
- Pulmonary Rehabilitation Unit, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
| | - Ilknur Naz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Katip Celebi University, Izmir, Turkey
| | - Seher Susam
- Department of Radiology, Radiology Unit, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
| | - Ahmet Emin Erbaycu
- Department of Chest Diseases, Radiology Unit, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
| | - Serhan Olcay
- Department of Chest Diseases, Burdur State Hospital, Burdur, Turkey
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