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Pérez-Torres Lobato MR, Mejías Trueba M, Rodríguez Ramallo H, Álvarez Del Vayo Benito C, Iglesias Aguilar MDC, Gaboli M. Prolonged treatment with inhaled ampicillin in children with non-cystic fibrosis bronchiectasis. Arch Bronconeumol 2021; 57:662-664. [PMID: 35702908 DOI: 10.1016/j.arbr.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/02/2020] [Indexed: 06/15/2023]
Affiliation(s)
| | - Marta Mejías Trueba
- Servicio de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | | | - Mirella Gaboli
- Unidad de Neumología Pediátrica, Servicio de Pediatría, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
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De la Rosa Carrillo D, Martínez-García MÁ, Barreiro E, Tabernero Huguet E, Costa Sola R, García-Clemente MM, Celorrio Jiménez N, Rodríguez Pons L, Calero Acuña C, Rodríguez Hermosa JL, Golpe R, Dacal Quintas R, Sánchez-Cuéllar S, Torres Arroyo I, Blanco Aparicio M, Almadana Pacheco V, Miravitlles M. Effectiveness and Safety of Inhaled Antibiotics in Patients With Chronic Obstructive Pulmonary Disease. A Multicentre Observational Study. Arch Bronconeumol 2021; 58:11-21. [PMID: 33849721 DOI: 10.1016/j.arbres.2021.03.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND We aimed to describe the effectiveness and safety of inhaled antibiotics in chronic obstructive pulmonary disease (COPD) patients, as well as the patient profile in which they are usually prescribed and the patient groups that can most benefit from this treatment. METHODS Multicentre retrospective observational cohort study in COPD patients who had received ≥1 dose of inhaled antibiotics in the last 5 years. Clinical data from the two years prior to and subsequent to the start of the treatment were compared. PRIMARY OUTCOME COPD exacerbations. SECONDARY OUTCOMES side effects, symptomatology (sputum purulence, dyspnoea), microbiological profile and pathogen eradication. RESULTS Of 693 COPD patients analyzed (aged 74.1; 86.3% men; mean FEV1=43.7%), 71.7% had bronchiectasis and 46.6% presented chronic bronchial infection (CBI) by Pseudomonas aeruginosa (PA). After 1 year of treatment with inhaled antibiotics, there was a significant decrease in the number of exacerbations (-33.3%; P<.001), hospital admissions (-33.3%; P<.001) and hospitalization days (-26.2%; P=.003). We found no difference in effectiveness between patients with or without associated bronchiectasis. Positive patient outcomes were more pronounced in PA-eradicated patients. We found a significant reduction in daily expectoration (-33.1%; P=.024), mucopurulent/purulent sputum (-53.9%; P<.001), isolation of any potentially pathogenic microorganisms (PPM) (-16.7%; P<.001), CBI by any PPM (-37.4%; P<.001) and CBI by PA (-49.8%; P<.001). CBI by any PPM and ≥three previous exacerbations were associated with a better treatment response. 25.4% of patients presented non-severe side-effects, the most frequent of these being bronchospasm (10.5%), dyspnoea (8.8%) and cough (1.7%). CONCLUSIONS In COPD patients with multiple exacerbations and/or CBI by any PPM (especially PA), inhaled antibiotics appear to be an effective and safe treatment, regardless of the presence of bronchiectasis.
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Affiliation(s)
- David De la Rosa Carrillo
- Pneumology Service, Hospital de la Santa Creu i Sant Pau, C. Sant Quintí 89, 08041, Barcelona, Spain.
| | - Miguel-Ángel Martínez-García
- Pneumology Service, Hospital Universitario y Politécnico La Fe, Av. de Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - Esther Barreiro
- Pulmonology Department, Hospital del MAR-IMIM, CEXS (UPF), CIBERES, Passeig Marítim de la Barceloneta 25-29, 08003, Barcelona, Spain
| | - Eva Tabernero Huguet
- Pneumology Service, Hospital de Cruces, Cruces Plaza, s/n, 48903, Barakaldo, Bizkaia, Spain
| | - Roser Costa Sola
- Pneumology Service, Hospital Mutua de Terrassa, Plaça del Doctor Robert 5, 08221, Terrassa, Barcelona, Spain
| | | | - Nuria Celorrio Jiménez
- Pneumology Service, Hospital de Viladecans, Av. de Gavà 38, 08840, Viladecans, Barcelona, Spain
| | - Laura Rodríguez Pons
- Pneumology Service, Hospital Universitario Germans Trias i Pujol, Carretera de Canyet, s/n, 08916, Badalona, Barcelona, Spain
| | - Carmen Calero Acuña
- Pneumology Service, Hospital Universitario Virgen del Rocio, Av. Manuel Siurot, s/n, 41013, Sevilla, Spain
| | - Juan Luís Rodríguez Hermosa
- Pneumology Service, Hospital Clínico San Carlos, School of Medicine, Universidad Complutense de Madrid, Calle del Profesor Martín Lagos, s/n, 28040, Madrid, Spain
| | - Rafael Golpe
- Pneumology Service, Hospital Universitario Lucus Augusti, Rúa Dr. Ulises Romero 1, 27003, Lugo, Spain
| | - Raquel Dacal Quintas
- Pneumology Service, Complexo Hospitalario Universitario de Ourense, Calle Ramon Puga Noguerol 54, 32005, Ourense, Spain
| | - Silvia Sánchez-Cuéllar
- Pneumology Service, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este 80, 28031, Madrid, Spain
| | - Irene Torres Arroyo
- Pneumology Service, Hospital Fundación Alcorcón, Calle Budapest 1, 28922, Alcorcón, Madrid, Spain
| | - Marina Blanco Aparicio
- Pneumology Service, Complexo Hospitalario Universitario A Coruña, Xubias de Arriba 84, 15006, A Coruña, Spain
| | - Virginia Almadana Pacheco
- Pneumology Service, Hospital Universitario Virgen de la Macarena, Calle Dr. Fedriani 3, 41009, Sevilla, Spain
| | - Marc Miravitlles
- Pneumology Service, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorios (CIBERES), Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain
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Pérez-Torres Lobato MR, Mejías Trueba M, Rodríguez Ramallo H, Álvarez Del Vayo Benito C, Iglesias Aguilar MDC, Gaboli M. Prolonged Treatment With Inhaled Ampicillin in Children With Non-cystic Fibrosis Bronchiectasis. Arch Bronconeumol 2020; 57:S0300-2896(20)30538-X. [PMID: 33494941 DOI: 10.1016/j.arbres.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/21/2020] [Accepted: 12/02/2020] [Indexed: 11/26/2022]
Affiliation(s)
| | - Marta Mejías Trueba
- Servicio de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | | | | | - Mirella Gaboli
- Unidad de Neumología Pediátrica, Servicio de Pediatría, Hospital Universitario Virgen del Rocío, Sevilla, España.
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de la Rosa Carrillo D, López-Campos JL, Alcázar Navarrete B, Calle Rubio M, Cantón Moreno R, García-Rivero JL, Máiz Carro L, Olveira Fuster C, Martínez-García MÁ. Consensus Document on the Diagnosis and Treatment of Chronic Bronchial Infection in Chronic Obstructive Pulmonary Disease. Arch Bronconeumol 2020; 56:651-664. [PMID: 32540279 DOI: 10.1016/j.arbres.2020.04.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/22/2020] [Accepted: 04/01/2020] [Indexed: 02/07/2023]
Abstract
Although the chronic presence of microorganisms in the airways of patients with stable chronic obstructive pulmonary disease (COPD) confers a poor outcome, no recommendations have been established in disease management guidelines on how to diagnose and treat these cases. In order to guide professionals, the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) has prepared a document which aims to answer questions on the clinical management of COPD patients in whom microorganisms are occasionally or habitually isolated. Since the available scientific evidence is too heterogeneous to use in the creation of a clinical practice guideline, we have drawn up a document based on existing scientific literature and clinical experience, addressing the definition of different clinical situations and their diagnosis and management. The text was drawn up by consensus and approved by a large group of respiratory medicine experts with extensive clinical and scientific experience in the field, and has been endorsed by the SEPAR Scientific Committee.
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Affiliation(s)
| | - José Luís López-Campos
- Servicio de Neumología, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
| | - Bernardino Alcázar Navarrete
- Servicio de Neumología, Hospital Regional Universitario de Málaga. Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, España
| | - Myriam Calle Rubio
- Servicio de Neumología, Hospital de Alta Resolución de Loja, Loja, Granada, España
| | - Rafael Cantón Moreno
- Servicio de Neumología, Unidad de Infección Bronquial Crónica, Fibrosis Quística y Bronquiectasias, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Juan Luis García-Rivero
- Servicio de Neumología, Hospital Clínico San Carlos. Departamento de Medicina, Facultad de Medicina, UCM, Madrid, España
| | - Luís Máiz Carro
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España
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Lopez-Campos JL, Miravitlles M, de la Rosa Carrillo D, Cantón R, Soler-Cataluña JJ, Martinez-Garcia MA. Current Challenges in Chronic Bronchial Infection in Patients with Chronic Obstructive Pulmonary Disease. J Clin Med 2020; 9:E1639. [PMID: 32481769 PMCID: PMC7356662 DOI: 10.3390/jcm9061639] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/14/2022] Open
Abstract
Currently, chronic obstructive pulmonary disease (COPD) patients and their physicians face a number of significant clinical challenges, one of which is the high degree of uncertainty related to chronic bronchial infection (CBI). By reviewing the current literature, several challenges can be identified, which should be considered as goals for research. One of these is to establish the bases for identifying the biological and clinical implications of the presence of potentially pathogenic microorganisms in the airways that should be more clearly elucidated according to the COPD phenotype. Another urgent area of research is the role of long-term preventive antibiotics. Clinical trials need to be carried out with inhaled antibiotic therapy to help clarify the profile of those antibiotics. The role of inhaled corticosteroids in patients with COPD and CBI needs to be studied to instruct the clinical management of these patients. Finally, it should be explored and confirmed whether a suitable antimicrobial treatment during exacerbations may contribute to breaking the vicious circle of CBI in COPD. The present review addresses the current state of the art in these areas to provide evidence which will enable us to progressively plan better healthcare for these patients.
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Affiliation(s)
- José Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, 41013 Seville, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.M.); (M.A.M.-G.)
| | - Marc Miravitlles
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.M.); (M.A.M.-G.)
- Pneumology Department, Hospital Universitari Vall d’Hebron/Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
| | | | - Rafael Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain;
| | | | - Miguel Angel Martinez-Garcia
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.M.); (M.A.M.-G.)
- Pneumology Department, Universitary and Polytechnic La Fe Hospital, 46015 Valencia, Spain
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