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Martínez-García MA, Olveira C, Girón R, García-Clemente M, Máiz L, Sibila O, Golpe R, Rodríguez-Hermosa JL, Barreiro E, Méndez R, Prados C, Rodríguez-López J, Oscullo G, de la Rosa D. Reliability of blood eosinophil count in steady-state bronchiectasis. Pulmonology 2024:S2531-0437(23)00204-0. [PMID: 38182470 DOI: 10.1016/j.pulmoe.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/14/2023] [Accepted: 11/21/2023] [Indexed: 01/07/2024] Open
Abstract
RATIONALE The baseline value of eosinophils in peripheral blood (BEC) has been associated with different degrees of severity, prognosis and response to treatment in patients with bronchiectasis. It is not known, however, if this basal value remains constant over time. OBJECTIVES The aim of this study was to assess whether the BEC remains stable in the long term in patients with bronchiectasis. METHODS AND MEASUREMENTS Patients from the RIBRON registry of bronchiectasis diagnosed by computed tomography with at least 2 BEC measurements one year apart were included in the study. Patients with asthma and those taking anti-eosinophilic drugs were excluded. Reliability was assessed using the intra-class correlation coefficient (ICC). A patient with a BEC of at least 300 cells/uL or less than 100 cells/uL was considered eosinophilic or eosinopenic, respectively. Group changes over time were also calculated. MAIN RESULTS Seven hundred and thirteen patients were finally included, with a mean age of 66.5 (13.2) years (65.8 % women). A total of 2701 BEC measurements were performed, with a median number of measurements per patient of 4 (IQR: 2-5) separated by a median of 12.1 (IQR: 10.5-14.3) months between two consecutive measurements. The ICC was good (>0.75) when calculated between two consecutive measurements (approximately one year apart) but had dropped significantly by the time of the next annual measurements. Similarly, the change from an eosinophilic or eosinopenic patient to a non-eosinophilic or non-eosinopenic patient, respectively, was less than 30 % during the first year with respect to the baseline value but was close to 50 % in later measurements. CONCLUSIONS Given the significant changes observed in the baseline value of the BEC over time, its monitoring is necessary in patients with bronchiectasis in order to more reliably assess its usefulness.
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Affiliation(s)
- M A Martínez-García
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; CIBERES de Enfermedades Respiratorias. ISCIII. Madrid. Spain.
| | - C Olveira
- Servicio de Neumología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Universidad de Málaga, Málaga, Spain
| | - R Girón
- Servicio de Neumología, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
| | - M García-Clemente
- Servicio de Neumología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - L Máiz
- Servicio de Neumología, Hospital Ramón y Cajal, Madrid, Spain
| | - O Sibila
- Servicio de Neumología, Hospital Clínico, Barcelona, Spain
| | - R Golpe
- Servicio de Neumología, Hospital Lucus Augusti, Lugo, Spain
| | | | - E Barreiro
- Servicio de Neumología, Hospital del Mar-IMIM, UPF, CIBERES, Barcelona, Spain; CIBERES de Enfermedades Respiratorias. ISCIII. Madrid. Spain
| | - Raúl Méndez
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; CIBERES de Enfermedades Respiratorias. ISCIII. Madrid. Spain
| | - C Prados
- Servicio de Neumología, Hospital La Paz, Madrid, Spain
| | - J Rodríguez-López
- Servicio de Neumología, Hospital San Agustín, Avilés, Asturias, Spain
| | - G Oscullo
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - D de la Rosa
- Servicio de Neumología, Hospital Santa Creu i Sant Pau, Barcelona, Spain
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Martínez-García MÁ, Oscullo G, Gomez-Olivas JD. Peripheral cellular biomarkers in bronchiectasis. Respir Med Res 2023; 84:101063. [PMID: 38029651 DOI: 10.1016/j.resmer.2023.101063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/29/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Miguel Ángel Martínez-García
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, España; CIBERES de Enfermedades Respiratorias, ISCIII, Madrid, Spain.
| | - Grace Oscullo
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, España
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de la Rosa-Carrillo D, Máiz-Carro L, Martínez-García MÁ. What Have We Learned About Bronchiectasis From RIBRON (Spanish Bronchiectasis Registry)? Arch Bronconeumol 2023; 59:625-626. [PMID: 37516559 DOI: 10.1016/j.arbres.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/31/2023]
Affiliation(s)
| | - Luis Máiz-Carro
- Servicio de Neumologia, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Miguel Ángel Martínez-García
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; CIBERES de Enfermedades Respiratorias, ISCIII, Madrid, Spain
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Martínez-García MÁ, Méndez R, Olveira C, Girón R, García-Clemente M, Máiz L, Sibila O, Golpe R, Rodríguez-Hermosa JL, Barreiro E, Prados C, Rodríguez-López J, Oscullo G, Labarca G, de la Rosa D. The U-Shaped Relationship Between Eosinophil Count and Bronchiectasis Severity: The Effect of Inhaled Corticosteroids. Chest 2023; 164:606-613. [PMID: 37088355 DOI: 10.1016/j.chest.2023.04.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Although a proven relationship exists between the blood eosinophil count (BEC) and the severity of both asthma and COPD, its relationship with bronchiectasis has not been well established. The objective of this study was to analyze the relationship between BEC and the number and severity of exacerbations, and patients' responses to inhaled corticosteroid (IC) treatment in bronchiectasis RESEARCH QUESTION: Does an association exist among BEC, the number of exacerbations and severity of bronchiectasis, and IC treatment? STUDY DESIGN AND METHODS This was a multicenter (43 centers) prospective observational study derived from the Spanish Bronchiectasis Registry. Patients with proven bronchiectasis and a known BEC were included, whereas those with asthma or antieosinophilic treatments were excluded. Patients were divided into four groups according to the BEC at the time of inclusion in the study in a steady-state situation: (1) eosinopenic bronchiectasis (< 50 eosinophils/μL), (2) low number of eosinophils (51-100/μL), (3) normal number of eosinophils (101-300/μL), and (4) eosinophilic bronchiectasis (> 300 eosinophils/μL). RESULTS Nine hundred twenty-eight patients finally were included: 123 patients (13.3%) with < 50 eosinophils/μL (eosinopenic group), 164 patients (17.7%) with 50-100 eosinophils/μL, 488 patients (52.6%) with 101-300 eosinophils/μL, and 153 patients (16.5%) with > 300 eosinophils/μL (eosinophilic group). BEC showed a significant U-shaped relationship with severity, exacerbations, lung function, microbiologic profile, and IC treatment (these being higher in the eosinopenic group compared with the eosinophilic group). IC treatment significantly decreased the number and severity of exacerbations only in the group of bronchiectasis patients with > 300 eosinophils/μL. INTERPRETATION A significant U-shaped relationship was found between BEC and severity and exacerbations in bronchiectasis that was more pronounced in the eosinopenic group. IC treatment decreased the number and severity of exacerbations only in the eosinophilic group.
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Affiliation(s)
- Miguel Ángel Martínez-García
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; CIBERES de Enfermedades Respiratorias, ISCIII, Madrid, Spain.
| | - Raúl Méndez
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; CIBERES de Enfermedades Respiratorias, ISCIII, Madrid, Spain
| | - Casilda Olveira
- Servicio de Neumología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Universidad de Málaga, Málaga, Spain
| | - Rosa Girón
- Servicio de Neumología, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Luis Máiz
- Servicio de Neumología, Hospital Ramón y Cajal, Madrid, Spain
| | - Oriol Sibila
- Servicio de Neumología, Hospital Clínico, Barcelona, Spain
| | - Rafael Golpe
- Servicio de Neumología, Hospital Lucus Augusti, Lugo, Spain
| | | | - Esther Barreiro
- CIBERES de Enfermedades Respiratorias, ISCIII, Madrid, Spain; Servicio de Neumología, Hospital del Mar-IMIM, UPF, CIBERES, Barcelona, Spain
| | | | | | - Grace Oscullo
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Gonzalo Labarca
- Division of Sleep Medicine, Harvard Medical School, Boston, MA; Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepción, Concepción, Chile
| | - David de la Rosa
- Servicio de Neumología, Hospital Santa Creu i Sant Pau, Barcelona, Spain
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Solarat B, Perea L, Faner R, de La Rosa D, Martínez-García MÁ, Sibila O. Pathophysiology of Chronic Bronchial Infection in Bronchiectasis. Arch Bronconeumol 2023; 59:101-108. [PMID: 36180278 DOI: 10.1016/j.arbres.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 02/07/2023]
Abstract
Bronchiectasis is a complex and heterogeneous disease. Its pathophysiology is poorly understood, but chronic bronchial infection plays an important role in its natural history, and is associated with poor quality of life, more exacerbations and increased mortality. Pseudomonas aeruginosa, Haemophilus influenzae and Staphylococcus aureus are the most common bacteria related to chronic bronchial infection. Non-tuberculous mycobacteria, fungi and respiratory viruses are also present during clinical stability, and may increase the risk of acute exacerbation. Chronic inflammation is present in bronchiectasis, especially neutrophilic inflammation. However, macrophages and eosinophils also play a key role in the disease. Finally, airway epithelium has innate mechanisms such as mucociliary clearance and antibacterial molecules like mucins and antimicrobial peptides that protect the airways from pathogens. This review addresses how the persistence of microorganisms in the airways and the imbalance of the immune system contribute to the development of chronic bronchial infection in bronchiectasis.
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Affiliation(s)
- Belén Solarat
- Respiratory Department, Hospital Clínic, IDIBAPS, CIBERES, C. de Villaroel, 170, 08036 Barcelona, Spain
| | - Lidia Perea
- Respiratory Department, Hospital Clínic, IDIBAPS, CIBERES, C. de Villaroel, 170, 08036 Barcelona, Spain
| | - Rosa Faner
- Respiratory Department, Hospital Clínic, IDIBAPS, CIBERES, C. de Villaroel, 170, 08036 Barcelona, Spain
| | - David de La Rosa
- Respiratory Department, Hospital Sant Pau, C. Sant Quintí, 89, 08041 Barcelona, Spain
| | - Miguel Ángel Martínez-García
- Respiratory Department, Hospital La Fe, CIBERES, Avinguda de Fernando Abril Martorell, 106, 46026 València, Spain
| | - Oriol Sibila
- Respiratory Department, Hospital Clínic, IDIBAPS, CIBERES, C. de Villaroel, 170, 08036 Barcelona, Spain.
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Peripheral Neutrophil-to-Lymphocyte Ratio in Bronchiectasis: A Marker of Disease Severity. Biomolecules 2022; 12:biom12101399. [PMID: 36291608 PMCID: PMC9599714 DOI: 10.3390/biom12101399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
Most patients with bronchiectasis have a predominantly neutrophilic inflammatory profile, although other cells such as lymphocytes (as controllers of bronchial inflammation) and eosinophils also play a significant pathophysiological role. Easy-to-interpret blood biomarkers with a discriminative capacity for severity or prognosis are needed. The objective of this study was to assess whether the peripheral neutrophil-to-lymphocyte ratio (NLR) is associated with different outcomes of severity in bronchiectasis. A total of 1369 patients with bronchiectasis from the Spanish Registry of Bronchiectasis were included. To compare groups, the sample was divided into increasing quartiles of NLR ratio. Correlations between quantitative variables were established using Pearson's P test. A simple linear regression (with the value of exacerbations as a quantitative variable) was used to determine the independent relationship between the number and severity of exacerbations and the NLR ratio. The area under the curve (AUC)-ROC was used to determine the predictive capacity of the NLR for severe bronchiectasis, according to the different multidimensional scores. Mean age: 69 (15) years (66.3% of women). The mean NLR was 2.92 (2.03). A higher NLR was associated with more severe bronchiectasis (with an especially significant discriminative power for severe forms) according to the commonly used scores (FACED, E-FACED and BSI), as well as with poorer quality of life (SGRQ), more comorbidities (Charlson index), infection by pathogenic microorganisms, and greater application of treatment. Furthermore, the NLR correlated better with severity scores than other parameters of systemic inflammation. Finally, it was an independent predictor of the incident number and severity of exacerbations. In conclusion, the NLR is an inexpensive and easy-to-measure marker of systemic inflammation for determining severity and predicting exacerbations (especially the most severe) in patients with bronchiectasis.
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