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Pieters ALP, van der Veer T, Meerburg JJ, Andrinopoulou ER, Vd Eerden MM, Ciet P, Aliberti S, Burgel PR, Crichton ML, Shoemark A, Goeminne PC, Shteinberg M, Loebinger MR, Haworth CS, Blasi F, Tiddens HA, Caudri D, Chalmers JD. Structural Lung Disease and Clinical Phenotype in Bronchiectasis Patients: The EMBARC CT Study. Am J Respir Crit Care Med 2024. [PMID: 38635862 DOI: 10.1164/rccm.202311-2109oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/18/2024] [Indexed: 04/20/2024] Open
Abstract
RATIONALE Chest computed tomography -scans (CTs) are essential to diagnose and monitor bronchiectasis (BE). To date, little quantitative data is available about the nature and extent of structural lung abnormalities (SLA) on CTs of BE patients. OBJECTIVES to investigate SLA on CTs of patients with bronchiectasis and the relationship of SLAs to clinical features using the European Bronchiectasis Registry (EMBARC) Methods: CTs from BE patients included in the EMBARC registry were analyzed using the validated Bronchiectasis Scoring Technique for CT (BEST-CT). BEST-CT subscores are expressed as % of total lung volume. Scored items are: atelectasis/consolidation (%ATCON), bronchiectasis with and without mucus plugging (%BEMP, %BEwMP), airway wall thickening (%AWT), mucus plugging (%MP), ground-glass opacities (%GGO), bullae (%BUL), airways and parenchyma (%A,%P). Four composite scores were calculated: Total BE (%TBE=%BEMP+%BEwMP), total MP (%TMP=%BEMP+%MP), total inflammatory changes (%TinF=%ATCON+%BEMP+%MP+%GGO) and total disease (%DIS= all but %A & %P).¬ Measurments and Main Results: CTs of 524 BE patients were analyzed. Mean (range) of subscores were: %TBE 4.6 (2.3-7.7), %TMP 4.2 (1.2-8.1), %TinF 8.3 (3.5-16.7) and %DIS 14.9 (9.1-25.9). BE associated with primary ciliary dyskinesia was associated with more SLA, while COPD was associated with less SLA. Lower FEV1, longer disease duration, Pseudomonas aeruginosa and NTM infection, and severe exacerbations were all independently associated with worse SLA. CONCLUSION Patients with bronchiectasis have highly heterogeneous type and extent of structural lung abnormalities. Strong relationships between radiological disease and clinical features suggest CT analysis may be a useful tool for clinical phenotyping.
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Affiliation(s)
- Angelina L P Pieters
- Elisabeth-TweeSteden Ziekenhuis, 7898, Radiology, Tilburg, Netherlands
- Erasmus MC, 6993, Radiology, Rotterdam, Netherlands
| | | | | | | | | | - Pierluigi Ciet
- Erasmus MC, 6993, Radiology, Rotterdam, Zuid-Holland, Netherlands
- Erasmus MC, 6993, Pediatrics, Respiratory Medicine and Allergology, Rotterdam, Zuid-Holland, Netherlands
| | - Stefano Aliberti
- Humanitas University, 437807, Department of Biomedical Sciences, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, 9268, Respiratory Unit, Rozzano, Italy
| | - Pierre-Regis Burgel
- Service de Pneumologie, Hôpital Cochin, AP-HP and Université Paris Descartes (EA2511), Sorbonne Paris Cité, Paris, France
| | - Megan L Crichton
- University of Dundee, 3042, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Amelia Shoemark
- Royal Brompton Hospital, EM Unit, London, United Kingdom of Great Britain and Northern Ireland
- University of Dundee, 3042, Clinical and molecular medicine, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Pieter C Goeminne
- AZ Nikolaas, 82428, Department of Respiratory Disease, AZ Nikolaas, Sint-Niklaas, Sint-Niklaas, Belgium
- UZ Leuven, Department of Respiratory Disease, Leuven, Belgium
| | - Michal Shteinberg
- Lady Davies Carmel Medical Center, 37255, Pulmonology Institute and CF center, Haifa, Northern Israel, Israel
- Technion Israel Institute of Technology, 26747, The B. Rappaport Faculty of Medicine, Haifa, Israel
| | - Michael R Loebinger
- Royal Brompton and Harefield NHS Foundation Trust, Department of Respiratory Medicine, London, United Kingdom of Great Britain and Northern Ireland
| | - Charles S Haworth
- Royal Papworth Hospital, 2144, Cambridge Centre for Lung Infection, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Francesco Blasi
- University of Milano, Dipartimento Toraco-Polmonare e Cardiovascolare, Milan, Italy
| | - Harm Awm Tiddens
- ErasmusMC-Sophia Chidlren's Hospital, Pediatric pulmonology, Rotterdam, South Holland, Netherlands
| | - Daan Caudri
- Erasmus MC, Medical University Rotterdam, Pediatrics, Rotterdam, Netherlands;
| | - James D Chalmers
- University of Dundee, 3042, Dundee, United Kingdom of Great Britain and Northern Ireland
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2
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Spinou A, Hererro-Cortina B, Aliberti S, Goeminne PC, Polverino E, Dimakou K, Haworth CS, Loebinger MR, De Soyza A, Vendrell M, Burgel PR, McDonnell M, Sutharsan S, Skrgat S, Maiz-Carro L, Sibila O, Stolz D, Kauppi P, Bossios A, Hill AT, Clifton I, Crichton ML, Walker P, Menendez R, Borecki S, Obradovic D, Nowinski A, Amorim A, Torres A, Lorent N, Welte T, Blasi F, Makek MJ, Shteinberg M, Boersma W, Elborn JS, Chalmers JD, Ringshausen FC. Airway clearance management in people with bronchiectasis: data from the European Bronchiectasis Registry (EMBARC). Eur Respir J 2024:2301689. [PMID: 38609097 DOI: 10.1183/13993003.01689-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/02/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND International guidelines recommend airway clearance management as one of the important pillars of bronchiectasis treatment. However, the extent to which airway clearance is used for people with bronchiectasis in Europe is unclear. The aim of the study was to identify the use of airway clearance management in patients with bronchiectasis across different countries and factors influencing airway clearance use. METHODS Prospective observational study using data from the EMBARC Registry between January 2015 and April 2022. Pre-specified options for airway clearance management were recorded, including airway clearance techniques, devices and use of mucoactive drugs. RESULTS 16 723 people with bronchiectasis from 28 countries were included in the study. Mean age was 67 years (interquartile range 57-74 years, range 18-100 years) and 61% were females. Seventy-two percent of the participants reported daily sputum expectoration and 52% (95% CI 51-53%) of all participants reported using regular airway clearance management. Active cycle of breathing technique was used by 28% of the patients and airway clearance devices by 16% of participants. The frequency of airway clearance management and techniques used varied significantly between different countries. Patients who used airway clearance management had greater disease severity and worse symptoms, including a higher daily sputum volume compared to those who did not use it regularly. Mucoactive drugs were also more likely to be used in patients with more severe disease. Access to specialist respiratory physiotherapy was low throughout Europe, but particularly low in Eastern Europe. CONCLUSIONS Only half of the people with bronchiectasis in Europe use airway clearance management. Use and access to devices, mucoactive drugs and specialist chest physiotherapy appears to be limited in many European countries.
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Affiliation(s)
- Arietta Spinou
- Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, UK
- King's Centre for Lung Health, King's College London
- Arietta Spinou and Beatriz Herrero-Cortina contributed equally to this paper
| | - Beatriz Hererro-Cortina
- Universidad San Jorge, Zaragoza, Spain
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) de Aragón, Zaragoza, Spain
- Arietta Spinou and Beatriz Herrero-Cortina contributed equally to this paper
| | - Stefano Aliberti
- IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Eva Polverino
- Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBERES, Barcelona, Spain
| | - Katerina Dimakou
- 5th Respiratory Department and Bronchiectasis Unit, ''SOTIRIA" General Hospital of Chest Diseases Medical Practice: 86 Kifisias Ave, Athens, Greece
| | - Charles S Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital and University of Cambridge, Cambridge, UK
| | - Michael R Loebinger
- Royal Brompton and Harefield Hospitals and National Heart and Lung Institute, Imperial College London, UK
| | - Anthony De Soyza
- Population and Health Science Institute, Newcastle University and NIHR Biomedical Research Centre for Ageing, Freeman Hospital, Newcastle, UK
| | - Montserrat Vendrell
- Department of Pulmonology, Dr Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), University of Girona, Spain
| | - Pierre Regis Burgel
- Department of Respiratory Medicine and French Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP
- Université Paris Cité, Inserm U1016, Institut Cochin, Paris, France
| | - Melissa McDonnell
- Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland
| | - Sivagurunathan Sutharsan
- Department of Pulmonary Medicine, University Hospital Essen - Ruhrlandklinik, Adult Cystic Fibrosis Center, University of Duisburg-Essen, Essen, Germany
| | - Sabina Skrgat
- University Medical Centre Ljubljana, Department of Pulmonary Diseases and Allergy, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Luiz Maiz-Carro
- Chronic Bronchial Infection Unit, Pneumology Service, Ramón y Cajal Hospital, Alcalá de Henares University, Madrid, Spain
| | - Oriol Sibila
- Servicio de Neumología, Instituto Clínico de Respiratorio. IDIBAPS. Hospital Clínic, University of Barcelona, Spain
- CIBER de enfermedades respiratorias, ISCIII, Madrid, Spain
| | - Daiana Stolz
- Department of Pneumology, Faculty of Medicine, University of Freiburg, Germany
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University of Basel, Switzerland
| | - Paula Kauppi
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Apostolos Bossios
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
- Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Adam T Hill
- Royal Infirmary of Edinburgh, Department of Respiratory Medicine, Edinburgh, Edinburgh, UK
| | - Ian Clifton
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Megan L Crichton
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Paul Walker
- Liverpool University Hospitals Foundation NHS Trust, Liverpool, UK
| | - Rosario Menendez
- Pneumology Department, Hospital Universitario y Politécnico La Fe-Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Sermin Borecki
- Cerrahpasa Medical Faculty, Department of Pulmonology Diseases, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Dusanka Obradovic
- Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
- Institute for pulmonary diseases, , Sremska Kamenica, Serbia
| | - Adam Nowinski
- Department of Epidemiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Adelina Amorim
- Pulmonology Department - Centro Hospitalar Universitário S.João and Faculty of Medicine - University of Porto, Portugal
| | - Antoni Torres
- Department of Pulmonology Hospital Clinic of Barcelona, Spain University of Barcelona, CIBERES, IDIBAPS, ICREA Barcelona, Spain
| | - Natalie Lorent
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Tobias Welte
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
- European Reference Network on Rare and Complex Respiratory Diseases, Frankfurt, Germany
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mateja Jankovic Makek
- University of Zagreb School of Medicine and University Hospital Centre Zagreb, Croatia
- Clinic for Pulmonary diseases, University Hospital Centre Zagreb
| | - Michal Shteinberg
- Pulmonology Institute and CF Center, Carmel Medical Center, Haifa, Israel
- the B. Rappaport Faculty of Medicine, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Wim Boersma
- Department of Pulmonary Diseases, Northwest Clinics, Alkmaar, Netherlands
| | - J Stuart Elborn
- Faculty of Medicine, Health and Life Sciences, Queen's University, Belfast, UK
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Felix C Ringshausen
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
- European Reference Network on Rare and Complex Respiratory Diseases, Frankfurt, Germany
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3
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Fleming A, Galey M, Briggs L, Edwards M, Hogg C, John S, Wilkinson S, Quinn E, Rai R, Burgoyne T, Rogers A, Patel MP, Griffin P, Muller S, Carr SB, Loebinger MR, Lucas JS, Shah A, Jose R, Mitchison HM, Shoemark A, Miller DE, Morris-Rosendahl DJ. Combined approaches, including long-read sequencing, address the diagnostic challenge of HYDIN in primary ciliary dyskinesia. Eur J Hum Genet 2024:10.1038/s41431-024-01599-7. [PMID: 38605126 DOI: 10.1038/s41431-024-01599-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/08/2024] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
Primary ciliary dyskinesia (PCD), a disorder of the motile cilia, is now recognised as an underdiagnosed cause of bronchiectasis. Accurate PCD diagnosis comprises clinical assessment, analysis of cilia and the identification of biallelic variants in one of 50 known PCD-related genes, including HYDIN. HYDIN-related PCD is underdiagnosed due to the presence of a pseudogene, HYDIN2, with 98% sequence homology to HYDIN. This presents a significant challenge for Short-Read Next Generation Sequencing (SR-NGS) and analysis, and many diagnostic PCD gene panels do not include HYDIN. We have used a combined approach of SR-NGS with bioinformatic masking of HYDIN2, and state-of-the-art long-read Nanopore sequencing (LR_NGS), together with analysis of respiratory cilia including transmission electron microscopy and immunofluorescence to address the underdiagnosis of HYDIN as a cause of PCD. Bioinformatic masking of HYDIN2 after SR-NGS facilitated the detection of biallelic HYDIN variants in 15 of 437 families, but compromised the detection of copy number variants. Supplementing testing with LR-NGS detected HYDIN deletions in 2 families, where SR-NGS had detected a single heterozygous HYDIN variant. LR-NGS was also able to confirm true homozygosity in 2 families when parental testing was not possible. Utilising a combined genomic diagnostic approach, biallelic HYDIN variants were detected in 17 families from 242 genetically confirmed PCD cases, comprising 7% of our PCD cohort. This represents the largest reported HYDIN cohort to date and highlights previous underdiagnosis of HYDIN-associated PCD. Moreover this provides further evidence for the utility of LR-NGS in diagnostic testing, particularly for regions of high genomic complexity.
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Affiliation(s)
- Andrew Fleming
- Clinical Genetics and Genomics Laboratory, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, SW3 6NP, UK
| | - Miranda Galey
- Division of Genetic Medicine, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, WA, USA
- Department of Laboratory Medicine and Pathology, University of Washington and Seattle Children's Hospital, Seattle, WA, 98105, USA
| | - Lizi Briggs
- Clinical Genetics and Genomics Laboratory, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, SW3 6NP, UK
| | - Matthew Edwards
- Clinical Genetics and Genomics Laboratory, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, SW3 6NP, UK
| | - Claire Hogg
- Primary Ciliary Dyskinesia Centre, Royal Brompton and Harefield Clinical Group, Guy's and St. Thomas' NHS Foundation Trust, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
| | - Shibu John
- Clinical Genetics and Genomics Laboratory, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, SW3 6NP, UK
| | - Sam Wilkinson
- Clinical Genetics and Genomics Laboratory, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, SW3 6NP, UK
| | - Ellie Quinn
- Clinical Genetics and Genomics Laboratory, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, SW3 6NP, UK
| | - Ranjit Rai
- Primary Ciliary Dyskinesia Centre, Royal Brompton and Harefield Clinical Group, Guy's and St. Thomas' NHS Foundation Trust, London, SW3 6NP, UK
| | - Tom Burgoyne
- Primary Ciliary Dyskinesia Centre, Royal Brompton and Harefield Clinical Group, Guy's and St. Thomas' NHS Foundation Trust, London, SW3 6NP, UK
- Genetics and Genomic Medicine Department, University College London, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Andy Rogers
- Primary Ciliary Dyskinesia Centre, Royal Brompton and Harefield Clinical Group, Guy's and St. Thomas' NHS Foundation Trust, London, SW3 6NP, UK
| | - Mitali P Patel
- Genetics and Genomic Medicine Department, University College London, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- MRC Prion Unit at UCL, Institute of Prion Diseases, UCL, London, W1W 7FF, UK
| | - Paul Griffin
- Primary Ciliary Dyskinesia Centre, Royal Brompton and Harefield Clinical Group, Guy's and St. Thomas' NHS Foundation Trust, London, SW3 6NP, UK
| | - Steven Muller
- Clinical Genetics and Genomics Laboratory, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, SW3 6NP, UK
| | - Siobhan B Carr
- Primary Ciliary Dyskinesia Centre, Royal Brompton and Harefield Clinical Group, Guy's and St. Thomas' NHS Foundation Trust, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
| | - Michael R Loebinger
- Primary Ciliary Dyskinesia Centre, Royal Brompton and Harefield Clinical Group, Guy's and St. Thomas' NHS Foundation Trust, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
- Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, SO16 6YD, UK
| | - Anand Shah
- Primary Ciliary Dyskinesia Centre, Royal Brompton and Harefield Clinical Group, Guy's and St. Thomas' NHS Foundation Trust, London, SW3 6NP, UK
- MRC Centre of Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, W2 1PG, UK
| | - Ricardo Jose
- Primary Ciliary Dyskinesia Centre, Royal Brompton and Harefield Clinical Group, Guy's and St. Thomas' NHS Foundation Trust, London, SW3 6NP, UK
| | - Hannah M Mitchison
- Genetics and Genomic Medicine Department, University College London, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- MRC Prion Unit at UCL, Institute of Prion Diseases, UCL, London, W1W 7FF, UK
| | - Amelia Shoemark
- Primary Ciliary Dyskinesia Centre, Royal Brompton and Harefield Clinical Group, Guy's and St. Thomas' NHS Foundation Trust, London, SW3 6NP, UK
- Respiratory Research Group, Molecular and Cellular Medicine, University of Dundee, Dundee, DD1 9SY, UK
| | - Danny E Miller
- Division of Genetic Medicine, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, WA, USA
- Department of Laboratory Medicine and Pathology, University of Washington and Seattle Children's Hospital, Seattle, WA, 98105, USA
- Brotman Baty Institute for Precision Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Deborah J Morris-Rosendahl
- Clinical Genetics and Genomics Laboratory, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, SW3 6NP, UK.
- National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK.
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4
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Thomson RM, Loebinger MR, Burke AJ, Morgan LC, Waterer GW, Ganslandt C. OPTIMA: An Open-Label, Noncomparative Pilot Trial of Inhaled Molgramostim in Pulmonary Nontuberculous Mycobacterial Infection. Ann Am Thorac Soc 2024; 21:568-576. [PMID: 37948736 DOI: 10.1513/annalsats.202306-532oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/08/2023] [Indexed: 11/12/2023] Open
Abstract
Rationale: Inhaled granulocyte-macrophage colony-stimulating factor (GM-CSF) has been proposed as a potential immunomodulatory treatment for nontuberculous mycobacterial (NTM) infection.Objectives: This open-label, noncomparative pilot trial investigated the efficacy and safety of inhaled GM-CSF (molgramostim nebulizer solution) in patients with predominantly treatment-refractory pulmonary NTM infection (Mycobacterium avium complex [MAC] and M. abscessus [MABS]), either in combination with ongoing guideline-based therapy (GBT) or as monotherapy in patients who had stopped GBT because of lack of efficacy or intolerability.Methods: Thirty-two adult patients with refractory NTM infection (MAC, n = 24; MABS, n = 8) were recruited into two cohorts: those with (n = 16) and without (n = 16) ongoing GBT. Nebulized molgramostim 300 μg/d was administered over 48 weeks. Sputum cultures and smears and clinical assessments (6-min-walk distance, symptom scores, Quality of Life-Bronchiectasis Questionnaire score, and body weight) were collected every 4 weeks during treatment and 12 weeks after the end of treatment. The primary endpoint was sputum culture conversion, defined as three consecutive monthly negative cultures during the treatment period.Results: Eight patients (25%) achieved culture conversion on treatment (seven [29.2%] patients with MAC infection, one [12.5%] patient with MABS infection); in four patients, this was durable after the end of treatment. Of the 24 patients with MAC infection, an additional 4 patients had a partial response, converting from smear positive at baseline to smear negative at the end of treatment, and time to positivity in liquid culture media increased. Two of these patients sustained negative cultures from the end of treatment. Other clinical endpoints were unchanged. Serious adverse events were mainly pulmonary exacerbations or worsening NTM infection. Three deaths, not treatment related, were reported.Conclusions: In this population of patients with severe NTM disease, molgramostim was safe and well tolerated. Sputum culture conversion rates for patients with MAC infection (29.2%) were greater than reported for similar refractory MAC cohorts managed with GBT alone. Less benefit was seen for MABS infection. No serious safety concerns were identified. Further evaluation in a larger cohort is warranted.Clinical trial registered with www.clinicaltrials.gov (NCT03421743).
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Affiliation(s)
- Rachel M Thomson
- School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Greenslopes, Queensland, Australia
- The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Michael R Loebinger
- National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London, United Kingdom
| | - Andrew J Burke
- School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
- The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Lucy C Morgan
- Concord Repatriation Hospital, Sydney, New South Wales, Australia
| | - Grant W Waterer
- East Metropolitan Health Service, Royal Perth Bentley Group, University of Western Australia, Perth, Western Australia, Australia; and
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5
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Aliberti S, Ringshausen FC, Dhar R, Haworth CS, Loebinger MR, Dimakou K, Crichton ML, De Soyza A, Vendrell M, Burgel PR, McDonnell M, Skrgat S, Maiz Carro L, de Roux A, Sibila O, Bossios A, van der Eerden M, Kauppi P, Wilson R, Milenkovic B, Menendez R, Murris M, Borekci S, Munteanu O, Obradovic D, Nowinski A, Amorim A, Torres A, Lorent N, Van Braeckel E, Altenburg J, Shoemark A, Shteinberg M, Boersma W, Goeminne PC, Elborn JS, Hill AT, Welte T, Blasi F, Polverino E, Chalmers JD. Objective sputum colour assessment and clinical outcomes in bronchiectasis: data from the European Bronchiectasis Registry (EMBARC). Eur Respir J 2024; 63:2301554. [PMID: 38609095 PMCID: PMC11024393 DOI: 10.1183/13993003.01554-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/02/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND A validated 4-point sputum colour chart can be used to objectively evaluate the levels of airway inflammation in bronchiectasis patients. In the European Bronchiectasis Registry (EMBARC), we tested whether sputum colour would be associated with disease severity and clinical outcomes. METHODS We used a prospective, observational registry of adults with bronchiectasis conducted in 31 countries. Patients who did not produce spontaneous sputum were excluded from the analysis. The Murray sputum colour chart was used at baseline and at follow-up visits. Key outcomes were frequency of exacerbations, hospitalisations for severe exacerbations and mortality during up to 5-year follow-up. RESULTS 13 484 patients were included in the analysis. More purulent sputum was associated with lower forced expiratory volume in 1 s (FEV1), worse quality of life, greater bacterial infection and a higher bronchiectasis severity index. Sputum colour was strongly associated with the risk of future exacerbations during follow-up. Compared to patients with mucoid sputum (reference group), patients with mucopurulent sputum experienced significantly more exacerbations (incident rate ratio (IRR) 1.29, 95% CI 1.22-1.38; p<0.0001), while the rates were even higher for patients with purulent (IRR 1.55, 95% CI 1.44-1.67; p<0.0001) and severely purulent sputum (IRR 1.91, 95% CI 1.52-2.39; p<0.0001). Hospitalisations for severe exacerbations were also associated with increasing sputum colour with rate ratios, compared to patients with mucoid sputum, of 1.41 (95% CI 1.29-1.56; p<0.0001), 1.98 (95% CI 1.77-2.21; p<0.0001) and 3.05 (95% CI 2.25-4.14; p<0.0001) for mucopurulent, purulent and severely purulent sputum, respectively. Mortality was significantly increased with increasing sputum purulence, hazard ratio 1.12 (95% CI 1.01-1.24; p=0.027), for each increment in sputum purulence. CONCLUSION Sputum colour is a simple marker of disease severity and future risk of exacerbations, severe exacerbations and mortality in patients with bronchiectasis.
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Affiliation(s)
- Stefano Aliberti
- Respiratory Unit, IRCCS Humanitas Research Hospital, Pieve Emanuele, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Felix C Ringshausen
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, German Center for Lung Research (DZL), Hannover, Germany
- European Reference Network on Rare and Complex Respiratory Diseases, Frankfurt, Germany
| | | | - Charles S Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital and University of Cambridge, Cambridge, UK
| | - Michael R Loebinger
- Royal Brompton and Harefield Hospitals and National Heart and Lung Institute, Imperial College London, London, UK
| | - Katerina Dimakou
- 5th Respiratory Department and Bronchiectasis Unit, "Sotiria" General Hospital of Chest Diseases Medical Practice, Athens, Greece
| | - Megan L Crichton
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Anthony De Soyza
- Population and Health Science Institute, Newcastle University and NIHR Biomedical Research Centre for Ageing, Freeman Hospital, Newcastle, UK
| | - Montse Vendrell
- Department of Pulmonology, Dr Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), University of Girona, Girona, Spain
| | - Pierre-Regis Burgel
- Department of Respiratory Medicine and French Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP, Paris, France
- Université Paris Cité, Inserm U1016, Institut Cochin, Paris, France
| | - Melissa McDonnell
- Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland
| | - Sabina Skrgat
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
- Division of Internal Medicine, Pulmonary Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Luis Maiz Carro
- Chronic Bronchial Infection Unit, Pneumology Service, Ramón y Cajal Hospital, Alcalá de Henares University, Madrid, Spain
| | - Andres de Roux
- Pneumologische Praxis am Schloss Charlottenburg, Berlin, Germany
| | - Oriol Sibila
- Servicio de Neumología, Instituto Clínico de Respiratorio, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Apostolos Bossios
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
- Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Robert Wilson
- Royal Brompton and Harefield Hospitals and National Heart and Lung Institute, Imperial College London, London, UK
| | - Branislava Milenkovic
- Clinic for Pulmonary Diseases, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Rosario Menendez
- Pneumology Department, Hospital Universitario y Politécnico La Fe - Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Marlene Murris
- Department of Respiratory Diseases, CHU Toulouse, Toulouse, France
| | - Sermin Borekci
- Department of Pulmonology Diseases, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Oxana Munteanu
- Pneumology/Allergology Division, University of Medicine and Pharmacy Nicolae Testemitanu, Chisinau, Moldova
| | - Dusanka Obradovic
- Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
- Institute for Pulmonary Diseases, Sremska Kamenica, Serbia
| | - Adam Nowinski
- Department of Epidemiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Adelina Amorim
- Pulmonology Department, Centro Hospitalar Universitário S. João and Faculty of Medicine, University of Porto, Porto, Portugal
| | - Antoni Torres
- Servicio de Neumología, Instituto Clínico de Respiratorio, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Natalie Lorent
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Eva Van Braeckel
- Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Josje Altenburg
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Amelia Shoemark
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Michal Shteinberg
- Pulmonology Institute and CF Center, Carmel Medical Center, Haifa, Israel
- B. Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Wim Boersma
- Department of Pulmonary Diseases, Northwest Clinics, Alkmaar, The Netherlands
| | - Pieter C Goeminne
- Department of Respiratory Disease, AZ Nikolaas, Sint-Niklaas, Belgium
| | - J Stuart Elborn
- Faculty of Medicine, Health and Life Sciences, Queen's University, Belfast, UK
| | - Adam T Hill
- Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Tobias Welte
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, German Center for Lung Research (DZL), Hannover, Germany
- European Reference Network on Rare and Complex Respiratory Diseases, Frankfurt, Germany
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eva Polverino
- Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBERES, Barcelona, Spain
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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Polverino E, Dimakou K, Traversi L, Bossios A, Haworth CS, Loebinger MR, De Soyza A, Vendrell M, Burgel PR, Mertsch P, McDonnell M, Škrgat S, Maiz Carro L, Sibila O, van der Eerden M, Kauppi P, Hill AT, Wilson R, Milenkovic B, Menendez R, Murris M, Digalaki T, Crichton ML, Borecki S, Obradovic D, Nowinski A, Amorim A, Torres A, Lorent N, Welte T, Blasi F, Van Braeckel E, Altenburg J, Shoemark A, Shteinberg M, Boersma W, Elborn JS, Aliberti S, Ringshausen FC, Chalmers JD, Goeminne PC. Bronchiectasis and asthma: Data from the European Bronchiectasis Registry (EMBARC). J Allergy Clin Immunol 2024:S0091-6749(24)00189-1. [PMID: 38401857 DOI: 10.1016/j.jaci.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/15/2023] [Accepted: 01/18/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Asthma is commonly reported in patients with a diagnosis of bronchiectasis. OBJECTIVE The aim of this study was to evaluate whether patients with bronchiectasis and asthma (BE+A) had a different clinical phenotype and different outcomes compared with patients with bronchiectasis without concomitant asthma. METHODS A prospective observational pan-European registry (European Multicentre Bronchiectasis Audit and Research Collaboration) enrolled patients across 28 countries. Adult patients with computed tomography-confirmed bronchiectasis were reviewed at baseline and annual follow-up visits using an electronic case report form. Asthma was diagnosed by the local investigator. Follow-up data were used to explore differences in exacerbation frequency between groups using a negative binomial regression model. Survival analysis used Cox proportional hazards regression. RESULTS Of 16,963 patients with bronchiectasis included for analysis, 5,267 (31.0%) had investigator-reported asthma. Patients with BE+A were younger, were more likely to be female and never smokers, and had a higher body mass index than patients with bronchiectasis without asthma. BE+A was associated with a higher prevalence of rhinosinusitis and nasal polyps as well as eosinophilia and Aspergillus sensitization. BE+A had similar microbiology but significantly lower severity of disease using the bronchiectasis severity index. Patients with BE+A were at increased risk of exacerbation after adjustment for disease severity and multiple confounders. Inhaled corticosteroid (ICS) use was associated with reduced mortality in patients with BE+A (adjusted hazard ratio 0.78, 95% CI 0.63-0.95) and reduced risk of hospitalization (rate ratio 0.67, 95% CI 0.67-0.86) compared with control subjects without asthma and not receiving ICSs. CONCLUSIONS BE+A was common and was associated with an increased risk of exacerbations and improved outcomes with ICS use. Unexpectedly we identified significantly lower mortality in patients with BE+A.
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Affiliation(s)
- Eva Polverino
- Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, CIBERES, Barcelona, Spain
| | - Katerina Dimakou
- Fifth Respiratory Department and Bronchiectasis Unit, General Hospital for Chest Diseases "Sotiria," Athens, Greece
| | - Letizia Traversi
- Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, CIBERES, Barcelona, Spain
| | - Apostolos Bossios
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden; Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Charles S Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Michael R Loebinger
- National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College London, London, United Kingdom
| | - Anthony De Soyza
- Population and Health Science Institute, Newcastle University, Newcastle, United Kingdom; NIHR Biomedical Research Centre for Ageing, Freeman Hospital, Newcastle, United Kingdom
| | - Montserrat Vendrell
- Department of Pulmonology, Girona Biomedical Research Institute Dr Josep Trueta University Hospital (IDIBGI), University of Girona, Girona, Spain
| | - Pierre-Régis Burgel
- Department of Medicine V, University Hospital, LMU Munich, Munich, Germany; Department of Respiratory Medicine and French Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP, Paris, France; Institut Cochin, Université Paris Cité, INSERM U1016, Paris, France
| | - Pontus Mertsch
- Department of Medicine V, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center, German Center for Lung Research (DZL), Munich, Germany
| | - Melissa McDonnell
- Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland
| | - Sabina Škrgat
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia; Pulmonary Department, Division of Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Luis Maiz Carro
- Chronic Bronchial Infection Unit, Pneumology Service, Ramón y Cajal Hospital, Alcalá de Henares University, Madrid, Spain
| | - Oriol Sibila
- Servicio de Neumología, Instituto Clínico de Respiratorio, Hospital Clínic Barcelona, August Pi Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain; CIBERES, ISCIII, Madrid, Spain
| | | | - Paula Kauppi
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Adam T Hill
- Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Robert Wilson
- Cambridge Centre for Lung Infection, Royal Papworth Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Branislava Milenkovic
- Clinic for Pulmonary Diseases, University Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Rosario Menendez
- Pneumology Department, Hospital Universitario y Politécnico La Fe-Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Marlene Murris
- Department of Respiratory Diseases, CHU de Toulouse, Toulouse, France
| | - Tonia Digalaki
- Fifth Respiratory Department and Bronchiectasis Unit, General Hospital for Chest Diseases "Sotiria," Athens, Greece
| | - Megan L Crichton
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Sermin Borecki
- Department of Pulmonology Diseases, Cerrahpasa Medical Faculty, İstanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Dusanka Obradovic
- Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia; Institute for Pulmonary Diseases, Put doktora Goldmana 4, Sremska Kamenica, Serbia
| | - Adam Nowinski
- Department of Epidemiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Adelina Amorim
- Pulmonology Department, Centro Hospitalar Universitário São João and Faculty of Medicine, University of Porto, Porto, Portugal
| | - Antoni Torres
- Department of Pulmonology, Hospital Clinic, University of Barcelona, CIBERES, IDIBAPS, ICREA, Barcelona, Spain
| | - Natalie Lorent
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Tobias Welte
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage & Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany; European Reference Network on Rare and Complex Respiratory Diseases, Frankfurt, Germany
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eva Van Braeckel
- Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Josje Altenburg
- Department of Pulmonary Diseases, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Amelia Shoemark
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Michal Shteinberg
- Pulmonology Institute and CF Center, Carmel Medical Center, Haifa, Israel; B. Rappaport Faculty of Medicine, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Wim Boersma
- Department of Pulmonary Diseases, Northwest Clinics, Alkmaar, The Netherlands
| | - J Stuart Elborn
- Faculty of Medicine, Health and Life Sciences, Queen's University, Belfast, Northern Ireland
| | - Stefano Aliberti
- Respiratory Unit, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Felix C Ringshausen
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage & Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany; European Reference Network on Rare and Complex Respiratory Diseases, Frankfurt, Germany
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom.
| | - Pieter C Goeminne
- Department of Respiratory Disease, AZ Nikolaas, Sint-Niklaas, Belgium
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Polverino E, De Soyza A, Dimakou K, Traversi L, Bossios A, Crichton ML, Ringshausen FC, Vendrell M, Burgel PR, Haworth CS, Loebinger MR, Lorent N, Pink I, McDonnell M, Skrgat S, Maiz Carro L, Sibila O, Vd Eerden MM, Kauppi P, Shoemark A, Amorim A, Brown JS, Hurst JR, Miravitlles M, Menendez R, Torres A, Welte T, Blasi F, Altenburg J, Shteinberg M, Boersma W, Elborn SJ, Goeminne PC, Aliberti S, Chalmers JD. The Association Between Bronchiectasis and Chronic Obstructive Pulmonary Disease: Data from the European Bronchiectasis Registry (EMBARC). Am J Respir Crit Care Med 2024. [PMID: 38271696 DOI: 10.1164/rccm.202309-1614oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/25/2024] [Indexed: 01/27/2024] Open
Abstract
RATIONALE AND OBJECTIVE Bronchiectasis and COPD are associated conditions but misdiagnosis is believed to be common. A recently published international consensus definition of bronchiectasis (BE) and COPD association: The ROSE criteria (radiological bronchiectasis(R), obstruction: FEV1/FVC ratio<0.7 (O), symptoms (S) and exposure:≥10 pack year smoking (E) allows objective diagnosis of the BE-COPD association. METHODS Analysis of the EMBARC registry, a prospective observational study of patients with CT confirmed bronchiectasis from 28 countries. The ROSE criteria were used to objectively defined BE-COPD association. Key outcomes during up to 5-years follow-up were exacerbations, hospitalization and mortality. MEASUREMENT AND MAIN RESULTS 16730 patients with bronchiectasis were included. 4336 had a co-diagnosis of COPD and these patients had more exacerbations, worse quality of life and higher severity scores. We observed marked overdiagnosis of COPD using the ROSE criteria: 22.2% of patients with a diagnosis of COPD did not have airflow obstruction and 31.9% did not have a history of ≥10 pack years smoking. Therefore the proportion meeting the ROSE criteria for COPD was 2157 (55.4%). Compared to patients without COPD, patients meeting ROSE criteria had increased risk of exacerbations and exacerbations resulting in hospitalisation during follow-up (IRR 1.25 95%CI 1.15-1.35 and 1.69 95%CI 1.51-1.90 respectively) but patients with a diagnosis of COPD who did not meet ROSE criteria also had increased risk of exacerbations. CONCLUSIONS The label of COPD is often applied to bronchiectasis patients without objective evidence of airflow obstruction and smoking history. Patients with a clinical label of COPD have worse clinical outcomes.
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Affiliation(s)
- Eva Polverino
- Hospital Universitari Vall d'Hebron , Institut de Recerca Vall d'Hebron , Barcelona, Spain
| | - Anthony De Soyza
- Freeman Hospital, 105565, Newcastle upon Tyne, Newcastle upon Tyne , United Kingdom of Great Britain and Northern Ireland
| | - Katerina Dimakou
- "Sotiria" Chest Hospital, 5th Pulmonary Department, Athens, Greece
| | - Letizia Traversi
- Vall d'Hebron Institut de Recerca, 203275, Barcelona, Catalunya, Spain
| | - Apostolos Bossios
- Karolinska Institutet, Institute of Environmental Medicine, Stockholm, Sweden
- Karolinska University Hospital, 59562, Department of Respiratory Medicine and Allergy, Stockholm, Sweden
| | - Megan L Crichton
- University of Dundee, 3042, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Felix C Ringshausen
- Hannover Medical School, Department of Respiratory Medicine, Hannover, Germany
| | | | - Pierre-Regis Burgel
- Service de Pneumologie, Hôpital Cochin, AP-HP and Université Paris Descartes (EA2511), Sorbonne Paris Cité, Paris, France
| | - Charles S Haworth
- Royal Papworth Hospital, 2144, Cambridge Centre for Lung Infection, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Michael R Loebinger
- Royal Brompton Hospital, 156726, London, United Kingdom of Great Britain and Northern Ireland
| | | | - Isabell Pink
- Hannover Medical School, 9177, Respiratory Medicine and Infectious Diseases, Hannover, Niedersachsen, Germany
- German Center for Lung Research, 542891, Giessen, Hessen, Germany
- European Reference Network Respiratory Diseases, 622266, Frankfurt am Main, Hessen, Germany
| | - Melissa McDonnell
- Galway University Hospitals, 58040, Respiratory, Galway, Ireland
- National University of Ireland Galway, 8799, Lung Biology Group, Galway, Ireland
| | - Sabina Skrgat
- University Medical Centre Ljubljana, 37667, Department of Pulmonary Diseases and Allergy, Ljubljana, Slovenia
- University Clinic Golnik, 68936, Respiratory and Allergic Diseases, Golnik, Slovenia
| | - Luis Maiz Carro
- Chronic Bronchial Infection Unit, Pneumology Service, Ramón y Cajal Hospital, Alcalá de Henares University, Madrid, Spain
| | - Oriol Sibila
- Hospital Sant Pau, Servei de Pneumologia, Barcelona, Spain
| | | | - Paula Kauppi
- Helsinki University Central Hospital, 159841, Helsinki, Uusimaa, Finland
| | - Amelia Shoemark
- University of Dundee College of Medicine Dentistry and Nursing, 85326, Molecular and Clinical Medicine, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Adelina Amorim
- University of Porto, 26706, Faculty of Medicine, Porto, Portugal
- Centro Hospitalar Universitario de Sao Joao, 285211, Porto, Portugal
| | - Jeremy S Brown
- University College London, Centre for Respiratory Research, London, United Kingdom of Great Britain and Northern Ireland
| | - John R Hurst
- University College London, 4919, UCL Respiratory, London, United Kingdom of Great Britain and Northern Ireland
| | - Marc Miravitlles
- Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Pneumology Department, Barcelona, Spain
| | - Rosario Menendez
- Hospital Universitario La Fe, Servicio de Neumologia, Valencia, Spain
| | - Antoni Torres
- Respiratory Institute, Hospital Clinic of Barcelona, Pulmonary Intensive Care Unit, Barcelona, Spain
| | - Tobias Welte
- Medizinische Hochschule Hannover, Direktor der Abteilung Pneumologie, Hannover, Germany
| | - Francesco Blasi
- University of Milano, Dipartimento Toraco-Polmonare e Cardiovascolare, Milan, Italy
| | - Josje Altenburg
- Academic Medical Center, 26066, pulmonary diseases, Amsterdam, North Holland, Netherlands
| | - Michal Shteinberg
- Lady Davies Carmel Medical Center, 37255, Pulmonology Institute and CF center, Haifa, Northern Israel, Israel
- Technion Israel Institute of Technology, 26747, The B. Rappaport Faculty of Medicine, Haifa, Israel
| | - Wim Boersma
- Northwest Clinics, Pulmonary diseases, alkmaar, Netherlands
| | - Stuart J Elborn
- Queen's University Belfast, 1596, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Pieter C Goeminne
- AZ Nikolaas, 82428, Department of Respiratory Disease, AZ Nikolaas, Sint-Niklaas, Sint-Niklaas, Belgium
- Department of Respiratory Disease, UZ, Leuven, Belgium
| | - Stefano Aliberti
- Humanitas University, 437807, Department of Biomedical Sciences, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, 9268, Respiratory Unit, Rozzano, Italy
| | - James D Chalmers
- University of Dundee, 3042, Dundee, United Kingdom of Great Britain and Northern Ireland;
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Ringshausen FC, Shapiro AJ, Nielsen KG, Mazurek H, Pifferi M, Donn KH, van der Eerden MM, Loebinger MR, Zariwala MA, Leigh MW, Knowles MR, Ferkol TW. Safety and efficacy of the epithelial sodium channel blocker idrevloride in people with primary ciliary dyskinesia (CLEAN-PCD): a multinational, phase 2, randomised, double-blind, placebo-controlled crossover trial. Lancet Respir Med 2024; 12:21-33. [PMID: 37660715 DOI: 10.1016/s2213-2600(23)00226-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/10/2023] [Accepted: 05/25/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Mucociliary clearance is dysfunctional in people with primary ciliary dyskinesia, resulting in the accumulation of dehydrated mucus in the airways that is difficult to clear. We undertook a study to assess the benefit on lung function of treatment with a nebulised epithelial sodium channel (ENaC) blocker, idrevloride, with or without hypertonic saline, in people with primary ciliary dyskinesia. METHODS The CLEAN-PCD trial was a phase 2, randomised, double-blind, placebo-controlled crossover trial conducted at 32 tertiary adult and paediatric care centres and university hospitals in Canada, Denmark, Germany, Italy, the Netherlands, Poland, the UK, and the USA. People with a confirmed diagnosis of primary ciliary dyskinesia, aged 12 years or older, with a percentage of predicted FEV1 (ppFEV1) in the range of 40% to <90%, were randomly assigned in a 2:2:1:1 ratio (block size=6), stratified by ppFEV1 at screening, to one of four sequences: (1) idrevloride in hypertonic saline in treatment period 1 then hypertonic saline in treatment period 2; (2) hypertonic saline in treatment period 1 then idrevloride in hypertonic saline in treatment period 2; (3) idrevloride in treatment period 1 then placebo in treatment period 2; and (4) placebo in treatment period 1 then idrevloride in treatment period 2. The idrevloride dose was 85 μg and hypertonic saline was 4·2% NaCl. 3 mL of each study treatment was nebulised twice daily for 28 days in treatment periods 1 and 2; the two 28-day treatment periods were separated by a 28-day washout period. The primary endpoint was absolute change from baseline in ppFEV1 after 28 days. Safety assessments and reports of adverse events were made at clinic visits during each treatment period and by a follow-up telephone call 28 days after the last dose of study drug. Additionally, adverse events could be reported at a follow-up telephone call 3 days after the start of dosing and as they arose. Participants who received at least one dose of study drug were included in the safety analyses (safety set), and those who also had spirometry data were included in the efficacy analyses (full analysis set). The completed study is registered (EudraCT 2015-004917-26; ClinicalTrials.govNCT02871778). FINDINGS Between Sep 14, 2016, and May 31, 2018, 216 patients were screened and 123 were randomly assigned to one of four crossover sequences. Across the two treatment periods, treatment with idrevloride in hypertonic saline was initiated in 80 patients and completed in 78 patients (all 78 had data available and were included in the analysis); hypertonic saline initiated in 81 patients and completed in 76 patients (75 had data available and were included in the analysis); idrevloride initiated in 37 patients and completed in 35 patients (34 had data available and were included in the analysis); and placebo initiated in 36 patients and completed in 34 patients (all 34 had data available and were included in the analysis). Greater absolute increases in ppFEV1 from baseline to 28 days of treatment were seen with idrevloride in hypertonic saline (least-squares mean absolute change from baseline 1·0 percentage points, 95% CI -0·4 to 2·4) than with hypertonic saline alone (least-squares mean absolute change from baseline of -0·5 percentage points, -2·0 to 0·9; difference 1·5 percentage points, 95% CI <0·1 to 3·0; p=0·044). There was no significant difference in ppFEV1 for the parallel comparison of idrevloride in hypertonic saline compared with placebo or the crossover comparison of idrevloride with placebo. Adverse events were similar across treatments (57 to 65% of patients). Cough occurred in a greater proportion of participants during treatments that contained idrevloride or hypertonic saline compared with placebo, and oropharyngeal pain occurred in a greater proportion of participants during idrevloride treatments than during treatment with hypertonic saline alone or placebo, whereas chest discomfort was more common during treatments that included hypertonic saline. INTERPRETATION In this phase 2 crossover study, idrevloride in hypertonic saline was safe and associated with improved lung function over a 28-day period in people with primary ciliary dyskinesia compared with hypertonic saline alone. Larger, longer clinical studies are warranted to explore the potential benefits of idrevloride in combination with hypertonic saline in people with primary ciliary dyskinesia. FUNDING Parion Sciences, under agreement with Vertex Pharmaceuticals.
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Affiliation(s)
- Felix C Ringshausen
- Department of Respiratory Medicine and Infectious Diseases, German Center for Lung Research and European Reference Network for Rare and Complex Lung Diseases, Hannover Medical School, Hannover, Germany.
| | - Adam J Shapiro
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre Research Institute, Montreal, QC, Canada
| | - Kim G Nielsen
- Danish Primary Ciliary Dyskinesia Centre, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henryk Mazurek
- Department of Pneumonology and Cystic Fibrosis, National Institute of Tuberculosis and Lung Disorders, Rabka-Zdroj, Poland
| | - Massimo Pifferi
- Department of Paediatrics, University Hospital of Pisa, Pisa, Italy
| | | | | | - Michael R Loebinger
- Host Defence Unit and National Heart and Lung Institute, Royal Brompton Hospital and Imperial College London, London, UK
| | - Maimoona A Zariwala
- Department of Pathology and Laboratory Medicine, Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Margaret W Leigh
- Department of Pediatrics, Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael R Knowles
- Department of Medicine, Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas W Ferkol
- Department of Pediatrics, Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Aliberti S, Blasi F, Burgel PR, Calcagno A, Fløe A, Grogono D, Papavasileiou A, Polverino E, Prados C, Rohde G, Salzer HJ, Sánchez-Montalvá A, Shteinberg M, Van Braeckel E, van Ingen J, Veziris N, Wagner D, Loebinger MR. Mycobacterium avium complex pulmonary disease patients with limited treatment options. ERJ Open Res 2024; 10:00610-2023. [PMID: 38226066 PMCID: PMC10789256 DOI: 10.1183/23120541.00610-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/05/2023] [Indexed: 01/17/2024] Open
Abstract
How to identify MAC-PD patients with limited treatment options: an expert consensus https://bit.ly/3QwLQ8T.
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Affiliation(s)
- Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Pierre-Régis Burgel
- Respiratory Medicine, Université Paris Cité, Inserm U1016, Institut Cochin, Paris, France
- Cochin Hospital, Department of Respiratory Medicine, Publique Hôpitaux de Paris, Paris, France
| | - Andrea Calcagno
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Andreas Fløe
- Department of Respiratory Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Dorothy Grogono
- Cambridge Centre of Lung Infection, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Eva Polverino
- Respiratory Medicine, Adult Bronchiectasis and Cystic Fibrosis, University Hospital Vall D'Hebron, VHIR, CIBERES, Barcelona, Spain
| | - Concepción Prados
- Pulmonology, Cystic fibrosis, Bronchiectasis, Bronquial Infections, La Paz University Hospital, Madrid, Spain
| | - Gernot Rohde
- Goethe University Frankfurt, University Hospital, Medical Clinic 1, Respiratory Medicine and Allergology, Frankfurt am Main, Germany
| | - Helmut J.F. Salzer
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine 4 - Pneumology, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
- Ignaz Semmelweis Institute, Interuniversity Institute for Infection Research, Vienna, Austria
| | - Adrián Sánchez-Montalvá
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS, Universitat Autónoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Micobateria Infection Study Group (GEIM) from Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain
| | - Michal Shteinberg
- Carmel Medical Center and the Technion-Israel Institute of Technology, B. Rappaport Faculty of Medicine, Haifa, Israel
| | - Eva Van Braeckel
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
- Respiratory Infection and Defense Lab (RIDL), Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Jakko van Ingen
- Clinical Microbiologist, Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicolas Veziris
- Sorbonne Université, Centre d'Immunologie et des Maladies Infectieuses (Cimi-Paris), UMR 1135, Department of Bacteriology, Saint-Antoine Hospital, APHP, Sorbonne-Université, Centre National de Référence des Mycobactéries, Paris, France
| | - Dirk Wagner
- Department of Internal Medicine II, Division of Infectious Diseases, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael R. Loebinger
- Host Defence Unit, Royal Brompton Hospital, and NHLI, Imperial College, London, United Kingdom
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10
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Kos R, Goutaki M, Kobbernagel HE, Rubbo B, Shoemark A, Aliberti S, Altenburg J, Anagnostopoulou P, Athanazio RA, Beydon N, Dell SD, Emiralioglu N, Ferkol TW, Loebinger MR, Lorent N, Maître B, Marthin J, Morgan LC, Nielsen KG, Ringshausen FC, Shteinberg M, Tiddens HA, Maitland-Van der Zee AH, Chalmers JD, Lucas JS, Haarman EG. A BEAT-PCD consensus statement: a core outcome set for pulmonary disease interventions in primary ciliary dyskinesia. ERJ Open Res 2024; 10:00115-2023. [PMID: 38196895 PMCID: PMC10772902 DOI: 10.1183/23120541.00115-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/24/2023] [Indexed: 01/11/2024] Open
Abstract
Background Consistent use of reliable and clinically appropriate outcome measures is a priority for clinical trials, with clear definitions to allow comparability. We aimed to develop a core outcome set (COS) for pulmonary disease interventions in primary ciliary dyskinesia (PCD). Methods A multidisciplinary international PCD expert panel was set up. A list of outcomes was created based on published literature. Using a modified three-round e-Delphi technique, the panel was asked to decide on relevant end-points related to pulmonary disease interventions and how they should be reported. First, inclusion of an outcome in the COS was determined. Second, the minimum information that should be reported per outcome. The third round finalised statements. Consensus was defined as ≥80% agreement among experts. Results During the first round, experts reached consensus on four out of 24 outcomes to be included in the COS. Five additional outcomes were discussed in subsequent rounds for their use in different subsettings. Consensus on standardised methods of reporting for the COS was reached. Spirometry, health-related quality-of-life scores, microbiology and exacerbations were included in the final COS. Conclusion This expert consensus resulted in a COS for clinical trials on pulmonary health among people with PCD.
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Affiliation(s)
- Renate Kos
- Dept of Pulmonary Medicine, Amsterdam University Medical Centres – loc. AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Helene E. Kobbernagel
- Danish Primary Ciliary Dyskinesia Centre, Paediatric Pulmonary Service, Dept of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bruna Rubbo
- School of Health Sciences, University of Southampton, Southampton, UK
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Amelia Shoemark
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Stefano Aliberti
- Dept of Biomedical Sciences, Humanitas University, Milan, Italy
- Respiratory Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Josje Altenburg
- Dept of Pulmonary Medicine, Amsterdam University Medical Centres – loc. AMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Rodrigo A. Athanazio
- Heart Institute (InCor) Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Nicole Beydon
- Pulmonary Division, Sorbonne Université, INSERM U938, Paris, France
- Unité d'Exploration Fonctionnelle Respiratoire, Hôpital Armand-Trousseau, Paris, France
| | - Sharon D. Dell
- Dept of Paediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Pediatric Respiratory Medicine, Provincial Health Services Authority, BC Children's Hospital, Vancouver, Canada
| | - Nagehan Emiralioglu
- Dept of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Thomas W. Ferkol
- Dept of Pediatrics, University of North Carolina School of Medicine and Marsico Lung Institute, Chapel Hill, NC, USA
| | - Michael R. Loebinger
- Dept of Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Natalie Lorent
- Dept of Pediatrics, University Hospital Leuven, Leuven, Belgium
| | - Bernard Maître
- Service de Pneumologie, Hôpital Henri Mondor et Centre Hospitalier Intercommunal de Créteil, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - June Marthin
- Danish Primary Ciliary Dyskinesia Centre, Paediatric Pulmonary Service, Dept of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lucy C. Morgan
- Dept of Microbiology and Infectious Diseases, Concord Repatriation and General Hospital, NSW Health Pathology, Sydney, Australia
| | - Kim G. Nielsen
- Danish Primary Ciliary Dyskinesia Centre, Paediatric Pulmonary Service, Dept of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Felix C. Ringshausen
- Dept of Respiratory Medicine, Hannover Medical School (MHH), Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- European Reference Network for Rare and Complex Lung Diseases (ERN-LUNG), Frankfurt am Main, Germany
| | - Michal Shteinberg
- Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
- Pulmonology Institute and CF Center, Carmel Medical Center, Haifa, Israel
| | - Harm A.W.M. Tiddens
- Dept of Pediatric Pulmonology and Allergology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Dept of Radiology, Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands
- Thirona, Nijmegen, The Netherlands
| | - Anke H. Maitland-Van der Zee
- Dept of Pulmonary Medicine, Amsterdam University Medical Centres – loc. AMC, University of Amsterdam, Amsterdam, The Netherlands
- Dept of Paediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - James D. Chalmers
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Jane S.A. Lucas
- Faculty of Medicine, University of Southampton, School of Clinical and Experimental Sciences, Southampton, UK
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Eric G. Haarman
- Dept of Paediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands
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11
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Kumar K, Ponnuswamy A, Capstick TG, Chen C, McCabe D, Hurst R, Morrison L, Moore F, Gallardo M, Keane J, Harwood S, Sinnett T, Bryant S, Breen R, Kon OM, Lipman M, Loebinger MR, Dhasmana DJ. Non-tuberculous mycobacterial pulmonary disease (NTM-PD): Epidemiology, diagnosis and multidisciplinary management. Clin Med (Lond) 2024; 24:100017. [PMID: 38387207 PMCID: PMC11024839 DOI: 10.1016/j.clinme.2024.100017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Non-tuberculous mycobacteria (NTM) are ubiquitous environmental organisms that can cause significant disease in both immunocompromised and immunocompetent individuals. The incidence of NTM pulmonary disease (NTM-PD) is rising globally. Diagnostic challenges persist and treatment efficacy is variable. This article provides an overview of NTM-PD for clinicians. We discuss how common it is, who is at risk, how it is diagnosed and the multidisciplinary approach to its clinical management.
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Affiliation(s)
- Kartik Kumar
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK. https://twitter.com/DrKartikKumar
| | - Aravind Ponnuswamy
- Department of Respiratory Medicine, Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Chester Medical School, University of Chester, Chester, UK
| | - Toby Gd Capstick
- Pharmacy Department, St James's University Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK. https://twitter.com/tcapper78
| | - Christabelle Chen
- Pharmacy Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK. https://twitter.com/Christab3lleMin
| | - Douglas McCabe
- Pharmacy Department, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Rhys Hurst
- Department of Thoracic Medicine, Royal Papworth Hospital, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK. https://twitter.com/RespPT_rhys
| | - Lisa Morrison
- West of Scotland Adult Cystic Fibrosis Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Fiona Moore
- West of Scotland Adult Cystic Fibrosis Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Matt Gallardo
- Tuberculosis Service, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Jennie Keane
- Tuberculosis Service, Raphael House, Essex Partnership University NHS Foundation Trust, Rochford, UK
| | | | | | - Sarah Bryant
- NTM Network UK, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Ronan Breen
- Department of Respiratory Medicine, Forth Valley Royal Hospital, NHS Forth Valley, Larbert, UK
| | - Onn Min Kon
- National Heart and Lung Institute, Imperial College London, London, UK; Department of Respiratory Medicine, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK. https://twitter.com/onnmin
| | - Marc Lipman
- Department of Respiratory Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK; UCL Respiratory, Division of Medicine, University College London, London, UK
| | - Michael R Loebinger
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK. https://twitter.com/mloebinger
| | - Devesh J Dhasmana
- Department of Respiratory Medicine, Victoria Hospital, NHS Fife, Kirkcaldy, UK; School of Medicine, North Haugh, University of St Andrews, St Andrews, UK.
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12
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Loebinger MR, Quint JK, van der Laan R, Obradovic M, Chawla R, Kishore A, van Ingen J. Response. Chest 2023; 164:e156-e157. [PMID: 37945200 DOI: 10.1016/j.chest.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 11/12/2023] Open
Affiliation(s)
| | - Jennifer K Quint
- Royal Brompton Hospital and NHLI, Imperial College London, London, England
| | | | | | | | | | - Jakko van Ingen
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
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13
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Loebinger MR, Quint JK, van der Laan R, Obradovic M, Chawla R, Kishore A, van Ingen J. Risk Factors for Nontuberculous Mycobacterial Pulmonary Disease: A Systematic Literature Review and Meta-Analysis. Chest 2023; 164:1115-1124. [PMID: 37429481 DOI: 10.1016/j.chest.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/19/2023] [Accepted: 06/08/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Nontuberculous mycobacterial pulmonary disease (NTM-PD) is widely underdiagnosed, and certain patient groups, such as those with underlying respiratory diseases, are at increased risk of developing the disease. Understanding patients at risk is essential to allow for prompt testing and diagnosis and appropriate management to prevent disease progression. RESEARCH QUESTION What are the risk factors for NTM-PD that should prompt a physician to consider NTM testing and diagnosis? STUDY DESIGN AND METHODS Electronic searches of PubMed and EMBASE were conducted in July 2021 for the period 2011-2021. Inclusion criteria were studies of patients with NTM-PD with associated risk factors. Data were extracted and assessed using the Newcastle-Ottawa Scale. Data analysis was conducted using the R-based "meta" package. Only studies that reported association outcomes for cases with NTM-PD compared with control participants (healthy populations or participants without NTM-PD) were considered for the meta-analysis. RESULTS Of the 9,530 searched publications, 99 met the criteria for the study. Of these, 24 formally reported an association between possible risk factors and the presence of NTM-PD against a control population and were included in the meta-analysis. Comorbid respiratory disease was associated with a significant increase in the OR for NTM-PD (bronchiectasis [OR, 21.43; 95% CI, 5.90-77.82], history of TB [OR, 12.69; 95% CI, 2.39-67.26], interstitial lung disease [OR, 6.39; 95% CI, 2.65-15.37], COPD [OR, 6.63; 95% CI, 4.57-9.63], and asthma [OR, 4.15; 95% CI, 2.81-6.14]). Other factors noted to be associated with an increased risk of NTM-PD were the use of inhaled corticosteroids (OR 4.46; 95% CI, 2.13-9.35), solid tumors (OR, 4.66; 95% CI, 1.04-20.94) and the presence of pneumonia (OR, 5.54; 95% CI, 2.72-11.26). INTERPRETATION The greatest risk for NTM-PD is conferred by comorbid respiratory diseases such as bronchiectasis. These findings could help with identification of patient populations at risk for NTM-PD to drive prompt testing and appropriate initiation of therapy.
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Affiliation(s)
| | - Jennifer K Quint
- Royal Brompton Hospital and NHLI, Imperial College London, London, England
| | | | | | | | | | - Jakko van Ingen
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
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14
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Kumar K, Loebinger MR. Concomitant or sequential pulmonary infection with non-tuberculous mycobacteria and Aspergillus. Int J Tuberc Lung Dis 2023; 27:797-802. [PMID: 37880890 DOI: 10.5588/ijtld.23.0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
Non-tuberculous mycobacteria (NTM) and Aspergillus are ubiquitous organisms that have the potential to cause significant pulmonary disease in certain clinical contexts. An association is known to exist between NTM and Aspergillus lung infections. However, it is unclear if NTM infection predisposes to Aspergillus infection or vice versa. It is also unclear whether treatment for one results in a favourable ecological niche that facilitates the growth of the other and promotes subsequent clinical disease. An improved understanding of the link between these two pulmonary pathogens is critical to guide improvements in clinical practice, and ultimately, enhance outcomes among patients who are at risk of experiencing these infections, either concomitantly or sequentially. Here, we discuss the association between pulmonary NTM and Aspergillus infections. We address the frequency with which coinfection or sequential infections are reported to occur, predisposing risk factors that have been identified and the impact on clinical outcomes. Current data on the mechanistic links between NTM and Aspergillus lung infections are also considered. The potential implications for routine clinical practice are explored.
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Affiliation(s)
- K Kumar
- National Heart and Lung Institute, Imperial College London, London, Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M R Loebinger
- National Heart and Lung Institute, Imperial College London, London, Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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15
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Dedrick RM, Abad L, Storey N, Kaganovsky AM, Smith BE, Aull HA, Cristinziano M, Morkowska A, Murthy S, Loebinger MR, Hatfull GF, Satta G. The problem of Mycobacterium abscessus complex: multi-drug resistance, bacteriophage susceptibility and potential healthcare transmission. Clin Microbiol Infect 2023; 29:1335.e9-1335.e16. [PMID: 37364635 PMCID: PMC10583746 DOI: 10.1016/j.cmi.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES Mycobacterium abscessus complex is responsible for 2.6-13.0% of all non-tuberculous mycobacterial pulmonary infections and these are notoriously difficult to treat due to the complex regimens required, drug resistance and adverse effects. Hence, bacteriophages have been considered in clinical practice as an additional treatment option. Here, we evaluated antibiotic and phage susceptibility profiles of M. abscessus clinical isolates. Whole-genome sequencing (WGS) revealed the phylogenetic relationships, dominant circulating clones (DCCs), the likelihood of patient-to-patient transmission and the presence of prophages. METHODS Antibiotic susceptibility testing was performed using CLSI breakpoints (n = 95), and plaque assays were used for phage susceptibility testing (subset of n = 88, 35 rough and 53 smooth morphology). WGS was completed using the Illumina platform and analysed using Snippy/snp-dists and Discovery and Extraction of Phages Tool (DEPhT). RESULTS Amikacin and Tigecycline were the most active drugs (with 2 strains resistant to amikacin, and one strain with Tigecycline MIC of 4 μg/mL). Most strains were resistant to all other drugs tested, with Linezolid and Imipenem showing the least resistance, at 38% (36/95) and 55% (52/95), respectively. Rough colony morphotype strains were more phage-susceptible than smooth strains (77%-27/35 versus 48%-25/53 in the plaque assays, but smooth strains are not killed efficiently by those phages in liquid infection assay). We have also identified 100 resident prophages, some of which were propagated lytically. DCC1 (20%-18/90) and DCC4 (22%-20/90) were observed to be the major clones and WGS identified 6 events of possible patient-to-patient transmission. DISCUSSION Many strains of M. abscessus complex are intrinsically resistant to available antibiotics and bacteriophages represent an alternative therapeutic option, but only for strains with rough morphology. Further studies are needed to elucidate the role of hospital-borne M. abscessus transmission.
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Affiliation(s)
- Rebekah M Dedrick
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lawrence Abad
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nathaniel Storey
- Department of Microbiology, Virology and Infection Control, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ari M Kaganovsky
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bailey E Smith
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Haley A Aull
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Madison Cristinziano
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Saraswathi Murthy
- Royal Brompton and Harefield Hospitals, Guys and St Thomas's NHS Foundation Trust, London, UK
| | - Michael R Loebinger
- Royal Brompton and Harefield Hospitals, Guys and St Thomas's NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Graham F Hatfull
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Giovanni Satta
- Centre for Clinical Microbiology, University College London, London, UK; Infection Division, University College London Hospitals NHS Foundation Trust, London, UK.
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16
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Chalmers JD, Polverino E, Crichton ML, Ringshausen FC, De Soyza A, Vendrell M, Burgel PR, Haworth CS, Loebinger MR, Dimakou K, Murris M, Wilson R, Hill AT, Menendez R, Torres A, Welte T, Blasi F, Altenburg J, Shteinberg M, Boersma W, Elborn JS, Goeminne PC, Aliberti S. Bronchiectasis in Europe: data on disease characteristics from the European Bronchiectasis registry (EMBARC). Lancet Respir Med 2023; 11:637-649. [PMID: 37105206 DOI: 10.1016/s2213-2600(23)00093-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Bronchiectasis is a heterogeneous, neglected disease with few multicentre studies exploring the causes, severity, microbiology, and treatment of the disease across Europe. This aim of this study was to describe the clinical characteristics of bronchiectasis and compare between different European countries. METHODS EMBARC is an international clinical research network for bronchiectasis. We report on a multicentre, prospective, observational, non-interventional, cohort study (the EMBARC registry) conducted across 27 European countries and Israel. Comprehensive clinical data were collected from adult patients (aged ≥18 years) at baseline and annual follow-up visits using electronic case report form. Data from individual countries were grouped into four regions (the UK, northern and western Europe, southern Europe, and central and eastern Europe according to modified EU EuroVoc classification). Follow-up data were used to explore differences in exacerbation frequency between regions using a negative binomial regression model. FINDINGS Between Jan 12, 2015, and April 12, 2022, 16 963 individuals were enrolled. Median age was 67 years (IQR 57-74), 10 335 (60·9%) participants were female and 6628 (39·1%) were male. The most common cause of bronchiectasis in all 16 963 participants was post-infective disease in 3600 (21·2%); 6466 individuals (38·1%) were classified as idiopathic. Individuals with bronchiectasis experienced a median of two exacerbations (IQR 1-4) per year and 4483 (26·4%) patients had a hospitalisation for exacerbation in the previous year. When examining the percentage of all isolated bacteria, marked differences in microbiology were seen between countries, with a higher frequency of Pseudomonas aeruginosa and lower Haemophilus influenzae frequency in southern Europe, compared with higher H influenzae in the UK and northern and western Europe. Compared with other regions, patients in central and eastern Europe had more severe bronchiectasis measured by the Bronchiectasis Severity Index (51·3% vs 35·1% in the overall cohort) and more exacerbations leading to hospitalisations (57·9% vs 26·4% in the overall cohort). Overall, patients in central and eastern Europe had an increased frequency of exacerbations (adjusted rate ratio [RR] 1·12, 95% CI 1·01-1·25) and a higher frequency of exacerbations leading to hospitalisations (adjusted RR 1·71, 1·44-2·02) compared with patients in other regions. Treatment of bronchiectasis was highly heterogeneous between regions. INTERPRETATION Bronchiectasis shows important geographical variation in causes, microbiology, severity, and outcomes across Europe. FUNDING European Union-European Federation of Pharmaceutical Industries and Associations Innovative Medicines Initiative. TRANSLATIONS For the Arabic, French, German, Greek, Hebrew, Irish, Russian and Spanish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
| | - Eva Polverino
- Pneumology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Thorax Institute, Institute of Biomedical Research August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Megan L Crichton
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Felix C Ringshausen
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany; European Reference Network on Rare and Complex Respiratory Diseases, Frankfurt, Germany
| | - Anthony De Soyza
- Population and Health Science Institute, Newcastle University and NIHR Biomedical Research Centre for Ageing, Freeman Hospital, Newcastle, UK
| | - Montserrat Vendrell
- Department of Pulmonology, Dr Trueta University Hospital, IDIBGL UdG, Girona, Spain
| | - Pierre Régis Burgel
- Department of Respiratory Medicine and French Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP and Université Paris Cité, Inserm U1016, Institut Cochin, Paris, France
| | - Charles S Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital and University of Cambridge, Cambridge, UK
| | - Michael R Loebinger
- Royal Brompton and Harefield Hospitals and National Heart and Lung Institute, Imperial College London, London, UK
| | - Katerina Dimakou
- 5th Respiratory Medicine Department, General Hospital for Chest Diseases of Athens SOTIRIA, Athens, Greece
| | - Marlene Murris
- Department of Respiratory Diseases, CHU Toulouse, Toulouse, France
| | - Robert Wilson
- Royal Brompton and Harefield Hospitals and National Heart and Lung Institute, Imperial College London, London, UK
| | - Adam T Hill
- Royal Infirmary of Edinburgh, Department of Respiratory Medicine, Edinburgh, Edinburgh, UK
| | - Rosario Menendez
- Pneumology Department, Hospital Universitario y Politécnico La Fe-Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Pneumology Department, Hospital Universitario y Politécnico La Fe, Avda, Valencia, Spain
| | - Antoni Torres
- Hospital Clinic of Barcelona, Spain University of Barcelona, CIBERES, IDIBAPS, Barcelona, Spain
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany; European Reference Network on Rare and Complex Respiratory Diseases, Frankfurt, Germany
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Josje Altenburg
- Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Michal Shteinberg
- Pulmonology Institute and CF Center, Carmel Medical Center, Haifa, Israel
| | - Wim Boersma
- Department of Pulmonary Diseases, Northwest Clinics, Alkmaar, Netherlands
| | - J Stuart Elborn
- Faculty of Medicine, Health and Life Sciences, Queen's University, Belfast, UK
| | | | - Stefano Aliberti
- IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Chalmers JD, Aliberti S, Altenburg J, Blasi F, Clarke C, Chotirmall SH, Crichton ML, Dhar R, Goeminne P, Haworth C, Loebinger MR, Lorent N, Polverino E, Ringshausen FC, Shoemark A, Shteinberg M, Sibila O, Spinou A, Welte T. Transforming clinical research and science in bronchiectasis: EMBARC3, a European Respiratory Society Clinical Research Collaboration. Eur Respir J 2023; 61:2300769. [PMID: 37385653 DOI: 10.1183/13993003.00769-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 05/27/2023] [Indexed: 07/01/2023]
Affiliation(s)
- James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Josje Altenburg
- Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Clare Clarke
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Megan L Crichton
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Raja Dhar
- Department of Pulmonology, C K Birla Group of Hospitals, Kolkata, India
| | - Pieter Goeminne
- Department of Respiratory Disease, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Charles Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital and University of Cambridge, Cambridge, UK
| | - Michael R Loebinger
- Royal Brompton and Harefield Hospitals, and National Heart and Lung Institute, Imperial College London, London, UK
| | - Natalie Lorent
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
- Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Eva Polverino
- Pneumology Dept, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Ciber de Enfermedades Respiratorias CIBERES, Barcelona, Spain
| | - Felix C Ringshausen
- Department of Respiratory Medicine, Hannover Medical School (MHH), Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- European Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG), Frankfurt, Germany
| | - Amelia Shoemark
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
- Royal Brompton and Harefield Hospitals, and National Heart and Lung Institute, Imperial College London, London, UK
| | - Michal Shteinberg
- Pulmonology Institute and CF Center, Carmel Medical Center, Haifa, Israel
| | - Oriol Sibila
- Hospital Clinic of Barcelona, University of Barcelona, CIBERES, IDIBAPS, Barcelona, Spain
| | - Arietta Spinou
- Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School (MHH), Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- European Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG), Frankfurt, Germany
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18
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Bradley JM, Ferguson K, Bailey A, O’Neill K, McLeese RH, Hill AT, Loebinger MR, Carroll M, Chalmers JD, Gatheral T, Johnson C, De Soyza A, Hurst JR, Downey DG, Elborn JS. Clinimetric Properties of Outcome Measures in Bronchiectasis. Ann Am Thorac Soc 2023; 20:648-659. [PMID: 36548542 PMCID: PMC10174126 DOI: 10.1513/annalsats.202206-493oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 12/22/2022] [Indexed: 12/24/2022] Open
Abstract
Rationale: There is a lack of outcome measures with robust clinimetric properties in bronchiectasis. Objectives: To determine the clinimetric properties (reliability over 1 year during clinical stability and responsiveness over the course of antibiotics for pulmonary exacerbation) of objective and patient-reported outcome measures. Methods: This multicenter cohort study included adults with bronchiectasis from seven hospitals in the United Kingdom. Participants attended four visits, 4 months apart over 1 year while clinically stable and at the beginning and end of exacerbation and completed lung function (spirometry and multiple breath washout), provided a blood sample for C-reactive protein (CRP) measurement, and completed health-related quality of life (HRQoL) questionnaires (Quality of Life-Bronchiectasis, St. George's Respiratory Questionnaire, and EuroQoL 5-Dimensions 5-Levels). Results: Participants (n = 132) had a mean (standard deviation) age of 66 (11) years, and 64% were female. Lung function parameters (forced expiratory volume in one second [FEV1], standard lung clearance index [LCI2.5]) were reliable over time [coefficient of variation (CV): <10%]). Regarding responsiveness, FEV1 demonstrated better properties than LCI2.5; therefore, a clear justification for the use of LCI2.5 in future trials is needed. CRP was less reliable (CV > 20%) over time than FEV1 and LCI2.5, and whereas CRP had a large mean change between the start and end of an exacerbation, this may have been driven by a small number of patients having a large change in CRP. Reliability of HRQoL questionnaires and questionnaire domains ranged from acceptable (CV: 20-30%) to good (CV: 10-20%), and HRQoL were responsive to treatment of exacerbations. Considering the specific questionnaire domain relevant to the intervention and its associated clinimetric properties is important. Additional statistics will support future power and/or sample size analysis. Conclusions: This information on the clinimetric properties of lung function parameters, CRP, and HRQoL parameters should be used to inform the choice of outcome measures used in future bronchiectasis trials.
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Affiliation(s)
- Judy M. Bradley
- Wellcome-Wolfson Institute for Experimental Medicine and
- Wellcome Trust-Wolfson Northern Ireland Clinical Research Facility, Queen’s University Belfast, Belfast, United Kingdom
| | - Kathryn Ferguson
- Northern Ireland Clinical Research Network, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | | | | | - Rebecca H. McLeese
- Wellcome Trust-Wolfson Northern Ireland Clinical Research Facility, Queen’s University Belfast, Belfast, United Kingdom
| | - Adam T. Hill
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Michael R. Loebinger
- Host Defence Unit, Royal Brompton Hospital, Imperial College London, London, United Kingdom
| | - Mary Carroll
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | - Timothy Gatheral
- Department of Respiratory Medicine, University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, United Kingdom
| | - Christopher Johnson
- Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, United Kingdom
| | - Anthony De Soyza
- Population and Health Science Institute, National Institute of Health Research Biomedical Research Centre on Ageing, Newcastle University, Newcastle, United Kingdom; and
| | - John R. Hurst
- Department of Respiratory Medicine, University College London, London, United Kingdom
| | | | - J. Stuart Elborn
- Wellcome-Wolfson Institute for Experimental Medicine and
- Host Defence Unit, Royal Brompton Hospital, Imperial College London, London, United Kingdom
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19
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van Tonder AJ, Ellis HC, Churchward CP, Kumar K, Ramadan N, Benson S, Parkhill J, Moffatt MF, Loebinger MR, Cookson WOC. M ycobacterium avium complex genomics and transmission in a London hospital. Eur Respir J 2023; 61:2201237. [PMID: 36517182 PMCID: PMC10116071 DOI: 10.1183/13993003.01237-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/23/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Non-tuberculous mycobacteria (NTM) are environmental microorganisms and opportunistic pathogens in individuals with pre-existing lung conditions such as cystic fibrosis (CF) and non-CF bronchiectasis. While recent studies of Mycobacterium abscessus have identified transmission within single CF centres as well as nationally and globally, transmission of other NTM species is less well studied. METHODS To investigate the potential for transmission of the Mycobacterium avium complex (MAC) we sequenced 996 isolates from 354 CF and non-CF patients at the Royal Brompton Hospital (London, UK; collected 2013-2016) and analysed them in a global context. Epidemiological links were identified from patient records. Previously published genomes were used to characterise global population structures. RESULTS We identified putative transmission clusters in three MAC species, although few epidemiological links could be identified. For M. avium, lineages were largely limited to single countries, while for Mycobacterium chimaera, global transmission clusters previously associated with heater-cooler units (HCUs) were found. However, the immediate ancestor of the lineage causing the major HCU-associated outbreak was a lineage already circulating in patients. CONCLUSIONS CF and non-CF patients shared transmission chains, although the lack of epidemiological links suggested that most transmission is indirect and may involve environmental intermediates or asymptomatic carriage in the wider population.
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Affiliation(s)
| | - Huw C Ellis
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Kartik Kumar
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Newara Ramadan
- Department of Microbiology, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Susan Benson
- Department of Microbiology, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Julian Parkhill
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Miriam F Moffatt
- National Heart and Lung Institute, Imperial College London, London, UK
- These three authors contributed equally
| | - Michael R Loebinger
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
- These three authors contributed equally
| | - William O C Cookson
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
- These three authors contributed equally
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20
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Loebinger MR, van der Laan R, Obradovic M, van Ingen J. Global survey of physician testing practices for non-tuberculous mycobacteria. ERJ Open Res 2023; 9:00737-2022. [PMID: 37143838 PMCID: PMC10152245 DOI: 10.1183/23120541.00737-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/14/2023] [Indexed: 04/01/2023] Open
Abstract
BackgroundCertain patients are at greater risk of developing non-tuberculous mycobacterial pulmonary disease (NTM-PD), including those with lung conditions such as bronchiectasis. Testing for non-tuberculous mycobacteria (NTM) in patients at risk is necessary to identify NTM-PD and start appropriate management. The aim of this survey was to evaluate current testing practices for NTM and identify testing triggers.MethodsPhysicians (n=455) who see ≥1 patient with NTM-PD in a typical 12-month period and test for NTM as part of practice from Europe, the USA, Canada, Australia, New Zealand and Japan participated in a 10-min anonymised survey on NTM testing practices.ResultsBronchiectasis, chronic obstructive pulmonary disease (COPD) and use of immunosuppressants were the factors most likely to prompt testing among physicians in this survey (90%, 64% and 64%, respectively) with radiological findings the most common reason leading to considering NTM testing in patients with bronchiectasis and COPD (62% and 74%, respectively). Macrolide monotherapy in patients with bronchiectasis and inhaled corticosteroid use in patients with COPD were not important triggers for testing (15% and 9% of physicians, respectively). Persistent cough and weight loss triggered testing in >75% of physicians. Testing triggers were markedly different for physicians in Japan, with CF prompting testing in fewer physicians compared with other regions.ConclusionsTesting for NTM is influenced by underlying disease, clinical symptoms or radiological changes, but clinical practice varies considerably. Adherence to guideline recommendations for NTM testing is limited in certain patient subgroups and varies across regions. Clear recommendations on NTM testing are needed.
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21
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Ellis HC, Moffatt MF, Churchward C, Cuthbertson L, Cookson WO, Loebinger MR. Molecular assessment of mycobacterial burden in the treatment of nontuberculous mycobacterial disease. ERJ Open Res 2023; 9:00435-2022. [PMID: 36949959 PMCID: PMC10026000 DOI: 10.1183/23120541.00435-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 10/16/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction Nontuberculous pulmonary disease causes significant morbidity and mortality. Efforts to tackle infections are hampered by the lack of reliable biomarkers for diagnosis, assessment and prognostication. The aim of this study was to develop molecular assays capable of identifying and quantifying multiple nontuberculous mycobacterial (NTM) species and to examine their utility in following individual patients' clinical courses. Methods DNA was extracted from 410 sputum samples obtained longitudinally from a cohort of 38 patients who were commencing treatment for either Mycobacterium abscessus or Mycobacterium avium complex or who were patients with bronchiectasis who had never had positive cultures for mycobacteria. NTM quantification was performed with quantitative PCR assays developed in-house. Results The molecular assays had high in vitro sensitivity and specificity for the detection and accurate quantification of NTM species. The assays successfully identified NTM DNA from human sputum samples (in vivo sensitivity: 0.86-0.87%; specificity: 0.62-0.95%; area under the curve: 0.74-0.92). A notable association between NTM copy number and treatment (Friedman ANOVA (df)=22.8 (3), p≤0.01 for M. abscessus treatment group) was also demonstrated. Conclusion The quantitative PCR assays developed in this study provide affordable, real-time and rapid measurement of NTM burden, with significant implications for prompt management decisions.
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Affiliation(s)
- Huw C. Ellis
- Host Defence Unit, Royal Brompton Hospital, London, UK
- Imperial College London, London, UK
| | | | | | | | | | - Michael R. Loebinger
- Host Defence Unit, Royal Brompton Hospital, London, UK
- Imperial College London, London, UK
- Corresponding author: Michael Loebinger ()
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22
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Shoemark A, Griffin H, Wheway G, Hogg C, Lucas JS, Camps C, Taylor J, Carroll M, Loebinger MR, Chalmers JD, Morris-Rosendahl D, Mitchison HM, De Soyza A, Brown D, Ambrose JC, Arumugam P, Bevers R, Bleda M, Boardman-Pretty F, Boustred CR, Brittain H, Caulfield MJ, Chan GC, Fowler T, Giess A, Hamblin A, Henderson S, Hubbard TJP, Jackson R, Jones LJ, Kasperaviciute D, Kayikci M, Kousathanas A, Lahnstein L, Leigh SEA, Leong IUS, Lopez FJ, Maleady-Crowe F, McEntagart M, Minneci F, Moutsianas L, Mueller M, Murugaesu N, Need AC, O'Donovan P, Odhams CA, Patch C, Perez-Gil D, Pereira MB, Pullinger J, Rahim T, Rendon A, Rogers T, Savage K, Sawant K, Scott RH, Siddiq A, Sieghart A, Smith SC, Sosinsky A, Stuckey A, Tanguy M, Taylor Tavares AL, Thomas ERA, Thompson SR, Tucci A, Welland MJ, Williams E, Witkowska K, Wood SM. Genome sequencing reveals underdiagnosis of primary ciliary dyskinesia in bronchiectasis. Eur Respir J 2022; 60:13993003.00176-2022. [PMID: 35728977 DOI: 10.1183/13993003.00176-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/12/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Bronchiectasis can result from infectious, genetic, immunological and allergic causes. 60-80% of cases are idiopathic, but a well-recognised genetic cause is the motile ciliopathy, primary ciliary dyskinesia (PCD). Diagnosis of PCD has management implications including addressing comorbidities, implementing genetic and fertility counselling and future access to PCD-specific treatments. Diagnostic testing can be complex; however, PCD genetic testing is moving rapidly from research into clinical diagnostics and would confirm the cause of bronchiectasis. METHODS This observational study used genetic data from severe bronchiectasis patients recruited to the UK 100,000 Genomes Project and patients referred for gene panel testing within a tertiary respiratory hospital. Patients referred for genetic testing due to clinical suspicion of PCD were excluded from both analyses. Data were accessed from the British Thoracic Society audit, to investigate whether motile ciliopathies are underdiagnosed in people with bronchiectasis in the UK. RESULTS Pathogenic or likely pathogenic variants were identified in motile ciliopathy genes in 17 (12%) out of 142 individuals by whole-genome sequencing. Similarly, in a single centre with access to pathological diagnostic facilities, 5-10% of patients received a PCD diagnosis by gene panel, often linked to normal/inconclusive nasal nitric oxide and cilia functional test results. In 4898 audited patients with bronchiectasis, <2% were tested for PCD and <1% received genetic testing. CONCLUSIONS PCD is underdiagnosed as a cause of bronchiectasis. Increased uptake of genetic testing may help to identify bronchiectasis due to motile ciliopathies and ensure appropriate management.
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Affiliation(s)
- Amelia Shoemark
- Respiratory Research Group, Molecular and Cellular Medicine, University of Dundee, Dundee, UK
- Royal Brompton Hospital and NHLI, Imperial College London, London, UK
- Newcastle University and NIHR Biomedical Research Centre for Ageing, Freeman Hospital, Newcastle upon Tyne, UK
| | - Helen Griffin
- Primary Immunodeficiency Group, Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
- Newcastle University and NIHR Biomedical Research Centre for Ageing, Freeman Hospital, Newcastle upon Tyne, UK
| | - Gabrielle Wheway
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Claire Hogg
- Royal Brompton Hospital and NHLI, Imperial College London, London, UK
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | | | - Carme Camps
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Clinical Informatics Research Office, John Radcliffe Hospital, Oxford, UK
| | - Jenny Taylor
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Clinical Informatics Research Office, John Radcliffe Hospital, Oxford, UK
| | - Mary Carroll
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - James D Chalmers
- Respiratory Research Group, Molecular and Cellular Medicine, University of Dundee, Dundee, UK
| | - Deborah Morris-Rosendahl
- Clinical Genetics and Genomics, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust and NHLI, Imperial College London, London, UK
| | - Hannah M Mitchison
- Genetics and Genomic Medicine Department, University College London, UCL Great Ormond Street Institute of Child Health, London, UK
- These authors contributed equally to this manuscript
| | - Anthony De Soyza
- Newcastle University and NIHR Biomedical Research Centre for Ageing, Freeman Hospital, Newcastle upon Tyne, UK
- These authors contributed equally to this manuscript
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23
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Hill AT, Grillo L, Gruffydd-Jones K, Payne K, Souto M, Sullivan A, Wildgoose J, Loebinger MR. British Thoracic Society Quality Standard for Clinically Significant Bronchiectasis in Adults 2022. BMJ Open Respir Res 2022; 9:9/1/e001369. [PMID: 36198571 PMCID: PMC9621156 DOI: 10.1136/bmjresp-2022-001369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/07/2022] Open
Abstract
This British Thoracic Society Quality Standard for Clinically Significant Bronchiectasis in Adults 2022 aims to encourage good practice by setting standards of high-quality respiratory care that services should follow.
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Affiliation(s)
| | | | | | | | | | | | | | - Michael R Loebinger
- Royal Brompton and Harefield Hospitals, London, UK,National Heart and Lung Institute, Imperial College London, London, UK
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24
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Kumar K, Loebinger MR. Response. Chest 2022; 162:e107. [PMID: 35940662 DOI: 10.1016/j.chest.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Kartik Kumar
- National Heart and Lung Institute, Imperial College London, London, England; Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, England
| | - Michael R Loebinger
- National Heart and Lung Institute, Imperial College London, London, England; Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, England.
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25
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Hughes DA, Rosenthal M, Cuthbertson L, Ramadan N, Felton I, Simmonds NJ, Loebinger MR, Price H, Armstrong-James D, Elborn JS, Cookson WO, Moffatt MF, Davies JC. An invisible threat? Aspergillus positive cultures and co-infecting bacteria in airway samples. J Cyst Fibros 2022; 22:320-326. [PMID: 35871975 DOI: 10.1016/j.jcf.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Aspergillus fumigatus (Af) infection is associated with poor lung health in chronic suppurative lung diseases but often goes undetected. We hypothesised that inhibition of Af growth by Pseudomonas aeruginosa (Pa) increases the frequency of false-negative Af culture in co-infected people. Using a substantial group of cystic fibrosis (CF) airway samples, we assessed the relationship between Af and bacterial pathogens, additionally comparing fungal culture with next-generation sequencing. METHODS Frequency of co-culture was assessed for 44,554 sputum/BAL cultures, from 1,367 CF patients between the years 2010-2020. In a subgroup, Internal Transcribed Spacer-2 (ITS2) fungal sequencing was used to determine sequencing-positive, culture-negative (S+/C-) rates. RESULTS Pa+ samples were nearly 40% less likely (P<0.0001) than Pa- samples to culture Af, an effect that was also seen with some other Gram-negative isolates. This impact varied with Pa density and appeared to be moderated by Staphylococcus aureus co-infection. Sequencing identified Af-S+/C- for 40.1% of tested sputa. Samples with Pa had higher rates of Af-S+/C- (49.3%) than those without (35.7%; RR 1.38 [1.02-1.93], P<0.05). Af-S+/C- rate was not changed by other common bacterial infections. Pa did not affect the S+/C- rates of Candida, Exophiala or Scedosporium. CONCLUSIONS Pa/ Af co-positive cultures are less common than expected in CF. Our findings suggest an Af-positive culture is less likely in the presence of Pa. Interpretation of negative cultures should be cautious, particularly in Pa-positive samples, and a companion molecular diagnostic could be useful. Further work investigating mechanisms, alternative detection techniques and other chronic suppurative lung diseases is needed.
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Affiliation(s)
- Dominic A Hughes
- King's College Hospital NHS Foundation Trust, London, UK; National Heart & Lung Institute, Imperial College London, Emmanuel Kaye Building, 1B Manresa Road, London SW3 6LR, UK.
| | - Mark Rosenthal
- Royal Brompton Hospital, Guy's & St Thomas' Trust, London, UK
| | - Leah Cuthbertson
- National Heart & Lung Institute, Imperial College London, Emmanuel Kaye Building, 1B Manresa Road, London SW3 6LR, UK
| | - Newara Ramadan
- Royal Brompton Hospital, Guy's & St Thomas' Trust, London, UK
| | - Imogen Felton
- Royal Brompton Hospital, Guy's & St Thomas' Trust, London, UK
| | - Nicholas J Simmonds
- National Heart & Lung Institute, Imperial College London, Emmanuel Kaye Building, 1B Manresa Road, London SW3 6LR, UK; Royal Brompton Hospital, Guy's & St Thomas' Trust, London, UK
| | - Michael R Loebinger
- National Heart & Lung Institute, Imperial College London, Emmanuel Kaye Building, 1B Manresa Road, London SW3 6LR, UK; Royal Brompton Hospital, Guy's & St Thomas' Trust, London, UK
| | - Henry Price
- Department of Physics, Imperial College London, UK
| | - Darius Armstrong-James
- Royal Brompton Hospital, Guy's & St Thomas' Trust, London, UK; Department of Infectious Diseases, Imperial College London, UK
| | | | - William O Cookson
- National Heart & Lung Institute, Imperial College London, Emmanuel Kaye Building, 1B Manresa Road, London SW3 6LR, UK
| | - Miriam F Moffatt
- National Heart & Lung Institute, Imperial College London, Emmanuel Kaye Building, 1B Manresa Road, London SW3 6LR, UK
| | - Jane C Davies
- National Heart & Lung Institute, Imperial College London, Emmanuel Kaye Building, 1B Manresa Road, London SW3 6LR, UK; Royal Brompton Hospital, Guy's & St Thomas' Trust, London, UK
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26
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Kumar K, Loebinger MR, Ghafur S. The role of wirelessly observed therapy in improving treatment adherence. Future Healthc J 2022; 9:179-182. [DOI: 10.7861/fhj.2021-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Hull RC, Huang JTJ, Barton AK, Keir HR, Ellis H, Cookson WOC, Moffatt MF, Loebinger MR, Chalmers JD. Sputum Proteomics in Nontuberculous Mycobacterial Lung Disease. Chest 2022; 161:1180-1191. [PMID: 34838525 DOI: 10.1016/j.chest.2021.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/30/2021] [Accepted: 11/06/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Nontuberculous mycobacterial (NTM) infections are difficult to diagnose and treat. Biomarkers to identify patients with active infection or at risk of disease progression would have clinical utility. Sputum is the most frequently used matrix for the diagnosis of NTM lung disease. RESEARCH QUESTION Can sputum proteomics be used to identify NTM-associated inflammatory profiles in sputum? STUDY DESIGN AND METHODS Patients with NTM lung disease and a matched cohort of patients with COPD, bronchiectasis (BE), and cystic fibrosis (CF) without NTM lung disease were enrolled from two hospitals in the United Kingdom. Liquid chromatography-tandem mass spectrometry was used to identify proteomic biomarkers associated with underlying diagnosis (COPD, BE, and CF), the presence of NTM lung disease defined according to American Thoracic Society/Infectious Diseases Society of America criteria, and severity of NTM. A subset of patients receiving guideline-concordant NTM treatment were studied to identify protein changes associated with treatment response. RESULTS This study analyzed 95 sputum samples from 55 subjects (BE, n = 21; COPD, n = 19; CF, n = 15). Underlying disease and infection with Pseudomonas aeruginosa were the strongest drivers of sputum protein profiles. Comparing protein abundance in COPD, BE, and CF found that 12 proteins were upregulated in CF compared with COPD, including MPO, AZU1, CTSG, CAT, and RNASE3, with 21 proteins downregulated, including SCGB1A1, IGFBP2, SFTPB, GC, and CFD. Across CF, BE, and COPD, NTM infection (n = 15) was not associated with statistically significant differences in sputum protein profiles compared with those without NTM. Two proteins associated with iron chelation were significantly downregulated in severe NTM disease. NTM treatment was associated with heterogeneous changes in the sputum protein profile. Patients with NTM and a decrease in immune response proteins had a subjective symptomatic improvement. INTERPRETATION Sputum proteomics identified candidate biomarkers of NTM severity and treatment response. However, underlying lung disease and typical bacterial pathogens such as P aeruginosa are also key determinants of the sputum proteomic profile.
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Affiliation(s)
- Rebecca C Hull
- Department of Infection, Immunity and Cardiovascular Diseases, University of Sheffield, Sheffield, United Kingdom; Florey Institute, University of Sheffield, Sheffield, United Kingdom
| | - Jeffrey T J Huang
- Division of Systems Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom
| | - Alun K Barton
- Division of Systems Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom
| | - Holly R Keir
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom
| | - Huw Ellis
- Royal Brompton and Harefield NHS Foundation Trust, London, England; National Heart and Lung Institute, Imperial College, London, England
| | - William O C Cookson
- Royal Brompton and Harefield NHS Foundation Trust, London, England; National Heart and Lung Institute, Imperial College, London, England
| | - Miriam F Moffatt
- Royal Brompton and Harefield NHS Foundation Trust, London, England; National Heart and Lung Institute, Imperial College, London, England
| | - Michael R Loebinger
- Royal Brompton and Harefield NHS Foundation Trust, London, England; National Heart and Lung Institute, Imperial College, London, England
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom.
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28
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Shoemark A, Shteinberg M, De Soyza A, Haworth CS, Richardson H, Gao Y, Perea L, Dicker AJ, Goeminne PC, Cant E, Polverino E, Altenburg J, Keir HR, Loebinger MR, Blasi F, Welte T, Sibila O, Aliberti S, Chalmers JD. Characterization of Eosinophilic Bronchiectasis: A European Multicohort Study. Am J Respir Crit Care Med 2022; 205:894-902. [PMID: 35050830 DOI: 10.1164/rccm.202108-1889oc] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Bronchiectasis is classically considered a neutrophilic disorder, but eosinophilic subtypes have recently been described. Objectives: To use multiple datasets available through the European Multicentre Bronchiectasis Audit and Research Collaboration to characterize eosinophilic bronchiectasis as a clinical entity focusing on the impact of eosinophils on bronchiectasis exacerbations. Methods: Patients were included from five countries to examine the relationships between blood eosinophil counts and clinical phenotypes after excluding coexisting asthma. 16S rRNA sequencing was used to examine relationships between eosinophil counts and the sputum microbiome. A post hoc analysis of the PROMIS (Inhaled Promixin in the Treatment of Non-Cystic Fibrosis Bronchiectasis) phase 2 trial was used to examine the impact of blood eosinophil counts on exacerbations in patients with Pseudomonas aeruginosa infection. Measurements and Main Results: A relationship between sputum and blood eosinophil counts was demonstrated in two cohorts. In analysis of 1,007 patients from five countries, 22.6% of patients had blood eosinophil counts of ⩾300 cells/μl. Counts of <100 cells/μl were associated with higher bronchiectasis severity and increased mortality. There was no clear relationship with exacerbations. Blood eosinophil counts of ⩾300 cells/μl were associated with both Streptococcus- and Pseudomonas-dominated microbiome profiles. To investigate the relationship of eosinophil counts with exacerbations after controlling for the confounding effects of infection, 144 patients were studied in a clinical trial after treatment with antipseudomonal antibiotics. Compared with patients with blood eosinophil counts of <100 cells/μl (reference), elevated eosinophil counts of 100-299 cells/μl (hazard ratio, 2.38; 95% confidence interval, 1.33-4.25; P = 0.003) and ⩾300 cells/μl (hazard ratio, 3.99; 95% confidence interval, 2.20-7.85; P < 0.0001) were associated with shorter time to exacerbation. Conclusions: Eosinophilic bronchiectasis affects approximately 20% of patients. After accounting for infection status, raised blood eosinophil counts are associated with shortened time to exacerbation.
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Affiliation(s)
- Amelia Shoemark
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom.,Royal Brompton Hospital and Imperial College London, London, United Kingdom
| | - Michal Shteinberg
- Pulmonology Institute and Cystic Fibrosis Center, Carmel Medical Center, Haifa, Israel
| | - Anthony De Soyza
- Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.,National Institute for Health Research Biomedical Research Centre for Ageing, Freeman Hospital, Newcastle, United Kingdom
| | - Charles S Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge, United Kingdom.,Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Hollian Richardson
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Yonghua Gao
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lidia Perea
- Hospital Clinic of Barcelona, University of Barcelona, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Alison J Dicker
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Pieter C Goeminne
- Department of Respiratory Disease, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Erin Cant
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Eva Polverino
- Pneumology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Thorax Institute, Institute of Biomedical Research August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Josje Altenburg
- Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Holly R Keir
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | | | - Francesco Blasi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Tobias Welte
- Department of Pulmonary Medicine and Infectious Diseases, Hannover University School of Medicine, Hannover, Germany
| | - Oriol Sibila
- Hospital Clinic of Barcelona, University of Barcelona, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Respiratory Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
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29
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Kumar K, Daley CL, Griffith DE, Loebinger MR. Management of Mycobacterium avium complex and Mycobacterium abscessus pulmonary disease: therapeutic advances and emerging treatments. Eur Respir Rev 2022; 31:31/163/210212. [PMID: 35140106 DOI: 10.1183/16000617.0212-2021] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/03/2021] [Indexed: 12/14/2022] Open
Abstract
Nontuberculous mycobacterial pulmonary disease (NTM-PD) remains a challenging condition to diagnose and treat effectively. Treatment of NTM-PD is prolonged, frequently associated with adverse effects and has variable success. In this review, we consider the factors influencing clinicians when treating NTM-PD and discuss outcomes from key studies on the pharmacological management of Mycobacterium avium complex pulmonary disease and M. abscessus pulmonary disease. We highlight issues relating to treatment-related toxicity and provide an overview of repurposed and emerging therapies for NTM-PD.
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Affiliation(s)
- Kartik Kumar
- National Heart and Lung Institute, Imperial College London, London, UK.,Host Defence Unit, Dept of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Charles L Daley
- Division of Mycobacterial and Respiratory Infections, Dept of Medicine, National Jewish Health, Denver, CO, USA.,School of Medicine, University of Colorado, Aurora, CO, USA
| | - David E Griffith
- Division of Mycobacterial and Respiratory Infections, Dept of Medicine, National Jewish Health, Denver, CO, USA
| | - Michael R Loebinger
- National Heart and Lung Institute, Imperial College London, London, UK .,Host Defence Unit, Dept of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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30
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Halbeisen FS, Pedersen ESL, Goutaki M, Spycher BD, Amirav I, Boon M, Malena CC, Crowley S, Emiralioglu N, Haarman EG, Karadag B, Koerner-Rettberg C, Latzin P, Loebinger MR, Lucas JS, Mazurek H, Morgan L, Marthin J, Pohunek P, Santamaria F, Schwerk N, Thouvenin G, Yiallouros P, Nielsen KG, Kuehni CE. Lung function from school age to adulthood in primary ciliary dyskinesia. Eur Respir J 2022; 60:13993003.01918-2021. [PMID: 35301251 DOI: 10.1183/13993003.01918-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 02/26/2022] [Indexed: 11/05/2022]
Abstract
Primary ciliary dyskinesia (PCD) presents with symptoms early in life and the disease course may be progressive, but longitudinal data on lung function are scarce. This multinational cohort study describes lung function trajectories in children, adolescents, and young adults with PCD. We analysed data from 486 patients with repeated lung function measurements obtained between the age of 6 and 24 years from the international PCD Cohort (iPCD) and calculated z-scores for forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio using the Global Lung Function Initiative 2012 references. We described baseline lung function and change of lung function over time and described their associations with possible determinants in mixed-effects linear regression models. Overall, FEV1, FVC, and FEV1/FVC z-scores declined over time (average crude annual FEV1 decline was -0.07 z-scores) but not at the same rate for all patients. FEV1 z-scores improved over time in 21% of patients, remained stable in 40% and declined in 39%. Low BMI was associated with poor baseline lung function and with further decline. Results differed by country and ultrastructural defect, but we found no evidence of differences by sex, calendar year of diagnosis, age at diagnosis, diagnostic certainty, or laterality defect. Our study shows that on average lung function in PCD declines throughout the entire period of lung growth, from childhood to young adult age, even among patients treated in specialised centres. It is essential to develop strategies to reverse this tendency and improve prognosis.
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Affiliation(s)
- Florian S Halbeisen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,These authors contributed equally to the manuscript
| | - Eva S L Pedersen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,These authors contributed equally to the manuscript
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern Unviersity Hospital, University of Bern, Bern, Switzerland
| | - Ben D Spycher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Israel Amirav
- The PCD Israeli Consortium.,Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Mieke Boon
- Department of Paediatrics, University Hospital Gasthuisberg, Leuven, Belgium
| | - Cohen-Cymberknoh Malena
- Pediatric Pulmonology Unit and Cystic fibrosis Center, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Suzanne Crowley
- Paediatric Department of Allergy and Lung Diseases, Oslo University Hospital, Oslo, Norway
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Eric G Haarman
- Department of Pediatric Pulmonology, Emma Children's Hospital, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bulent Karadag
- Department of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Cordula Koerner-Rettberg
- Department of Paediatric Pneumology, University Children's Hospital of Ruhr University Bochum, Bochum, Germany
| | - Philipp Latzin
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern Unviersity Hospital, University of Bern, Bern, Switzerland.,on behalf of the Swiss PCD Group
| | - Michael R Loebinger
- Host Defence Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, NIHR Respiratory Biomedical Research Centre, University of Southampton and University Hospital, Southampton, UK
| | - Henryk Mazurek
- Department of Pneumonology and Cystic Fibrosis, Institute of Tuberculosis and Lung Disorders, ul.Prof.Rudnika 3b, Rabka - Zdrój, Poland
| | - Lucy Morgan
- Department of Respiratory Medicine, Concord Hospital Clinical School, University of Sydney, Sydney, Australia
| | - June Marthin
- Department of Respiratory Medicine, Concord Hospital Clinical School, University of Sydney, Sydney, Australia
| | - Petr Pohunek
- Paediatric Department, 2nd Faculty of Medicine, Charles University Prague and University Hospital Motol, Prague, Czech Republic
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Napoli, Italy
| | - Nicolaus Schwerk
- Clinic for paediatric pneumology, allergology and neonatology, Hannover Medical School, Hannover, Germany
| | - Guillaume Thouvenin
- Pediatric Pulmonology Department, APHP Hôpital Trousseau, Sorbonne Université, Sorbonne Université, Centre de Recherche Saint-Antoine (CRSA), Inserm UMR_S938, Paris, France.,on behalf of the French Reference Centre for Rare Lung Diseases RespiRare®
| | | | - Kim G Nielsen
- Danish PCD Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland .,Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern Unviersity Hospital, University of Bern, Bern, Switzerland
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31
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Kumar K, Loebinger MR. Nontuberculous Mycobacterial Pulmonary Disease: Clinical Epidemiologic Features, Risk Factors, and Diagnosis: The Nontuberculous Mycobacterial Series. Chest 2022; 161:637-646. [PMID: 34627854 DOI: 10.1016/j.chest.2021.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/26/2021] [Accepted: 10/02/2021] [Indexed: 10/20/2022] Open
Abstract
Nontuberculous mycobacterial pulmonary disease (NTM-PD) continues to impose a significant clinical burden of disease on susceptible patients. The incidence of NTM-PD is rising globally, but it remains a condition that is challenging to diagnose and treat effectively. This review provides an update on the global epidemiologic features, risk factors, and diagnostic considerations associated with the management of NTM-PD.
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Affiliation(s)
- Kartik Kumar
- National Heart and Lung Institute, Imperial College London, London, England; Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, England
| | - Michael R Loebinger
- National Heart and Lung Institute, Imperial College London, London, England; Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, England.
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32
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Aliberti S, Goeminne PC, O'Donnell AE, Aksamit TR, Al-Jahdali H, Barker AF, Blasi F, Boersma WG, Crichton ML, De Soyza A, Dimakou KE, Elborn SJ, Feldman C, Tiddens H, Haworth CS, Hill AT, Loebinger MR, Martinez-Garcia MA, Meerburg JJ, Menendez R, Morgan LC, Murris MS, Polverino E, Ringshausen FC, Shteinberg M, Sverzellati N, Tino G, Torres A, Vandendriessche T, Vendrell M, Welte T, Wilson R, Wong CA, Chalmers JD. Criteria and definitions for the radiological and clinical diagnosis of bronchiectasis in adults for use in clinical trials: international consensus recommendations. Lancet Respir Med 2022; 10:298-306. [PMID: 34570994 DOI: 10.1016/s2213-2600(21)00277-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/27/2021] [Accepted: 06/03/2021] [Indexed: 12/26/2022]
Abstract
Bronchiectasis refers to both a clinical disease and a radiological appearance that has multiple causes and can be associated with a range of conditions. Disease heterogeneity and the absence of standardised definitions have hampered clinical trials of treatments for bronchiectasis and are important challenges in clinical practice. In view of the need for new therapies for non-cystic fibrosis bronchiectasis to reduce the disease burden, we established an international taskforce of experts to develop recommendations and definitions for clinically significant bronchiectasis in adults to facilitate the standardisation of terminology for clinical trials. Systematic reviews were used to inform discussions, and Delphi processes were used to achieve expert consensus. We prioritised criteria for the radiological diagnosis of bronchiectasis and suggest recommendations on the use and central reading of chest CT scans to confirm the presence of bronchiectasis for clinical trials. Furthermore, we developed a set of consensus statements concerning the definitions of clinical bronchiectasis and its specific signs and symptoms, as well as definitions for chronic bacterial infection and sustained culture conversion. The diagnosis of clinically significant bronchiectasis requires both clinical and radiological criteria, and these expert recommendations and proposals should help to optimise patient recruitment into clinical trials and allow reliable comparisons of treatment effects among different interventions for bronchiectasis. Our consensus proposals should also provide a framework for future research to further refine definitions and establish definitive guidance on the diagnosis of bronchiectasis.
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Affiliation(s)
- Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
| | - Pieter C Goeminne
- Department of Respiratory Disease, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Anne E O'Donnell
- Division of Pulmonary, Critical Care and Sleep Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Timothy R Aksamit
- Mayo Clinic Pulmonary Disease and Critical Care Medicine, Rochester, MN, USA
| | | | - Alan F Barker
- Pulmonary and Critical Care, Oregon Health and Science University, Portland, OR, USA
| | - Francesco Blasi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | | | - Megan L Crichton
- Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK
| | - Anthony De Soyza
- Population and Health Science Institute, Newcastle University, National Institute for Health Research Biomedical Research Centre for Ageing and Freeman Hospital, Newcastle, UK
| | - Katerina E Dimakou
- Fifth Respiratory Department, Sotiria Hospital for Chest Diseases, Athens, Greece
| | - Stuart J Elborn
- Faculty of Medicine, Health and Life Sciences at Queen's University Belfast, Belfast, UK
| | - Charles Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Harm Tiddens
- Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands
| | - Charles S Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital and University of Cambridge, Cambridge, UK
| | | | - Michael R Loebinger
- Host Defence Unit, Royal Brompton Hospital and Imperial College London, London, UK
| | | | | | - Rosario Menendez
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Lucy C Morgan
- Concord Clinical School, Sydney Medical School, The University of Sydney, NSW, Australia
| | - Marlene S Murris
- Department of Pulmonology, Transplantation, and Cystic Fibrosis Centre, Larrey Hospital, Toulouse, France
| | - Eva Polverino
- Adult Cystic Fibrosis and Bronchiectasis Unit, Respiratory Disease Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Felix C Ringshausen
- Hannover Medical School, Department of Respiratory Medicine, Member of the German Centre for Lung Research, Hannover, Germany
| | - Michal Shteinberg
- Pulmonology Institute and Cystic Fibrosis Centre, Carmel Medical Centre and the Technion-Israel Institute of Technology, Haifa, Israel
| | - Nicola Sverzellati
- Scienze Radiologiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Gregory Tino
- Penn Presbyterian Medical Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Antoni Torres
- Pulmonology Department, Hospital Clinic, Universitat of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Ciber de Enfermedades Respiratorias, ICREA Academia, Barcelona, Spain
| | | | - Montserrat Vendrell
- Department of Pneumology Dr Josep Trueta Hospital, Biomedical Research Institute of Girona, Universitat de Girona, Girona, Spain
| | - Tobias Welte
- Hannover Medical School, Department of Respiratory Medicine, Member of the German Centre for Lung Research, Hannover, Germany
| | - Robert Wilson
- Host Defence Unit, Royal Brompton Hospital and Imperial College London, London, UK
| | - Conroy A Wong
- Department of Respiratory Medicine, Middlemore Hospital, Counties Manukau District Health Board and University of Auckland, Auckland, New Zealand
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK
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33
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Meldrum OW, Belchamber KBR, Chichirelo-Konstantynovych KD, Horton KL, Konstantynovych TV, Long MB, McDonnell MJ, Perea L, Garcia-Basteiro AL, Loebinger MR, Duarte R, Keir HR. ERS International Congress 2021: highlights from the Respiratory Infections Assembly. ERJ Open Res 2022; 8:00642-2021. [PMID: 35615420 PMCID: PMC9124871 DOI: 10.1183/23120541.00642-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/12/2022] [Indexed: 12/15/2022] Open
Abstract
The European Respiratory Society Annual Congress 2021 took place virtually for the second year running due to the coronavirus pandemic. The congress programme featured more than 400 sessions and 3000 abstract presentations, covering the entire respiratory science and medicine field. In this article, Early Career Members of the Respiratory Infections Assembly summarise a selection of sessions across a broad range of topics, including presentations on bronchiectasis, non-tuberculosis mycobacteria, tuberculosis, cystic fibrosis and COVID-19.
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34
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Abstract
Bronchiectasis is a heterogeneous and increasingly prevalent chronic pulmonary disease that is associated with significant morbidity. In this review, we outline how patients with bronchiectasis may present clinically and describe an approach to its diagnosis, including how to identify an underlying aetiology. We discuss the important considerations when treating either acute exacerbations or stable disease and provide an overview of the role of long-term antimicrobials, airway clearance methods and other supportive management.
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Affiliation(s)
| | - Kartik Kumar
- Imperial College London, London, UK and Royal Brompton Hospital, London, UK
| | | | - Andrew Jones
- Wythenshawe Hospital, Manchester, UK and The University of Manchester, Manchester, UK
| | - Michael R Loebinger
- lead for tuberculosis service, clinical director of laboratory medicine and professor of practice (respiratory medicine), Imperial College London, London, UK and Royal Brompton Hospital, London, UK
| | - Robert Lord
- Wythenshawe Hospital, Manchester, UK and The University of Manchester, Manchester, UK
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35
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Abstract
Bronchiectasis is a heterogenous disease with multiple etiologies and associated comorbidities. As bronchiectasis is a complex disease, it is unsound to think of it as a single disease particularly when the differing etiologies are likely to be driving bronchiectasis through initial divergent molecular pathways, known as endotypes, that phenotypically present as the same disease due to protracted airway inflammation, but revealing potential differing underlying mechanisms that may have disparity of drug responses. Improved understanding of the cellular immune, inflammatory, and microbiological milieu associated with clinical and radiological features of bronchiectasis has resulted in the recognition of important endotypes and phenotypes that will allow for personalized treatments to improve quality of life and outcomes of patients with bronchiectasis. Here we discuss clinical and radiological phenotypes, as well as emerging molecular endotypes that are possible treatable traits in bronchiectasis.
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Affiliation(s)
- Ricardo J José
- Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom.,Centre for Inflammation and Tissue Repair, University College London, London, United Kingdom
| | - Michael R Loebinger
- Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
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36
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van Ingen J, Aliberti S, Andrejak C, Chalmers JD, Codecasa LR, Daley CL, Hasegawa N, Griffith DE, Hoefsloot W, Huitt G, Jarand J, Jhun BW, Loebinger MR, Marras TK, Morimoto K, Polverino E, Ringshausen FC, Santin M, Thomson R, Wagner D, Wallace RJ, Winthrop KL, Yim JJ. Management of Drug Toxicity in Mycobacterium avium Complex Pulmonary Disease: An Expert Panel Survey. Clin Infect Dis 2021; 73:e256-e259. [PMID: 32910814 PMCID: PMC8491833 DOI: 10.1093/cid/ciaa1361] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/07/2020] [Indexed: 11/25/2022] Open
Abstract
Adverse events are frequent in nontuberculous mycobacteria pulmonary disease
treatment, but evidence to support their management is scarce. An expert panel
survey on management of adverse events shows consistent opinions on management
of hepatoxicity, ocular toxicity, ototoxicity, tinnitus, and gastrointestinal
upset. These opinions can provide assistance in individual patient management
decisions.
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Affiliation(s)
- Jakko van Ingen
- Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stefano Aliberti
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy.,Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy
| | - Claire Andrejak
- Department of Pneumology, University Hospital of Amiens-Picardie, Amiens, France
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, United Kingdom
| | - Luigi R Codecasa
- Regional Tuberculosis Reference Centre, Villa Marelli Institute-Niguarda Hospital, Milan, Italy
| | - Charles L Daley
- Division of Mycobacterial and Respiratory Infections, National Jewish Health and University of Colorado, Denver, Colorado, USA
| | - Naoki Hasegawa
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - David E Griffith
- Department of Medicine, University of Texas Health Science Center at Tyler, Tyler, Texas, USA
| | - Wouter Hoefsloot
- Center for Infectious Diseases, Department of Pulmonology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gwen Huitt
- Division of Mycobacterial and Respiratory Infections, National Jewish Health and University of Colorado, Denver, Colorado, USA
| | - Julie Jarand
- Division of Respiratory Medicine, Department of Medicine, University of Calgary, Calgary, Canada
| | - Byung Woo Jhun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Michael R Loebinger
- Host Defence Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Theodore K Marras
- Departments of Medicine at the Toronto Western Hospital/University Health Network and the University of Toronto, Toronto, Canada
| | - Kozo Morimoto
- Respiratory Disease Center, Fukujuji Hospital, Anti-Tuberculosis Association, Tokyo, Japan
| | - Eva Polverino
- Servei de Pneumologia, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Barcelona, Spain
| | - Felix C Ringshausen
- Department of Respiratory Medicine, Hannover Medical School and Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
| | - Miguel Santin
- Service of Infectious Diseases, Bellvitge University Hospital, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Rachel Thomson
- Gallipoli Medical Research Institute, University of Queensland, Brisbane, Australia
| | - Dirk Wagner
- Division of Infectious Diseases, Department of Medicine II, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Richard J Wallace
- Mycobacteria/Nocardia Research Laboratory, University of Texas Health Science Center at Tyler, Tyler, Texas, USA
| | | | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Seoul National University College of Medicine, Seoul, South Korea
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Rademacher J, Dettmer S, Fuge J, Vogel-Claussen J, Shin HO, Shah A, Pedro PI, Wilson R, Welte T, Wacker F, Loebinger MR, Ringshausen FC. The Primary Ciliary Dyskinesia Computed Tomography Score in Adults with Bronchiectasis: A Derivation und Validation Study. Respiration 2021; 100:499-509. [PMID: 33895745 PMCID: PMC8220914 DOI: 10.1159/000514927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 01/07/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) is a rare genetic disorder which requires a complex diagnostic workup. Thus, an easy and widely available screening method would be helpful to identify patients who need a further diagnostic workup for PCD. OBJECTIVES The aim of the study was to develop and validate a computed tomography (CT) score for PCD to facilitate etiological diagnosis in adults with bronchiectasis. METHOD Chest CTs from 121 adults with bronchiectasis were scored for bronchiectasis morphology, distribution, and associated findings. Patients with and without the etiological diagnosis of PCD (46 and 75, respectively) were compared. Significantly, different imaging findings (p < 0.05) in univariate analysis were considered for multivariate analysis. Distinct findings were used to build the score. Based on this score, receiver operating characteristic (ROC) curve analysis was performed. The score was validated with 2 independent cohorts, another cohort from the same institution with 56 patients (28 with PCD) and an external cohort from another referral center with 172 patients (86 with PCD). RESULTS The following parameters predicted PCD in adults with bronchiectasis and were included in the score with weighting according to their regression coefficients: 2 points were given for predominance in the middle/lower lobe, 2 points for tree-in-bud pattern, 2 points for atelectasis or prior resection of a middle/lower lobe, and 3 points for absence of emphysema and fibrosis. Situs inversus was only observed in subjects with PCD (Kartagener syndrome) and, thus, was not used in the primary ciliary dyskinesia computed tomography (PCD-CT) score as group comparisons could not be performed. ROC curve analysis revealed an area under the curve (AUC) of 0.90 (95% CI 0.85-0.96). Youden index was the highest at a threshold of >6 with a sensitivity of 83% and a specificity of 83%. In the validation cohorts, ROC curve analysis confirmed the performance of the score with an AUC of 0.83 (95% CI 0.72-0.94) in the first validation cohort and 0.79 (95% CI 0.73-0.86) in the external validation cohort. CONCLUSIONS The PCD-CT score provides the first validated CT score for PCD and helps physicians in identifying adult bronchiectasis patients who require further diagnostic workup. Key message: The PCD-CT score provides the first validated CT score to assist physicians in identifying adult bronchiectasis patients who require a further diagnostic workup for PCD. It potentially improves earlier recognition of this rare and underdiagnosed disease.
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Affiliation(s)
- Jessica Rademacher
- Department of Respiratory Medicine, Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Sabine Dettmer
- Department of Radiology, Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany,*Sabine Dettmer,
| | - Jan Fuge
- Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Jens Vogel-Claussen
- Department of Radiology, Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Hoen-oh Shin
- Department of Radiology, Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Anand Shah
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Paula Inês Pedro
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Rob Wilson
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Frank Wacker
- Department of Radiology, Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Michael R. Loebinger
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Felix C. Ringshausen
- Department of Respiratory Medicine, Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
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McLeese RH, Spinou A, Alfahl Z, Tsagris M, Stuart Elborn J, Chalmers JD, De Soyza A, Loebinger MR, Birring SS, Fragkos KC, Wilson R, O'Neill K, Bradley JM. Psychometrics of HRQoL questionnaires in bronchiectasis: A systematic review and meta-analysis. Eur Respir J 2021; 58:13993003.00025-2021. [PMID: 33888521 PMCID: PMC8581652 DOI: 10.1183/13993003.00025-2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/02/2021] [Indexed: 11/21/2022]
Abstract
Introduction Understanding the psychometric properties of health-related quality of life (HRQoL) questionnaires can help inform selection in clinical trials. Our objective was to assess the psychometric properties of HRQoL questionnaires in bronchiectasis using a systematic review and meta-analysis of the literature. Methods A literature search was conducted. HRQoL questionnaires were assessed for psychometric properties (reliability, validity, minimal clinically important difference (MCID) and floor/ceiling effects). Meta-analyses assessed the associations of HRQoL with clinical measures and responsiveness of HRQoL in clinical trials. Results 166 studies and 12 HRQoL questionnaires were included. The Bronchiectasis Health Questionnaire (BHQ), Leicester Cough Questionnaire (LCQ), Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) and Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) had good internal consistency in all domains reported (Cronbach's α≥0.7) across all studies, and the Quality of Life-Bronchiectasis (QOL-B), St George's Respiratory Questionnaire (SGRQ), Chronic Respiratory Disease Questionnaire (CRDQ) and Seattle Obstructive Lung Disease Questionnaire (SOLQ) had good internal consistency in all domains in the majority of (but not all) studies. BHQ, SGRQ, LCQ and CAT had good test–retest reliability in all domains reported (intraclass correlation coefficient ≥0.7) across all studies, and QOL-B, CRDQ and SOLQ had good test–retest reliability in all domains in the majority of (but not all) studies. HRQoL questionnaires were able to discriminate between demographics, important markers of clinical status, disease severity, exacerbations and bacteriology. For HRQoL responsiveness, there was a difference between the treatment and placebo effect. Conclusions SGRQ was the most widely used HRQoL questionnaire in bronchiectasis studies and it had good psychometric properties; however, good psychometric data are emerging on the bronchiectasis-specific HRQoL questionnaires QOL-B and BHQ. Future studies should focus on the medium- to long-term test–retest reliability, responsiveness and MCID in these HRQoL questionnaires which show potential in bronchiectasis. The psychometric properties of health-related quality of life questionnaires should inform the selection of patient-reported outcomes in bronchiectasis clinical trialshttps://bit.ly/3wQuSrm
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Affiliation(s)
- Rebecca H McLeese
- The Wellcome Trust-Wolfson Northern Ireland Clinical Research Facility, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Arietta Spinou
- Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Zina Alfahl
- The Wellcome Trust-Wolfson Northern Ireland Clinical Research Facility, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.,School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Michail Tsagris
- Department of Economics, University of Crete, Rethymnon, Greece
| | - J Stuart Elborn
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK
| | - Anthony De Soyza
- Respiratory Department, Institute of Cellular Medicine, Newcastle University and Freeman Hospital, Sir William Leech Research Centre, Newcastle upon Tyne, UK
| | | | - Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | | | - Robert Wilson
- Host Defence Unit, Royal Brompton Hospital, London, UK
| | - Katherine O'Neill
- The Wellcome Trust-Wolfson Northern Ireland Clinical Research Facility, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.,Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.,Co-senior authors
| | - Judy M Bradley
- The Wellcome Trust-Wolfson Northern Ireland Clinical Research Facility, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK .,Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.,Co-senior authors
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39
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De Soyza A, Mawson P, Hill AT, Elborn S, Bradley JM, Haworth CS, Floto RA, Wilson R, Loebinger MR, Carroll M, Crichton M, Chalmers JD, Sullivan A, Brown J, Hurst JR, Duckers J, Kelly M, Steer J, Gatheral T, Walker PP, Winstanley C, McGuire A, Denning D, McNally R. BronchUK: protocol for an observational cohort study and biobank in bronchiectasis. ERJ Open Res 2021; 7:00775-2020. [PMID: 33898620 PMCID: PMC8053912 DOI: 10.1183/23120541.00775-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/23/2020] [Indexed: 11/09/2022] Open
Abstract
Bronchiectasis has been a largely overlooked disease area in respiratory medicine. This is reflected by a shortage of large-scale studies and lack of approved therapies, in turn leading to a variation of treatment across centres. BronchUK (Bronchiectasis Observational Cohort and Biobank UK) is a multicentre, prospective, observational cohort study working collaboratively with the European Multicentre Bronchiectasis Audit and Research Collaboration project. The inclusion criteria for patients entering the study are a clinical history consistent with bronchiectasis and computed tomography demonstrating bronchiectasis. Main exclusion criteria are 1) patients unable to provide informed consent, 2) bronchiectasis due to known cystic fibrosis or where bronchiectasis is not the main or co-dominant respiratory disease, 3) age <18 years, and 4) prior lung transplantation for bronchiectasis. The study is aligned to standard UK National Health Service (NHS) practice with an aim to recruit a minimum of 1500 patients from across at least nine secondary care centres. Patient data collected at baseline includes demographics, aetiology testing, comorbidities, lung function, radiology, treatments, microbiology and quality of life. Patients are followed up annually for a maximum of 5 years and, where able, blood and/or sputa samples are collected and stored in a central biobank. BronchUK aims to collect robust longitudinal data that can be used for analysis into current NHS practice and patient outcomes, and to become an integral resource to better inform future interventional studies in bronchiectasis. BronchUK is a multicentre, observational cohort study and biobank collecting longitudinal patient data to be used for analysis into current NHS practice and patient outcomes, and to better inform the design of future interventional studieshttps://bit.ly/3svngZc
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Affiliation(s)
- Anthony De Soyza
- Population and Health Science Institute, Newcastle University, National Institute of Health Research Biomedical Research Centre, Newcastle, UK
| | | | - Adam T Hill
- Royal Infirmary and University of Edinburgh, Edinburgh, UK
| | - Stuart Elborn
- The Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, UK
| | - Judy M Bradley
- The Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, UK
| | - Charles S Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge, UK.,Cambridge Centre for Lung Infection, Royal Papworth Hospital and Department of Medicine, University of Cambridge, Cambridge, UK
| | - R Andres Floto
- Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge, UK.,Cambridge Centre for Lung Infection, Royal Papworth Hospital and Department of Medicine, University of Cambridge, Cambridge, UK
| | - Robert Wilson
- Host Defence Unit, Royal Brompton Hospital, Imperial College London, London, UK
| | - Michael R Loebinger
- Host Defence Unit, Royal Brompton Hospital, Imperial College London, London, UK
| | - Mary Carroll
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - Anita Sullivan
- Dept of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jeremy Brown
- UCL Respiratory, University College London, London, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Jamie Duckers
- Cardiff and Vale University Health Board, Cardiff, UK
| | - Martin Kelly
- Altnagelvin Area Hospital, Western Health and Social Care Trust, Londonderry, UK
| | - John Steer
- North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Tim Gatheral
- University Hospitals of Morecambe Bay NHS Foundation Trust, Morecambe, UK
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Chalmers JD, Haworth CS, Metersky ML, Loebinger MR, Blasi F, Sibila O, O'Donnell AE, Sullivan EJ, Mange KC, Fernandez C, Zou J, Daley CL. Phase 2 Trial of the DPP-1 Inhibitor Brensocatib in Bronchiectasis. N Engl J Med 2020; 383:2127-2137. [PMID: 32897034 DOI: 10.1056/nejmoa2021713] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with bronchiectasis have frequent exacerbations that are thought to be related to neutrophilic inflammation. The activity and quantity of neutrophil serine proteases, including neutrophil elastase, are increased in the sputum of patients with bronchiectasis at baseline and increase further during exacerbations. Brensocatib (INS1007) is an oral reversible inhibitor of dipeptidyl peptidase 1 (DPP-1), an enzyme responsible for the activation of neutrophil serine proteases. METHODS In a phase 2, randomized, double-blind, placebo-controlled trial, we randomly assigned, in a 1:1:1 ratio, patients with bronchiectasis who had had at least two exacerbations in the previous year to receive placebo, 10 mg of brensocatib, or 25 mg of brensocatib once daily for 24 weeks. The time to the first exacerbation (primary end point), the rate of exacerbations (secondary end point), sputum neutrophil elastase activity, and safety were assessed. RESULTS Of 256 patients, 87 were assigned to receive placebo, 82 to receive 10 mg of brensocatib, and 87 to receive 25 mg of brensocatib. The 25th percentile of the time to the first exacerbation was 67 days in the placebo group, 134 days in the 10-mg brensocatib group, and 96 days in the 25-mg brensocatib group. Brensocatib treatment prolonged the time to the first exacerbation as compared with placebo (P = 0.03 for 10-mg brensocatib vs. placebo; P = 0.04 for 25-mg brensocatib vs. placebo). The adjusted hazard ratio for exacerbation in the comparison of brensocatib with placebo was 0.58 (95% confidence interval [CI], 0.35 to 0.95) in the 10-mg group (P = 0.03) and 0.62 (95% CI, 0.38 to 0.99) in the 25-mg group (P = 0.046). The incidence-rate ratio was 0.64 (95% CI, 0.42 to 0.98) in the 10-mg group, as compared with placebo (P = 0.04), and 0.75 (95% CI, 0.50 to 1.13) in the 25-mg group, as compared with placebo (P = 0.17). With both brensocatib doses, sputum neutrophil elastase activity was reduced from baseline over the 24-week treatment period. The incidence of dental and skin adverse events of special interest was higher with the 10-mg and 25-mg brensocatib doses, respectively, than with placebo. CONCLUSIONS In this 24-week trial, reduction of neutrophil serine protease activity with brensocatib in patients with bronchiectasis was associated with improvements in bronchiectasis clinical outcomes. (Funded by Insmed; WILLOW ClinicalTrials.gov number, NCT03218917.).
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Affiliation(s)
- James D Chalmers
- From the Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee (J.D.C.), Royal Papworth Hospital NHS Foundation Trust and Department of Medicine, University of Cambridge, Cambridge (C.S.H.), and Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London (M.R.L.) - all in the United Kingdom; the University of Connecticut School of Medicine, Farmington (M.L.M.); the Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (F.B.); the Department of Pulmonary Medicine, Respiratory Institute, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, and University of Barcelona, Barcelona (O.S.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Georgetown University Medical Center, Washington, DC (A.E.O.); Insmed, Bridgewater, NJ (E.J.S., K.C.M., C.F., J.Z.); and the Department of Medicine, National Jewish Health and the University of Colorado, Denver (C.L.D.)
| | - Charles S Haworth
- From the Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee (J.D.C.), Royal Papworth Hospital NHS Foundation Trust and Department of Medicine, University of Cambridge, Cambridge (C.S.H.), and Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London (M.R.L.) - all in the United Kingdom; the University of Connecticut School of Medicine, Farmington (M.L.M.); the Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (F.B.); the Department of Pulmonary Medicine, Respiratory Institute, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, and University of Barcelona, Barcelona (O.S.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Georgetown University Medical Center, Washington, DC (A.E.O.); Insmed, Bridgewater, NJ (E.J.S., K.C.M., C.F., J.Z.); and the Department of Medicine, National Jewish Health and the University of Colorado, Denver (C.L.D.)
| | - Mark L Metersky
- From the Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee (J.D.C.), Royal Papworth Hospital NHS Foundation Trust and Department of Medicine, University of Cambridge, Cambridge (C.S.H.), and Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London (M.R.L.) - all in the United Kingdom; the University of Connecticut School of Medicine, Farmington (M.L.M.); the Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (F.B.); the Department of Pulmonary Medicine, Respiratory Institute, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, and University of Barcelona, Barcelona (O.S.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Georgetown University Medical Center, Washington, DC (A.E.O.); Insmed, Bridgewater, NJ (E.J.S., K.C.M., C.F., J.Z.); and the Department of Medicine, National Jewish Health and the University of Colorado, Denver (C.L.D.)
| | - Michael R Loebinger
- From the Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee (J.D.C.), Royal Papworth Hospital NHS Foundation Trust and Department of Medicine, University of Cambridge, Cambridge (C.S.H.), and Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London (M.R.L.) - all in the United Kingdom; the University of Connecticut School of Medicine, Farmington (M.L.M.); the Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (F.B.); the Department of Pulmonary Medicine, Respiratory Institute, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, and University of Barcelona, Barcelona (O.S.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Georgetown University Medical Center, Washington, DC (A.E.O.); Insmed, Bridgewater, NJ (E.J.S., K.C.M., C.F., J.Z.); and the Department of Medicine, National Jewish Health and the University of Colorado, Denver (C.L.D.)
| | - Francesco Blasi
- From the Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee (J.D.C.), Royal Papworth Hospital NHS Foundation Trust and Department of Medicine, University of Cambridge, Cambridge (C.S.H.), and Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London (M.R.L.) - all in the United Kingdom; the University of Connecticut School of Medicine, Farmington (M.L.M.); the Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (F.B.); the Department of Pulmonary Medicine, Respiratory Institute, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, and University of Barcelona, Barcelona (O.S.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Georgetown University Medical Center, Washington, DC (A.E.O.); Insmed, Bridgewater, NJ (E.J.S., K.C.M., C.F., J.Z.); and the Department of Medicine, National Jewish Health and the University of Colorado, Denver (C.L.D.)
| | - Oriol Sibila
- From the Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee (J.D.C.), Royal Papworth Hospital NHS Foundation Trust and Department of Medicine, University of Cambridge, Cambridge (C.S.H.), and Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London (M.R.L.) - all in the United Kingdom; the University of Connecticut School of Medicine, Farmington (M.L.M.); the Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (F.B.); the Department of Pulmonary Medicine, Respiratory Institute, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, and University of Barcelona, Barcelona (O.S.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Georgetown University Medical Center, Washington, DC (A.E.O.); Insmed, Bridgewater, NJ (E.J.S., K.C.M., C.F., J.Z.); and the Department of Medicine, National Jewish Health and the University of Colorado, Denver (C.L.D.)
| | - Anne E O'Donnell
- From the Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee (J.D.C.), Royal Papworth Hospital NHS Foundation Trust and Department of Medicine, University of Cambridge, Cambridge (C.S.H.), and Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London (M.R.L.) - all in the United Kingdom; the University of Connecticut School of Medicine, Farmington (M.L.M.); the Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (F.B.); the Department of Pulmonary Medicine, Respiratory Institute, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, and University of Barcelona, Barcelona (O.S.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Georgetown University Medical Center, Washington, DC (A.E.O.); Insmed, Bridgewater, NJ (E.J.S., K.C.M., C.F., J.Z.); and the Department of Medicine, National Jewish Health and the University of Colorado, Denver (C.L.D.)
| | - Eugene J Sullivan
- From the Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee (J.D.C.), Royal Papworth Hospital NHS Foundation Trust and Department of Medicine, University of Cambridge, Cambridge (C.S.H.), and Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London (M.R.L.) - all in the United Kingdom; the University of Connecticut School of Medicine, Farmington (M.L.M.); the Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (F.B.); the Department of Pulmonary Medicine, Respiratory Institute, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, and University of Barcelona, Barcelona (O.S.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Georgetown University Medical Center, Washington, DC (A.E.O.); Insmed, Bridgewater, NJ (E.J.S., K.C.M., C.F., J.Z.); and the Department of Medicine, National Jewish Health and the University of Colorado, Denver (C.L.D.)
| | - Kevin C Mange
- From the Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee (J.D.C.), Royal Papworth Hospital NHS Foundation Trust and Department of Medicine, University of Cambridge, Cambridge (C.S.H.), and Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London (M.R.L.) - all in the United Kingdom; the University of Connecticut School of Medicine, Farmington (M.L.M.); the Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (F.B.); the Department of Pulmonary Medicine, Respiratory Institute, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, and University of Barcelona, Barcelona (O.S.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Georgetown University Medical Center, Washington, DC (A.E.O.); Insmed, Bridgewater, NJ (E.J.S., K.C.M., C.F., J.Z.); and the Department of Medicine, National Jewish Health and the University of Colorado, Denver (C.L.D.)
| | - Carlos Fernandez
- From the Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee (J.D.C.), Royal Papworth Hospital NHS Foundation Trust and Department of Medicine, University of Cambridge, Cambridge (C.S.H.), and Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London (M.R.L.) - all in the United Kingdom; the University of Connecticut School of Medicine, Farmington (M.L.M.); the Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (F.B.); the Department of Pulmonary Medicine, Respiratory Institute, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, and University of Barcelona, Barcelona (O.S.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Georgetown University Medical Center, Washington, DC (A.E.O.); Insmed, Bridgewater, NJ (E.J.S., K.C.M., C.F., J.Z.); and the Department of Medicine, National Jewish Health and the University of Colorado, Denver (C.L.D.)
| | - Jun Zou
- From the Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee (J.D.C.), Royal Papworth Hospital NHS Foundation Trust and Department of Medicine, University of Cambridge, Cambridge (C.S.H.), and Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London (M.R.L.) - all in the United Kingdom; the University of Connecticut School of Medicine, Farmington (M.L.M.); the Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (F.B.); the Department of Pulmonary Medicine, Respiratory Institute, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, and University of Barcelona, Barcelona (O.S.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Georgetown University Medical Center, Washington, DC (A.E.O.); Insmed, Bridgewater, NJ (E.J.S., K.C.M., C.F., J.Z.); and the Department of Medicine, National Jewish Health and the University of Colorado, Denver (C.L.D.)
| | - Charles L Daley
- From the Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee (J.D.C.), Royal Papworth Hospital NHS Foundation Trust and Department of Medicine, University of Cambridge, Cambridge (C.S.H.), and Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London (M.R.L.) - all in the United Kingdom; the University of Connecticut School of Medicine, Farmington (M.L.M.); the Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (F.B.); the Department of Pulmonary Medicine, Respiratory Institute, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, and University of Barcelona, Barcelona (O.S.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Georgetown University Medical Center, Washington, DC (A.E.O.); Insmed, Bridgewater, NJ (E.J.S., K.C.M., C.F., J.Z.); and the Department of Medicine, National Jewish Health and the University of Colorado, Denver (C.L.D.)
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O'Neill K, Ferguson K, Cosgrove D, Tunney MM, De Soyza A, Carroll M, Chalmers JD, Gatheral T, Hill AT, Hurst JR, Johnson C, Loebinger MR, Angyalosi G, Haworth CS, Jensen R, Ratjen F, Saunders C, Short C, Davies JC, Elborn JS, Bradley JM. Multiple breath washout in bronchiectasis clinical trials: is it feasible? ERJ Open Res 2020; 6:00363-2019. [PMID: 33083441 PMCID: PMC7553113 DOI: 10.1183/23120541.00363-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 07/19/2020] [Indexed: 01/22/2023] Open
Abstract
Background Evaluation of multiple breath washout (MBW) set-up including staff training, certification and central "over-reading" for data quality control is essential to determine the feasibility of MBW in future bronchiectasis studies. Aims To assess the outcomes of a MBW training, certification and central over-reading programme. Methods MBW training and certification was conducted in European sites collecting lung clearance index (LCI) data in the BronchUK Clinimetrics and/or i-BEST-1 studies. The blended training programme included the use of an eLearning tool and a 1-day face-to-face session. Sites submitted MBW data to trained central over-readers who determined validity and quality. Results Thirteen training days were delivered to 56 participants from 22 sites. Of 22 sites, 18 (82%) were MBW naïve. Participant knowledge and confidence increased significantly (p<0.001). By the end of the study recruitment, 15 of 22 sites (68%) had completed certification with a mean (range) time since training of 6.2 (3-14) months. In the BronchUK Clinimetrics study, 468 of 589 (79%) tests met the quality criteria following central over-reading, compared with 137 of 236 (58%) tests in the i-BEST-1 study. Conclusions LCI is feasible in a bronchiectasis multicentre clinical trial setting; however, consideration of site experience in terms of training as well as assessment of skill drift and the need for re-training may be important to reduce time to certification and optimise data quality. Longer times to certification, a higher percentage of naïve sites and patients with worse lung function may have contributed to the lower success rate in the i-BEST-1 study.
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Affiliation(s)
- Katherine O'Neill
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University - Belfast, Belfast, UK.,On behalf of the BRONCH-UK consortium.,On behalf of the i-BEST-1 Trial Team
| | | | | | - Michael M Tunney
- School of Pharmacy, Queen's University - Belfast, Belfast, UK.,On behalf of the i-BEST-1 Trial Team
| | - Anthony De Soyza
- Newcastle University, Newcastle upon Tyne, UK.,On behalf of the BRONCH-UK consortium
| | - Mary Carroll
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.,On behalf of the BRONCH-UK consortium
| | - James D Chalmers
- University of Dundee, College of Medicine, Dundee, UK.,On behalf of the BRONCH-UK consortium.,On behalf of the i-BEST-1 Trial Team
| | - Timothy Gatheral
- Department of Respiratory Medicine, University Hospitals of Morecambe Bay NHS Foundation Trust, Morecambe Bay, UK.,On behalf of the BRONCH-UK consortium
| | - Adam T Hill
- Royal Infirmary and University of Edinburgh, Edinburgh, Scotland, UK.,On behalf of the BRONCH-UK consortium
| | - John R Hurst
- UCL Respiratory, University College London, London, UK.,On behalf of the BRONCH-UK consortium
| | - Christopher Johnson
- Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge, UK.,On behalf of the BRONCH-UK consortium
| | - Michael R Loebinger
- National Heart and Lung Institute, Imperial College London, London, UK.,Royal Brompton and Harefield NHS Foundation Trust, London, UK.,On behalf of the BRONCH-UK consortium.,On behalf of the i-BEST-1 Trial Team
| | - Gerhild Angyalosi
- Novartis Pharma AG, Basel, Switzerland.,On behalf of the i-BEST-1 Trial Team
| | - Charles S Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge, UK.,On behalf of the i-BEST-1 Trial Team
| | | | | | - Clare Saunders
- National Heart and Lung Institute, Imperial College London, London, UK.,Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Christopher Short
- National Heart and Lung Institute, Imperial College London, London, UK.,Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Jane C Davies
- National Heart and Lung Institute, Imperial College London, London, UK.,Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - J Stuart Elborn
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University - Belfast, Belfast, UK.,On behalf of the BRONCH-UK consortium.,On behalf of the i-BEST-1 Trial Team
| | - Judy M Bradley
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University - Belfast, Belfast, UK.,On behalf of the BRONCH-UK consortium.,On behalf of the i-BEST-1 Trial Team
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42
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Doyle OM, van der Laan R, Obradovic M, McMahon P, Daniels F, Pitcher A, Loebinger MR. Identification of potentially undiagnosed patients with nontuberculous mycobacterial lung disease using machine learning applied to primary care data in the UK. Eur Respir J 2020; 56:13993003.00045-2020. [PMID: 32430411 DOI: 10.1183/13993003.00045-2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/23/2020] [Indexed: 01/23/2023]
Abstract
Nontuberculous mycobacterial lung disease (NTMLD) is a rare lung disease often missed due to a low index of suspicion and unspecific clinical presentation. This retrospective study was designed to characterise the prediagnosis features of NTMLD patients in primary care and to assess the feasibility of using machine learning to identify undiagnosed NTMLD patients.IQVIA Medical Research Data (incorporating THIN, a Cegedim Database), a UK electronic medical records primary care database was used. NTMLD patients were identified between 2003 and 2017 by diagnosis in primary or secondary care or record of NTMLD treatment regimen. Risk factors and treatments were extracted in the prediagnosis period, guided by literature and expert clinical opinion. The control population was enriched to have at least one of these features.741 NTMLD and 112 784 control patients were selected. Annual prevalence rates of NTMLD from 2006 to 2016 increased from 2.7 to 5.1 per 100 000. The most common pre-existing diagnoses and treatments for NTMLD patients were COPD and asthma and penicillin, macrolides and inhaled corticosteroids. Compared to random testing, machine learning improved detection of patients with NTMLD by almost a thousand-fold with AUC of 0.94. The total prevalence of diagnosed and undiagnosed cases of NTMLD in 2016 was estimated to range between 9 and 16 per 100 000.This study supports the feasibility of machine learning applied to primary care data to screen for undiagnosed NTMLD patients, with results indicating that there may be a substantial number of undiagnosed cases of NTMLD in the UK.
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Affiliation(s)
- Orla M Doyle
- Predictive Analytics, Real World Analytical Solutions, IQVIA, London, UK.,These authors contributed equally
| | - Roald van der Laan
- Insmed Utrecht, Utrecht, The Netherlands.,These authors contributed equally
| | - Marko Obradovic
- Insmed Utrecht, Utrecht, The Netherlands .,These authors contributed equally
| | | | | | | | - Michael R Loebinger
- Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
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43
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Loebinger MR, Polverino E, Chalmers JD, Tiddens HA, Goossens H, Tunney M, Ringshausen FC, Hill AT, Pathan R, Angyalosi G, Blasi F, Elborn SJ, Haworth CS. Efficacy and safety of TOBI Podhaler in Pseudomonas aeruginosa-infected bronchiectasis patients: iBEST study. Eur Respir J 2020; 57:13993003.01451-2020. [DOI: 10.1183/13993003.01451-2020] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/18/2020] [Indexed: 12/24/2022]
Abstract
The study aimed to determine the efficacy of a safe and well-tolerated dose and regimen of tobramycin inhalation powder (TIP) on Pseudomonas aeruginosa sputum density in patients with bronchiectasis.This is a phase II, double-blind, randomised study in bronchiectasis patients aged ≥18 years with chronic P. aeruginosa infection. Patients were randomised 1:1:1 to either cohort A: three capsules of TIP once daily (84 mg); cohort B: five capsules once daily (140 mg) or cohort C: four capsules twice daily (224 mg). Within each cohort, patients were further randomised 2:2:1 either to TIP continuously, TIP cyclically (alternating 28 days of TIP and placebo) or placebo for 16 weeks, respectively and were followed up for 8 weeks.Overall, 107 patients were randomised to cohorts A (n=34), B (n=36) and C (n=37). All three TIP doses significantly reduced the P. aeruginosa sputum density from baseline to day 29 versus placebo in a dose-dependent manner (p≤0.0001, each). A smaller proportion of patients in the continuous-TIP (34.1%) and cyclical-TIP (35.7%) groups experienced pulmonary exacerbations versus placebo (47.6%) and also required fewer anti-pseudomonal antibiotics (38.6% on continuous TIP and 42.9% on cyclical TIP) versus placebo (57.1%) although not statistically significant. Pulmonary exacerbation of bronchiectasis was the most frequent (37.4%) adverse event. Overall, TIP was well tolerated, however, 23.4% of the patients discontinued the study drug due to adverse events.Continuous- and cyclical-TIP regimens with all three doses were safe and effective in reducing the P. aeruginosa sputum density in patients with bronchiectasis and chronic P. aeruginosa infection.
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44
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Wynne SC, Patel S, Barker RE, Jones SE, Walsh JA, Kon SS, Cairn J, Loebinger MR, Wilson R, Man WDC, Nolan CM. Anxiety and depression in bronchiectasis: Response to pulmonary rehabilitation and minimal clinically important difference of the Hospital Anxiety and Depression Scale. Chron Respir Dis 2020; 17:1479973120933292. [PMID: 32545998 PMCID: PMC7301664 DOI: 10.1177/1479973120933292] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The aims of the study were to evaluate the responsiveness of Hospital Anxiety and Depression Scale-Anxiety (HADS-A) subscale and HADS-Depression (HADS-D) subscale to pulmonary rehabilitation (PR) in patients with bronchiectasis compared to a matched group of patients with chronic obstructive pulmonary disease (COPD) and provide estimates of the minimal clinically important difference (MCID) of HADS-A and HADS-D in bronchiectasis. Patients with bronchiectasis and at least mild anxiety or depression (HADS-A ≥ 8 or/and HADS-D ≥ 8), as well as a propensity score-matched control group of patients with COPD, underwent an 8-week outpatient PR programme (two supervised sessions per week). Within- and between-group changes were calculated in response to PR. Anchor- and distribution-based methods were used to estimate the MCID. HADS-A and HADS-D improved in response to PR in both patients with bronchiectasis and those with COPD (median (25th, 75th centile)/mean (95% confidence interval) change: HADS-A change: bronchiectasis −2 (−5, 0), COPD −2 (−4, 0); p = 0.43 and HADS-D change: bronchiectasis −2 (−2 to −1), COPD −2 (−3 to −2); p = 0.16). Using 26 estimates, the MCID for HADS-A and HADS-D was −2 points. HADS-A and HADS-D are responsive to PR in patients with bronchiectasis and symptoms of mood disorder, with an MCID estimate of −2 points.
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Affiliation(s)
- Stephanie C Wynne
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Suhani Patel
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.,Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Ruth E Barker
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.,Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Sarah E Jones
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.,Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Jessica A Walsh
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.,Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Samantha Sc Kon
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.,Department of Respiratory Medicine, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.,The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Julius Cairn
- Department of Respiratory Medicine, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Michael R Loebinger
- National Heart and Lung Institute, Imperial College London, London, UK.,Host Defence Unit, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Robert Wilson
- National Heart and Lung Institute, Imperial College London, London, UK.,Host Defence Unit, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - William D-C Man
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.,Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.,National Heart and Lung Institute, Imperial College London, London, UK.,Department of Respiratory Medicine, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Claire M Nolan
- Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.,Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
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Cuthbertson L, Felton I, James P, Cox MJ, Bilton D, Schelenz S, Loebinger MR, Cookson WOC, Simmonds NJ, Moffatt MF. The fungal airway microbiome in cystic fibrosis and non-cystic fibrosis bronchiectasis. J Cyst Fibros 2020; 20:295-302. [PMID: 32540174 PMCID: PMC8048771 DOI: 10.1016/j.jcf.2020.05.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 02/08/2023]
Abstract
The prevalence of fungal disease is increasing in CF and non-CF bronchiectasis. Effective management of fungal disease requires an understanding of the mycobiome. Culture methods alone are inadequate for the accurate diagnosis of fungal disease. Our study provides a framework to characterize fungal airway disease using NGS. NGS can improve detection and clinical management of fungal infections.
Background The prevalence of fungal disease in cystic fibrosis (CF) and non-CF bronchiectasis is increasing and the clinical spectrum is widening. Poor sensitivity and a lack of standard diagnostic criteria renders interpretation of culture results challenging. In order to develop effective management strategies, a more accurate and comprehensive understanding of the airways fungal microbiome is required. The study aimed to use DNA sequences from sputum to assess the load and diversity of fungi in adults with CF and non-CF bronchiectasis. Methods Next generation sequencing of the ITS2 region was used to examine fungal community composition (n = 176) by disease and underlying clinical subgroups including allergic bronchopulmonary aspergillosis, chronic necrotizing pulmonary aspergillosis, non-tuberculous mycobacteria, and fungal bronchitis. Patients with no known active fungal disease were included as disease controls. Results ITS2 sequencing greatly increased the detection of fungi from sputum. In patients with CF fungal diversity was lower, while burden was higher than those with non-CF bronchiectasis. The most common operational taxonomic unit (OTU) in patients with CF was Candida parapsilosis (20.4%), whereas in non-CF bronchiectasis sputum Candida albicans (21.8%) was most common. CF patients with overt fungal bronchitis were dominated by Aspergillus spp., Exophiala spp., Candida parapsilosis or Scedosporium spp. Conclusion This study provides a framework to more accurately characterize the extended spectrum of fungal airways diseases in adult suppurative lung diseases.
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Affiliation(s)
- Leah Cuthbertson
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK; National Heart and Lung Institute, Imperial College, London SW3 6LY, UK
| | - Imogen Felton
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK; National Heart and Lung Institute, Imperial College, London SW3 6LY, UK
| | - Phillip James
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK; National Heart and Lung Institute, Imperial College, London SW3 6LY, UK
| | - Michael J Cox
- National Heart and Lung Institute, Imperial College, London SW3 6LY, UK
| | - Diana Bilton
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK; National Heart and Lung Institute, Imperial College, London SW3 6LY, UK
| | - Silke Schelenz
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK
| | - Michael R Loebinger
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK; National Heart and Lung Institute, Imperial College, London SW3 6LY, UK
| | - William O C Cookson
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK; National Heart and Lung Institute, Imperial College, London SW3 6LY, UK.
| | - Nicholas J Simmonds
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK; National Heart and Lung Institute, Imperial College, London SW3 6LY, UK
| | - Miriam F Moffatt
- National Heart and Lung Institute, Imperial College, London SW3 6LY, UK
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46
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Osborne W, Fernandes M, Brooks S, Grist E, Sayer C, Hansell DM, Wilson R, Shah A, Loebinger MR. Pulsed echinocandin therapy in azole intolerant or multiresistant chronic pulmonary aspergillosis: A retrospective review at a UK tertiary centre. Clin Respir J 2020; 14:571-577. [PMID: 32077238 DOI: 10.1111/crj.13171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/12/2020] [Accepted: 02/17/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Chronic pulmonary aspergillosis (CPA) is a fungal disease with high mortality and morbidity. Guidelines suggest treatment with azoles as first-line therapy. However, patients often develop treatment intolerance or increasingly azole resistance. OBJECTIVES This retrospective review assesses outcomes in azole resistant or intolerant patients with CPA treated with cyclical echinocandin therapy. METHODS We retrospectively examined records of 25 patients with CPA treated with cyclical caspofungin, 6 of whom were either azole-resistant or azole intolerant. Baseline characteristics, high-resolution computed tomography severity scores, forced expiratory volume after 1 minute (FEV1), forced vital capacity (FVC), body mass index and serology (Aspergillus fumigatus-specific IgG, Aspergillus fumigatus-specific IgE, total IgE and CRP) were assessed before and after caspofungin. RESULTS Of the six patients, four (66%) started caspofungin due to intolerance and two (33%) due to pan-azole resistance. On treatment, there was stability in FEV1 with an overall mortality of 33% during the follow-up period with a median survival of 875.5 days (IQR 529-1024). No significant change in serology (A. fumigatus-specific IgG and CRP was seen. CONCLUSIONS With pulsed echinocandin therapy, azole-intolerant or pan-resistant CPA patients have similar mortality rates to azole-naïve CPA patients. Pulsed echinocandin therapy may present a strategy to stabilize CPA in patients with pan resistance or intolerance to, azole therapy.
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Affiliation(s)
- William Osborne
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | | | - Emily Grist
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Charlie Sayer
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - David M Hansell
- Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Robert Wilson
- Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Anand Shah
- Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Michael R Loebinger
- Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
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Chua F, Armstrong-James D, Desai SR, Barnett J, Kouranos V, Kon OM, José R, Vancheeswaran R, Loebinger MR, Wong J, Cutino-Moguel MT, Morgan C, Ledot S, Lams B, Yip WH, Li L, Lee YC, Draper A, Kho SS, Renzoni E, Ward K, Periselneris J, Grubnic S, Lipman M, Wells AU, Devaraj A. The role of CT in case ascertainment and management of COVID-19 pneumonia in the UK: insights from high-incidence regions. Lancet Respir Med 2020; 8:438-440. [PMID: 32220663 PMCID: PMC7104153 DOI: 10.1016/s2213-2600(20)30132-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 03/16/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Felix Chua
- Interstitial Lung Disease Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK.
| | - Darius Armstrong-James
- Department of Infectious Disease and Medical Mycology, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Sujal R Desai
- Department of Radiology, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Joseph Barnett
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Vasileios Kouranos
- Interstitial Lung Disease Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Onn Min Kon
- Department of Respiratory Medicine, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Ricardo José
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Rama Vancheeswaran
- Department of Integrated Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Michael R Loebinger
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Joyce Wong
- Department of Cardiology, Harefield Hospital, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | | | - Cliff Morgan
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Stephane Ledot
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Boris Lams
- Respiratory Medicine and Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Wing Ho Yip
- Division of Respiratory Medicine, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Leski Li
- Department of Radiology, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Ying Cheong Lee
- Department of Radiology, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Adrian Draper
- Department of Respiratory Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sze Shyang Kho
- Department of Medicine, Sarawak General Hospital, Sarawak, Malaysia
| | - Elisabetta Renzoni
- Interstitial Lung Disease Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Katie Ward
- Department of Respiratory Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jimstan Periselneris
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Sisa Grubnic
- Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Marc Lipman
- Department of Respiratory Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Athol U Wells
- Interstitial Lung Disease Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
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Loebinger MR, Birring SS. Patient reported outcomes for non-tuberculous mycobacterial disease. Eur Respir J 2020; 55:55/1/1902204. [DOI: 10.1183/13993003.02204-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 11/14/2019] [Indexed: 11/05/2022]
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Fassad MR, Patel MP, Shoemark A, Cullup T, Hayward J, Dixon M, Rogers AV, Ollosson S, Jackson C, Goggin P, Hirst RA, Rutman A, Thompson J, Jenkins L, Aurora P, Moya E, Chetcuti P, O'Callaghan C, Morris-Rosendahl DJ, Watson CM, Wilson R, Carr S, Walker W, Pitno A, Lopes S, Morsy H, Shoman W, Pereira L, Constant C, Loebinger MR, Chung EMK, Kenia P, Rumman N, Fasseeh N, Lucas JS, Hogg C, Mitchison HM. Clinical utility of NGS diagnosis and disease stratification in a multiethnic primary ciliary dyskinesia cohort. J Med Genet 2019; 57:322-330. [PMID: 31879361 DOI: 10.1136/jmedgenet-2019-106501] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/23/2019] [Accepted: 11/01/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD), a genetically heterogeneous condition enriched in some consanguineous populations, results from recessive mutations affecting cilia biogenesis and motility. Currently, diagnosis requires multiple expert tests. METHODS The diagnostic utility of multigene panel next-generation sequencing (NGS) was evaluated in 161 unrelated families from multiple population ancestries. RESULTS Most (82%) families had affected individuals with biallelic or hemizygous (75%) or single (7%) pathogenic causal alleles in known PCD genes. Loss-of-function alleles dominate (73% frameshift, stop-gain, splice site), most (58%) being homozygous, even in non-consanguineous families. Although 57% (88) of the total 155 diagnostic disease variants were novel, recurrent mutations and mutated genes were detected. These differed markedly between white European (52% of families carry DNAH5 or DNAH11 mutations), Arab (42% of families carry CCDC39 or CCDC40 mutations) and South Asian (single LRRC6 or CCDC103 mutations carried in 36% of families) patients, revealing a striking genetic stratification according to population of origin in PCD. Genetics facilitated successful diagnosis of 81% of families with normal or inconclusive ultrastructure and 67% missing prior ultrastructure results. CONCLUSIONS This study shows the added value of high-throughput targeted NGS in expediting PCD diagnosis. Therefore, there is potential significant patient benefit in wider and/or earlier implementation of genetic screening.
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Affiliation(s)
- Mahmoud R Fassad
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, UK.,Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Mitali P Patel
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Amelia Shoemark
- PCD Diagnostic Team and Department of Pediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Thomas Cullup
- NE Thames Regional Molecular Genetics Laboratory, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Jane Hayward
- NE Thames Regional Molecular Genetics Laboratory, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Mellisa Dixon
- PCD Diagnostic Team and Department of Pediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Andrew V Rogers
- Host Defence Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Sarah Ollosson
- PCD Diagnostic Team and Department of Pediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Claire Jackson
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust and Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Patricia Goggin
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust and Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Robert A Hirst
- Centre for PCD Diagnosis and Research, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Andrew Rutman
- Centre for PCD Diagnosis and Research, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - James Thompson
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust and Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lucy Jenkins
- NE Thames Regional Molecular Genetics Laboratory, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Paul Aurora
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Department of Respiratory, Critical Care and Anaesthesia Unit, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Eduardo Moya
- Children's Services (Paediatrics), Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Philip Chetcuti
- Department of Respiratory Paediatrics, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Chris O'Callaghan
- Centre for PCD Diagnosis and Research, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK.,Department of Respiratory, Critical Care and Anaesthesia Unit, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Deborah J Morris-Rosendahl
- Clinical Genetics and Genomics Laboratory, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Robert Wilson
- Host Defence Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Siobhan Carr
- PCD Diagnostic Team and Department of Pediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Woolf Walker
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust and Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andreia Pitno
- PCD Diagnostic Team and Department of Pediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Laboratório de Histologia e Patologia Comparada, Instituto de Medicina Molecular, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Susana Lopes
- CEDOC, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Heba Morsy
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Walaa Shoman
- Department of Pediatrics, Faculty of Medicine, Alexandria University Children's Hospital, Alexandria, Egypt
| | - Luisa Pereira
- Paediatric Pulmonology Unit, Department of Pediatrics, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Carolina Constant
- Paediatric Pulmonology Unit, Department of Pediatrics, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | | | - Eddie M K Chung
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Priti Kenia
- Department of Respiratory Paediatrics, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Nisreen Rumman
- Pediatrics Department, Makassed Hospital, East Jerusalem, Israel
| | - Nader Fasseeh
- Department of Pediatrics, Faculty of Medicine, Alexandria University Children's Hospital, Alexandria, Egypt
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust and Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Claire Hogg
- PCD Diagnostic Team and Department of Pediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Hannah M Mitchison
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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50
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Bradley JM, Anand R, O’Neill B, Ferguson K, Clarke M, Carroll M, Chalmers J, De Soyza A, Duckers J, Hill AT, Loebinger MR, Copeland F, Gardner E, Campbell C, Agus A, McGuire A, Boyle R, McKinney F, Dickson N, McAuley DF, Elborn S. A 2 × 2 factorial, randomised, open-label trial to determine the clinical and cost-effectiveness of hypertonic saline (HTS 6%) and carbocisteine for airway clearance versus usual care over 52 weeks in adults with bronchiectasis: a protocol for the CLEAR clinical trial. Trials 2019; 20:747. [PMID: 31856887 PMCID: PMC6921594 DOI: 10.1186/s13063-019-3766-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 09/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current guidelines for the management of bronchiectasis (BE) highlight the lack of evidence to recommend mucoactive agents, such as hypertonic saline (HTS) and carbocisteine, to aid sputum removal as part of standard care. We hypothesise that mucoactive agents (HTS or carbocisteine, or a combination) are effective in reducing exacerbations over a 52-week period, compared to usual care. METHODS This is a 52-week, 2 × 2 factorial, randomized, open-label trial to determine the clinical effectiveness and cost effectiveness of HTS 6% and carbocisteine for airway clearance versus usual care - the Clinical and cost-effectiveness of hypertonic saline (HTS 6%) and carbocisteine for airway clearance versus usual care (CLEAR) trial. Patients will be randomised to (1) standard care and twice-daily nebulised HTS (6%), (2) standard care and carbocisteine (750 mg three times per day until visit 3, reducing to 750 mg twice per day), (3) standard care and combination of twice-daily nebulised HTS and carbocisteine, or (4) standard care. The primary outcome is the mean number of exacerbations over 52 weeks. Key inclusion criteria are as follows: adults with a diagnosis of BE on computed tomography, BE as the primary respiratory diagnosis, and two or more pulmonary exacerbations in the last year requiring antibiotics and production of daily sputum. DISCUSSION This trial's pragmatic research design avoids the significant costs associated with double-blind trials whilst optimising rigour in other areas of trial delivery. The CLEAR trial will provide evidence as to whether HTS, carbocisteine or both are effective and cost effective for patients with BE. TRIAL REGISTRATION EudraCT number: 2017-000664-14 (first entered in the database on 20 October 2017). ISRCTN.com, ISRCTN89040295. Registered on 6 July/2018. Funder: National Institute for Health Research, Health Technology Assessment Programme (15/100/01). SPONSOR Belfast Health and Social Care Trust. Ethics Reference Number: 17/NE/0339. Protocol version: v3.0 Final_14052018.
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Affiliation(s)
- Judy Martina Bradley
- Wellcome-Wolfson Institute For Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Rohan Anand
- Wellcome-Wolfson Institute For Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Brenda O’Neill
- Centre for Health and Rehabilitation Technologies (CHaRT), Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Kathryn Ferguson
- Northern Ireland Clinical Research Network, Belfast Health and Social Care Trust, Belfast, UK
| | - Mike Clarke
- Northern Ireland Methodology Hub, Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Mary Carroll
- Southampton University Hospitals NHS Trust, Southampton, UK
| | | | - Anthony De Soyza
- NIHR Biomedical research centre (BRC) for Aging, Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - Jamie Duckers
- Cardiff and Vale University Health Board, University Hospital Llandough, Penarth, UK
| | - Adam T. Hill
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Michael R. Loebinger
- Faculty of Medicine, National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London, UK
| | - Fiona Copeland
- PCD Family Support Group, Ciliopathy Alliance, London, UK
| | - Evie Gardner
- Northern Ireland Clinical Trials Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Christina Campbell
- Northern Ireland Clinical Trials Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Ashley Agus
- Northern Ireland Clinical Trials Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Alistair McGuire
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Roisin Boyle
- Northern Ireland Clinical Trials Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Fionnuala McKinney
- Northern Ireland Clinical Trials Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Naomi Dickson
- Northern Ireland Clinical Trials Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Danny F. McAuley
- Wellcome-Wolfson Institute For Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Stuart Elborn
- Wellcome-Wolfson Institute For Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
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