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Dallal Bashi YH, Ali A, Al Ayoub Y, Assi KH, Mairs R, McCarthy HO, Tunney MM, Kett VL. Inhaled dry powder liposomal azithromycin for treatment of chronic lower respiratory tract infection. Int J Pharm 2024; 653:123841. [PMID: 38266939 DOI: 10.1016/j.ijpharm.2024.123841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/05/2024] [Accepted: 01/20/2024] [Indexed: 01/26/2024]
Abstract
A dry powder inhaled liposomal azithromycin formulation was developed for the treatment of chronic respiratory diseases such as cystic fibrosis and bronchiectasis. Key properties including liposome size, charge and encapsulation efficiency powder size, shape, glass transition temperature (Tg), water content and in vitro respiratory deposition were determined. Antimicrobial activity against cystic fibrosis (CF) respiratory pathogens was determined by MIC, MBC and biofilm assays. Cytotoxicity and cellular uptake studies were performed using A549 cells. The average liposome size was 105 nm, charge was 55 mV and encapsulation efficiency was 75 %. The mean powder particle size d[v,50] of 4.54 µm and Mass Median Aerodynamic Diameter (MMAD) was 5.23 µm with a mean Tg of 76˚C and water content of 2.1 %. These excellent physicochemical characteristics were maintained over one year. Liposomal loaded azithromycin demonstrated enhanced activity against P. aeruginosa clinical isolates grown in biofilm. The formulation was rapidly delivered into bacterial cells with > 75 % uptake in 1 h. Rapid uptake into A549 cells via a cholesterol-dependent endocytosis pathway with no cytotoxic effects apparent. These data demonstrate that this formulation could offer benefits over current treatment regimens for people with chronic respiratory infection.
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Affiliation(s)
| | - Ahlam Ali
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK
| | - Yuosef Al Ayoub
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK; School of Pharmacy, University of Bradford, UK
| | - Khaled H Assi
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK; School of Pharmacy, University of Bradford, UK
| | - Rachel Mairs
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK
| | - Helen O McCarthy
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK
| | - Michael M Tunney
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK
| | - Vicky L Kett
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK.
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2
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Bergantini L, Baker J, Bossios A, Braunstahl GJ, Conemans LH, Lombardi F, Mathioudakis AG, Pobeha P, Ricciardolo FLM, Prada Romero LP, Schleich F, Snelgrove RJ, Trinkmann F, Uller L, Beech A. ERS International Congress 2023: highlights from the Airway Diseases Assembly. ERJ Open Res 2024; 10:00891-2023. [PMID: 38529346 PMCID: PMC10962455 DOI: 10.1183/23120541.00891-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 03/27/2024] Open
Abstract
In this review, early career and senior members of Assembly 5 (Airway Diseases, Asthma, COPD and Chronic Cough) present key recent findings pertinent to airway diseases that were presented during the European Respiratory Society International Congress 2023 in Milan, Italy, with a particular focus on asthma, COPD, chronic cough and bronchiectasis. During the congress, an increased number of symposia, workshops and abstract presentations were organised. In total, 739 abstracts were submitted for Assembly 5 and the majority of these were presented by early career members. These data highlight the increased interest in this group of respiratory diseases.
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Affiliation(s)
- Laura Bergantini
- Respiratory Disease Unit, Department of Medical Sciences, Surgery, and Neurosciences, University of Siena, Siena, Italy
| | - James Baker
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Apostolos Bossios
- Karolinska Severe Asthma Center, Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gert-Jan Braunstahl
- Franciscus Gasthuis and Vlietland Hospital, Rotterdam, The Netherlands
- Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Francesco Lombardi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alexander G. Mathioudakis
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Pavol Pobeha
- Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Fabio Luigi Massimo Ricciardolo
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- Institute of Translational Pharmacology, National Research Council (IFT-CNR), Palermo, Italy
| | | | - Florence Schleich
- Respiratory Medicine, CHU Sart-Tilman B35, University of Liège, GIGA I3, Liège, Belgium
| | | | - Frederik Trinkmann
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at Heidelberg University Hospital, Translational Lung Research Center Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Biomedical Informatics, Center for Preventive Medicine and Digital Health, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Lena Uller
- Department of Experimental Medical Science, Unit of Respiratory Immunopharmacology, Lund University, Lund, Sweden
| | - Augusta Beech
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Medicines Evaluation Unit, Manchester University NHS Foundation Trust, Manchester, UK
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3
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Bos S, Murray J, Marchetti M, Cheng GS, Bergeron A, Wolff D, Sander C, Sharma A, Badawy SM, Peric Z, Piekarska A, Pidala J, Raj K, Penack O, Kulkarni S, Beestrum M, Linke A, Rutter M, Coleman C, Tonia T, Schoemans H, Stolz D, Vos R. ERS/EBMT clinical practice guidelines on treatment of pulmonary chronic graft- versus-host disease in adults. Eur Respir J 2024; 63:2301727. [PMID: 38485149 DOI: 10.1183/13993003.01727-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/21/2024] [Indexed: 04/02/2024]
Abstract
Chronic graft-versus-host disease (cGvHD) is a common complication after allogeneic haematopoietic stem cell transplantation, characterised by a broad disease spectrum that can affect virtually any organ. Although pulmonary cGvHD is a less common manifestation, it is of great concern due to its severity and poor prognosis. Optimal management of patients with pulmonary cGvHD is complicated and no standardised approach is available. The purpose of this joint European Respiratory Society (ERS) and European Society for Blood and Marrow Transplantation task force was to develop evidence-based recommendations regarding the treatment of pulmonary cGvHD phenotype bronchiolitis obliterans syndrome in adults. A multidisciplinary group representing specialists in haematology, respiratory medicine and methodology, as well as patient advocates, formulated eight PICO (patient, intervention, comparison, outcome) and two narrative questions. Following the ERS standardised methodology, we conducted systematic reviews to address these questions and used the Grading of Recommendations Assessment, Development and Evaluation approach to develop recommendations. The resulting guideline addresses common therapeutic options (inhalation therapy, fluticasone-azithromycin-montelukast, imatinib, ibrutinib, ruxolitinib, belumosudil, extracorporeal photopheresis and lung transplantation), as well as other aspects of general management, such as lung functional and radiological follow-up and pulmonary rehabilitation, for adults with pulmonary cGvHD phenotype bronchiolitis obliterans syndrome. These recommendations include important advancements that could be incorporated in the management of adults with pulmonary cGvHD, primarily aimed at improving and standardising treatment and improving outcomes.
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Affiliation(s)
- Saskia Bos
- Dept of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John Murray
- Dept of Haematology and Transplant Unit, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Monia Marchetti
- Dept of Haematology, Azienda Ospedaliera Nazionale SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Guang-Shing Cheng
- Division of Clinical Research, Fred Hutchinson Cancer Research Center and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Washington, Seattle, WA, USA
| | - Anne Bergeron
- Dept of Pulmonology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Daniel Wolff
- Dept of Medicine III, Haematology and Oncology, University Hospital Regensburg, Regensberg, Germany
| | - Clare Sander
- Dept of Respiratory Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Akshay Sharma
- Dept of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sherif M Badawy
- Dept of Pediatrics, Division of Haematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Zinaida Peric
- Dept of Haematology, University Hospital Zagreb, Zagreb, Croatia
- TCWP (Transplant Complications Working Party) of the EBMT
| | - Agnieszka Piekarska
- Dept of Haematology and Transplantology, Medical University of Gdansk, Gdansk, Poland
| | - Joseph Pidala
- Dept of Medical Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Kavita Raj
- Dept of Haematology, University College London Hospital NHS Foundation Trust, London, UK
| | - Olaf Penack
- TCWP (Transplant Complications Working Party) of the EBMT
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Dept of Hematology, Oncology and Tumorimmunology, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Samar Kulkarni
- Dept of Haematology and Transplant Unit, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Molly Beestrum
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Matthew Rutter
- ERS Patient Advocacy Committee
- Dept of Respiratory Physiology, Addenbrooke's Hospital, Cambridge, UK
| | | | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Hélène Schoemans
- Dept of Haematology, University Hospitals Leuven, Leuven, Belgium
- Dept of Public Health and Primary Care, ACCENT VV, KU Leuven - University of Leuven, Leuven, Belgium
| | - Daiana Stolz
- Clinic of Respiratory Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Contributed equally as senior author
| | - Robin Vos
- Dept of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- Contributed equally as senior author
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Cordeiro R, Choi H, Haworth CS, Chalmers JD. The Efficacy and Safety of Inhaled Antibiotics for the Treatment of Bronchiectasis in Adults: Updated Systematic Review and Meta-Analysis. Chest 2024:S0012-3692(24)00139-9. [PMID: 38309462 DOI: 10.1016/j.chest.2024.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/15/2023] [Accepted: 01/21/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Inhaled antibiotics are recommended conditionally by international bronchiectasis guidelines for the treatment of patients with bronchiectasis, but results of individual studies are inconsistent. A previous meta-analysis demonstrated promising results regarding the efficacy and safety of inhaled antibiotics in bronchiectasis. Subsequent publications have supplemented the existing body of evidence further in this area. RESEARCH QUESTION To what extent do inhaled antibiotics demonstrate both efficacy and safety as a treatment option for adults with bronchiectasis?. STUDY DESIGN AND METHODS Systematic review and meta-analysis of randomized controlled trials of inhaled antibiotics in adult patients with bronchiectasis. We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and ClinicalTrials.gov for eligible studies. Studies were included if they enrolled adults with bronchiectasis diagnosed by CT imaging and had a treatment duration of at least 4 weeks. The primary end point was exacerbation frequency, with additional key efficacy end points including severe exacerbations, bacterial load, symptoms, quality of life, and FEV1. Data were pooled through random-effects meta-analysis. RESULTS Twenty studies involving 3,468 patients were included. Inhaled antibiotics were associated with reduced number of patients with exacerbations (risk ratio, 0.85; 95% CI, 0.75-0.96), a slight reduction in exacerbation frequency (rate ratio [RR], 0.78; 95% CI, 0.68-0.91), a probable reduction in the frequency of severe exacerbations (RR, 0.48; 95% CI, 0.31-0.74), and a likely slight increase in time to first exacerbation (hazard ratio, 0.80; 95% CI, 0.68-0.94). Inhaled antibiotics likely lead to a slight increase in the Quality of Life-Bronchiectasis respiratory symptom score (2.51; 95% CI, 0.44-4.31) and may reduce scores on the St. George's Respiratory Questionnaire (-3.13; 95% CI, -5.93 to -0.32). Bacterial load consistently was reduced, but FEV1 was not changed with treatment. Evidence suggests little to no difference in adverse effects between groups (OR, 0.99; 95% CI, 0.75-1.30). Antibiotic-resistant organisms likely were increased by treatment. INTERPRETATION Inhaled antibiotics result in a slight reduction in exacerbations, a probable reduction in severe exacerbations, and a likely slight improvement in symptoms and quality of life in adults with bronchiectasis. TRIAL REGISTRY International Prospective Register of Systematic Reviews; No.: CRD42023384694; URL: https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
- Ricardo Cordeiro
- Department of Pulmonology, Centro Hospitalar do Oeste, Torres Vedras, Portugal
| | - Hayoung Choi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Charles S Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital NHS Foundation Trust, University of Cambridge, Cambridge, England; Department of Medicine, University of Cambridge, Cambridge, England
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland.
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Pandya CD, Vekaria HJ, Zamorano M, Trout AL, Ritzel RM, Guzman GU, Bolden C, Sullivan PG, Gensel JC, Miller BA. Azithromycin reduces hemoglobin-induced innate neuroimmune activation. Exp Neurol 2024; 372:114574. [PMID: 37852468 DOI: 10.1016/j.expneurol.2023.114574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/11/2023] [Accepted: 10/14/2023] [Indexed: 10/20/2023]
Abstract
Neonatal intraventricular hemorrhage (IVH) releases blood products into the lateral ventricles and brain parenchyma. There are currently no medical treatments for IVH and surgery is used to treat a delayed effect of IVH, post-hemorrhagic hydrocephalus. However, surgery is not a cure for intrinsic brain injury from IVH, and is performed in a subacute time frame. Like many neurological diseases and injuries, innate immune activation is implicated in the pathogenesis of IVH. Innate immune activation is a pharmaceutically targetable mechanism to reduce brain injury and post-hemorrhagic hydrocephalus after IVH. Here, we tested the macrolide antibiotic azithromycin, which has immunomodulatory properties, to reduce innate immune activation in an in vitro model of microglial activation using the blood product hemoglobin (Hgb). We then utilized azithromycin in our in vivo model of IVH, using intraventricular blood injection into the lateral ventricle of post-natal day 5 rat pups. In both models, azithromycin modulated innate immune activation by several outcome measures including mitochondrial bioenergetic analysis, cytokine expression and flow cytometric analysis. This suggests that azithromycin, which is safe for neonates, could hold promise for modulating innate immune activation after IVH.
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Affiliation(s)
- Chirayu D Pandya
- Center for Advanced Translational Stroke Science (CATSS), Department of Neurosurgery, University of Kentucky College of Medicine, Lexington, KY 40536, United States of America
| | - Hemendra J Vekaria
- Spinal Cord and Brain Injury Research Center (SCoBIRC), Department of Neuroscience, University of Kentucky College of Medicine, Lexington, KY 40536, United States of America
| | - Miriam Zamorano
- Department of Pediatric Surgery, University of Texas Health Science Center at Houston, 77030, United States of America
| | - Amanda L Trout
- Center for Advanced Translational Stroke Science (CATSS), Department of Neurosurgery, University of Kentucky College of Medicine, Lexington, KY 40536, United States of America
| | - Rodney M Ritzel
- Lexington Veterans' Affairs Healthcare System, Lexington, KY 40502, United States of America
| | - Gary U Guzman
- Lexington Veterans' Affairs Healthcare System, Lexington, KY 40502, United States of America
| | - Christopher Bolden
- Department of Pediatric Surgery, University of Texas Health Science Center at Houston, 77030, United States of America
| | - Patrick G Sullivan
- Spinal Cord and Brain Injury Research Center (SCoBIRC), Department of Neuroscience, University of Kentucky College of Medicine, Lexington, KY 40536, United States of America; Lexington Veterans' Affairs Healthcare System, Lexington, KY 40502, United States of America
| | - John C Gensel
- Spinal Cord and Brain Injury Research Center (SCoBIRC), Department of Physiology, University of Kentucky College of Medicine, Lexington, KY 40536, United States of America
| | - Brandon A Miller
- Department of Pediatric Surgery, University of Texas Health Science Center at Houston, 77030, United States of America.
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Chen W, Ran S, Li C, Li Z, Wei N, Li J, Li N. Elevated Eosinophil Counts in Acute Exacerbations of Bronchiectasis: Unveiling a Distinct Clinical Phenotype. Lung 2024; 202:53-61. [PMID: 38228883 PMCID: PMC10896926 DOI: 10.1007/s00408-023-00668-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/18/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Non-cystic fibrosis bronchiectasis is a chronic respiratory disease characterized by bronchial dilation. However, the significance of elevated eosinophil counts in acute exacerbations of bronchiectasis remains unclear. METHODS This retrospective case-control study included 169 hospitalized patients with acute exacerbations of non-cystic fibrosis bronchiectasis. Based on blood eosinophil levels, patients were categorized into eosinophilic and non-eosinophilic bronchiectasis groups. Various clinical variables, including lung function, comorbidities and clinical features were collected for analysis. The study aimed to examine the differences between these groups and their clinical phenotypes. RESULTS Eosinophilic bronchiectasis (EB) was present in approximately 22% of all hospitalized patients with bronchiectasis, and it was more prevalent among male smokers (P < 0.01). EB exhibited greater severity of bronchiectasis, including worse airway obstruction, higher scores in the E-FACED (FACED combined with exacerbations) and bronchiectasis severity index (BSI), a high glucocorticoids medication possession ratio, and increased hospitalization cost (P < 0.05 or P < 0.01). Furthermore, we observed a significant positive correlation between blood eosinophil count and both sputum eosinophils (r = 0.49, P < 0.01) and serum total immunoglobulin E levels (r = 0.21, P < 0.05). Additional analysis revealed that patients with EB had a higher frequency of shortness of breath (P < 0.05), were more likely to have comorbid sinusitis (P < 0.01), and exhibited a greater number of lung segments affected by bronchiectasis (P < 0.01). CONCLUSIONS These findings suggest that EB presents a distinct pattern of bronchiectasis features, confirming the notion that it is a specific phenotype.
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Affiliation(s)
- Weixin Chen
- Department of Chinese and Western Medicine in Clinical Medicine, The Clinical School of Chinese and Western Medicine of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Siyi Ran
- Department of Chinese and Western Medicine in Clinical Medicine, The Clinical School of Chinese and Western Medicine of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Chenchang Li
- Department of Chinese and Western Medicine in Clinical Medicine, The Clinical School of Chinese and Western Medicine of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Zhixin Li
- Department of Chinese and Western Medicine in Clinical Medicine, The Clinical School of Chinese and Western Medicine of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Nili Wei
- State Key Laboratory of Respiratory Disease, Department of Allergy and Clinical Immunology, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Jing Li
- State Key Laboratory of Respiratory Disease, Department of Allergy and Clinical Immunology, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Naijian Li
- State Key Laboratory of Respiratory Disease, Department of Allergy and Clinical Immunology, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.
- Johns Hopkins Asthma & Allergy Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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7
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Waitayangkoon P, Moon SJ, Tirupur Ponnusamy JJ, Zeng L, Driban J, McAlindon T. Long-Term Safety Profiles of Macrolides and Tetracyclines: A Systematic Review and Meta-Analysis. J Clin Pharmacol 2024; 64:164-177. [PMID: 37751595 DOI: 10.1002/jcph.2358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/17/2023] [Indexed: 09/28/2023]
Abstract
Macrolides and tetracyclines are antibiotics that have a range of anti-inflammatory properties beyond their microbial capabilities. Although these antibiotics have been in widespread use, the long-term safety profiles are limited. We performed a systematic review and meta-analysis of randomized clinical trials that compared macrolides or tetracyclines with placeboes to provide long-term safety information. We searched Medline and EMBASE from inception to October 2022 and identified studies that reported study drug-related death, serious adverse events (SAEs), or withdrawal rates, and common adverse effects of each drug. Relative risk (RR) and number needed to harm were calculated. Of the 52 randomized clinical trials included, there are 3151 participants on doxycycline, 2519 participants on minocycline, 3049 participants on azithromycin, 763 participants on clarithromycin, 262 participants on erythromycin, and 100 participants on roxithromycin. There was no death related to any study drugs and rates of SAE were not significantly different from placebo in any drug. Overall withdrawal rates were slightly higher than placebo in doxycycline (RR, 1.30; 95% CI, 1.12-1.52) and minocycline (RR, 1.29; 95% CI, 1.15-1.46). Withdrawal rates due to adverse events were higher in doxycycline (RR, 2.82; 95% CI, 1.88-4.22), minocycline (RR, 1.48; 95% CI, 1.09-1.98), and azithromycin (RR, 1.53; 95% CI, 1.13-2.08). Gastrointestinal disturbances are the most common tolerable adverse effects for every drug. Photosensitivity and rash are the second most common adverse effects for doxycycline and minocycline. We found no evidence that long-term use up to 2 years of macrolides or tetracyclines was associated with increased risk of SAEs.
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Affiliation(s)
- Palapun Waitayangkoon
- Department of Medicine, MetroWest Medical Center, Tufts University School of Medicine, Framingham, MA, USA
| | - Soo Jin Moon
- Department of Medicine, MetroWest Medical Center, Tufts University School of Medicine, Framingham, MA, USA
| | | | - Li Zeng
- Department of Immunology, Tufts University School of Medicine, Boston, MA, USA
| | - Jeffrey Driban
- Division of Rheumatology, Allergy & Immunology, Tufts Medical Center, Boston, MA, USA
| | - Timothy McAlindon
- Division of Rheumatology, Allergy & Immunology, Tufts Medical Center, Boston, MA, USA
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8
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Conceição M, Shteinberg M, Goeminne P, Altenburg J, Chalmers JD. Eradication treatment for Pseudomonas aeruginosa infection in adults with bronchiectasis: a systematic review and meta-analysis. Eur Respir Rev 2024; 33:230178. [PMID: 38296344 PMCID: PMC10828832 DOI: 10.1183/16000617.0178-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/24/2023] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Pseudomonas aeruginosa is the most commonly isolated pathogen in bronchiectasis and is associated with worse outcomes. Eradication treatment is recommended by guidelines, but the evidence base is limited. The expected success rate of eradication in clinical practice is not known. METHODS We conducted a systematic review and meta-analysis according to Meta-Analysis of Observational Studies in Epidemiology guidelines. PubMed, Embase, the Cochrane Database of Systematic Reviews and Clinicaltrials.gov were searched for studies investigating P. aeruginosa eradication treatment using antibiotics (systemic or inhaled) in patients with bronchiectasis. The primary outcome was the percentage of patients negative for P. aeruginosa at 12 months after eradication treatment. Cystic fibrosis was excluded. RESULTS Six observational studies including 289 patients were included in the meta-analysis. Our meta-analysis found a 12-month P. aeruginosa eradication rate of 40% (95% CI 34-45%; p<0.00001), with no significant heterogeneity (I2=0%). Combined systemic and inhaled antibiotic treatment was associated with a higher eradication rate (48%, 95% CI 41-55%) than systemic antibiotics alone (27%, 13-45%). CONCLUSION Eradication treatment in bronchiectasis results in eradication of P. aeruginosa from sputum in ∼40% of cases at 12 months. Combined systemic and inhaled antibiotics achieve higher eradication rates than systemic antibiotics alone.
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Affiliation(s)
- Mariana Conceição
- Pulmonology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Michal Shteinberg
- Pulmonology Institute and CF Center, Carmel Medical Center, Haifa, Israel
| | - Pieter Goeminne
- Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Josje Altenburg
- Department of Respiratory Disease, AZ Nikolaas, Sint-Niklaas, Belgium
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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9
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Li R, Li J, Zhou X. Lung microbiome: new insights into the pathogenesis of respiratory diseases. Signal Transduct Target Ther 2024; 9:19. [PMID: 38228603 DOI: 10.1038/s41392-023-01722-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/25/2023] [Accepted: 11/22/2023] [Indexed: 01/18/2024] Open
Abstract
The lungs were long thought to be sterile until technical advances uncovered the presence of the lung microbial community. The microbiome of healthy lungs is mainly derived from the upper respiratory tract (URT) microbiome but also has its own characteristic flora. The selection mechanisms in the lung, including clearance by coughing, pulmonary macrophages, the oscillation of respiratory cilia, and bacterial inhibition by alveolar surfactant, keep the microbiome transient and mobile, which is different from the microbiome in other organs. The pulmonary bacteriome has been intensively studied recently, but relatively little research has focused on the mycobiome and virome. This up-to-date review retrospectively summarizes the lung microbiome's history, composition, and function. We focus on the interaction of the lung microbiome with the oropharynx and gut microbiome and emphasize the role it plays in the innate and adaptive immune responses. More importantly, we focus on multiple respiratory diseases, including asthma, chronic obstructive pulmonary disease (COPD), fibrosis, bronchiectasis, and pneumonia. The impact of the lung microbiome on coronavirus disease 2019 (COVID-19) and lung cancer has also been comprehensively studied. Furthermore, by summarizing the therapeutic potential of the lung microbiome in lung diseases and examining the shortcomings of the field, we propose an outlook of the direction of lung microbiome research.
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Affiliation(s)
- Ruomeng Li
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Jing Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China.
| | - Xikun Zhou
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.
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10
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Remiker A, Bolling K, Verbsky J. Common Variable Immunodeficiency. Med Clin North Am 2024; 108:107-121. [PMID: 37951645 DOI: 10.1016/j.mcna.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Common variable immunodeficiency (CVID) is the most common primary immune deficiency characterized by impaired production of specific immunoglobulin. The clinical manifestations are heterogeneous including acquisition of recurrent bacterial infections after a period of wellness, lymphoproliferation, autoimmunity, pulmonary disease, liver disease, enteropathy, granulomas, and an increased risk of malignancy. The etiology of CVID is largely unknown, with a considerable number of patients having an underlying genetic defect causing immune dysregulation. The antibody deficiency found in CVID is treated with lifelong immunoglobulin therapy, which is preventative of the majority of infections when given regularly.
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Affiliation(s)
- Allison Remiker
- Division of Hematology/Oncology/Blood and Marrow Transplantation, Department of Pediatrics, Medical College of Wisconsin, and Children's Wisconsin, Milwaukee, WI, USA.
| | - Kristina Bolling
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Medical College of Wisconsin, and Children's Wisconsin, Milwaukee, WI, USA
| | - James Verbsky
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Medical College of Wisconsin, and Children's Wisconsin, Milwaukee, WI, USA; Division of Rheumatology, Department of Pediatrics, Medical College of Wisconsin, and Children's Wisconsin, Milwaukee, WI, USA
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11
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Sawka A, Burke A. Medications and Monitoring in Treatment of Nontuberculous Mycobacterial Pulmonary Disease. Clin Chest Med 2023; 44:815-828. [PMID: 37890918 DOI: 10.1016/j.ccm.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
In the treatment of nontuberculous mycobacteria (NTM) lung disease, clinicians must consider potential toxicities that may occur as a result of prolonged exposure to a multidrug antibiotic regimen. Frequent clinical and microbiological monitoring is required to assess response and guide treatment duration. This article summarizes toxicity profiles of the antibiotics that are most frequently prescribed for the treatment of NTM lung disease. The role of therapeutic drug monitoring during use of amikacin and linezolid is discussed. The available evidence to guide frequency and extent of medication monitoring during NTM treatment is provided.
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Affiliation(s)
- Alice Sawka
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Andrew Burke
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia.
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12
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McShane PJ. Investigation and Management of Bronchiectasis in Nontuberculous Mycobacterial Pulmonary Disease. Clin Chest Med 2023; 44:731-742. [PMID: 37890912 DOI: 10.1016/j.ccm.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
Patients with nontuberculous mycobacterial (NTM) lung infection require life-long attention to their bronchiectasis, whether or not their NTM infection has been cured. The identification of the cause of bronchiectasis and/or coexisting diseases is important because it may affect therapeutic strategies. Airway clearance is the mainstay of bronchiectasis management. It can include multiple breathing techniques, devices, and mucoactive agents. The exact airway clearance regimen should be customized to each individual patient. Chronic pathogenic airway bacteria, such as Pseudomonas aeruginosa, may warrant consideration of eradication therapy and/or chronic use of maintenance inhaled antibiotics.
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Affiliation(s)
- Pamela J McShane
- Department of Medicine, University of Texas Health Science Center at Tyler, 11937 Hwy 271, Tyler, TX 75708, USA.
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13
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Niyitanga T, Khan MQ, Ahmad K, Khan RA. Fabrication of an Azithromycin Sensor. BIOSENSORS 2023; 13:986. [PMID: 37998161 PMCID: PMC10669414 DOI: 10.3390/bios13110986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Abstract
Azithromycin (AZY) is a well-known top-prioritized antibiotic and is used by humans in strong concentrations. However, the side effects of the AZY antibiotic may cause some serious and significant damage to humans and the environment. Thus, there is a need to develop effective and sensitive sensors to monitor accurate concentrations of AZY. In the last decade, electrochemistry-based sensors have received enormous attention from the scientific community because of their high sensitivity, selectivity, cost-effectiveness, fast response, rapid detection response, simple fabrication, and working principle. It is important to mention that electrochemical sensors rely on the properties of electrode modifiers. Hence, the selection of electrode materials is of great significance when designing and developing efficient and robust electrochemical sensors. In this study, we fabricated an AZY sensor by utilizing a molybdenum disulfide/titanium aluminum carbide (MoS2@Ti3AlC2) composite as the electrode material. The MoS2@Ti3AlC2 composite was synthesized via a simple sonication process. The synthesized MoS2@Ti3AlC2 composite was characterized using a powder X-ray diffraction (XRD) method to examine the phase purity and formation of the MoS2@Ti3AlC2 composite. Scanning electron microscopy (SEM) was used to study the surface morphological features of the prepared MoS2@Ti3AlC2 composite, whereas energy dispersive X-ray spectroscopy (EDAX) was adopted to determine the elemental composition of the prepared MoS2@Ti3AlC2 composite. The glassy carbon (GC) electrode was modified with the prepared MoS2@Ti3AlC2 composite and applied as the AZY sensor. The sensing performance of the MoS2@Ti3AlC2 composite-modified GC electrode was studied using linear sweep voltammetry. The sensor demonstrated excellent performance when determining AZY and showed a good detection limit of 0.009 µM with a sensitivity of 6.77 µA/µM.cm2.
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Affiliation(s)
- Theophile Niyitanga
- School of Materials Science and Engineering, Yeungnam University, Gyeongsan 38541, Republic of Korea;
| | - Mohd Quasim Khan
- Department of Chemistry, M.M.D.C, Moradabad, M.J.P. Rohilkhand University, Bareilly 244001, UP, India
| | - Khursheed Ahmad
- School of Materials Science and Engineering, Yeungnam University, Gyeongsan 38541, Republic of Korea;
| | - Rais Ahmad Khan
- Department of Chemistry, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
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14
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Barbosa M, Chalmers JD. Bronchiectasis. Presse Med 2023; 52:104174. [PMID: 37778637 DOI: 10.1016/j.lpm.2023.104174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/03/2023] Open
Abstract
Bronchiectasis is a final common pathway of a wide variety of underlying conditions including infectious, autoimmune, allergic, genetic and inflammatory conditions. Patients experience a chronic disease with variable clinical symptoms and course, but most experience cough, sputum production and recurrent exacerbations. Symptoms of bronchiectasis lead to poor quality of life and exacerbations are the major driver of morbidity and mortality. Patients are often chronically infected with bacteria with the most common being Pseudomonas aeruginosa and Haemophilus influenzae. Treatment of bronchiectasis includes standardised testing to identify the underlying cause with targeted treatment if immune deficiency, allergic bronchopulmonary aspergillosis or non-tuberculous mycobacterial infection, for example, are identified. Airway clearance is the mainstay of therapy for patients with symptoms of cough and sputum production. Frequently exacerbating patients may benefit from long term antibiotic or mucoactive therapies. Bronchiectasis is a heterogeneous disease and increasingly precision medicine approaches are advocated to target treatments most appropriately and to limit the emergence of antimicrobial resistance.
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Affiliation(s)
- Miguel Barbosa
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
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15
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Saito Z, Yoshida M, Uchiyama S, Nishioka S, Tamura K, Tamura N. Usefulness of High-resolution Computed Tomography for Macrolide Therapy of Idiopathic Bronchiectasis. Open Respir Med J 2023; 17:e187430642307250. [PMID: 37916133 PMCID: PMC10507212 DOI: 10.2174/18743064-v17-230822-2022-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/11/2023] [Accepted: 06/12/2023] [Indexed: 11/03/2023] Open
Abstract
Background High-resolution computed tomography (HRCT) correlates with clinical symptoms, respiratory function, and quality of life in bronchiectasis. Objective We aimed to investigate the relationship between macrolide and acute exacerbation (AE) in idiopathic bronchiectasis classified by the Bronchiectasis Radiologically Indexed CT Score (BRICS). Methods We retrospectively reviewed the medical records of patients diagnosed with idiopathic bronchiectasis between April 2014 and December 2020 at a single hospital. Overall, 115 patients with idiopathic bronchiectasis were selected and divided into three groups, according to the BRICS. Each group was divided into subgroups with and without macrolide therapy, and the number of patients with AE in each group was retrospectively compared. Results About 45, 48, and 22 patients were included in the mild, moderate, and severe groups, respectively. In the mild group, the subgroup with macrolide therapy had significantly fewer patients with single AE than those without macrolide ( P = 0.029). There was no significant difference in the moderate and severe groups ( P = 1.00 and 0.64, respectively). In the multiple AE, the subgroup with macrolide therapy had significantly fewer patients than those without macrolide therapy in the mild, moderate, and severe groups ( P = 0.024, 0.029, and 0.026, respectively). Conclusion HRCT severity assessment might be useful in predicting treatment efficacy in patients with idiopathic bronchiectasis without previous AEs. Further large-scale clinical trials are required on the usefulness of HRCT in the future.
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Affiliation(s)
- Zenya Saito
- Division of Respiratory Diseases, Department of Internal Medicine,
Atsugi City Hospital,
Kanagawa,
Japan
| | - Masahiro Yoshida
- Division of Respiratory Diseases, Department of Internal Medicine,
Atsugi City Hospital,
Kanagawa,
Japan
| | - Shota Uchiyama
- Division of Respiratory Diseases, Department of Internal Medicine,
Atsugi City Hospital,
Kanagawa,
Japan
| | - Saiko Nishioka
- Division of Respiratory Diseases, Department of Internal Medicine,
Atsugi City Hospital,
Kanagawa,
Japan
| | - Kentaro Tamura
- Division of Respiratory Diseases, Department of Internal Medicine,
Atsugi City Hospital,
Kanagawa,
Japan
| | - Nobumasa Tamura
- Division of Respiratory Diseases, Department of Internal Medicine,
Atsugi City Hospital,
Kanagawa,
Japan
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16
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Goolam Mahomed A, Maasdorp SD, Barnes R, van Aswegen H, Lupton-Smith A, Allwood B, Calligaro G, Feldman C, Kalla IS. South African Thoracic Society position statement on the management of non-cystic fibrosis bronchiectasis in adults: 2023. Afr J Thorac Crit Care Med 2023; 29:10.7196/AJTCCM.2023.v29i2.647. [PMID: 37638142 PMCID: PMC10450449 DOI: 10.7196/ajtccm.2023.v29i2.647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/10/2023] [Indexed: 08/29/2023] Open
Abstract
Background Bronchiectasis is a chronic lung disorder that affects the lives of many South Africans. Post-tuberculosis (TB) bronchiectasis is an important complication of previous pulmonary TB and a common cause of bronchiectasis in South Africa (SA). No previous statements on the management of bronchiectasis in SA have been published. Objectives To provide a position statement that will act as a template for the management of adult patients with bronchiectasis in SA. Methods The South African Thoracic Society appointed an editorial committee to compile a position statement on the management of adult non-cystic fibrosis (CF) bronchiectasis in SA. Results A position statement addressing the management of non-CF bronchiectasis in adults in SA was compiled. This position statement covers the epidemiology, aetiology, diagnosis, investigations and various aspects of management of adult patients with non-CF bronchiectasis in SA. Conclusion Bronchiectasis has largely been a neglected lung condition, but new research has improved the outlook for patients. Collaboration between interprofessional team members in patient management is important. In SA, more research into the epidemiology of bronchiectasis, especially post-TB bronchiectasis and HIV-associated bronchiectasis, is required. Abstract The South African Thoracic Society mandated a multidisciplinary team of healthcare providers to compile a position statement on the management of non-cystic fibrosis bronchiectasis in South Africa (SA). International guidelines on the management of bronchiectasis were reviewed and used as a basis from which the current position statement was compiled. This is the first position statement on the management of adult non-cystic fibrosis bronchiectasis in SA. A description of the epidemiology and aetiology of bronchiectasis is provided, as well as guidance on its diagnosis and management. The position statement provides guidance on the management of bronchiectasis to healthcare providers, policymakers and regulatory authorities.
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Affiliation(s)
| | - S D Maasdorp
- Division of Pulmonology and Critical Care, Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein,
South Africa
| | - R Barnes
- Department of Physiotherapy, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - H van Aswegen
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - A Lupton-Smith
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - B Allwood
- Division of Pulmonology, Department of Internal Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - G Calligaro
- Division of Pulmonology, Department of Internal Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - C Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - I S Kalla
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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17
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Zhang XX, Chen ZM, He ZF, Guan WJ. Advances in pharmacotherapy for bronchiectasis in adults. Expert Opin Pharmacother 2023; 24:1075-1089. [PMID: 37161410 DOI: 10.1080/14656566.2023.2210763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Bronchiectasis has become a growing concern of chronic airway disease because of the enormous socioeconomic burden. Four cardinal interdependent components - impaired airway defense, recurrent airway infections, inflammatory response, and airway damage, in conjunction with the underlying etiology, have collectively played a role in modulating the vicious vortex of the pathogenesis and progression of bronchiectasis. Current pharmacotherapy aims to target at these aspects to break the vicious vortex. AREAS COVERED The authors retrieve and review, in MEDLINE, Web of Science and ClinicalTrials.gov registry, the studies about pharmacotherapy for bronchiectasis from these aspects: antibiotics, mucoactive medications, bronchodilators, anti-inflammatory drug, and etiological treatment. EXPERT OPINION Future drug development and clinical trials of bronchiectasis need to pay more attention to the different phenotypes or endotypes of bronchiectasis. There is a need for the development of novel inhaled antibiotics that could reduce bacterial loads, improve quality-of-life, and decrease exacerbation risks. More efforts are needed to explore the next-generation neutrophil-targeted therapeutic drugs that are expected to ameliorate respiratory symptom burden, reduce exacerbation risks, and hinder airway destruction in bronchiectasis.
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Affiliation(s)
- Xiao-Xian Zhang
- Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhao-Ming Chen
- Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhen-Feng He
- Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei-Jie Guan
- Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Thoracic Surgery, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
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18
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Terpstra LC, Altenburg J, Doodeman HJ, Piñeros YSS, Lutter R, Heijerman HGM, Boersma WG. The effect of azithromycin on sputum inflammatory markers in bronchiectasis. BMC Pulm Med 2023; 23:151. [PMID: 37118704 PMCID: PMC10148509 DOI: 10.1186/s12890-023-02444-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/18/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Long term macrolide treatment has been found beneficial in bronchiectasis (BE) -pathogical bronchial dilatation- possibly due to a combined anti-bacterial and immunomodulatory effect. The exact mechanism of inflammatory response is unknown. Here, we investigated the effect of maintenance macrolide treatment on the inflammatory response in BE. In addition, we assessed the inflammatory profile in BE in relation to disease severity. METHODS During the BAT randomized controlled trial (investigating the effect of 1 year of azithromycin (AZM) in 83 BE patients), data on BE severity, lung function and sputum microbiology was collected. For the current study, a wide range of inflammatory markers were analysed in 3- monthly sputum samples in all participants. RESULTS At baseline, marked neutrophilic but also eosinophilic inflammation was present in both groups, which remained stable throughout the study and was not affected by AZM treatment. Significant upregulation of pro-inflammatory markers correlated with FEV1 < 50% (TNFα, ECP, IL-21, IL-1, p = 0.01- 0.05), H. influenzae (HI) colonization (MPO, ECP, MIP-1, TNFα, IL-21, Il-8, IL-1, IL-1α, p < 0.001 - 0.04) and number of exacerbations (MPO, ECP, VEGF, MMP-9, p = 0.003 - 0.01). Surprisingly, colonization with P. aeruginosa (PA) was found to correlate with an attenuated inflammatory response compared to non-PA colonized. In placebo-treated patients, presence of an infectious exacerbation was reflected by a significant excessive increase in inflammation as compared to a non-significant upregulation in the AZM-treated patients. CONCLUSION One year of AZM treatment did not result in attenuation of the inflammatory response in BE. Increasing disease severity and the presence of an exacerbation were reflected by upregulation of pro-inflammatory markers.
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Affiliation(s)
- L C Terpstra
- Department of Pulmonary Diseases, Northwest Clinics, Wilhelminalaan 12, 1812 JD, Alkmaar, The Netherlands.
| | - J Altenburg
- Department of Pulmonary Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - H J Doodeman
- Department of Northwest Academy, Northwest Clinics, Alkmaar, The Netherlands
| | - Y S Sabogal Piñeros
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - R Lutter
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - H G M Heijerman
- Department of Pulmonary Diseases, University Medical Centre Utrecht and Utrecht University, Utrecht, The Netherlands
| | - W G Boersma
- Department of Pulmonary Diseases, Northwest Clinics, Wilhelminalaan 12, 1812 JD, Alkmaar, The Netherlands
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19
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Mesfin N, Sangani R, Shankar DA, Reardon C. New Frontiers in Therapeutics for Interstitial Lung Diseases. Am J Respir Crit Care Med 2023; 207:1089-1091. [PMID: 36735934 PMCID: PMC10112432 DOI: 10.1164/rccm.202206-1035rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 02/03/2023] [Indexed: 02/05/2023] Open
Affiliation(s)
- Nathan Mesfin
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Ruchika Sangani
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Divya A Shankar
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Christine Reardon
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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20
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Lutz C, Feiten S, Chakupurakal G, Heymanns J, Thomalla J, van Roye C, Weide R. Patients with indolent lymphomas are at high risk of infections: experience from a German outpatient clinic. BMC Immunol 2023; 24:2. [PMID: 36631764 PMCID: PMC9833869 DOI: 10.1186/s12865-022-00536-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 12/23/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Patients with indolent B-cell non-Hodgkin lymphomas (B-NHLs) have an increased risk of infections which is caused by pathomechanisms of the diseases itself but also as a result of anti-tumor therapy. Especially the effects of anti-CD20 antibodies are well understood as these lead to decreased antibody production. Most studies regarding immunodeficiency in B-NHLs were conducted with multiple myeloma and chronic lymphocytic leukemia patients. As these studies not always represent the general population we collected and analyzed real world data from patients with indolent lymphomas and a control group (CG). RESULTS Patients with B-NHLs undergoing therapy or who were regularly monitored in a watch and wait approach had, over the time of one year, an increased rate of infections compared to the CG of 145 healthy volunteers (mean: 11.66 vs. 7.13 infections per 1000 days). Consistent with this finding B-NHL patients received more antibiotic treatment (mean: 11.17 vs. 6.27 days) and were more often hospitalized than persons from the CG (mean: 5.19 vs. 0.99 days per 1000 days). Lymphoma patients without immunodeficiency had a lower infection rate than patients with non-symptomatic and symptomatic immunodeficiency (mean: 10.91 vs. 12.07 and 12.36 per 1000 days). The number of infections differed statistically significant for the subgroups and CG (7.13 per 1000 days). Patients with symptomatic immunodeficiency were mostly treated with regular immunoglobulin substitutions and infection rates were comparable to those of patients with asymptomatic immunodeficiency. CONCLUSIONS Our data suggest the use of an approach with regular immune monitoring including the measurement of immunoglobulin levels and regular appointments for clinical assessment of all indolent lymphoma patients in order to identify patients with increased risk of infections. It also raises the question if patients with immunodeficiency should be treated more often with regular immunoglobulin substitution, but so far more studies are necessary to answer this question.
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Affiliation(s)
- Christoph Lutz
- Praxis für Hämatologie und Onkologie Koblenz, Neversstr. 5, 56068, Koblenz, Germany.
| | - Stefan Feiten
- grid.488965.eInstitut für Versorgungsforschung in der Onkologie, Koblenz, Germany
| | - Geothy Chakupurakal
- grid.477753.50000 0004 0560 2414Praxis für Hämatologie und Onkologie Koblenz, Neversstr. 5, 56068 Koblenz, Germany
| | - Jochen Heymanns
- grid.477753.50000 0004 0560 2414Praxis für Hämatologie und Onkologie Koblenz, Neversstr. 5, 56068 Koblenz, Germany
| | - Jörg Thomalla
- grid.477753.50000 0004 0560 2414Praxis für Hämatologie und Onkologie Koblenz, Neversstr. 5, 56068 Koblenz, Germany
| | - Christoph van Roye
- grid.477753.50000 0004 0560 2414Praxis für Hämatologie und Onkologie Koblenz, Neversstr. 5, 56068 Koblenz, Germany
| | - Rudolf Weide
- grid.477753.50000 0004 0560 2414Praxis für Hämatologie und Onkologie Koblenz, Neversstr. 5, 56068 Koblenz, Germany
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21
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Vicendese D, Yerkovich S, Grimwood K, Valery PC, Byrnes CA, Morris PS, Dharmage SC, Chang AB. Long-term Azithromycin in Children With Bronchiectasis Unrelated to Cystic Fibrosis: Treatment Effects Over Time. Chest 2023; 163:52-63. [PMID: 36030839 DOI: 10.1016/j.chest.2022.08.2216] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/11/2022] [Accepted: 08/12/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Following evidence from randomized controlled trials, patients with bronchiectasis unrelated to cystic fibrosis receive long-term azithromycin to reduce acute respiratory exacerbations. However, the period when azithromycin is effective and which patients are likely to most benefit remain unknown. RESEARCH QUESTIONS (i) What is the period after its commencement when azithromycin is most effective? and (ii) Which factors may modify azithromycin effects? STUDY DESIGN AND METHODS A secondary analysis was conducted of our previous randomized controlled trial involving 89 indigenous children with bronchiectasis unrelated to cystic fibrosis. Semi-parametric Poisson regression identified the azithromycin efficacy period. Multivariable Poisson regression identified factors that modify azithromycin effect. RESULTS Azithromycin was associated with fewer exacerbations per child-week during weeks 4 through 96, with the most effective period observed between weeks 17 and 62. Eleven factors were associated with different azithromycin effects; four were significant at the P < .05 level. Compared with their counterparts, higher reduction in exacerbations was observed in children with nasopharyngeal carriage of bacterial pathogens (incidence rate ratio [IRR] = 0.81 [95% CI, 0.57-1.14] vs 0.29 [0.20-0.44]; P < .001); New Zealand children (IRR = 0.73 [0.51-1.03] vs 0.39 [0.28-0.55]; P = .012); and those with higher weight-for-height z scores (interaction IRR = 0.82 [0.67-0.99]; P = .044). Compared with their counterparts, lower reduction was observed in those born preterm (IRR = 0.41 [0.30-0.55] vs 0.74 [0.49-1.10]; P = .012). INTERPRETATION Regular azithromycin is best used for at least 17 weeks and up to 62 weeks, as these periods provide maximum benefit for indigenous children with bronchiectasis unrelated to cystic fibrosis. Several factors modified azithromycin benefits; however, these traits need confirmation in larger studies before being adopted into clinical practice. CLINICAL TRIALS REGISTRATION Australian New Zealand Clinical Trials Registry; ACTRN12610000383066.
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Affiliation(s)
- Don Vicendese
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; School of Engineering and Mathematical Sciences, La Trobe University, Bundoora, VIC, Australia.
| | - Stephanie Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Child Health Division, Menzies School of Health Research, Darwin, NT, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Keith Grimwood
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia; School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia; Departments of Infectious Diseases, and Paediatrics, Gold Coast Health, Gold Coast, QLD, Australia
| | - Patricia C Valery
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Catherine A Byrnes
- Department of Paediatrics, University of Auckland, Auckland, New Zealand; Paediatric Respiratory Medicine, Starship Children's Health & Kidz First Hospital, Auckland, New Zealand
| | - Peter S Morris
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia; Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Paediatrics, Royal Darwin Hospital, Darwin, NT, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Child Health Division, Menzies School of Health Research, Darwin, NT, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
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22
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Hanitsch LG. Bronchiectasis and obstructive lung diseases in primary antibody deficiencies and beyond: update on management and pathomechanisms. Curr Opin Allergy Clin Immunol 2022; 22:335-342. [PMID: 36165423 DOI: 10.1097/aci.0000000000000856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Pulmonary complications are among the most frequent manifestations in patients with primary antibody deficiency (PAD), contributing significantly to morbidity and mortality. Here, we focus on recent findings in obstructive pulmonary disease and bronchiectasis in PAD. Since specific data on patients with PAD is limited and management mostly follows general recommendations, this review also aims to summarize data from the immunocompetent population. RECENT FINDINGS Potential risk factors for the development and progression of bronchiectasis include reduced immunoglobulins and lower CD4 cells. In addition, Pseudomonas aeruginosa and an altered microbiome might contribute to local inflammation and disease progression. Findings on the contribution of neutrophils and eosinophils in the affected immunocompetent population require confirmation in PAD. Despite its high global burden, there is an extreme paucity of data on chronic obstructive pulmonary disease in PAD. Lower IgA and IgM are associated with asthma in PAD, but the heterogeneity of prevalence among PAD groups is poorly understood. Recent observations of non-IgE-mediated pathomechanisms in asthma may be of particular interest in PAD patients. SUMMARY Management of PAD patients with chronic lung disease requires a multidisciplinary team approach including immunology, pulmonology, infectious disease and physiotherapy. Diagnostic processes should be harmonized to ensure a more precise perspective on prevalence and disease courses.
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Affiliation(s)
- Leif G Hanitsch
- Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin.,Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Center for Regenerative Therapies, Berlin, Germany
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23
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Franz T, Negele J, Bruno P, Böttcher M, Mitchell-Flack M, Reemts L, Krone A, Mougiakakos D, Müller AJ, Zautner AE, Kahlfuss S. Pleiotropic effects of antibiotics on T cell metabolism and T cell-mediated immunity. Front Microbiol 2022; 13:975436. [DOI: 10.3389/fmicb.2022.975436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022] Open
Abstract
T cells orchestrate adaptive and innate immune responses against pathogens and transformed cells. However, T cells are also the main adaptive effector cells that mediate allergic and autoimmune reactions. Within the last few years, it has become abundantly clear that activation, differentiation, effector function, and environmental adaptation of T cells is closely linked to their energy metabolism. Beyond the provision of energy equivalents, metabolic pathways in T cells generate building blocks required for clonal expansion. Furthermore, metabolic intermediates directly serve as a source for epigenetic gene regulation by histone and DNA modification mechanisms. To date, several antibiotics were demonstrated to modulate the metabolism of T cells especially by altering mitochondrial function. Here, we set out to systematically review current evidence about how beta-lactam antibiotics, macrolides, fluoroquinolones, tetracyclines, oxazolidinones, nitroimidazoles, and amphenicols alter the metabolism and effector functions of CD4+ T helper cell populations and CD8+ T cells in vitro and in vivo. Based on this evidence, we have developed an overview on how the use of these antibiotics may be beneficial or detrimental in T cell-mediated physiological and pathogenic immune responses, such as allergic and autoimmune diseases, by altering the metabolism of different T cell populations.
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24
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Li K, Liu L, Ou Y. The efficacy of azithromycin to prevent exacerbation of non-cystic fibrosis bronchiectasis: a meta-analysis of randomized controlled studies. J Cardiothorac Surg 2022; 17:266. [PMID: 36221151 PMCID: PMC9555173 DOI: 10.1186/s13019-022-01882-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 06/28/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction The efficacy of azithromycin to prevent exacerbation for non-cystic fibrosis bronchiectasis remains controversial. We conduct this meta-analysis to explore the influence of azithromycin versus placebo for the treatment of non-cystic fibrosis bronchiectasis. Methods We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through July 2019 for randomized controlled trials (RCTs) assessing the efficacy of azithromycin versus placebo for non-cystic fibrosis bronchiectasis. This meta-analysis was performed using the random-effect model. Results Four RCTs were included in the meta-analysis. Overall, compared with control group for non-cystic-fibrosis bronchiectasis, azithromycin treatment was associated with improved free of exacerbation (odd ratios [OR] = 3.66; 95% confidence interval [CI] = 1.69–7.93; P = 0.001), reduced pulmonary exacerbations (OR = 0.27; 95% CI 0.13–0.59; P = 0.001) and number of pulmonary exacerbations (standard mean difference [SMD] = − 0.87; 95% CI − 1.21 to − 0.54; P < 0.00001), but demonstrate no obvious impact on forced expiratory volume in 1 s (FEV1), score on St George’s respiratory questionnaire, nausea or vomiting, adverse events. Conclusions Azithromycin is effective to prevent exacerbation of non-cystic fibrosis bronchiectasis.
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Affiliation(s)
- Kui Li
- Department of Respiratory and Critical Care Medicine, Chongqing Bishan District People's Hospital, 57 Canghou Lane, Bishan, Chongqing, 400000, China.
| | - Li Liu
- Department of Respiratory and Critical Care Medicine, Chongqing Bishan District People's Hospital, 57 Canghou Lane, Bishan, Chongqing, 400000, China
| | - Yan Ou
- Department of Respiratory and Critical Care Medicine, Chongqing Bishan District People's Hospital, 57 Canghou Lane, Bishan, Chongqing, 400000, China
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25
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Brown MA, Jabeen M, Bharj G, Hinks TSC. Non-typeable Haemophilus influenzae airways infection: the next treatable trait in asthma? Eur Respir Rev 2022; 31:220008. [PMID: 36130784 PMCID: PMC9724834 DOI: 10.1183/16000617.0008-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/04/2022] [Indexed: 11/05/2022] Open
Abstract
Asthma is a complex, heterogeneous condition that affects over 350 million people globally. It is characterised by bronchial hyperreactivity and airways inflammation. A subset display marked airway neutrophilia, associated with worse lung function, higher morbidity and poor response to treatment. In these individuals, recent metagenomic studies have identified persistent bacterial infection, particularly with non-encapsulated strains of the Gram-negative bacterium Haemophilus influenzae. Here we review knowledge of non-typeable H. influenzae (NTHi) in the microbiology of asthma, the immune consequences of mucosal NTHi infection, various immune evasion mechanisms, and the clinical implications of NTHi infection for phenotyping and targeted therapies in neutrophilic asthma. Airway neutrophilia is associated with production of neutrophil chemokines and proinflammatory cytokines in the airways, including interleukin (IL)-1β, IL-6, IL-8, IL-12, IL-17A and tumour necrosis factor. NTHi adheres to and invades the lower respiratory tract epithelium, inducing the NLR family pyrin domain containing 3 (NLRP3) and absent in melanoma 2 (AIM2) inflammasomes. NTHi reduces expression of tight-junction proteins, impairing epithelial integrity, and can persist intracellularly. NTHi interacts with rhinoviruses synergistically via upregulation of intracellular cell adhesion molecule 1 and promotion of a neutrophilic environment, to which NTHi is adapted. We highlight the clinical relevance of this emerging pathogen and its relevance for the efficacy of long-term macrolide therapy in airways diseases, we identify important unanswered questions and we propose future directions for research.
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Affiliation(s)
- Mary Ashley Brown
- Respiratory Medicine Unit and National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Experimental Medicine Division, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Maisha Jabeen
- Respiratory Medicine Unit and National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Experimental Medicine Division, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Gurpreet Bharj
- Respiratory Medicine Unit and National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Experimental Medicine Division, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
- Mammalian Genetics Unit, MRC Harwell Institute, Oxford, UK
| | - Timothy S C Hinks
- Respiratory Medicine Unit and National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Experimental Medicine Division, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
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26
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Volpato M, Vialaret J, Hirtz C, Petit A, Suehs C, Patarin J, Matzner-Lober E, Vachier I, Molinari N, Bourdin A, Charriot J. Rheology predicts sputum eosinophilia in patients with muco-obstructive lung diseases. Biochem Biophys Res Commun 2022; 622:64-71. [PMID: 35843096 DOI: 10.1016/j.bbrc.2022.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/07/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Mucus is known to play a pathogenic role in muco-obstructive lung diseases, but little is known about the determinants of mucus rheology. The purpose of this study is to determine which sputum components influence sputum rheology in patients with muco-obstructive lung diseases. METHODS We performed a cross sectional prospective cohort study. Spontaneous sputum was collected from consecutive patients with muco-obstructive lung diseases. Sputum rheology was assessed using the Rheomuco® rheometer (Rheonova, Grenoble); the elastic modulus G', viscous modulus G″, and the critical stress threshold σc were recorded. Key quantitative and qualitative biological sputum components were determined by cytology, nucleic acid amplification tests and mass spectrometry. RESULTS 48 patients were included from January to August 2019. Among them, 10 had asthma, 14 COPD and 24 non-CF bronchiectasis (NCFB). The critical stress threshold σc predicted a sputum eosinophilia superior to 1.25% with 89.19% accuracy (AUC = 0.8762). G' and G″ are positively correlated with MUC5AC protein concentration ((rho = 0.361; P = .013) and (rho = 0.335; P = .021), respectively). σc was positively correlated with sputum eosinophilia (rho = 0.394; P = .012), MUC5B (rho = 0.552; P < .001) and total protein (rho = 0.490; P < .001) concentrations. G' and G″ were significantly higher in asthma patients (G' = 14.49[7.18-25.26]Pa, G'' = 3.0[2.16-5.38]Pa) compared to COPD (G' = 5.01[2.94-6.48]Pa, P = .010; G'' = 1.45[1.16-1.94]Pa, P = .006) and to NCFB (G' = 4.99[1.49-10.49]Pa, P = .003; G'' = 1.46[0.71-2.47]Pa, P = .002). CONCLUSION In muco-obstructive lung diseases, rheology predicts sputum eosinophilia and is correlated with mucin concentrations, regardless of the underlying disease. CLINICAL TRIAL REGISTRATION (registrar, website, and registration number), where applicable NCT04081740.
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Affiliation(s)
- Mathilde Volpato
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France.
| | - Jerome Vialaret
- Clinical Proteomics Platform, LBPC, IRMB, CHU Montpellier, Montpellier University, Montpellier, France.
| | - Christophe Hirtz
- Clinical Proteomics Platform, LBPC, IRMB, CHU Montpellier, Montpellier University, Montpellier, France.
| | - Aurélie Petit
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France; Medecine Biologie Meditérrannée, France.
| | - Carey Suehs
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France; Department of Medical Information, Montpellier University Hospitals, La Colombière Hospital, Montpellier Cedex, France.
| | - Jérémy Patarin
- Rheonova, domaine universitaire, 1270 rue de la piscine, 38400 Saint Martin d'Hères, France.
| | - Eric Matzner-Lober
- Continuing Education ENSAE-ENSAI (CEPE), Rennes University 2, Rennes, France.
| | | | - Nicolas Molinari
- Department of Medical Information, Montpellier University Hospitals, La Colombière Hospital, Montpellier Cedex, France; IMAG, CNRS, Univ Montpellier, CHU Montpellier, Montpellier, France.
| | - Arnaud Bourdin
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France; PhyMedExp INSERM U1046, Montpellier, France.
| | - Jeremy Charriot
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France; PhyMedExp INSERM U1046, Montpellier, France.
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27
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Mao Y, Chen L, He T, Li J, Zou A, Li F, Chen F, Fan B, Ni W, Xiao W, You H, Fu W. Daily versus three-times-weekly azithromycin in Chinese patients with non-cystic fibrosis bronchiectasis: protocol for a prospective, open-label and randomised controlled trial. BMJ Open 2022; 12:e059186. [PMID: 35803624 PMCID: PMC9272127 DOI: 10.1136/bmjopen-2021-059186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Non-cystic fibrosis bronchiectasis (NCFB) brought a heavy healthcare burden worldwide. Macrolide maintenance therapy was proved to be helpful in reducing exacerbation of NCFB. However, the optimal dosing regimens of macrolides have not been determined, and its efficacy in Chinese NCFB population has not been validated. This protocol describes a head-to-head clinical trial designed to compare the efficacy of two dosing regimens of azithromycin in Chinese NCFB population. METHODS AND ANALYSIS This prospective, open-label and randomised controlled trial will be conducted in the First People's Hospital of Jiashan, China. Eligible patients with high-resolution CT defined NCFB will be randomly divided into three groups, which will receive either 250 mg daily azithromycin, or 500 mg three-times-weekly azithromycin or no treatment for 6 months. They will be followed up for another 6 months without treatment. The primary outcome is the mean rate of protocol-defined pulmonary exacerbation at 6 months. ETHICS AND DISSEMINATION Ethical approval was obtained from the First People's Hospital of Jiashan Ethics Committee. The findings will be disseminated in peer-reviewed publications. TRIAL REGISTRATION NUMBER ChiCTR2100052906.
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Affiliation(s)
- Yanxiong Mao
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Lan Chen
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Ting He
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Jing Li
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Aiping Zou
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Feng Li
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Fei Chen
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Bo Fan
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Weihao Ni
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Wei Xiao
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Huimin You
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
| | - Wenjiang Fu
- Department of Respiratory and Critical Care Medicine, First People's Hospital of Jiashan, Jiashan, Zhejiang, China
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Wang Y, Taylor SL, Choo JM, Papanicolas LE, Keating R, Hindmarsh K, Thomson RM, Morgan L, Rogers GB, Burr LD. Carriage and Transmission of Macrolide Resistance Genes in Patients With Chronic Respiratory Conditions and Their Close Contacts. Chest 2022; 162:56-65. [DOI: 10.1016/j.chest.2022.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/17/2021] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
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Lindemann PC, Mylvaganam H, Oppegaard O, Anthonisen IL, Zecic N, Skaare D. Case Report: Whole-Genome Sequencing of Serially Collected Haemophilus influenzae From a Patient With Common Variable Immunodeficiency Reveals Within-Host Evolution of Resistance to Trimethoprim-Sulfamethoxazole and Azithromycin After Prolonged Treatment With These Antibiotics. Front Cell Infect Microbiol 2022; 12:896823. [PMID: 35719354 PMCID: PMC9199433 DOI: 10.3389/fcimb.2022.896823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/04/2022] [Indexed: 12/01/2022] Open
Abstract
We report within-host evolution of antibiotic resistance to trimethoprim-sulfamethoxazole and azithromycin in a nontypeable Haemophilus influenzae strain from a patient with common variable immunodeficiency (CVID), who received repeated or prolonged treatment with these antibiotics for recurrent respiratory tract infections. Whole-genome sequencing of three longitudinally collected sputum isolates during the period April 2016 to January 2018 revealed persistence of a strain of sequence type 2386. Reduced susceptibility to trimethoprim-sulfamethoxazole in the first two isolates was associated with mutations in genes encoding dihydrofolate reductase (folA) and its promotor region, dihydropteroate synthase (folP), and thymidylate synthase (thyA), while subsequent substitution of a single amino acid in dihydropteroate synthase (G225A) rendered high-level resistance in the third isolate from 2018. Azithromycin co-resistance in this isolate was associated with amino acid substitutions in 50S ribosomal proteins L4 (W59R) and L22 (G91D), possibly aided by a substitution in AcrB (A604E) of the AcrAB efflux pump. All three isolates were resistant to aminopenicillins and cefotaxime due to TEM-1B beta-lactamase and identical alterations in penicillin-binding protein 3. Further resistance development to trimethoprim-sulfamethoxazole and azithromycin resulted in a multidrug-resistant phenotype. Evolution of multidrug resistance due to horizontal gene transfer and/or spontaneous mutations, along with selection of resistant subpopulations is a particular risk in CVID and other patients requiring repeated and prolonged antibiotic treatment or prophylaxis. Such challenging situations call for careful antibiotic stewardship together with supportive and supplementary treatment. We describe the clinical and microbiological course of events in this case report and address the challenges encountered.
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Affiliation(s)
- Paul Christoffer Lindemann
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
- *Correspondence: Paul Christoffer Lindemann, ; Dagfinn Skaare,
| | - Haima Mylvaganam
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Oddvar Oppegaard
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Nermin Zecic
- Department of Microbiology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Dagfinn Skaare
- Department of Microbiology, Vestfold Hospital Trust, Tønsberg, Norway
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30
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Assessment of Long-Term Macrolide Exposure on the Oropharyngeal Microbiome and Macrolide Resistance in Healthy Adults and Consequences for Onward Transmission of Resistance. Antimicrob Agents Chemother 2022; 66:e0224621. [PMID: 35293783 DOI: 10.1128/aac.02246-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
While the use of long-term macrolide therapy to prevent exacerbations in chronic respiratory diseases is widespread, its impact on the oropharyngeal microbiota and macrolide resistance, and the potential for onward transmission of resistance to close contacts are poorly understood. We determined the effects of long-term exposure to azithromycin or erythromycin on phenotypic and genotypic macrolide resistance within the oropharyngeal microbiome of healthy adults and their close contacts in a randomized, single-blinded, parallel-group trial of 4 weeks of twice-daily oral 400 mg erythromycin ethylsuccinate or twice-daily oral 125 mg azithromycin. Using oropharyngeal swabs collected from 20 index healthy adults and 20 paired close contacts, the oropharyngeal microbial composition and macrolide resistance in streptococci were assessed by 16S rRNA sequencing and antibiotic susceptibility testing of oropharyngeal cultures, respectively, at baseline and weeks 4 and 8 (washout). Targeted quantitative PCR of antibiotic resistance genes was performed to evaluate paired changes in resistance gene levels in index patients and close contacts and to relate the potential transmission of antibiotic resistance. Neither azithromycin nor erythromycin altered oropharyngeal microbiota characteristics significantly. Proportional macrolide resistance in oropharyngeal streptococci increased with both erythromycin and azithromycin, remaining above baseline levels for the azithromycin group at washout. Levels of resistance genes increased significantly with azithromycin[erm(B) and mef] and erythromycin (mef), returning to baseline levels at washout only for the erythromycin group. We found no evidence of onward transmission of resistance to close contacts, as indicated by the lack of concomitant changes in resistance gene levels detected in close contacts. (This study has been registered with the Australian and New Zealand Clinical Trials Registry under identifier ACTRN12617000278336.).
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Xu JF, Gao YH, Song YL, Qu JM, Guan WJ. Research advances and clinical management of bronchiectasis: Chinese perspective. ERJ Open Res 2022; 8:00017-2022. [PMID: 35415184 PMCID: PMC8995535 DOI: 10.1183/23120541.00017-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/22/2022] [Indexed: 11/20/2022] Open
Abstract
Bronchiectasis is a debilitating chronic suppurative airway disease that confers a substantial burden globally. Despite the notable prevalence, research on bronchiectasis in mainland China remains in its infancy. Nevertheless, there has been a significant leap in the quantity and quality of research, which has contributed to the ever-improving clinical practice. A nationwide collaborative platform has been established to foster multicentre studies, which will help increase the level of evidence further. Here, we summarise the status quo of clinical management and consider the research priorities for bronchiectasis that have been published previously. We also highlight the efforts of the Chinese medical communities to outline the core tasks that need to be addressed within the next decade. The remarkable progress made in bronchiectasis research has revolutionised clinical practice in mainland Chinahttps://bit.ly/3K8kQYr
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Antibiotic Management in Bronchiectasis. Clin Chest Med 2022; 43:165-177. [DOI: 10.1016/j.ccm.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Nielsen KG, Holgersen MG, Crowley S, Marthin JK. Chronic airway disease in primary ciliary dyskinesia—spiced with geno–phenotype associations. AMERICAN JOURNAL OF MEDICAL GENETICS PART C: SEMINARS IN MEDICAL GENETICS 2022; 190:20-35. [PMID: 35352480 PMCID: PMC9314966 DOI: 10.1002/ajmg.c.31967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 12/01/2022]
Abstract
Primary ciliary dyskinesia (PCD) can be defined as a multiorgan ciliopathy with a dominant element of chronic airway disease affecting the nose, sinuses, middle ear, and in particular, the lower airways. Although most patients with PCD are diagnosed during preschool years, it is obvious that the chronic lung disease starts its course already from birth. The many faces of the clinical picture change, as does lung function, structural lung damage, the burden of infection, and of treatment throughout life. A markedly severe neutrophil inflammation in the respiratory tract seems pervasive and is only to a minimal extent ameliorated by a treatment strategy, which is predominantly aimed at bacterial infections. An ever‐increasing understanding of the different aspects, their interrelationships, and possible different age courses conditioned by the underlying genotype is the focus of much attention. The future is likely to offer personalized medicine in the form of mRNA therapy, but to that end, it is of utmost importance that all patients with PCD be carefully characterized and given a genetic diagnosis. In this narrative review, we have concentrated on lower airways and summarized the current understanding of the chronic airway disease in this motile ciliopathy. In addition, we highlight the challenges, gaps, and opportunities in PCD lung disease research.
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Affiliation(s)
- Kim G Nielsen
- Department of Paediatrics and Adolescent Medicine Danish PCD & chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, ERN Accredited Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Mathias G Holgersen
- Department of Paediatrics and Adolescent Medicine Danish PCD & chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, ERN Accredited Copenhagen Denmark
| | - Suzanne Crowley
- Paediatric Department of Allergy and Lung Diseases Oslo University Hospital, Rikshospitalet Oslo Norway
| | - June K Marthin
- Department of Paediatrics and Adolescent Medicine Danish PCD & chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, ERN Accredited Copenhagen Denmark
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35
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Henkle E, Daley CL, Curtis JR, Chan B, Aksamit TR, Winthrop KL. Comparative safety of inhaled corticosteroids and macrolides in Medicare enrollees with bronchiectasis. ERJ Open Res 2022; 8:00786-2020. [PMID: 35265701 PMCID: PMC8899493 DOI: 10.1183/23120541.00786-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/17/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Bronchiectasis is an increasingly common chronic inflammatory airway disease. We evaluated secondary safety outcomes in a comparative effectiveness study of chronic inhaled corticosteroids (ICS) and macrolide monotherapy in bronchiectasis patients. Methods We conducted a retrospective study using US Medicare Parts A, B and D (but not C) 2006–2014 datasets. Among those with a pulmonologist-associated bronchiectasis claim (ICD-9-CM 494.0 or 494.1), without cystic fibrosis, we identified the first new use of either chronic (>28 days) ICS or macrolide monotherapy. For each drug exposure, we calculated crude incidence rates of the secondary safety outcomes: arrhythmia, myocardial infarction, sensorineural hearing loss, hip fracture and opportunistic infections. We calculated a propensity score (PS) for ICS use using demographic, clinical and utilisation characteristics and compared risks of macrolides versus ICS for each outcome using PS decile-adjusted Cox regression models. Results Of 285 043 Medicare patients with bronchiectasis, we identified 6500 (2%) macrolide and 83 589 (29%) ICS new users. Key covariates were balanced across exposure groups within decile. Myocardial infarction, hip fracture and opportunistic infection were not significantly associated with treatment. Macrolides were associated with a decreased risk of arrhythmia (adjusted hazard ratio (aHR) 0.87, 95% CI 0.80–0.94) and an increased risk of sensorineural hearing loss (aHR 1.38, 95% CI 1.56–1.22) compared to ICS. Conclusions Macrolides were not associated with an elevated risk of acute cardiac events compared to ICS. The increased risk of hearing loss in macrolide users compared to ICS users in older bronchiectasis patients should be balanced against known benefits of macrolides. Comparison of risks of cardiac outcomes (arrhythmia and myocardial infarction), hearing loss, opportunistic infections and hip fracture between macrolide and ICS users with bronchiectasis using a robust propensity-score adjusted new-user methodologyhttps://bit.ly/3KIVp0O
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Huang HY, Chung FT, Lin CY, Lo CY, Huang YT, Huang YC, Lai YT, Gan ST, Ko PC, Lin HC, Chung KF, Wang CH. Influence of Comorbidities and Airway Clearance on Mortality and Outcomes of Patients With Severe Bronchiectasis Exacerbations in Taiwan. Front Med (Lausanne) 2022; 8:812775. [PMID: 35127767 PMCID: PMC8814605 DOI: 10.3389/fmed.2021.812775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/08/2021] [Indexed: 12/18/2022] Open
Abstract
Bronchiectasis is characterized by systemic inflammation and multiple comorbidities. This study aimed to investigate the clinical outcomes based on the bronchiectasis etiology comorbidity index (BACI) score in patients hospitalized for severe bronchiectasis exacerbations. We included non-cystic fibrosis patients hospitalized for severe bronchiectasis exacerbations between January 2008 and December 2016 from the Chang Gung Research Database (CGRD) cohort. The main outcome was the 1-year mortality rate after severe exacerbations. We used the Cox regression model to assess the risk factors of 1-year mortality. Of 1,235 patients who were hospitalized for severe bronchiectasis exacerbations, 641 were in the BACI < 6 group and 594 in the BACI ≥ 6 group. The BACI ≥ 6 group had more previous exacerbations and a lower FEV1. Pseudomonas aeruginosa (19.1%) was the most common bacterium, followed by Klebsiella pneumoniae (7.5%). Overall, 11.8% of patients had respiratory failure and the hospital mortality was 3.0%. After discharge, compared to the BACI < 6 group, the BACI ≥ 6 group had a significantly higher cumulative incidence of respiratory failure and mortality in a 1-year follow-up. The risk factors for 1-year mortality in a multivariate analysis include age [hazard ratio (HR) 4.38, p = 0.01], being male (HR 4.38, p = 0.01), and systemic corticosteroid usage (HR 6.35, p = 0.001), while airway clearance therapy (ACT) (HR 0.50, p = 0.010) was associated with a lower mortality risk. An increased risk of respiratory failure and mortality in a 1-year follow-up after severe exacerbations was observed in bronchiectasis patients with multimorbidities, particularly older age patients, male patients, and patients with a history of systemic corticosteroid use. ACT could effectively improve the risk for 1-year mortality.
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Affiliation(s)
- Hung-Yu Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Thoracic Medicine, New Taipei City Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City, Taiwan
| | - Fu-Tsai Chung
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Thoracic Medicine, New Taipei City Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City, Taiwan.,Department of Respiratory Care, New Taipei City Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City, Taiwan
| | - Chun-Yu Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Yu Lo
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Chen Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Te Lai
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Saint Paul's Hospital, Taoyuan, Taiwan
| | - Shu-Ting Gan
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Po-Chuan Ko
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Horng-Chyuan Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kian Fan Chung
- Biomedical Research Unit, Experimental Studies, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, United Kingdom
| | - Chun-Hua Wang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Terpstra LC, Altenburg J, Bronsveld I, de Kruif MD, Berk Y, Snijders D, Rozemeijer W, Heijerman HGM, Boersma WG. Effects of long-term tobramycin inhalation solution (TIS) once daily on exacerbation rate in patients with non-cystic fibrosis bronchiectasis. Respir Res 2022; 23:330. [PMID: 36463180 PMCID: PMC9719617 DOI: 10.1186/s12931-022-02243-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/06/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Use of long-term tobramycin inhalation solution (TIS) has been shown beneficial in cystic fibrosis (CF) and earlier findings also suggest a benefit in non-CF bronchiectasis. We investigated the efficacy and safety of maintenance TIS once daily (OD) in frequent exacerbating bronchiectasis patients chronically infected by different pathogens sensitive for tobramycin. OBJECTIVE The primary outcome was the frequency of exacerbations during the 12-month study period. Secondary outcomes were time to first exacerbation, change in lung function and quality of life (QoL), bacterial analysis and safety. MATERIALS/PATIENTS IN THIS MULTICENTER RCT PATIENTS AGED ≥ 18-YEAR-OLD WERE INCLUDED WITH CONFIRMED BRONCHIECTASIS AND ≥ 2 EXACERBATIONS IN THE PRECEDING YEAR. PATIENTS WERE ASSIGNED (1:1) TO RECEIVE TIS OR PLACEBO OD FOR 1-YEAR.: RESULTS: 58 patients were included of which 52 were analyzed in the mITT analysis. TIS reduced exacerbation frequency with a RR of 0.74 (95% CI 0.49-1.14) (p = 0.15). Within the TIS population a decrease in number of exacerbations was found (2; p = 0.00), which was also seen in the placebo-treated patients (1.5; p = 0.00). In the TIS-treated patients the QoL improved (LRTI-VAS p = 0.02 Leicester Cough p = 0.02) without additional safety concerns. No differences were found for the other secondary outcomes. CONCLUSION Long-term TIS OD is a safe treatment modality and showed a non-significant reduced exacerbation frequency of 0.74 as compared to placebo in bronchiectasis patients chronically infected by tobramycin sensitive pathogens. TIS OD may be a potential therapeutic strategy in selected patients with bronchiectasis suffering from a high burden of disease. TRAIL REGISTRATION NUMBER The BATTLE study was registered at Clinical trials.gov number: NCT02657473 . Date: 13 august 2016.
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Affiliation(s)
- Lotte C. Terpstra
- Department of Pulmonary Diseases, Northwest Clinics, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands
| | - Josje Altenburg
- grid.5650.60000000404654431Department of Pulmonary Diseases, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Inez Bronsveld
- grid.5477.10000000120346234Department of Pulmonary Diseases, Utrecht University, Utrecht, The Netherlands
| | - Martijn D. de Kruif
- grid.416905.fDepartment of Pulmonary Diseases, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Yvonne Berk
- grid.413327.00000 0004 0444 9008Department of Pulmonary Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Dominic Snijders
- grid.416219.90000 0004 0568 6419Department of Pulmonary Diseases, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Wouter Rozemeijer
- Department of Medical Microbiology, Northwest Clinics, Alkmaar, The Netherlands
| | - Harry G. M. Heijerman
- grid.5477.10000000120346234Department of Pulmonary Diseases, Utrecht University, Utrecht, The Netherlands
| | - Wim G. Boersma
- Department of Pulmonary Diseases, Northwest Clinics, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands
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Long-term, low-dose macrolide antibiotic treatment in pediatric chronic airway diseases. Pediatr Res 2022; 91:1036-1042. [PMID: 34120139 PMCID: PMC9122820 DOI: 10.1038/s41390-021-01613-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/27/2021] [Accepted: 05/17/2021] [Indexed: 02/05/2023]
Abstract
Macrolide antibiotics are one of the most commonly used broad-spectrum antibiotics. They have an inhibitory effect on a variety of respiratory pathogens; besides, they have non-anti-infective effects, including anti-inflammatory, regulating airway secretion, immune regulation, and other effects. A growing number of studies have shown that the non-anti-infective effects of macrolides have important and potential value in the treatment of pediatric chronic airway diseases; the therapy was described as "long-term, low-dose usage"; unfortunately, there is no guideline or consensus that applies to children. To better carry out the mechanism and clinical research of non-anti-infective effect and promote its rational use in children, the authors summarize the evidence of the usage of long-term, low-dose macrolide antibiotic therapy (LLMAT) in the treatment of chronic airway diseases in children and the progress in recent years. IMPACT: This review summarizes the evidence (mostly in recent 5 years) of the usage of long-term, low-dose macrolide antibiotic therapy in the treatment of chronic airway diseases. The recent studies and guidelines support and enrich the point that long-term, low-dose macrolide antibiotic therapy has potential benefit for children with severe asthma, CF, non-CF bronchiectasis, and BO, which provides clinical references and is of clinical interest. Long-term, low-dose macrolide antibiotic therapy has good safety, and no serious events have been reported; however, potential cardiac side effects and macrolide resistance should be clinically noted.
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Guan Y, Zhang X, Yang H, Xu H, Zhao S. Long-Term Azithromycin Treatment in Pediatric Primary Ciliary Dyskinesia: A Retrospective Study. Front Pediatr 2022; 10:905253. [PMID: 35757125 PMCID: PMC9226474 DOI: 10.3389/fped.2022.905253] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/18/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Primary ciliary dyskinesia (PCD) is a rare genetic disease mainly involved in lung dysfunction. PCD patient outcomes after azithromycin (AZM) treatment have rarely been reported. This study was aimed to assess AZM treatment effects on disease progression of pediatric PCD patients. STUDY DESIGN This retrospective follow-up study involved PCD patients diagnosed from 2009 to 2021. Changes of clinical outcomes, pulmonary function, and chest computed tomography findings were compared between untreated and AZM-treated patients. RESULTS Of 71 enrolled patients (median follow-up duration of 3.1 years), 34 received AZM (AZM-treated group) and 37 received no AZM (AZM-untreated group). At diagnosis, no significant intergroup differences in age, sex, height, weight, number of respiratory exacerbations, and FEV1% and FVC% predicted values were found, although FEF25-75% predicted was lower in AZM-treated group. Between treatment initiation and follow-up, patients in AZM-treated group had less respiratory exacerbations than that of AZM-untreated group (mean ± SD, 1.4 ± 0.8 vs. 3.0 ± 2.1, times/year P = 0.001) and fewer AZM-treated group patients exhibited exercise intolerance. Increases above baseline of AZM-treated FEV1% and FVC% predicted values exceeded that of AZM-untreated group, but intergroup differences were insignificant (FEV1% predicted: (median, IQR) 5.3 [-13.4, 9.4] vs. 1.8 [-12.1, 9.5], P = 0.477; FVC% predicted: (median, IQR) 6.7 [-7.6, 18.8] vs. 1.6 [-5.6, 7.6], P = 0.328). CONCLUSION Long-term AZM treatment can reduce respiratory infection frequency and may maintain pulmonary diseases stable in pediatric PCD patients with worse lung function.
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Affiliation(s)
- Yuhong Guan
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiang Zhang
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Haiming Yang
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Hui Xu
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Shunying Zhao
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
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Antibiotic Stewardship und chronische Lungenerkrankungen. ZEITSCHRIFT FÜR PNEUMOLOGIE 2022; 19. [PMCID: PMC9568979 DOI: 10.1007/s10405-022-00478-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Hintergrund Ziel dieser Arbeit Material und Methoden Ergebnisse und Diskussion
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Terpstra LC, Altenburg J, Mohamed Hoesein FA, Bronsveld I, Go S, van Rijn PAC, De Jong PA, Heijerman HGM, Boersma WG. The effect of maintenance azithromycin on radiological features in patients with bronchiectasis - Analysis from the BAT randomized controlled trial. Respir Med 2021; 192:106718. [PMID: 34974413 DOI: 10.1016/j.rmed.2021.106718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 11/25/2021] [Accepted: 12/12/2021] [Indexed: 10/19/2022]
Abstract
RATIONALE Bronchiectasis (abnormal dilatation of bronchi) is usually diagnosed by high resolution computed tomography (HRCT) and radiological severity has been found to correspond with clinical outcome. A beneficial effect of macrolides maintenance treatment in frequent exacerbating bronchiectasis patients has been established in randomized trials. This study was undertaken to prospectively evaluate the effect of long-term azithromycin (AZM) on radiological features in patients with bronchiectasis. METHODS The BAT randomized controlled trial (2008-2010) investigated the effect of 1 year of AZM (250 mg OD) in bronchiectasis with frequent exacerbations. Chest (HR)CT-scans at baseline and after one year of study treatment were obtained and scored by two radiologists according to the Brody - and the Bhalla scoring system. RESULTS 77 (93%) patients conducted the BAT trial were evaluated in this post-hoc analysis. A significant improvement of the radiological features based on the Brody score was found after one year of AZM therapy as compared to placebo (p = 0.024), with a not significant improvement of the Bhalla score (p=0.071). Especially the consolidation (Bhalla) and parenchymal changes (Brody) sub scores significantly improved (both p=0.030), and even a radiological deterioration was seen on the Brody bronchiectasis sub score for the placebo treated patients (mean 14.5 (11.7) vs.15.7 (11.9)). CONCLUSIONS The beneficial effect of long-term AZM treatment on radiological features was demonstrated in this randomized controlled trial. (HR)CT's can be used as an objective measure of treatment response in bronchiectasis. CLINICAL TRIAL REGISTRATION NUMBER NCT00415350.
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Affiliation(s)
- Lotte C Terpstra
- Department of Pulmonary Diseases, Northwest Clinics, Alkmaar, the Netherlands.
| | - Josje Altenburg
- Department of Pulmonary Diseases, Academic Medical Center, Amsterdam, the Netherlands
| | - Firdaus A Mohamed Hoesein
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Inez Bronsveld
- Department of Pulmonary Diseases, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Shirley Go
- Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands
| | - Philip A C van Rijn
- Department of Radiology, Department of Radiology, Slingeland Hospital, Doetinchem, the Netherlands
| | - Pim A De Jong
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Harry G M Heijerman
- Department of Pulmonary Diseases, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Wim G Boersma
- Department of Pulmonary Diseases, Northwest Clinics, Alkmaar, the Netherlands
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Wang R, Ding S, Lei C, Yang D, Luo H. The contribution of Pseudomonas aeruginosa infection to clinical outcomes in bronchiectasis: a prospective cohort study. Ann Med 2021; 53:459-469. [PMID: 33754900 PMCID: PMC7993380 DOI: 10.1080/07853890.2021.1900594] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/03/2021] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES The impact of Pseudomonas aeruginosa on the prognosis of bronchiectasis remains controversial. This study aimed to explore the prognostic value of P. aeruginosa in adult patients with bronchiectasis in central-southern China. PATIENTS AND METHODS This prospective cohort study enrolled 1,234 patients with bronchiectasis between 2013 and 2019. The independent impact of P. aeruginosa on all-cause mortality, annual exacerbations, and hospitalizations was assessed. RESULTS P. aeruginosa was isolated from 244 patients (19.8%). A total of 188 patients died over a follow-up period of 16 (1-36) months. Patients with P. aeruginosa had a longer disease course, poorer lung function, more lung lobe involvement, and more severe Bronchiectasis Severity Index (BSI) stage than those without P. aeruginosa. The independent impact of P. aeruginosa was observed on frequent hospitalizations but not on mortality and frequent exacerbations. Moderate- or high-risk comorbidities increased the risk of mortality (hazard ratio [HR]: 1.93, 95% confidence interval [CI]: 1.26-2.95), and this effect was magnified by the presence of P. aeruginosa (HR: 2.11, 95% CI: 1.28-3.48). CONCLUSIONS P. aeruginosa infection acts as a marker of disease severity as well as predictor of frequent hospitalizations. P. aeruginosa had no independent effect on all-cause mortality. P. aeruginosa combined with moderate- or high-risk comorbidities posed an increased risk of mortality. The management of comorbidities may be a critical target during the treatment of P. aeruginosa infection in bronchiectasis.KEY MESSAGE:P. aeruginosa increased the risk of frequent hospitalizations; however, it had no independent impact on all-cause mortality.P. aeruginosa combined with moderate- or high-risk comorbidities posed an increased risk of mortality.The management of comorbidities may be a critical target during the treatment of P. aeruginosa infection in bronchiectasis.
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Affiliation(s)
- Rongchun Wang
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Respiratory Disease, Central South University, Changsha, China
- Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, China
| | - Shuizi Ding
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Respiratory Disease, Central South University, Changsha, China
- Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, China
| | - Cheng Lei
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Respiratory Disease, Central South University, Changsha, China
- Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, China
| | - Danhui Yang
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Respiratory Disease, Central South University, Changsha, China
- Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, China
| | - Hong Luo
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Respiratory Disease, Central South University, Changsha, China
- Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, China
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Lim RK, Tremblay A, Lu S, Somayaji R. Evaluating hemoptysis hospitalizations among patients with bronchiectasis in the United States: a population-based cohort study. BMC Pulm Med 2021; 21:392. [PMID: 34852812 PMCID: PMC8638373 DOI: 10.1186/s12890-021-01762-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 11/19/2021] [Indexed: 12/04/2022] Open
Abstract
Background The burden of hospitalizations and mortality for hemoptysis due to bronchiectasis is not well characterized. The primary outcome of our study was to evaluate in-hospital mortality in patients admitted with hemoptysis and bronchiectasis, as well as the rates of bronchial artery embolization, length of stay, and hospitalization costs. Methods The authors queried the Nationwide Inpatient Sample (NIS) claims database for hospitalizations between 2016 and 2017 using the ICD-10-CM codes for hemoptysis and bronchiectasis in the United States. Multivariable regression was used to evaluate predictors of in-hospital mortality, embolization, length of stay, and hospital costs. Results There were 8240 hospitalizations (weighted) for hemoptysis in the United States from 2016 to 2017. The overall in-hospital mortality was 4.5%, but higher in males compared to females. Predictors of in-hospital mortality included undergoing three or more procedures, age, and congestive heart failure. Bronchial artery embolization (BAE) was utilized during 2.1% of hospitalizations and was more frequently used in those with nontuberculous mycobacteria and aspergillus infections, but not pseudomonal infections. The mean length of stay was 6 days and the median hospitalization cost per patient was USD $9,610. Having comorbidities and procedures was significantly associated with increased length of stay and costs. Conclusion Hemoptysis is a frequent indication for hospitalization among the bronchiectasis population. In-hospital death occurred in approximately 4.5% of hospitalizations. The effectiveness of BAE in treating and preventing recurrent hemoptysis from bronchiectasis needs to be explored.
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Affiliation(s)
- Rachel K Lim
- Department of Medicine, University of Calgary, Calgary, Canada. .,Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Alain Tremblay
- Department of Medicine, University of Calgary, Calgary, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Shengjie Lu
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ranjani Somayaji
- Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Microbiology, Immunology and Infectious Disease, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada
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Jayaram L, Vandal AC, Chang C, Lewis C, Tong C, Tuffery C, Bell J, Fergusson W, Jeon G, Milne D, Jones S, Karalus N, Hotu S, Wong C. Tiotropium treatment for bronchiectasis: a randomised, placebo-controlled, crossover trial. Eur Respir J 2021; 59:13993003.02184-2021. [PMID: 34795034 PMCID: PMC9178212 DOI: 10.1183/13993003.02184-2021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/08/2021] [Indexed: 11/05/2022]
Abstract
Tiotropium via HandiHaler® is an established long-acting, anticholinergic bronchodilator that prevents exacerbations and improves lung function in patients with COPD. We hypothesized that tiotropium would reduce pulmonary exacerbations and improve lung function in patients with stable bronchiectasis and airflow limitation, and assessed the effect of tiotropium on these outcomes. In a randomised, double-blind, 2-period crossover trial, we recruited adult patients from 3 hospitals in New Zealand. Patients were excluded if they had a smoking history of more than 20 pack years. Patients were assigned to either the tiotropium-placebo or placebo-tiotropium sequence in a 1:1 ratio, using randomly permuted blocks stratified by centre. Participants and investigators were masked to treatment allocation. Eligible patients received tiotropium 18mcg via the HandiHaler® device daily for 6 months followed by 6 months of placebo, or vice versa, with a washout period of 4 weeks. The primary endpoint was rate of event-based exacerbations during the 6-month period. Primary analyses were carried out in an intention-to-treat set. Ninety patients were randomly assigned and 85 completed both treatment cycles. The rate of exacerbations under the tiotropium treatment was 2.17 y-1 and 2.27 y-1 under placebo (rate ratio 0.96, 95% CI 0.72-1.27; p=0.77). Tiotropium, as compared with placebo, improved FEV1 by 58 mL (95% CI 23-92; p=0.002). Adverse events were similar under both treatments. Tiotropium via HandiHaler® over 6 months significantly improved lung function but not frequency of exacerbations. Further research is required to understand the clinical context and significance of these findings.
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Affiliation(s)
| | - Alain C Vandal
- University of Auckland.,Counties Manukau District Health Board
| | | | | | | | | | - Jill Bell
- Counties Manukau District Health Board
| | | | - Gene Jeon
- Counties Manukau District Health Board
| | - David Milne
- University of Auckland.,Auckland District Health Board
| | | | | | | | - Conroy Wong
- University of Auckland.,Counties Manukau District Health Board
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Pollock J, Chalmers JD. The immunomodulatory effects of macrolide antibiotics in respiratory disease. Pulm Pharmacol Ther 2021; 71:102095. [PMID: 34740749 PMCID: PMC8563091 DOI: 10.1016/j.pupt.2021.102095] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/25/2021] [Accepted: 10/29/2021] [Indexed: 12/21/2022]
Abstract
Macrolide antibiotics are well known for their antibacterial properties, but extensive research in the context of inflammatory lung disease has revealed that they also have powerful immunomodulatory properties. It has been demonstrated that these drugs are therapeutically beneficial in various lung diseases, with evidence they significantly reduce exacerbations in patients with COPD, asthma, bronchiectasis and cystic fibrosis. The efficacy demonstrated in patients infected with macrolide tolerant organisms such as Pseudomonas aeruginosa supports the concept that their efficacy is at least partly related to immunomodulatory rather than antibacterial effects. Inconsistent data and an incomplete understanding of their mechanisms of action hampers the use of macrolide antibiotics as immunomodulatory therapies. Macrolides recently demonstrated no clinically relevant immunomodulatory effects in the context of COVID-19 infection. This review provides an overview of macrolide antibiotics and discusses their immunomodulatory effects and mechanisms of action in the context of inflammatory lung disease.
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Affiliation(s)
- Jennifer Pollock
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK.
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Kricker JA, Page CP, Gardarsson FR, Baldursson O, Gudjonsson T, Parnham MJ. Nonantimicrobial Actions of Macrolides: Overview and Perspectives for Future Development. Pharmacol Rev 2021; 73:233-262. [PMID: 34716226 DOI: 10.1124/pharmrev.121.000300] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Macrolides are among the most widely prescribed broad spectrum antibacterials, particularly for respiratory infections. It is now recognized that these drugs, in particular azithromycin, also exert time-dependent immunomodulatory actions that contribute to their therapeutic benefit in both infectious and other chronic inflammatory diseases. Their increased chronic use in airway inflammation and, more recently, of azithromycin in COVID-19, however, has led to a rise in bacterial resistance. An additional crucial aspect of chronic airway inflammation, such as chronic obstructive pulmonary disease, as well as other inflammatory disorders, is the loss of epithelial barrier protection against pathogens and pollutants. In recent years, azithromycin has been shown with time to enhance the barrier properties of airway epithelial cells, an action that makes an important contribution to its therapeutic efficacy. In this article, we review the background and evidence for various immunomodulatory and time-dependent actions of macrolides on inflammatory processes and on the epithelium and highlight novel nonantibacterial macrolides that are being studied for immunomodulatory and barrier-strengthening properties to circumvent the risk of bacterial resistance that occurs with macrolide antibacterials. We also briefly review the clinical effects of macrolides in respiratory and other inflammatory diseases associated with epithelial injury and propose that the beneficial epithelial effects of nonantibacterial azithromycin derivatives in chronic inflammation, even given prophylactically, are likely to gain increasing attention in the future. SIGNIFICANCE STATEMENT: Based on its immunomodulatory properties and ability to enhance the protective role of the lung epithelium against pathogens, azithromycin has proven superior to other macrolides in treating chronic respiratory inflammation. A nonantibiotic azithromycin derivative is likely to offer prophylactic benefits against inflammation and epithelial damage of differing causes while preserving the use of macrolides as antibiotics.
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Affiliation(s)
- Jennifer A Kricker
- EpiEndo Pharmaceuticals, Reykjavik, Iceland (J.A.K., C.P.P., F.R.G., O.B., T.G., M.J.P.); Stem Cell Research Unit, Biomedical Center, University of Iceland, Reykjavik, Iceland (J.A.K., T.G.); Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (C.P.P.); Department of Respiratory Medicine (O.B.), Department of Laboratory Hematology (T.G.), Landspitali-University Hospital, Reykjavik, Iceland; Faculty of Biochemistry, Chemistry and Pharmacy, JW Goethe University Frankfurt am Main, Germany (M.J.P.)
| | - Clive P Page
- EpiEndo Pharmaceuticals, Reykjavik, Iceland (J.A.K., C.P.P., F.R.G., O.B., T.G., M.J.P.); Stem Cell Research Unit, Biomedical Center, University of Iceland, Reykjavik, Iceland (J.A.K., T.G.); Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (C.P.P.); Department of Respiratory Medicine (O.B.), Department of Laboratory Hematology (T.G.), Landspitali-University Hospital, Reykjavik, Iceland; Faculty of Biochemistry, Chemistry and Pharmacy, JW Goethe University Frankfurt am Main, Germany (M.J.P.)
| | - Fridrik Runar Gardarsson
- EpiEndo Pharmaceuticals, Reykjavik, Iceland (J.A.K., C.P.P., F.R.G., O.B., T.G., M.J.P.); Stem Cell Research Unit, Biomedical Center, University of Iceland, Reykjavik, Iceland (J.A.K., T.G.); Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (C.P.P.); Department of Respiratory Medicine (O.B.), Department of Laboratory Hematology (T.G.), Landspitali-University Hospital, Reykjavik, Iceland; Faculty of Biochemistry, Chemistry and Pharmacy, JW Goethe University Frankfurt am Main, Germany (M.J.P.)
| | - Olafur Baldursson
- EpiEndo Pharmaceuticals, Reykjavik, Iceland (J.A.K., C.P.P., F.R.G., O.B., T.G., M.J.P.); Stem Cell Research Unit, Biomedical Center, University of Iceland, Reykjavik, Iceland (J.A.K., T.G.); Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (C.P.P.); Department of Respiratory Medicine (O.B.), Department of Laboratory Hematology (T.G.), Landspitali-University Hospital, Reykjavik, Iceland; Faculty of Biochemistry, Chemistry and Pharmacy, JW Goethe University Frankfurt am Main, Germany (M.J.P.)
| | - Thorarinn Gudjonsson
- EpiEndo Pharmaceuticals, Reykjavik, Iceland (J.A.K., C.P.P., F.R.G., O.B., T.G., M.J.P.); Stem Cell Research Unit, Biomedical Center, University of Iceland, Reykjavik, Iceland (J.A.K., T.G.); Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (C.P.P.); Department of Respiratory Medicine (O.B.), Department of Laboratory Hematology (T.G.), Landspitali-University Hospital, Reykjavik, Iceland; Faculty of Biochemistry, Chemistry and Pharmacy, JW Goethe University Frankfurt am Main, Germany (M.J.P.)
| | - Michael J Parnham
- EpiEndo Pharmaceuticals, Reykjavik, Iceland (J.A.K., C.P.P., F.R.G., O.B., T.G., M.J.P.); Stem Cell Research Unit, Biomedical Center, University of Iceland, Reykjavik, Iceland (J.A.K., T.G.); Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (C.P.P.); Department of Respiratory Medicine (O.B.), Department of Laboratory Hematology (T.G.), Landspitali-University Hospital, Reykjavik, Iceland; Faculty of Biochemistry, Chemistry and Pharmacy, JW Goethe University Frankfurt am Main, Germany (M.J.P.)
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Sibila O, Laserna E, Shoemark A, Perea L, Bilton D, Crichton ML, De Soyza A, Boersma WG, Altenburg J, Chalmers JD. Heterogeneity of treatment response in bronchiectasis clinical trials. Eur Respir J 2021; 59:13993003.00777-2021. [PMID: 34675045 DOI: 10.1183/13993003.00777-2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/15/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Recent randomised clinical trials (RCTs) in Bronchiectasis have failed to reach their primary endpoints, suggesting a need to reassess how we measure treatment response. Exacerbations, quality of life (QOL) and lung function are the most common endpoints evaluated in bronchiectasis clinical trials. We aimed to determine the relationship between responses in terms of reduced exacerbations, improved symptoms and lung function in bronchiectasis. METHODS We evaluated treatment response in 3 RCTs that evaluated mucoactive therapy (inhaled Mannitol), an oral anti-inflammatory/antibiotic (Azithromycin) and an inhaled antibiotic (Aztreonam). Treatment response was defined by absence of exacerbations during follow-up, an improvement of QOL above the minimum clinically important difference (MCID) and an improvement in FEV1 of ≥100 mL from baseline. MEASUREMENTS AND MAIN RESULTS Cumulatively the three trials included 984 patients. Changes in FEV1, QOL and exacerbations were heterogeneous in all trials analysed. Improvements in QOL were not correlated to changes in FEV1 in the azithromycin and aztreonam trials (r=-0.17, p=0.1 and r=0.04, p=0.4) and weakly correlated in the mannitol trial (r=0.22, p<0.0001). An important placebo effect was observed in all trials, especially regarding improvements in QOL. Clinical meaningful lung function improvements were rare across all trials evaluated, suggesting that FEV1 is not a responsive measure in bronchiectasis. CONCLUSIONS Improvements in lung function, symptoms and exacerbation frequency are dissociated in bronchiectasis. FEV1 is poorly responsive and poorly correlated with other key outcome measures. Clinical parameters are poorly predictive of treatment response suggesting the need to develop biomarkers to identify responders.
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Affiliation(s)
- Oriol Sibila
- Respiratory Department, Hospital Clinic, IDIBAPS, CIBERES, Barcelona, Spain
| | - Elena Laserna
- Hospital Comarcal de Mollet, Mollet del Vallés, Spain
| | - Amelia Shoemark
- Scottish Centre for Respiratory Medicine, University of Dundee, Dundee, UK
| | - Lidia Perea
- Respiratory Department, Hospital Clinic, IDIBAPS, CIBERES, Barcelona, Spain
| | - Diana Bilton
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Megan L Crichton
- Scottish Centre for Respiratory Medicine, University of Dundee, Dundee, UK
| | - Anthony De Soyza
- Freeman Hospital Newcastle and University of Newcastle, Newcastle, UK
| | - Wim G Boersma
- Department of Pulmonary Diseases, Northwest Hospital Group, Alkmaar, Netherlands
| | | | - James D Chalmers
- Scottish Centre for Respiratory Medicine, University of Dundee, Dundee, UK
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Brooke-Hollidge A, Conway J, Lewis A. Gender differences in non-cystic fibrosis bronchiectasis severity and bacterial load: the potential role of hormones. Ther Adv Respir Dis 2021; 15:17534666211035311. [PMID: 34520299 PMCID: PMC8445533 DOI: 10.1177/17534666211035311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Non cystic-fibrosis bronchiectasis (NCFB) is a complex chronic respiratory disease, characterised by excessive sputum production and abnormal permanent dilation of bronchi. Mucus accumulation leads to recurrent bacterial infections and increased bacterial load, causing vicious cycles of structural damage and decreased lung function. Respiratory physiotherapy management of NCFB includes airway clearance techniques and use of nebulised, hypertonic saline. Despite advances in treatment, a consistent relationship has been observed between gender and disease occurrence, with a higher prevalence amongst females. Furthermore, NCFB presents most aggressively amongst post-menopausal females, a group likely exposed to higher levels of progesterone (P4) over a longer period of time. The effects of gender-specific hormones on bacterial load and physiotherapy management of people living with NCFB remain unknown. The aim of this narrative review was to discuss the potential influence of gender specific hormones on NCFB disease progression and influence on physiotherapy, medical management and future research. SCOPUS and PUBMED electronic databases were used to conduct searches for relevant studies using specific inclusion and exclusion criteria. Secondary inclusion of relevant literature was obtained from primary paper references. Previous literature suggests that P4 may impair Cilia Beat Frequency (CBF) in airway epithelium. Reduction in CBF may further reduce ability to expectorate amongst individuals with NCFB, increasing bacterial load and likelihood of exacerbations, negatively impacting on disease progression. Furthermore, coadministration of Estrogen has been suggested to offer opposing effects to that of P4 only. These findings question whether hormonal levels may be monitored, controlled and optimised within management and treatment of females with NCFB to improve airway clearance, reduce exacerbations and improve quality of life. Larger scale, long-term trials are required to further explore the effects of gender specific hormones on NCFB and the viability of treatment with hormone replacement therapy. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
| | | | - Adam Lewis
- College of Health, Medicine and Life Sciences, Brunel University London, Mary Seacole Building, Kingston Lane, Uxbridge, UB8 3PH, UK
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Current and Future Treatments in Primary Ciliary Dyskinesia. Int J Mol Sci 2021; 22:ijms22189834. [PMID: 34575997 PMCID: PMC8470068 DOI: 10.3390/ijms22189834] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 01/05/2023] Open
Abstract
Primary ciliary dyskinesia (PCD) is a rare genetic ciliopathy in which mucociliary clearance is disturbed by the abnormal motion of cilia or there is a severe reduction in the generation of multiple motile cilia. Lung damage ensues due to recurrent airway infections, sometimes even resulting in respiratory failure. So far, no causative treatment is available and treatment efforts are primarily aimed at improving mucociliary clearance and early treatment of bacterial airway infections. Treatment guidelines are largely based on cystic fibrosis (CF) guidelines, as few studies have been performed on PCD. In this review, we give a detailed overview of the clinical studies performed investigating PCD to date, including three trials and several case reports. In addition, we explore precision medicine approaches in PCD, including gene therapy, mRNA transcript and read-through therapy.
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Sars-Cov-2 Infection in Patients on Long-Term Treatment with Macrolides in Spain: A National Cross-Sectional Study. Antibiotics (Basel) 2021; 10:antibiotics10091039. [PMID: 34572621 PMCID: PMC8468207 DOI: 10.3390/antibiotics10091039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/12/2021] [Accepted: 08/20/2021] [Indexed: 12/27/2022] Open
Abstract
The aim of this study was to know the prevalence and severity of COVID-19 in patients treated with long-term macrolides and to describe the factors associated with worse outcomes. A cross-sectional study was conducted in Primary Care setting. Patients with macrolides dispensed continuously from 1 October 2019 to 31 March 2020, were considered. Main outcome: diagnosis of coronavirus disease-19 (COVID-19). Secondary outcomes: symptoms, severity, characteristics of patients, comorbidities, concomitant treatments. A total of 3057 patients met the inclusion criteria. Median age: 73 (64–81) years; 55% were men; 62% smokers/ex-smokers; 56% obese/overweight. Overall, 95% of patients had chronic respiratory diseases and four comorbidities as a median. Prevalence of COVID-19: 4.8%. This was in accordance with official data during the first wave of the pandemic. The most common symptoms were respiratory: shortness of breath, cough, and pneumonia. Additionally, 53% percent of patients had mild/moderate symptoms, 28% required hospital admission, and 19% died with COVID-19. The percentage of patients hospitalized and deaths were 2.6 and 5.8 times higher, respectively, in the COVID-19 group (p < 0.001). There was no evidence of a beneficial effect of long-term courses of macrolides in preventing SARS-CoV-2 infection or the progression to worse outcomes in old patients with underlying chronic respiratory diseases and a high burden of comorbidity.
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