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Wagner MJ, Dimitrov M, Lam GY, Leung W, Tyrrell GJ, Vethanayagam D. Microbiology sampling in non-cystic fibrosis bronchiectasis cases from northern Alberta. PLoS One 2023; 18:e0288704. [PMID: 37450508 PMCID: PMC10348526 DOI: 10.1371/journal.pone.0288704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
Non-cystic fibrosis bronchiectasis (NCFB) is a chronic respiratory disease resulting in chronic cough, thick sputum, and lower airway microbial colonization, akin to patients with cystic fibrosis (CF). NCFB is a common, yet under recognized entity which inflicts significant morbidity and mortality particularly to older individuals, with a rising prevalence in the developed world. Given that sputum cultures are a non-invasive method to characterize the lower airway microbiota in NCFB patients, for which pathogenic organisms are associated with worsened outcomes, we sought to characterize the microbiological pattern and clinical outcomes associated with sputum culture in a cohort of NCFB patients from Western Canada. A total of 20 subjects were prospectively recruited from various bronchiectasis clinics across the Greater Edmonton area. A retrospective chart review and a symptoms questionnaire was performed, gathering information not limited to symptoms, comorbidities, exacerbations, hospitalizations, sputum production, and sputum culture results over the prior 5 years. Subjects reported frequent hospitalization alongside a significant burden of symptoms. A large majority of sputum cultures grew pathogenic organisms such as Haemophilus influenzae and Pseudomonas aeruginosa. We also note the considerable waste and inefficiency associated with sputum cultures, outlining areas for which this important diagnostic modality can be improved. Accurate characterization of the airway microbiota alongside efficient delivery of health services are key to ensuring the proper treatment of individuals with NCFB, given their high disease burden and frequent hospitalization.
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Affiliation(s)
- Mitchell J. Wagner
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Monette Dimitrov
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Grace Y. Lam
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Winnie Leung
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Gregory J. Tyrrell
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Provincial Laboratory for Public Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - Dilini Vethanayagam
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Royle H, Kelly C. 'The likes of me running and walking? No chance': Exploring the perceptions of adult patients with bronchiectasis towards exercise. Chronic Illn 2023; 19:157-171. [PMID: 35695195 PMCID: PMC9843538 DOI: 10.1177/17423953221108223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective: To explore the views and experiences of adult patients with bronchiectasis towards exercise. Methods: Semi-structured interviews with ten patients with bronchiectasis were conducted to explore perceptions of exercise, potential barriers and facilitators of exercise. Inductive thematic analysis was used to identify key themes. Findings: Five main themes: 1. The language of exercise 2. Facilitators to exercise 3. Barriers to exercise 4. Exercise has a positive impact on health and life expectancy 5. Grief regarding loss of ability Discussion: Participants perceived exercise as positive, but there was variance regarding what this entailed. Findings suggest healthcare professionals should consider the language used when prescribing exercise and provide clarity for patients and reflect on their own role in advising on exercise. There were both common and differing barriers and facilitators to exercise between participants. Holistic needs and the identification of these potential barriers and facilitators to exercise could aid compliance. Further research is needed to explore generalisability and the effectiveness of behaviour change models to improve engagement with exercise.
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Affiliation(s)
- Holly Royle
- School of Health and Care Professions, 8629University of Winchester, Winchester, UK
| | - Carol Kelly
- Respiratory Research Centre, Health Research Institute, 6249Edge Hill University, Ormskirk, UK
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Levine H, Bar-On O, Nir V, West N, Dizitzer Y, Mussaffi H, Prais D. Reversible Bronchial Obstruction in Primary Ciliary Dyskinesia. J Clin Med 2022; 11:jcm11226791. [PMID: 36431268 PMCID: PMC9699262 DOI: 10.3390/jcm11226791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Inhaled bronchodilators are frequently used among patients with primary ciliary dyskinesia (PCD), although neither the effectiveness nor the prevalence of their use is known, due to the paucity of relevant studies. METHODS This is a retrospective analysis of pre- and post-bronchodilator spirometry results, of patients with PCD from two centers. Correlations were examined of bronchodilator response, with asthma and atopy markers. RESULTS Of 115 patients, 46 (40%) completed spirometry pre- and post-bronchodilation. Of these, 26 (56.5%) demonstrated reversible airway obstruction (increase in %FEV1 predicted ≥ 10%). Obstruction reversibility was not found to be associated with a family history of asthma, blood eosinophil level, elevated IgE, or atopy symptoms. Of the 46 patients who completed bronchodilator spirometry, 29 (63%) were regularly using bronchodilators and inhaled corticosteroids. CONCLUSIONS More than half of patients with PCD presented with reversible airway obstruction, without any correlation to markers of personal or familial atopy. Inhaled bronchodilators and corticosteroid therapies are commonly used for treating PCD. Evaluating bronchodilator response should be considered, and its effectiveness should be further studied.
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Affiliation(s)
- Hagit Levine
- Pulmonary Institute, Schneider Children’s Medical Center, Petah-Tikva 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +97-23-925-3654; Fax: +97-23-925-3308
| | - Ophir Bar-On
- Pulmonary Institute, Schneider Children’s Medical Center, Petah-Tikva 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Vered Nir
- Department of Pediatrics, Hillel-Yaffe Medical Center, Hadera 3810101, Israel
| | - Nicole West
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yotam Dizitzer
- Department of Pediatrics, Schneider Children’s Medical Center, Petah-Tikva 4920235, Israel
| | - Huda Mussaffi
- Pulmonary Institute, Schneider Children’s Medical Center, Petah-Tikva 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Dario Prais
- Pulmonary Institute, Schneider Children’s Medical Center, Petah-Tikva 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Singh P, Katoch CDS, Vardhan V, Chopra M, Singh S, Ahuja N. Functional impairment in bronchiectasis: Spirometry parameters versus St. George's Respiratory Questionnaire scores: Any co-relation? Lung India 2021; 38:545-551. [PMID: 34747737 PMCID: PMC8614608 DOI: 10.4103/lungindia.lungindia_707_20] [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: 08/28/2020] [Revised: 10/11/2020] [Accepted: 07/10/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Bronchiectasis is a common respiratory disease which has significant morbidity and mortality. Health-related quality of life scores are not routinely used for the assessment of bronchiectasis. The present study was undertaken with an aim to assess the clinical profile and functional impairment using spirometry in patients with bronchiectasis and to co-relate functional impairment with their St. George's Respiratory Questionnaire (SGRQ) score. METHODOLOGY This was a cross-sectional study carried out on 102 patients of bronchiectasis. All patients were assessed for clinical profile, spirometry, and SGRQ scores. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC were measured and compared with SGRQ scores. Data analysis was done using SPSS version 20.0 and MS-Excel. RESULTS Obstruction was found in 62.7% and significant bronchodilator reversibility was observed in 30.4%. All spirometry parameters individually and combined showed a negative co-relation which was stastically significant (P < 0.001). Best co-relation was with FEV1 r = -0.809; symptom score, r = -0.821; activity score, r= -0.849; impact score and r = -0.873 total score. FVC% versus symptoms score r = -0.735; activity score r = -0.729, impacts score r = -0.778; total score r = -0.792. FEV1/FVC versus symptoms score r = -0.227, activity score r = -0.278, impacts score r = -0.263, total score r = -0.274. CONCLUSION SGRQ scores have shown good correlation with functional impairment. It can be used as a modality to evaluate health status of patient in resource constraint settings.
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Affiliation(s)
- Priyanka Singh
- Department of Pulmonary Medicine, Army Hospital (Research and Referral), New Delhi, India
| | - C. D. S. Katoch
- Department of Pulmonary Medicine, Army Institute of Cardio-Thoracic Sciences, Pune, Maharashtra, India
| | - Vasu Vardhan
- Department of Pulmonary Medicine, Army College of Medical Sciences, New Delhi, India
| | - Manu Chopra
- Department of Pulmonary Medicine, Army Hospital (Research and Referral), New Delhi, India
| | - Sarvinder Singh
- Department of Pulmonary Medicine, Army Hospital (Research and Referral), New Delhi, India
| | - Nitin Ahuja
- Department of Hospital Administration, Army Hospital (Research and Referral), New Delhi, India
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Amaro R, Panagiotarakou M, Alcaraz V, Torres A. The efficacy of inhaled antibiotics in non-cystic fibrosis bronchiectasis. Expert Rev Respir Med 2018; 12:683-691. [DOI: 10.1080/17476348.2018.1500179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Rosanel Amaro
- Department of Pulmonary Medicine, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona - Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Meropi Panagiotarakou
- Department of Pneumonology, Sotiria General Hospital for Thoracic Diseases, Medical School, University of Athens, Barcelona, Spain
| | - Victoria Alcaraz
- Fundació Clínic per la Recerca Biomèdica, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Antoni Torres
- Department of Pulmonary Medicine, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona - Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
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Aksamit T, De Soyza A, Bandel TJ, Criollo M, Elborn JS, Operschall E, Polverino E, Roth K, Winthrop KL, Wilson R. RESPIRE 2: a phase III placebo-controlled randomised trial of ciprofloxacin dry powder for inhalation in non-cystic fibrosis bronchiectasis. Eur Respir J 2018; 51:51/1/1702053. [DOI: 10.1183/13993003.02053-2017] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/20/2017] [Indexed: 12/28/2022]
Abstract
We evaluated the efficacy and safety of ciprofloxacin dry powder for inhalation (DPI) in patients with non-cystic fibrosis bronchiectasis, two or more exacerbations in the previous year and predefined sputum bacteria.Patients were randomised 2:1 to twice-daily ciprofloxacin DPI 32.5 mg or placebo in 14- or 28-day on/off treatment cycles for 48 weeks. Primary end-points were time to first exacerbation and frequency of exacerbations. Enrolling countries and α level split (0.049 and 0.001 for 14- and 28-day cycles, respectively) differed from RESPIRE 1.Patients were randomised to ciprofloxacin DPI (14 days on/off (n=176) or 28 days on/off (n=171)) or placebo (14 days on/off (n=88) or 28 days on/off (n=86)). The exacerbation rate was low across treatment arms (mean±sd 0.6±0.9). Active treatment showed trends to prolonged time to first exacerbation (ciprofloxacin DPI 14 days on/off: hazard ratio 0.87, 95.1% CI 0.62–1.21; p=0.3965; ciprofloxacin DPI 28 days on/off: hazard ratio 0.71, 99.9% CI 0.39–1.27; p=0.0511) and reduced frequency of exacerbations (ciprofloxacin DPI 14 days on/off: incidence rate ratio 0.83, 95.1% CI 0.59–1.17; p=0.2862; ciprofloxacin DPI 28 days on/off: incidence rate ratio 0.55, 99.9% CI 0.30–1.02; p=0.0014), although neither achieved statistical significance. Ciprofloxacin DPI was well tolerated.Trends towards clinical benefit were seen with ciprofloxacin DPI, but primary end-points were not met.
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Kim C, Kim DG. Bronchiectasis. Tuberc Respir Dis (Seoul) 2012; 73:249-57. [PMID: 23236316 PMCID: PMC3517943 DOI: 10.4046/trd.2012.73.5.249] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Revised: 06/30/2012] [Accepted: 07/05/2012] [Indexed: 01/22/2023] Open
Abstract
The frequency of diagnosing bronchiectasis is increasing around the world. Cystic fibrosis is the most common inherited cause of bronchiectasis, but there is increasing recognition of significant numbers of patients with bronchiectasis from various causes. With increasing awareness of bronchiectasis, a significant number of research, concerning the causes and treatments, were published over the past few years. Investigation of the underlying cause of bronchiectasis is the most important key to effective management. The purpose of this report is to review the immunological abnormalities that cause bronchiectasis in those that the cystic fibrosis has been excluded, identify the available evidences of current management, and discuss several controversies in the treatment of this disorder.
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Affiliation(s)
- Changhwan Kim
- Department of Internal Medicine and Lung Research Institute, Hallym University College of Medicine, Chuncheon, Korea
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Abstract
Non-cystic fibrosis (CF) bronchiectasis is a common, potentially serious, condition. Further investigations should be performed in an attempt to identify the underlying cause because it may lead to a change in therapy and have significant prognostic implications. MRI is being investigated as a radiation free alternative to high-resolution CT scan of the chest. Many of the treatment recommendations for non-CF bronchiectasis have not been studied in randomized controlled trials but have been extrapolated from the management recommendations for CF. Studies are beginning to inform decisions regarding the management of non-CF bronchiectasis, and an understanding of the best treatment options is beginning to emerge.
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Affiliation(s)
- Charles Feldman
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Parktown, Johannesburg, South Africa.
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