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Yang J, Chen L, Yu H, Hu J, Qiu F. Effects of high-flow nasal cannula oxygen therapy in bronchiectasis and hypercapnia: a retrospective observational study. BMC Pulm Med 2024; 24:217. [PMID: 38698379 PMCID: PMC11067275 DOI: 10.1186/s12890-024-03037-2] [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: 02/01/2024] [Accepted: 04/24/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND The effectiveness of high-flow nasal cannula (HFNC) therapy in patients with bronchiectasis experiencing hypercapnia remains unclear. Our aim was to retrospectively analyze the short-term outcomes of HFNC therapy in such patients, and to further explore the predictors of HFNC treatment failure in this particular patient population. METHODS A retrospective review was conducted on patients with bronchiectasis who received HFNC (n = 70) for hypercapnia (arterial partial pressure of carbon dioxide, PaCO2 ≥ 45 mmHg) between September 2019 and September 2023. RESULTS In the study population, 30% of patients presented with acidemia (arterial pH < 7.35) at baseline. Within 24 h of HFNC treatment, there was a significant reduction in PaCO2 levels by a mean of 4.0 ± 12.7 mmHg (95% CI -7.0 to -1.0 mmHg). Concurrently, arterial pH showed a statistically significant increase with a mean change of 0.03 ± 0.06 (95% CI 0.01 to 0.04). The overall hospital mortality rate in our study was 17.5%. The median length of hospital stay was 11.0 days (interquartile range [IQR] 8.0 to 16.0 days). Sub-analysis revealed no statistically significant differences in hospital mortality (19.0% vs. 20.4%, p = 0.896), length of hospital stay (median 14.0 days [IQR 9.0 to 18.0 days] vs. 10.0 days [IQR 7.0 to 16.0 days], p = 0.117) and duration of HFNC application (median 5.0 days [IQR 2.0 to 8.5 days] vs. 6.0 days [IQR 4.9 to 9.5 days], p = 0.076) between the acidemia group and the non-acidemia group (arterial pH ≥ 7.35). However, more patients in the non-acidemia group had do-not-intubate orders. The overall treatment failure rate for HFNC was 28.6%. Logistic regression analysis identified the APACHE II score (OR 1.24 per point) as the independent predictor of HFNC failure. CONCLUSIONS In patients with bronchiectasis and hypercapnia, HFNC as an initial respiratory support can effectively reduce PaCO2 level within 24 h of treatment. A high APACHE II score has emerged as a prognostic indicator for HFNC treatment failure. These observations highlight randomized controlled trials to meticulously evaluate the efficacy of HFNC in this specific population.
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Affiliation(s)
- Jing Yang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Ningbo University, Liuting Street NO.59, Ningbo, 315010, Zhejiang, China.
| | - Lei Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Ningbo University, Liuting Street NO.59, Ningbo, 315010, Zhejiang, China
| | - Hang Yu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Ningbo University, Liuting Street NO.59, Ningbo, 315010, Zhejiang, China
| | - Jingjing Hu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Ningbo University, Liuting Street NO.59, Ningbo, 315010, Zhejiang, China
| | - Feng Qiu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Ningbo University, Liuting Street NO.59, Ningbo, 315010, Zhejiang, China
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Lee SC, Son KJ, Hoon Han C, Park SC, Jung JY. Cardiovascular and cerebrovascular-associated mortality in patients with preceding bronchiectasis exacerbation. Ther Adv Respir Dis 2022; 16:17534666221144206. [PMID: 36533883 PMCID: PMC9772950 DOI: 10.1177/17534666221144206] [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] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Bronchiectasis is associated with an increased incidence of atherosclerotic cardiovascular disease (ASCaVD) and atherosclerotic cerebrovascular disease (ASCeVD). Its effect on associated mortality is unclear. OBJECTIVES This study investigated the effects of bronchiectasis exacerbation prior to ASCaVD or ASCeVD events on mortality in patients with bronchiectasis using a large population-based database. METHODS A retrospective cohort of patients with bronchiectasis who experienced ASCaVD (n = 1066) or ASCeVD (n = 825) was studied for the first time using a nationwide population-based database (National Health Insurance Service-National Sample Cohort, Korea, 2002-2015). We classified each cohort according to the presence of moderate bronchiectasis exacerbation within 1 year before the ASCaVD or ASCeVD event. We evaluated 90-day, 1-year, and all-cause mortalities risk. RESULTS Within 1 year before the index ASCaVD or ASCeVD event, 149 (13.9%) and 112 (13.6%) patients with bronchiectasis experienced moderate exacerbation(s), respectively. Mild exacerbations did not different in frequency between the survivors and nonsurvivors. In both cohorts, more nonsurvivors experienced moderate exacerbations than survivors. The odds ratios of 90-day and 1-year mortalities and hazard ratios of all-cause mortalities on experiencing moderate exacerbations were 2.27 [95% confidence interval (CI) = 1.26-4.10], 3.30 (95% CI = 2.03-5.38), and 1.78 (95% CI = 1.35-2.34) in the bronchiectasis-ASCaVD cohort and 1.73 (95% CI = 0.94-3.19), 1.79 (95% CI = 1.07-3.00), and 1.47 (95% CI = 1.10-1.95), in the bronchiectasis-ASCeVD cohort. CONCLUSION Hospitalization or emergency room visit for bronchiectasis exacerbation within 1 year before ASCaVD or ASCeVD is associated with an increased ASCaVD- or ASCeVD-associated mortality.
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Affiliation(s)
| | | | - Chang Hoon Han
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
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3
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Factors associated with one-year mortality in hospitalised patients with exacerbated bronchiectasis. Arch Bronconeumol 2022; 58:773-775. [DOI: 10.1016/j.arbres.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/30/2022] [Indexed: 11/19/2022]
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4
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Jindal S. Long-term oxygen therapy – Supplement, maintenance, or palliative drug? Lung India 2022; 39:97-99. [PMID: 35259789 PMCID: PMC9053923 DOI: 10.4103/lungindia.lungindia_74_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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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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Congrete S, Metersky ML. Telemedicine and Remote Monitoring as an Adjunct to Medical Management of Bronchiectasis. Life (Basel) 2021; 11:life11111196. [PMID: 34833072 PMCID: PMC8622988 DOI: 10.3390/life11111196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 10/28/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022] Open
Abstract
The limited resources and the practice of social distancing during the COVID pandemic create a paradigm shift in the utilization of telemedicine in healthcare. However, the implementation of best practices is hampered in part by a lack of literature devoted to telehealth in bronchiectasis. In this commentary, we examine multiple approaches to structuring of telemedicine care for patients with bronchiectasis, highlight current evidence-based interventions that can be incorporated into the management of bronchiectasis, and describe our experience with telemedicine at the University of Connecticut Center for Bronchiectasis Care during the COVID-19 pandemic. The structural model must be adapted to different local dynamics and available technologies with careful attention to patient characteristics and access to technology to avoid the potential paradoxical effects of increasing patients’ burden and healthcare disparities in underserved populations.
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Park Y, Yong SH, Leem AY, Kim SY, Lee SH, Chung K, Kim EY, Jung JY, Kang YA, Park MS, Kim YS, Lee SH. Impact of non-cystic fibrosis bronchiectasis on critically ill patients in Korea: a retrospective observational study. Sci Rep 2021; 11:15757. [PMID: 34345008 PMCID: PMC8333349 DOI: 10.1038/s41598-021-95366-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/26/2021] [Indexed: 11/26/2022] Open
Abstract
This study investigated the impact of bronchiectasis on patients admitted to the intensive care unit (ICU) at a hospital in Korea. Patients with bronchiectasis were diagnosed using results of chest computed tomography performed before ICU admission. The severity of bronchiectasis was based on the number of affected lobes, and patients with ≥ 3 bronchiectatic lobes were classified into the severe bronchiectasis group. Overall, 823 patients were enrolled. The mean age was 66.0 ± 13.9 years, and 63.4% were men. Bronchiectasis and severe bronchiectasis were present in 148 (18.0%) and 108 (13.1%) patients, respectively. The increase in the number of bronchiectatic lobes was related to the rise in ICU mortality (P for trend = 0.012) and in-hospital mortality (P for trend = 0.004). Patients with severe bronchiectasis had higher odds for 28-day mortality [odds ratio (OR) 1.122, 95% confidence interval (CI) 1.024–1.230], ICU mortality (OR 1.119, 95% CI 1.023–1.223), and in-hospital mortality (OR 1.208, 95% CI 1.092–1.337). The severe bronchiectasis group showed lower overall survival (log-rank P < 0.001), and the adjusted hazard ratio was 1.535 (95% CI 1.178–2.001). Severe bronchiectasis had a negative impact on all-cause mortality during ICU and hospital stays, resulting in a lower survival rate.
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Affiliation(s)
- Youngmok Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Seung Hyun Yong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Ah Young Leem
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Song Yee Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Sang Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyungsoo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Eun Young Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Ji Ye Jung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Young Ae Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Moo Suk Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Young Sam Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Su Hwan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Detailleur S, Vos R, Goeminne P. The Deteriorating Patient: Therapies Including Lung Transplantation. Semin Respir Crit Care Med 2021; 42:623-638. [PMID: 34261186 DOI: 10.1055/s-0041-1730946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In this review paper, we discuss the characteristics that define severe bronchiectasis and which may lead to deterioration of noncystic fibrosis bronchiectasis. These characteristics were used to establish the current severity scores: bronchiectasis severity index (BSI), FACED, and E-FACED (exacerbation frequency, forced expiratory volume in 1 second, age, colonization, extension and dyspnea score). They can be used to predict mortality, exacerbation rate, hospital admission, and quality of life. Furthermore, there are different treatable traits that contribute to severe bronchiectasis and clinical deterioration. When present, they can be a target of the treatment to stabilize bronchiectasis.One of the first steps in treatment management of bronchiectasis is evaluation of compliance to already prescribed therapy. Several factors can contribute to treatment adherence, but to date no real interventions have been published to ameliorate this phenomenon. In the second step, treatment in deteriorating patients with bronchiectasis should be guided by the predominant symptoms, for example, cough, sputum, difficulty expectoration, exacerbation rate, or physical impairment. In the third step, we evaluate treatable traits that could influence disease severity in the deteriorating patient. Finally, in patients who are difficult to treat despite maximum medical treatment, eligibility for surgery (when disease is localized), should be considered. In case of end-stage disease, the evaluation for lung transplantation should be performed. Noninvasive ventilation can serve as a bridge to lung transplantation in patients with respiratory failure.
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Affiliation(s)
- Stephanie Detailleur
- Department of Respiratory Diseases, University Hospital Gasthuisberg, Leuven, Belgium
| | - Robin Vos
- Department of Respiratory Diseases, University Hospital Gasthuisberg, Leuven, Belgium
| | - Pieter Goeminne
- Department of Respiratory Diseases, AZ Nikolaas, Sint-Niklaas, Belgium
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9
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Zhang J, Wang S, Shao C. Reversible bronchial dilatation in adults. Clin Exp Pharmacol Physiol 2021; 48:966-970. [PMID: 33811371 DOI: 10.1111/1440-1681.13503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 09/27/2020] [Accepted: 03/26/2021] [Indexed: 11/28/2022]
Abstract
Bronchiectasis is characterized by the destruction of bronchial wall and persistent irreversible bronchiectasis due to respiratory infection and bronchial obstruction. Reversible bronchiectasis is rarely reported in adults. The study aims to evaluate dynamic changes in chest computed tomography (CT) findings and relevant factors affecting improvement or reversal of bronchiectasis. A total of 239 patients with bronchiectasis admitted to our hospital from January 2009 to December 2019 were retrospectively analyzed. 23 patients (group A) with bronchiectasis reversion or improvement confirmed by chest CT were matched with patients in group B according to gender and age (difference <5 years). 23 patients (group B) with bronchiectasis progression or no obvious improvement confirmed by chest CT were selected from the remaining patients. The clinical features and imaging findings of the two groups were compared. The duration of disease in group A was less than that in group B, and the stable period was longer (p < 0.05). There was no significant difference in other clinical features between the two groups. In contrast to the traditional concept of "Bronchiectasis", our results suggested that some adult bronchiectasis can be improved and completely radiologically reversed.
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Affiliation(s)
- Jun Zhang
- Department of Pulmonary Medicine, Shanghai Respiratory Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Sijiao Wang
- Department of Pulmonary Medicine, Shanghai Respiratory Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Changzhou Shao
- Department of Pulmonary Medicine, Shanghai Respiratory Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Pulmonary Medicine, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
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Sanchez-Muñoz G, López-de-Andrés A, Hernández-Barrera V, Pedraza-Serrano F, Jimenez-Garcia R, Lopez-Herranz M, Puente-Maestu L, de Miguel-Diez J. Hospitalizations for Community-Acquired and Non-Ventilator-Associated Hospital-Acquired Pneumonia in Spain: Influence of the Presence of Bronchiectasis. A Retrospective Database Study. J Clin Med 2020; 9:jcm9082339. [PMID: 32707912 PMCID: PMC7463658 DOI: 10.3390/jcm9082339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/13/2020] [Accepted: 07/21/2020] [Indexed: 12/17/2022] Open
Abstract
To examine and compare in-hospital mortality (IHM) of community-acquired pneumonia (CAP) and non-ventilator hospital-acquired pneumonia (NV-HAP) among patients with or without bronchiectasis (BQ) using propensity score matching. A retrospective observational epidemiological study using the Spanish Hospital Discharge Records, 2016–17. We identified 257,455 admissions with CAP (3.97% with BQ) and 17,069 with NV-HAP (2.07% with BQ). Patients with CAP and BQ had less comorbidity, lower IHM, and a longer mean length of hospital stay (p < 0.001) than non-BQ patients. They had a higher number of isolated microorganisms, including Pseudomonas aeruginosa. In patients with BQ and NV-HAP, no differences were observed with respect to comorbidity, in-hospital mortality (IHM), or mean length of stay. P. aeruginosa was more frequent (p = 0.028). IHM for CAP and NV-HAP with BQ was 7.89% and 20.06%, respectively. The factors associated with IHM in CAP with BQ were age, comorbidity, pressure ulcers, surgery, dialysis, and invasive ventilation, whereas in NV-HAP with BQ, the determinants were age, metastatic cancer, need for dialysis, and invasive ventilation. Patients with CAP and BQ have less comorbidity, lower IHM and a longer mean length of hospital stay than non-BQ patients. However, they had a higher number of isolated microorganisms, including Pseudomonas aeruginosa. In patients with BQ and NV-HAP, no differences were observed with respect to comorbidity, in-hospital mortality, or mean length of stay, but they had a greater frequency of infection by P. aeruginosa than non-BQ patients. Predictors of IHM for both types of pneumonia among BQ patients included dialysis and invasive ventilation.
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Affiliation(s)
- Gema Sanchez-Muñoz
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009 Madrid, Spain; (G.S.-M.); (F.P.-S.); (L.P.-M.); (J.d.M.-D.)
| | - Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, 28922 Madrid, Spain;
- Correspondence:
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, 28922 Madrid, Spain;
| | - Fernando Pedraza-Serrano
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009 Madrid, Spain; (G.S.-M.); (F.P.-S.); (L.P.-M.); (J.d.M.-D.)
| | - Rodrigo Jimenez-Garcia
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Marta Lopez-Herranz
- Faculty of Nursing, Physiotherapy and Podology, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Luis Puente-Maestu
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009 Madrid, Spain; (G.S.-M.); (F.P.-S.); (L.P.-M.); (J.d.M.-D.)
| | - Javier de Miguel-Diez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009 Madrid, Spain; (G.S.-M.); (F.P.-S.); (L.P.-M.); (J.d.M.-D.)
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Sin S, Yun SY, Kim JM, Park CM, Cho J, Choi SM, Lee J, Park YS, Lee SM, Yoo CG, Kim YW, Han SK, Lee CH. Mortality risk and causes of death in patients with non-cystic fibrosis bronchiectasis. Respir Res 2019; 20:271. [PMID: 31796019 PMCID: PMC6889428 DOI: 10.1186/s12931-019-1243-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 11/18/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND All-cause mortality risk and causes of death in bronchiectasis patients have not been fully investigated. The aim of this study was to compare the mortality risk and causes of death between individuals with bronchiectasis and those without bronchiectasis. METHODS Patients with or without bronchiectasis determined based on chest computed tomography (CT) at one centre between 2005 and 2016 were enrolled. Among the patients without bronchiectasis, a control group was selected after applying additional exclusion criteria. We compared the mortality risk and causes of death between the bronchiectasis and control groups without lung disease. Subgroup analyses were also performed according to identification of Pseudomonas or non-tuberculous mycobacteria, airflow limitation, and smoking status. RESULTS Of the total 217,702 patients who underwent chest CT, 18,134 bronchiectasis patients and 90,313 non-bronchiectasis patients were included. The all-cause mortality rate in the bronchiectasis group was 1608.8 per 100,000 person-years (95% confidence interval (CI), 1531.5-1690.0), which was higher than that in the control group (133.5 per 100,000 person-years; 95% CI, 124.1-143.8; P < 0.001). The bronchiectasis group had higher all-cause (adjusted hazard ratio (aHR), 1.26; 95% CI, 1.09-1.47), respiratory (aHR, 3.49; 95% CI, 2.21-5.51), and lung cancer-related (aHR, 3.48; 95% CI, 2.33-5.22) mortality risks than the control group. In subgroup analysis, patients with airflow limitation and ever smokers showed higher all-cause mortality risk among bronchiectasis patients. Therefore, we observed significant interrelation between bronchiectasis and smoking, concerning the risks of all-cause mortality (P for multiplicative interaction, 0.030, RERI, 0.432; 95% CI, 0.097-0.769) and lung cancer-related mortality (RERI, 8.68; 95% CI, 1.631-15.736). CONCLUSION Individuals with bronchiectasis had a higher risk of all-cause, respiratory, and lung cancer-related mortality compared to control group. The risk of all-cause mortality was more prominent in those with airflow limitation and in ever smokers.
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Affiliation(s)
- Sooim Sin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea
- Kangwon National University College of Medicine, Chuncheon, Republic of Korea
| | - Seo Young Yun
- Division of Pulmonary and Critical Care Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Centre, Seoul, Republic of Korea
| | - Jee Min Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Centre, Seoul, Republic of Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jaeyoung Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun Mi Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Sik Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chul-Gyu Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Whan Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung Koo Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea.
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12
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Rahaghi F, Omert L, Clark V, Sandhaus RA. Managing the Alpha-1 patient in the ICU: Adapting broad critical care strategies in AATD. J Crit Care 2019; 54:212-219. [PMID: 31614323 DOI: 10.1016/j.jcrc.2019.08.027] [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: 01/15/2019] [Revised: 07/17/2019] [Accepted: 08/27/2019] [Indexed: 10/26/2022]
Abstract
Alpha-1 Antitrypsin Deficiency (AATD) is a progressive pulmonary disease under-recognized or misdiagnosed by clinicians. Patients with AATD can develop a variety of organ-specific complications and as a result, often require hospitalization and treatment within critical care and ICU settings. Due to the complexity of AATD there are minimal guidelines in place to address the specific and highly variable needs of these patients in the critical care setting. This review presents clinical considerations with respect to the management of patients with AATD and provides treatment recommendations for these patients in the critical care setting. In addition, we have outlined certain aspects of the care of this patient population that may be of interest to critical care practitioners. With greater disease awareness and earlier diagnosis the onset of symptoms can be delayed, which will ultimately reduce the frequency of deleterious health consequences.
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Affiliation(s)
- Franck Rahaghi
- Pulmonary and Critical Care Division, Cleveland Clinic Florida, Weston, Florida, United States.
| | - Laurel Omert
- CSL Behring, King of Prussia, PA, United States.
| | - Virginia Clark
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, United States.
| | - Robert A Sandhaus
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, United States.
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13
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Hill AT, Sullivan AL, Chalmers JD, De Soyza A, Elborn SJ, Floto AR, Grillo L, Gruffydd-Jones K, Harvey A, Haworth CS, Hiscocks E, Hurst JR, Johnson C, Kelleher PW, Bedi P, Payne K, Saleh H, Screaton NJ, Smith M, Tunney M, Whitters D, Wilson R, Loebinger MR. British Thoracic Society Guideline for bronchiectasis in adults. Thorax 2019; 74:1-69. [PMID: 30545985 DOI: 10.1136/thoraxjnl-2018-212463] [Citation(s) in RCA: 233] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Adam T Hill
- Respiratory Medicine, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - Anita L Sullivan
- Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust (Queen Elizabeth Hospital), Birmingham, UK
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital, Dundee, UK
| | - Anthony De Soyza
- Institute of Cellular Medicine, NIHR Biomedical Research Centre for Aging and Freeman Hospital Adult Bronchiectasis service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Stuart J Elborn
- Royal Brompton Hospital and Imperial College London, and Queens University Belfast
| | - Andres R Floto
- Department of Medicine, University of Cambridge, Cambridge UK.,Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge UK
| | | | | | - Alex Harvey
- Department of Clinical Sciences, Brunel University London, London, UK
| | - Charles S Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge UK
| | | | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | | | - Peter W Kelleher
- Centre for Immunology and Vaccinology, Chelsea &Westminster Hospital Campus, Department of Medicine, Imperial College London.,Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital and Harefield NHS Foundation Trust, London.,Chest & Allergy Clinic St Mary's Hospital, Imperial College Healthcare NHS Trust
| | - Pallavi Bedi
- University of Edinburgh MRC Centre for Inflammation Research, Edinburgh, UK
| | | | | | | | - Maeve Smith
- University of Alberta, Edmonton, Alberta, Canada
| | - Michael Tunney
- School of Pharmacy, Queens University Belfast, Belfast, UK
| | | | - Robert Wilson
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital and Harefield NHS Foundation Trust, London
| | - Michael R Loebinger
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital and Harefield NHS Foundation Trust, London
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14
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Bartley J, Garrett J, Camargo CA, Scragg R, Vandal A, Sisk R, Milne D, Tai R, Jeon G, Cursons R, Wong C. Vitamin D 3 supplementation in adults with bronchiectasis: A pilot study. Chron Respir Dis 2018; 15:384-392. [PMID: 29490469 PMCID: PMC6234573 DOI: 10.1177/1479972318761646] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/24/2018] [Indexed: 11/15/2022] Open
Abstract
Vitamin D supplementation prevents acute respiratory infections and, through modulating innate and adaptive immunity, could have a potential role in bronchiectasis management. The primary aims of this pilot study were to assess serum 25-hydroxyvitamin D (25(OH)D) levels in New Zealand adults with bronchiectasis, and their 25(OH)D levels after vitamin D3 supplementation. Adults with bronchiectasis received an initial 2.5 mg vitamin D3 oral loading dose and 0.625 mg vitamin D3 weekly for 24 weeks. The primary outcome was serum 25(OH)D levels before and after vitamin D3 supplementation. Secondary outcomes (time to first infective exacerbation, exacerbation frequency, spirometry, health-related quality of life measures, sputum bacteriology and cell counts and chronic rhinosinusitis) were also assessed. This study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN 12612001222831). The initial, average 25(OH)D level was 71 nmol/L (95% confidence interval (CI): [58, 84]), rising to 218 nmol/L (95% CI: [199, 237]) at 12 weeks and 205 nmol/L (95% CI: [186, 224]) at 24 weeks. The initial serum cathelicidin level was 25 nmol/L (95% CI: [17, 33]), rising to 102 nmol/L (95% CI: [48, 156]) at 12 weeks and 151 nmol/L (95% CI: [97, 205]) at 24 weeks. Over the 24-week study period, we observed statistically significant changes of 1.11 (95% CI: [0.08, 2.14]) in the Leicester Cough Questionnaire and -1.97 (95% CI: [-3.71, -0.23]) in the Dartmouth COOP charts score. No significant adverse effects were recorded. Many New Zealand adults with bronchiectasis have adequate 25(OH)D levels. Weekly vitamin D3 supplementation significantly improved 25(OH)D levels.
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Affiliation(s)
- Jim Bartley
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Jeff Garrett
- Department of Respiratory Medicine, Middlemore Hospital, Auckland, New Zealand
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Robert Scragg
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Alain Vandal
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
- Ko Awatea, Counties Manukau District Health Board, Auckland, New Zealand
| | - Rose Sisk
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - David Milne
- Department of Radiology, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Ray Tai
- Department of Radiology, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Gene Jeon
- Middlemore Clinical Trials Unit, Middlemore Hospital, Auckland, New Zealand
| | - Ray Cursons
- Faculty of Science and Engineering, University of Waikato, Hamilton, New Zealand
| | - Conroy Wong
- Department of Respiratory Medicine, Middlemore Hospital, Auckland, New Zealand
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15
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Hung CT, Li SF, Chung WS. Increased risk of acute coronary syndrome in patients with bronchiectasis: A population-based cohort study. Respirology 2018; 23:828-834. [PMID: 29641845 DOI: 10.1111/resp.13298] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 02/16/2018] [Accepted: 02/26/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVE There are few studies on the relationship between bronchiectasis and acute coronary syndrome (ACS). We conducted a population-based cohort study to assess whether bronchiectasis was associated with an increased risk of ACS. METHODS We identified 3521 patients diagnosed with bronchiectasis between 2000 and 2010 (bronchiectasis cohort) and frequency matched them with 14 084 randomly selected people without bronchiectasis from the general population (comparison cohort) according to sex, age and index year using the Longitudinal Health Insurance Database. Both cohorts were followed until the end of 2010 to determine the ACS incidence. Hazard ratios of ACS were measured. RESULTS Based on 17 340 person-years for bronchiectasis patients and 73 639 person-years for individuals without bronchiectasis, the overall ACS risk was 40% higher in the bronchiectasis cohort (adjusted hazard ratio (HR) = 1.40; 95% CI: 1.20-1.62). Compared with those in the comparison cohort with one respiratory infection-related emergency room (ER) visit per year, the ACS risk was 5.46-fold greater in bronchiectasis patients with three or more ER visits per year (adjusted HR = 5.46, 95% CI: 4.29-6.96). Patients with bronchiectasis and three or more respiratory infection-related hospitalizations per year had an 8.15-fold higher ACS risk (adjusted HR = 8.15, 95% CI: 6.27-10.61). CONCLUSION Bronchiectasis patients, particularly those experiencing frequent exacerbations with three or more ER visits and consequent hospitalization per year, are at an increased ACS risk.
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Affiliation(s)
- Chin-Tun Hung
- Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Shu-Fen Li
- Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Wei-Sheng Chung
- Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
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16
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Hsieh MH, Fang YF, Chung FT, Lee CS, Chang YC, Liu YZ, Wu CH, Lin HC. Distance-saturation product of the 6-minute walk test predicts mortality of patients with non-cystic fibrosis bronchiectasis. J Thorac Dis 2017; 9:3168-3176. [PMID: 29221293 DOI: 10.21037/jtd.2017.08.53] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Previous surveillance methods to monitor the prognoses of patients with bronchiectasis are too complex for use in daily practice. The 6-minute walk test (6MWT) is a simple exercise test to predict the prognosis of chronic obstructive airway disease and numerous chronic lung diseases, including idiopathic pulmonary fibrosis. No studies have investigated exercise-induced oxygen desaturation (EID) and distance-saturation product (DSP) of 6MWT to predict the prognoses of patients with bronchiectasis. Methods This was a prospective study to identify correlations between variables of 6MWT and mortality in patients with bronchiectasis over a 6-year period. The study cohort included 69 patients with stable non-cystic fibrosis (non-CF) bronchiectasis who were regularly evaluated for functional status via 6-minute walk distance (6MWD), spirometry, BODE index, EID, and DSP. Results Of the 69 patients, 9 (13%) died and 60 (87%) survived during the 6-year follow-up period. The percentage of EID was higher [7 of 9 patients (78%) vs. 22 of 60 patients (27%), P=0.003] in the non-survivors group. The 6MWD (467.9±77.1 vs. 363.7±126.7 m, P=0.001) was higher in the survivors group. DSP was significantly lower in the non-survivors group (411.0±78.4 vs. 283.9±90.0 m%, P<0.001). Multivariate analysis showed that DSP (OR =0.983; 95% CI: 0.974-0.993, P=0.001) was the best parameter of 6MWT to predict mortality. Patients with a lower DSP of <280 m% were at a 66.5-fold greater risk (OR =66.5; 95% CI: 9.4-469.2) of 6-year mortality compared with those with DSP >280 m% (P<0.001). Conclusions DSP is a simple parameter to predict 6-year mortality in patients with non-CF bronchiectasis.
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Affiliation(s)
- Meng-Heng Hsieh
- Department of Thoracic Medicine, Chang Gung Medical Foundation, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Yueh-Fu Fang
- Department of Thoracic Medicine, Chang Gung Medical Foundation, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Fu-Tsai Chung
- Department of Thoracic Medicine, Chang Gung Medical Foundation, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chung-Shu Lee
- Department of Thoracic Medicine, Chang Gung Medical Foundation, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Yu-Chen Chang
- Department of Nuclear Medicine, Chang Gung Medical Foundation, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Yuan-Zhang Liu
- Department of Radiology, Chang Gung Medical Foundation, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Cheng-Hsien Wu
- Department of Radiology, Chang Gung Medical Foundation, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Horng-Chyuan Lin
- Department of Thoracic Medicine, Chang Gung Medical Foundation, Chang Gung University, College of Medicine, Taoyuan, Taiwan
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17
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Hind M, Polkey MI, Simonds AK. AJRCCM: 100-Year Anniversary. Homeward Bound: A Centenary of Home Mechanical Ventilation. Am J Respir Crit Care Med 2017; 195:1140-1149. [PMID: 28459325 DOI: 10.1164/rccm.201702-0285ci] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The evolution of home mechanical ventilation is an intertwined chronicle of negative and positive pressure modes and their role in managing ventilatory failure in neuromuscular diseases and other chronic disorders. The uptake of noninvasive positive pressure ventilation has resulted in widespread growth in home ventilation internationally and fewer patients being ventilated invasively. As with many applications of domiciliary medical technology, home ventilatory support has either led or run in parallel with acute hospital applications and has been influenced by medical and societal shifts in the approach to chronic care, the creation of community support teams, a preference of recipients to be treated at home, and economic imperatives. This review summarizes the trends and growing evidence base for ventilatory support outside the hospital.
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Affiliation(s)
- Matthew Hind
- National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton & Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Michael I Polkey
- National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton & Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Anita K Simonds
- National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton & Harefield National Health Service Foundation Trust, London, United Kingdom
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18
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Navaratnam V, Muirhead CR, Hubbard RB, De Soyza A. Critical care admission trends and outcomes in individuals with bronchiectasis in the UK. QJM 2016; 109:523-6. [PMID: 26582824 PMCID: PMC4986424 DOI: 10.1093/qjmed/hcv206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/15/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are limited data on admission trends and outcomes of individuals with bronchiectasis admitted to intensive care (ICU). Using national critical care data, we analysed admissions to ICU and estimated outcomes in terms of mortality in individuals with bronchiectasis and chronic obstructive pulmonary disease (COPD) admitted to ICU. METHODS Using data from the Intensive Care National Audit and Research Centre, admissions from bronchiectasis and COPD from 1 January 2009 to 31 December 2013 were extracted. Crude admission rates for bronchiectasis and COPD were calculated and Poisson regression was used to estimate unadjusted annual admission rate ratios. We investigated changes to length of stay on ICU, ICU mortality and in-hospital mortality during the study period. We also compared mortality rates in people with bronchiectasis and COPD aged 70 or above. RESULTS We found an annual increase of 8% (95% Confidence Interval [CI] 2-15) in the number of ICU admissions from bronchiectasis, whilst the yearly increase in ICU admissions from COPD was 1% (95% CI 0.3-2). ICU and in-hospital mortality was higher in individuals with bronchiectasis compared with those with COPD, especially in people aged 70 years or above. CONCLUSION Admission to ICU in people with bronchiectasis are uncommon, but are increasing in frequency over time, and carries a substantial mortality rate. This needs to be considered allocating health care resources and planning respiratory services.
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Affiliation(s)
- Vidya Navaratnam
- From the Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK BronchUK, a MRC Funded Partnership in Bronchiectasis
| | - Colin R Muirhead
- BronchUK, a MRC Funded Partnership in Bronchiectasis Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Richard B Hubbard
- From the Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK BronchUK, a MRC Funded Partnership in Bronchiectasis
| | - Anthony De Soyza
- BronchUK, a MRC Funded Partnership in Bronchiectasis Institute of Cellular Medicine, Newcastle University & Sir William Leech Centre, Newcastle upon Tyne, UK
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Malik S, Shneiderman B, Du F, Plaisant C, Bjarnadottir M. High-Volume Hypothesis Testing. ACM T INTERACT INTEL 2016. [DOI: 10.1145/2890478] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cohort comparison studies have traditionally been hypothesis driven and conducted in carefully controlled environments (such as clinical trials). Given two groups of event sequence data, researchers test a single hypothesis (e.g., does the group taking Medication A exhibit more deaths than the group taking Medication B?). Recently, however, researchers have been moving toward more exploratory methods of retrospective analysis with existing data. In this article, we begin by showing that the task of cohort comparison is specific enough to support automatic computation against a bounded set of potential questions and objectives, a method that we refer to as High-Volume Hypothesis Testing (HVHT). From this starting point, we demonstrate that the diversity of these objectives, both across and within different domains, as well as the inherent complexities of real-world datasets, still requires human involvement to determine meaningful insights. We explore how visualization and interaction better support the task of exploratory data analysis and the understanding of HVHT results (how significant they are, why they are meaningful, and whether the entire dataset has been exhaustively explored). Through interviews and case studies with domain experts, we iteratively design and implement visualization and interaction techniques in a visual analytics tool, CoCo. As a result of our evaluation, we propose six design guidelines for enabling users to explore large result sets of HVHT systematically and flexibly in order to glean meaningful insights more quickly. Finally, we illustrate the utility of this method with three case studies in the medical domain.
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Affiliation(s)
- Sana Malik
- University of Maryland, College Park, MD
| | | | - Fan Du
- University of Maryland, College Park, MD
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Tang X, Bi J, Yang D, Chen S, Li Z, Chen C, Wang G, Ju M, Wang J, Wang Y, Gong R, Bai C, Zhuo H, Jin X, Song Y. Emphysema is an independent risk factor for 5-year mortality in patients with bronchiectasis. CLINICAL RESPIRATORY JOURNAL 2016; 11:887-894. [PMID: 26662880 DOI: 10.1111/crj.12432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 11/04/2015] [Accepted: 12/04/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Bronchiectasis is a common disabling respiratory disease in China. However, the literatures that focused on the long-term prognosis and the risk factors for mortality are limited. OBJECTIVE The aim of this study was to identify risk factors for 5-year mortality in patients with bronchiectasis. METHODS A retrospective study was conducted. Patients who were newly diagnosed with bronchiectasis by thoracic conventional CT scans from January 2003 to March 2008 were assessed. Baseline characteristics, symptoms, radiographic extent, pulmonary function tests data and comorbidities were recorded through chart review. The vital status of the patients was obtained by telephone contact and record of hospital admission. Multivariate cox regression analysis was used to determine the independent risk factors for 5-year mortality. RESULTS Eighty-nine patients newly diagnosed with bronchiectasis were included in our cohort. The mean age of the cohort was 55.29 ± 16.15 and 49.4% of the patients were female. At the end of the study, 12 patients (13.5%) died and the mean survival time was 57.05 ± 1.09 months. Multivariate analysis revealed that long-term mortality was significantly associated with emphysema (HR, 5.62; 95% confidence interval [CI], 1.35-23.46; P = 0.02) and radiographic extent (HR, 1.62; 95% CI, 1.02-2.58; P = 0.04). CONCLUSION The main finding of our study was that emphysema might be a risk factor for mortality in patients with bronchiectasis.
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Affiliation(s)
- Xinjun Tang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai Respiratory Research Institute, Shanghai, People's Republic of China
| | - Jing Bi
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai Respiratory Research Institute, Shanghai, People's Republic of China
| | - Dawei Yang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai Respiratory Research Institute, Shanghai, People's Republic of China
| | - Shujing Chen
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai Respiratory Research Institute, Shanghai, People's Republic of China
| | - Zhuozhe Li
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai Respiratory Research Institute, Shanghai, People's Republic of China
| | - Cuicui Chen
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai Respiratory Research Institute, Shanghai, People's Republic of China
| | - Guifang Wang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai Respiratory Research Institute, Shanghai, People's Republic of China
| | - Mohan Ju
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai Respiratory Research Institute, Shanghai, People's Republic of China
| | - Jingru Wang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai Respiratory Research Institute, Shanghai, People's Republic of China
| | - Yanan Wang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai Respiratory Research Institute, Shanghai, People's Republic of China
| | - Ranxia Gong
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai Respiratory Research Institute, Shanghai, People's Republic of China
| | - Chunxue Bai
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai Respiratory Research Institute, Shanghai, People's Republic of China
| | - Hanjing Zhuo
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
| | - Xiaoyan Jin
- Department of Pulmonary Medicine, Tongren Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Yuanlin Song
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai Respiratory Research Institute, Shanghai, People's Republic of China
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ÇİFTCİ F, ŞEN E, SARYAL SB, ÖNEN ZP, GÜLBAY B, YILDIZ Ö, ACICAN T, KARABIYIKOĞLU G. The factors affecting survival in patients with bronchiectasis. Turk J Med Sci 2016; 46:1838-1845. [DOI: 10.3906/sag-1511-137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/27/2016] [Indexed: 11/03/2022] Open
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22
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Polverino E, Cilloniz C, Menendez R, Gabarrus A, Rosales-Mayor E, Alcaraz V, Terraneo S, Puig de la Bella Casa J, Mensa J, Ferrer M, Torres A. Microbiology and outcomes of community acquired pneumonia in non cystic-fibrosis bronchiectasis patients. J Infect 2015; 71:28-36. [PMID: 25882347 DOI: 10.1016/j.jinf.2015.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 03/25/2015] [Accepted: 03/28/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND It is general belief that Non-cystic fibrosis bronchiectasis (NCFB) is characterized by frequent community-acquired pneumonia. Nonetheless, the knowledge on clinical characteristics of CAP in NCFBE is poor and no specific recommendations are available. We aim to investigate clinical and microbiological characteristics of NCFBE patients with CAP. METHODS Prospective observational study of 3495 CAP patients (2000-2011). RESULTS We found 90 (2.0%) NCFBE-CAP that in comparison with non-bronchiectatic CAP (n, 3405) showed older age (mean ± [SD], NCFBE-CAP 73 ± 14 vs. CAP 65 ± 19yrs), more vaccinations (pneumococcal: 35% vs. 14%; influenza: 60% vs. 42%), comorbidities (n ≥ 2: 43% vs. 25%), previous antibiotics (38% vs. 22%), and inhaled steroids (53% vs. 16%) (p < 0.05 each). Streptococcus pneumoniae was the most frequent isolate in both groups (NCFBE-CAP 44.4% vs. CAP 42.7%; p = 0.821) followed by respiratory virus, mixed infections and atypical bacteria. Considering overall frequencies of the main pathogens (including monomicrobial and mixed infections) Pseudomonas aeruginosa (15.5% vs. 2.9%; p < 0.001) and Enterobacteriaceae (8.8% vs. 2.4%; p = 0.025) were more prevalent in NCFBE-CAP patients than in CAP. Despite these clinical and microbiological differences, NCFBE-CAP showed similar outcomes to CAP patients (mortality, length of hospital stay, etc.). CONCLUSIONS NCFBE-CAP patients are usually older and have more comorbidities but similar outcomes than general CAP population. Usual CAP pathogens, such as S. pneumoniae, are also involved in NCFBE-CAP but P. aeruginosa and other Enterobacteriaceae were globally more frequent than in CAP. Therefore, a wide microbiological investigation should be recommended in all NCFBE-CAP cases as well as routine pneumococcal vaccination for prevention of pneumonia.
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Affiliation(s)
- Eva Polverino
- Department of Pneumology, 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), Spain
| | - Catia Cilloniz
- Department of Pneumology, 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), Spain
| | - Rosario Menendez
- Department of Pneumology, Hospital La Fe Valencia, Ciber de Enfermedades Respiratorias (CIBERES), Spain
| | - Albert Gabarrus
- Department of Pneumology, 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), Spain
| | - Edmundo Rosales-Mayor
- Department of Pneumology, 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), Spain
| | - Victoria Alcaraz
- Department of Pneumology, 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), Spain
| | - Silvia Terraneo
- Respiratory Unit, San Paolo Hospital, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | | | - Josep Mensa
- Department of Infectious Disease, Hospital Clinic of Barcelona, Spain
| | - Miquel Ferrer
- Department of Pneumology, 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), Spain
| | - Antoni Torres
- Department of Pneumology, 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), Spain.
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Surgical treatment of bronchiectasis: A retrospective observational study of 260 patients. Int J Surg 2014; 12:1050-4. [DOI: 10.1016/j.ijsu.2014.08.398] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 08/19/2014] [Accepted: 08/21/2014] [Indexed: 11/18/2022]
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Goeminne PC, Nawrot TS, Ruttens D, Seys S, Dupont LJ. Mortality in non-cystic fibrosis bronchiectasis: a prospective cohort analysis. Respir Med 2014; 108:287-96. [PMID: 24445062 DOI: 10.1016/j.rmed.2013.12.015] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 12/22/2013] [Accepted: 12/27/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION There is limited data on mortality and associated morbidity in non-cystic fibrosis bronchiectasis (NCFB). Our aim was to analyze the overall mortality for all newly diagnosed patients from June 2006 onwards and to evaluate risk factors for mortality in this cohort. METHODS 245 patients who had a new diagnosis of NCFB between June 2006 and October 2012 at the University Hospital of Leuven, Belgium, were included in the analysis. Death was analyzed until end of November 2013. All patients had chest HRCT scan confirming the presence of bronchiectatic lesions and had symptoms of chronic productive cough. Univariate and multivariate Cox proportional hazard survival regression analysis was used to estimate hazard ratios (HR) and their 95% confidence intervals (CI) of variables possibly predicting mortality. RESULTS Overall mortality in NCFB patients who had a median follow-up of 5.18 years was 20.4%. Patients with NCFB and associated chronic obstructive pulmonary disease (COPD) had a mortality of 55% in that period. Univariate analysis showed higher mortality according to age, gender, smoking history, Pseudomonas aeruginosa status, spirometry, radiological extent, total number of sputum bacteria and underlying etiology. Multivariate analysis showed significant higher mortality with increasing age (HR = 1.045; p = 0.004), with increasing number of lobes affected (HR = 1.53; p = 0.009) and when patients had COPD associated NCFB (HR = 2.12; p = 0.038). The majority of the 50 deaths were respiratory related (n = 29; 58%). CONCLUSION NCFB patients with associated COPD disease had the highest mortality rates compared to the other NCFB patients. Additional risk factors for lower survival were increasing age and number of lobes affected.
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Affiliation(s)
- P C Goeminne
- University Hospital of Gasthuisberg, Department of Respiratory Disease, Leuven, Belgium.
| | - T S Nawrot
- Center for Environmental Sciences Hasselt University, Hasselt, Belgium
| | - D Ruttens
- University Hospital of Gasthuisberg, Department of Respiratory Disease, Leuven, Belgium
| | - S Seys
- Laboratory of Clinical Immunology, Catholic University of Leuven, Leuven, Belgium
| | - L J Dupont
- University Hospital of Gasthuisberg, Department of Respiratory Disease, Leuven, Belgium
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Hsieh MH, Fang YF, Chen GY, Chung FT, Liu YC, Wu CH, Chang YC, Lin HC. The role of the high-sensitivity C-reactive protein in patients with stable non-cystic fibrosis bronchiectasis. Pulm Med 2013; 2013:795140. [PMID: 24381758 PMCID: PMC3870862 DOI: 10.1155/2013/795140] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 09/26/2013] [Accepted: 10/18/2013] [Indexed: 11/23/2022] Open
Abstract
Study Objectives. The aim of this study is to investigate the correlation between serum high-sensitivity C-reactive protein (hs-CRP) and other clinical tools including high-resolution computed tomography (HRCT) in patients with stable non-CF bronchiectasis. Design. A within-subject correlational study of a group of patients with stable non-CF bronchiectasis, who were recruited from our outpatient clinic, was done over a two-year period. Measurements. Sixty-nine stable non-CF bronchiectasis patients were evaluated in terms of hs-CRP, 6-minute walk test, pulmonary function tests, and HRCT. Results. Circulating hs-CRP levels were significantly correlated with HRCT scores (n = 69, r = 0.473, P < 0.001) and resting oxygenation saturation (r = -0.269, P = 0.025). HRCT severity scores significantly increased in patients with hs-CRP level of 4.26 mg/L or higher (mean ± SD 28.1 ± 13.1) compared to those with hs-CRP level less than 4.26 mg/L (31.7 ± 9.8, P = 0.004). Oxygenation saturation at rest was lower in those with hs-CRP level of 4.26 mg/L or higher (93.5 ± 4.4%) compared to those with hs-CRP level less than 4.26 mg/L (96.4 ± 1.6%, P = 0.001). Conclusion. There was a good correlation between serum hs-CRP and HRCT scores in the patients with stable non-CF bronchiectasis.
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Affiliation(s)
- Meng-Heng Hsieh
- Department of Thoracic Medicine, Chang Gung Medical Foundation, Department of Chest Medicine, Chang Gung University, College of Medicine, Taoyuan 33342, Taiwan
| | - Yueh-Fu Fang
- Department of Thoracic Medicine, Chang Gung Medical Foundation, Department of Chest Medicine, Chang Gung University, College of Medicine, Taoyuan 33342, Taiwan
| | - Guan-Yuan Chen
- Department of Thoracic Medicine, Chang Gung Medical Foundation, Department of Chest Medicine, Chang Gung University, College of Medicine, Taoyuan 33342, Taiwan
| | - Fu-Tsai Chung
- Department of Thoracic Medicine, Chang Gung Medical Foundation, Department of Chest Medicine, Chang Gung University, College of Medicine, Taoyuan 33342, Taiwan
| | - Yuan-Chang Liu
- Department of Radiology, Chang Gung Medical Foundation, Department of Chest Medicine, Chang Gung University, College of Medicine, Taoyuan 33342, Taiwan
| | - Cheng-Hsien Wu
- Department of Radiology, Chang Gung Medical Foundation, Department of Chest Medicine, Chang Gung University, College of Medicine, Taoyuan 33342, Taiwan
| | - Yu-Chen Chang
- Department of Nuclear Medicine, Chang Gung Medical Foundation, Department of Chest Medicine, Chang Gung University, College of Medicine, Taoyuan 33342, Taiwan
| | - Horng-Chyuan Lin
- Department of Thoracic Medicine, Chang Gung Medical Foundation, Department of Chest Medicine, Chang Gung University, College of Medicine, Taoyuan 33342, Taiwan
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Bartley J, Garrett J, Grant CC, Camargo CA. Could vitamin d have a potential anti-inflammatory and anti-infective role in bronchiectasis? Curr Infect Dis Rep 2013; 15:148-57. [PMID: 23371406 DOI: 10.1007/s11908-013-0321-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Bronchiectasis is a chronic infective and inflammatory respiratory disease that causes significant morbidity and mortality. Patients with non-cystic-fibrosis bronchiectasis are frequently vitamin D deficient, and vitamin D levels correlate with disease severity. Infection-specific actions of vitamin D include the enhancement of innate immunity and the moderation of inflammation caused by the adaptive immune response. Potentially, vitamin D could influence the processes that lead to bronchiectasis and the frequency and severity of acute exacerbations. Randomized trials of vitamin D supplementation have shown effects that are likely to be protective against the development of bronchiectasis. Several issues need to be clarified before the development of clinical trials to investigate the role of vitamin D in bronchiectasis. These include an optimal vitamin D supplementation dose and appropriate and sensitive outcome measures that include assessment of exacerbation frequency and severity, lung function, and health-related quality of life.
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Affiliation(s)
- Jim Bartley
- Department of Surgery, University of Auckland, 10 Owens Road, Auckland, 1023, New Zealand,
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Alpha 1 antitrypsin deficiency in non cystic fibrosis bronchiectasis. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2013. [DOI: 10.1016/j.ejcdt.2013.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Roberts ME, Lowndes L, Milne DG, Wong CA. Socioeconomic deprivation, readmissions, mortality and acute exacerbations of bronchiectasis. Intern Med J 2012; 42:e129-36. [PMID: 21299784 DOI: 10.1111/j.1445-5994.2011.02444.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bronchiectasis is known to cause significant morbidity in children in New Zealand. Little is known of the disease in adults. AIM Our objective was to characterise a cohort of adults who presented to hospital with acute exacerbations of the disease. METHODS We retrospectively collected information on all exacerbations treated as inpatients from a single hospital in South Auckland, New Zealand during 2002. RESULTS We collected information on 307 exacerbations in 152 patients. Twenty-seven per cent were of Maaori ethnic origin, and 44% Pacific. Seventy per cent lived in areas categorised as the 20% most deprived in New Zealand. Comorbid conditions were present in 80% of patients - most commonly chronic obstructive pulmonary disease, asthma, diabetes and cardiac disease. Seventy (46%) patients had at least one readmission and 32 patients (21%) died within 12 months of admission to hospital. Greater deprivation was associated with increased mortality at 12 months after admission after adjusting for other factors (OR 11, 95% CI 2.0-61, P= 0.006). In the subgroup who underwent high-resolution computed tomographic scanning (93), increasing severity of bronchiectasis (modified Bhalla score) was associated with readmission within 12 months (P= 0.004), but not mortality (P= 0.419). CONCLUSIONS We have shown that exacerbations of bronchiectasis in South Auckland are more common in patients who are predominantly of Maaori or Pacific descent and are socioeconomically deprived. Admission to hospital for an exacerbation is associated with high readmission and mortality rates.
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Affiliation(s)
- M E Roberts
- Nottingham University Hospitals, Nottingham, UK
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30
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[Treatment of non-cystic fibrosis bronchiectasis]. Arch Bronconeumol 2011; 47:599-609. [PMID: 21798654 DOI: 10.1016/j.arbres.2011.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 05/31/2011] [Accepted: 06/03/2011] [Indexed: 10/17/2022]
Abstract
Bronchiectasis is currently growing in importance due to both the increase in the number of diagnoses made as well as the negative impact that its presence has on the baseline disease that generates it. A fundamental aspect in these patients is the colonization and infection of the bronchial mucous by potentially pathogenic microorganisms (PPM), which are the cause in most cases of the start of the chronic inflammatory process that results in the destruction and dilatation of the bronchial tree that is characteristic in these patients. The treatment of the colonization and chronic bronchial infection in these patients should be based on prolonged antibiotic therapy in its different presentations. Lately, the inhaled form is becoming especially prominent due to its high efficacy and limited production of important adverse effects. However, one must not overlook the fact that the management of patients with bronchiectasis should be multidisciplinary and multidimensional. In addition to antibiotic treatment, the collaboration of different medical and surgical specialties is essential for the management of the exacerbations, nutritional aspects, respiratory physiotherapy, muscle rehabilitation, complications, inflammation and bronchial hyperreactivity and the hypersecretion that characterizes these patients.
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Habesoglu MA, Ugurlu AO, Eyuboglu FO. Clinical, radiologic, and functional evaluation of 304 patients with bronchiectasis. Ann Thorac Med 2011; 6:131-6. [PMID: 21760844 PMCID: PMC3131755 DOI: 10.4103/1817-1737.82443] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 03/07/2011] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Bronchiectasis continues to be one of the major causes of morbidity and mortality in developing countries, with a probably underestimated higher prevalence than in developed countries. OBJECTIVE To assess the clinical profile of adult patients with bronchiectasis. METHODS We retrospectively reviewed the clinical, radiologic, and physiologic findings of 304 patients with bronchiectasis confirmed by high-resolution computed tomography. RESULTS Mean age of participants (45.7% males, 54.3% females) was 56 ± 25 years and 65.8% of them were lifetime non-smokers. Most common identified causes of bronchiectasis were childhood disease (22.7%), tuberculosis (15.5%), and pneumonia (11.5%). The predominant symptoms were productive cough (83.6%), dyspnea (72%), and hemoptysis (21.1%). The most common findings on chest examination were crackles (71.1%) and rhonchi (28.3%). Types of bronchiectasis were cylindrical in 47%, varicose in 9.9%, cystic in 45.1%, and multiple types in 24.3%. Involvement was multilobar in 75.3% and bilateral in 62.5%. Of 274 patients, 20.8% displayed normal pulmonary function test results, whereas 47.4%, 8% and 23.7% showed obstructive, restrictive, and mixed pattern, respectively. Patients with cystic disease had a higher frequency of hemoptysis (42%) and a greater degree of functional impairment, compared to other types. CONCLUSION In patients with bronchiectasis from southern Turkey, generally presenting with recurrent productive cough, hemoptysis, dyspnea, and persistent bibasilar rales, the etiology remains mainly idiopathic. Post-infectious bronchial destruction is one of the major identified underlying pathological processes. The clinical picture and the deterioration of the pulmonary function test might be more severe in patients with cystic type bronchiectasis.
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Affiliation(s)
- Mehmet Ali Habesoglu
- Department of Chest Disease, Baskent University Medical and Research Center, Adana, Turkey
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Ketchell I. Patients with cystic fibrosis should be intubated and ventilated. J R Soc Med 2010; 103 Suppl 1:S20-4. [PMID: 20573664 DOI: 10.1258/jrsm.2010.s11005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ian Ketchell
- All Wales Adult Cystic Fibrosis Centre, University Hospital Llandough, Penlan Road, Penarth CF64 2XX, UK.
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Finklea JD, Khan G, Thomas S, Song J, Myers D, Arroliga AC. Predictors of mortality in hospitalized patients with acute exacerbation of bronchiectasis. Respir Med 2010; 104:816-21. [PMID: 20363606 DOI: 10.1016/j.rmed.2009.11.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 11/24/2009] [Accepted: 11/26/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND In-hospital and long term outcomes of patients admitted to the hospital for acute exacerbation of bronchiectasis (AEB) has been evaluated in only a limited fashion. The resulting debilitation after an AEB can increase mortality. This study aims to evaluate the factors associated with mortality in patients admitted with an acute exacerbation of bronchiectasis (AEB). METHODS All charts of the patients admitted between 2003 and 2006 with an AEB were reviewed through an electronic database. Demographics, sputum cultures, pulmonary functions tests and other factors associated with long-term mortality were examined. The social security death index was used to determine long term mortality (http://ssdi.genealogy.rootsweb.com). RESULTS Forty-three patients (13 men and 30 women) with a mean age of 71.8+/-11.8 were studied. The hospital mortality was 9% and one-year mortality was 30% with a median survival of 46.6 months. Variables associated with mortality were male gender (female vs. male (HR), 0.36; (CI), 0.14-0.98; p=0.045), use of systemic steroids (with vs. without steroids HR, 3.12; CI 1.08-9.02; p=0.036), decreased FEV(1.0)% predicted (HR, 0.96; CI 0.92-0.999; p=0.042), elevated creatinine (HR, 2.36; CI 1.093-5.10; p=0.029), history of smoking (HR, 0.283; CI 0.097-0.825; p=0.021), and mechanical ventilation (HR, 66.011; CI 6.64-656.76; p=0.0004). CONCLUSIONS Male gender, elevated creatinine, decreased FEV(1.0)% predicted, mechanical ventilation, history of smoking, and acute use of systemic steroids during the hospitalization were associated with an increased risk of mortality.
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Affiliation(s)
- James D Finklea
- Department of Pulmonary, Allergy, and Critical Care Medicine, Emory University Hospital, Atlanta, Georgia, United States
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34
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Roberts HJ, Hubbard R. Trends in bronchiectasis mortality in England and Wales. Respir Med 2010; 104:981-5. [PMID: 20303725 DOI: 10.1016/j.rmed.2010.02.022] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 02/05/2010] [Accepted: 02/22/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND To provide information on the burden of bronchiectasis in England and Wales, we have examined trends in mortality using death certificate data available from the Office of National Statistics. METHODS We extracted data on deaths due to non-cystic fibrosis bronchiectasis for 2001-2007 inclusive and stratified deaths by sex and age group. We used Poisson regression to compare mortality rates. RESULTS Between 2001 and 2007, 5745 bronchiectasis related deaths were registered in England and Wales. When standardized to the 2007 population, this showed a rise in absolute numbers from 797 (2001) to 908 (2007). Statistical analyses suggested that the mortality rate is currently increasing at 3%/year (p < 0.001). Mortality rates were similar between men and women but there was a strong statistical interaction between age group and year (p < 0.001) Rates were increasing in the two oldest age groups but falling in the three youngest groups. DISCUSSION Currently just under 1000 people die from bronchiectasis each year in England and Wales. We found the number of deaths to be increasing at 3% per year. Although overall mortality was increasing, rates were increasing in older groups but falling in the younger groups. These mortality rates may underestimate the burden of disease from bronchiectasis as lack of knowledge about the disease may lead to underreporting. These are also mortality rather than incidence data and may reflect improvements in treatment. Bronchiectasis therefore remains a significant concern. Clinical provision will potentially need to increase in order to care for this patient group.
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Phua J, Ang YLE, See KC, Mukhopadhyay A, Santiago EA, Dela Pena EG, Lim TK. Noninvasive and invasive ventilation in acute respiratory failure associated with bronchiectasis. Intensive Care Med 2010; 36:638-47. [PMID: 20052456 DOI: 10.1007/s00134-009-1743-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Accepted: 09/10/2009] [Indexed: 12/12/2022]
Abstract
PURPOSE To describe the outcomes of patients with bronchiectasis and acute respiratory failure (ARF) treated with noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) after a failure of conservative measures, and to identify the predictors of hospital mortality and NIV failure. METHODS Retrospective review of bronchiectatic patients on NIV (n = 31) or IMV (n = 26) for ARF over 8 years in a medical intensive care unit (ICU) experienced in NIV. RESULTS At baseline, the NIV group had more patients with acute exacerbations without identified precipitating factors (87.1 vs. 34.6%, p < 0.001), higher pH (mean 7.25 vs. 7.18, p = 0.008) and PaO(2)/FiO(2) ratio (mean 249.4 vs. 173.2, p = 0.02), and a trend towards a lower APACHE II score (mean 25.3 vs. 28.4, p = 0.07) than the IMV group. There was no difference in hospital mortality between the two groups (25.8 vs. 26.9%, p > 0.05). The NIV failure rate (need for intubation or death in the ICU) was 32.3%. Using logistic regression, the APACHE II score was the only predictor of hospital mortality (OR 1.19 per point), and the PaO(2)/FiO(2) ratio was the only predictor of NIV failure (OR 1.02 per mmHg decrease). CONCLUSIONS The hospital mortality of patients with bronchiectasis and ARF approximates 25% and is predicted by the APACHE II score. When selectively applied, NIV fails in one-third of the patients, and this is predicted by hypoxemia. Our findings call for randomised controlled trials to compare NIV versus IMV in such patients.
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Affiliation(s)
- Jason Phua
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore, 119074, Singapore.
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36
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Goldring JJP, Wedzicha JA. Managing acute on chronic respiratory failure: a guide to non-invasive ventilation. Br J Hosp Med (Lond) 2008; 69:444-9. [DOI: 10.12968/hmed.2008.69.8.30740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- JJP Goldring
- Royal Free and University College Medical School, London NW3 2PF
| | - JA Wedzicha
- Royal Free and University College Medical School, London NW3 2PF
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37
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Chang AB, Redding GJ, Everard ML. Chronic wet cough: Protracted bronchitis, chronic suppurative lung disease and bronchiectasis. Pediatr Pulmonol 2008; 43:519-31. [PMID: 18435475 DOI: 10.1002/ppul.20821] [Citation(s) in RCA: 167] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The role of persistent and recurrent bacterial infection of the conducting airways (endobronchial infection) in the causation of chronic respiratory symptoms, particularly chronic wet cough, has received very little attention over recent decades other than in the context of cystic fibrosis (CF). This is probably related (at least in part) to the (a) reduction in non-CF bronchiectasis in affluent countries and, (b) intense focus on asthma. In addition failure to characterize endobronchial infections has led to under-recognition and lack of research. The following article describes our current perspective of inter-related endobronchial infections causing chronic wet cough; persistent bacterial bronchitis (PBB), chronic suppurative lung disease (CSLD) and bronchiectasis. In all three conditions, impaired muco-ciliary clearance seems to be the common risk factor that provides organisms the opportunity to colonize the lower airway. Respiratory infections in early childhood would appear to be the most common initiating event but other conditions (e.g., tracheobronchomalacia, neuromuscular disease) increases the risk of bacterial colonization. Clinically these conditions overlap and the eventual diagnosis is evident only with further investigations and long term follow up. However whether these conditions are different conditions or reflect severity as part of a spectrum is yet to be determined. Also misdiagnosis of asthma is common and the diagnostic process is further complicated by the fact that the co-existence of asthma is not uncommon. The principles of managing PBB, CSLD and bronchiectasis are the same. Further work is required to improve recognition, diagnosis and management of these causes of chronic wet cough in children.
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Affiliation(s)
- A B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
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Alzeer AH, Masood M, Basha SJ, Shaik SA. Survival of bronchiectatic patients with respiratory failure in ICU. BMC Pulm Med 2007; 7:17. [PMID: 18070340 PMCID: PMC2222020 DOI: 10.1186/1471-2466-7-17] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2007] [Accepted: 12/10/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The outcome of patients with bronchiectasis during and after their stay in the intensive care unit (ICU) has seldom been reported in the literature. Managing these patients in the ICU can be challenging because of the complex nature of their disease. This study aims to identify the in-hospital and long-term outcome of patients with bronchiectasis and respiratory failure (RF) in ICU. METHODS A retrospective study was carried out by studying all bronchiectatic patients admitted to the medical ICU for RF over a 10-year period (1995-2004). RESULTS The mean (+/- standard deviation) age of 35 patients was 63.5 +/- 11.7 years and APACHE score was 22.3 +/- 7.3. The 4-year mortality was 60%. Among the variables observed, age > 65 years (hazard ratio (HR): 4.15; 95% confidence interval (CI): 3.2-5.1), APACHE II score > 24 (2.6, 95% CI 1.7-3.5), intubation (2.81, 95 %CI 1.9-3.7), inotropic support (2.9, 95% CI 2.0-3.7), Home-O2 (4.0, 95% CI 2.7-5.2) and activity index (4.0, 95% CI 2.8-5.3) were associated with diminished survival in univariate analysis by Cox regression. By long rank test, survival probabilities were significantly low at these strata. Multivariate analysis of Cox proportional hazard model showed that age > 65 years (HR: 5.4, 95% CI 1.9-15.7); activity index (HR: 4.8, 95% CI 1.4-16.6); and inotropic support (HR: 3.8, 95% CI 1.5-10.1) were independently associated with reduced survival. CONCLUSION The decreased survival of ICU patients was associated with age > 65 years, activity index (bedridden or wheelchair-bound) and use of inotropic support.
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Affiliation(s)
- Abdulaziz H Alzeer
- Division of Pulmonology, Department of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia.
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Onen ZP, Gulbay BE, Sen E, Yildiz OA, Saryal S, Acican T, Karabiyikoglu G. Analysis of the factors related to mortality in patients with bronchiectasis. Respir Med 2007; 101:1390-7. [PMID: 17374480 DOI: 10.1016/j.rmed.2007.02.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Revised: 12/19/2006] [Accepted: 02/04/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Bronchiectasis is a common disabling but rarely fatal disease. However the long-term prognosis and risk factors for mortality are not well known. OBJECTIVE The aim of this study was to determine prospectively the survival and predictive factors of mortality in patients with bronchiectasis, during 4-year follow-up. PATIENTS AND METHODS From September 2000 to January 2005 survival of bronchiectasis (as evaluated by computed tomography) and predictors of mortality were assessed in 98 outpatients. Fifty-one of the patients had self-reported history of pulmonary infection including tuberculosis. Baseline data, reevaluated in every single year according to scheduled visits. RESULTS The mean age was 61+/-10 and 74% of the patients were female. In total, 16 patients (16.3%) died; mean survival time was 44.06+/-1.6 months. The survival rates were 97%, 89%, 76%, 58% at 1, 2, 3 and 4 years, respectively. Cox proportional hazard model revealed that long-term mortality was significantly associated with age, body mass index (BMI), Medical Research Council (MRC) dyspnea scale, vaccination, radiographic extent, hypoxemia, hypercapnia and functional parameters. However, MRC and BMI had more significant effects on the mortality than the functional parameters. CONCLUSIONS These results suggest that high BMI, regular vaccination and scheduled visits may have beneficial effects on the survival of bronchiectasis. Besides, presence of hypoxemia, hypercapnia, dyspnea level and radiographic extent were more closely correlated with mortality.
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Affiliation(s)
- Zeynep Pinar Onen
- Department of Pulmonary Diseases, School of Medicine, Ankara University, Ankara, Turkey.
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Williams TA, Dobb GJ, Finn JC, Knuiman M, Lee KY, Geelhoed E, Webb SAR. Data linkage enables evaluation of long-term survival after intensive care. Anaesth Intensive Care 2006; 34:307-15. [PMID: 16802482 DOI: 10.1177/0310057x0603400316] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Outcomes of intensive care are important to the patient and for assessment of benefit. Short-term outcomes after critical illness are well described, but less is known about long-term outcomes. This study describes the use of data linkage, combining intensive care unit (ICU) clinical data with administrative morbidity and mortality data, to assess long-term outcomes after treatment in ICU. The hospital-based cohort study was conducted in a 22-bed general ICU in a metropolitan teaching hospital. All patient admissions admitted to ICU from 1 January 1987 to 31 December 2002 were included. The prospective ICU clinical database with patient demographics, ICU diagnoses, severity of illness, daily assessment of organ failures and common daily treatments used was linked using probabilistic methods to the state-wide hospital morbidity and mortality databases to describe long-term survival. There were 26,019 ICU admissions (22,980 patients) with 25,972 records (99.8%) linked to a hospitalization event that included the index ICU admission. Unadjusted survival was 84.7% at 1 year decreasing progressively to 50.7% at 15 years. Age, type of admission, severity of illness (measured by Acute Physiologic and Chronic Health Evaluation (APACHE) II and the presence of organ failure), ICU length of stay, comorbidity (Chronic Health Evaluation and Charlson comorbidity index) and ICU admission diagnosis, were all associated with survival at 1, 3, 5, 10, and 15 year follow-up (P<0.001 at all time points). Linkage of clinical and administrative data provides a feasible method for ascertaining long-term survival after critical illness. Age, admission severity of illness, diagnosis and comorbidity influenced long-term unadjusted survival.
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Affiliation(s)
- T A Williams
- School of Population Health, University of Western Australia
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Gursel G. Does coexistence with bronchiectasis influence intensive care unit outcome in patients with chronic obstructive pulmonary disease? Heart Lung 2006; 35:58-65. [PMID: 16426936 DOI: 10.1016/j.hrtlng.2005.04.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2004] [Revised: 04/01/2005] [Accepted: 04/26/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Bronchiectasis is associated with chronic obstructive pulmonary disease (COPD) in 30% to 50% of patients. This study evaluated whether association with bronchiectasis has any influence on morbidity and mortality in patients with COPD during their intensive care unit (ICU) stay. METHODS The study was conducted at a respiratory ICU of a university hospital, and 93 mechanically ventilated patients with COPD were studied. Twenty-nine (31%) of 93 patients with COPD also had bronchiectasis. Patients with bronchiectasis had more frequent hospitalizations, more severe airflow limitation, and higher pulmonary artery pressure than patients without bronchiectasis. Duration of ICU (27+/-32 days [median: 14]; 16+/-16 days [median: 9]; P=.01) and hospital stays (44+/-44 days [median: 24.5]; 28+/-26 days (median: 20); P=.046) in patients with bronchiectasis were significantly longer than in patients without bronchiectasis, respectively. Bronchiectasis was an independent predictor for ICU stay longer than 10 days (odds ratio: 5, 95% confidence interval: 1.02-21, P=.043). The development rate of ventilator-associated pneumonia, especially with Pseudomonas aeruginosa, was significantly higher in patients with bronchiectasis (P=.034). Despite these prolonged durations, bronchiectasis did not increase mortality in this study population (P=.865). RESULTS These results suggest that the coexistence of bronchiectasis in patients with COPD may increase the duration of ICU stay and hospitalization but does not influence the mortality.
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Affiliation(s)
- Gul Gursel
- Gazi University School of Medicine, Intensive Care Unit of Pulmonary Diseases Department, Besevler, Ankara, Turkey
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42
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Affiliation(s)
- P Delaval
- Service de Pneumologie, CHU Rennes, rue Henri le Guilloux, 35033 Rennes Cedex, France.
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Bewick V, Cheek L, Ball J. Statistics review 12: survival analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2004; 8:389-94. [PMID: 15469602 PMCID: PMC1065034 DOI: 10.1186/cc2955] [Citation(s) in RCA: 279] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This review introduces methods of analyzing data arising from studies where the response variable is the length of time taken to reach a certain end-point, often death. The Kaplan–Meier methods, log rank test and Cox's proportional hazards model are described.
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Affiliation(s)
- Viv Bewick
- School of Computing, Mathematical and Information Sciences, University of Brighton, Brighton, UK.
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