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Mateus SP, Ribeiro-Alves M, Salles REB, Costa W, da Costa CH, Lopes AJ, Bártholo TP, Mafort TT, Tura BR, Rufino R. Mortality and comorbidities in patients with bronchiectasis over a 3-year follow-up. Medicine (Baltimore) 2022; 101:e32537. [PMID: 36596005 PMCID: PMC9803512 DOI: 10.1097/md.0000000000032537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
To identify the risk factors associated with all-cause mortality in patients with noncystic fibrosis bronchiectasis (NCFB). This prospective cohort study included 120 adult patients with NCFB, who were regularly treated at a specialized outpatient clinic of a university hospital between January 2017 and June 2020. All patients were diagnosed using high-resolution computed tomography. Demographic and clinical data, pulmonary function tests, and the Euro-quality-of-life 5-domain 3-level questionnaire were analyzed. The factors associated with death were determined using the Cox proportional hazards model. The all-cause mortality rate at 41 months was 10.8%. Adjusted multivariate analysis showed that the main contributing predictors for mortality were female sex, smoking, diabetes, chronic obstructive pulmonary disease, emergency visits, use of antibiotics due to exacerbation, secretion color change, exacerbation, predicted forced expiratory volume in 1 second, predicted forced vital capacity, lack of respiratory physiotherapy, absence of vaccination against pneumococci, and mobility domain. Multiple factors contribute to unfavorable outcomes in patients with NCFB, and early recognition of these factors may improve care management.
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Affiliation(s)
- Simone Paulo Mateus
- Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil
| | | | | | - Walter Costa
- Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil
| | - Claudia Henrique da Costa
- Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil
| | - Thiago Prudente Bártholo
- Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil
| | - Thiago Thomaz Mafort
- Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil
| | | | - Rogério Rufino
- Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil
- * Correspondence: Rogério Rufino, Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil (e-mail: )
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Mateus SP, Salles REB, Costa W, Costa CHD, Lopes AJ, Tura BR, Rufino R. Follow-up of a cohort of patients with noncystic fibrosis bronchiectasis for 1 year. Rev Assoc Med Bras (1992) 2022; 68:329-336. [PMID: 35442359 DOI: 10.1590/1806-9282.20210710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/01/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the quality of life of patients with noncystic fibrosis bronchiectasis during a 1-year follow-up by using the EuroQol - 5 Dimensions - 3 Levels (EQ-5D-3L) questionnaire. METHODS A cohort study was conducted with 100 patients with noncystic fibrosis bronchiectasis and followed up with face-to-face visits or by telephone contact every 3 months for 1 year. All patients were recruited from a single referral center for bronchiectasis. At the time of recruiting and at the end of 1 year, the EQ-5D-3L questionnaire was applied to evaluate the patients' quality of life. Variables, such as exacerbation, emergency care, comorbidities, hemoptysis, colonization, and hospitalization, were assessed. RESULTS Of the 100 patients, 99 completed the study and 72% were women. There were no marked limitations in the mobility and self-care domains during the follow-up. At the end of the follow-up, 32 patients were extremely anxious or depressed. The quality of life assessed by using EQ-5D-3L had an initial mean score of 0.545 and of 0.589 after 1 year, which was statistically significant (p=0.011). CONCLUSION Patients with noncystic fibrosis bronchiectasis have a poor quality of life, and the EQ-5D-3L questionnaire may be a tool for monitoring patients with bronchiectasis.
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Affiliation(s)
- Simone Paulo Mateus
- Universidade do Estado do Rio de Janeiro, Pulmonology Service, Department of Chest Diseases - Rio de Janeiro (RJ), Brazil
| | - Raquel Esteves Brandão Salles
- Universidade do Estado do Rio de Janeiro, Pulmonology Service, Department of Chest Diseases - Rio de Janeiro (RJ), Brazil
| | - Walter Costa
- Universidade do Estado do Rio de Janeiro, Pulmonology Service, Department of Chest Diseases - Rio de Janeiro (RJ), Brazil
| | - Claudia Henrique da Costa
- Universidade do Estado do Rio de Janeiro, Pulmonology Service, Department of Chest Diseases - Rio de Janeiro (RJ), Brazil
| | - Agnaldo José Lopes
- Universidade do Estado do Rio de Janeiro, Pulmonology Service, Department of Chest Diseases - Rio de Janeiro (RJ), Brazil
| | | | - Rogério Rufino
- Universidade do Estado do Rio de Janeiro, Pulmonology Service, Department of Chest Diseases - Rio de Janeiro (RJ), Brazil
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Elborn JS, Blasi F, Haworth CS, Ballmann M, Tiddens HAWM, Murris-Espin M, Chalmers JD, Cantin AM. Bronchiectasis and inhaled tobramycin: A literature review. Respir Med 2022; 192:106728. [PMID: 34998112 DOI: 10.1016/j.rmed.2021.106728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/24/2021] [Accepted: 12/29/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Inhaled antibiotics have been incorporated into contemporary European and British guidelines for bronchiectasis, yet no inhaled antibiotics have been approved in the United States or Europe for the treatment of bronchiectasis not related to cystic fibrosis. Pseudomonas aeruginosa infection is common in patients with bronchiectasis, contributing to a cycle of progressive inflammation, exacerbations, and airway remodelling. OBJECTIVE The aim of the current study was to identify and evaluate published studies of inhaled tobramycin solution or powder in patients with bronchiectasis and P. aeruginosa infection not associated with cystic fibrosis. METHODS A literature review was conducted utilising the PubMed and Cochrane databases. Studies published in the English language that reported safety and/or efficacy outcomes of inhaled tobramycin either alone or in combination with other antibiotics were included. RESULTS Seven clinical trials published between 1999 and 2021 were identified that met inclusion criteria. Inhaled tobramycin therapy was effective in reducing P. aeruginosa microbial density in the sputum of patients with bronchiectasis. Several studies demonstrated favourable impacts on hospitalisations, number and severity of exacerbations, and symptoms. Other studies were underpowered for these clinical outcomes or were exploratory in nature. Although tobramycin was generally well tolerated, some evidence of treatment-associated wheezing was reported. CONCLUSIONS In patients with bronchiectasis and chronic P. aeruginosa infection, inhaled tobramycin was effective in reducing the density of bacteria in sputum, which may be associated with additional clinical benefits. Definitive phase 3 trials of inhaled tobramycin in patients with bronchiectasis are indicated to determine clinical efficacy and long-term safety.
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Affiliation(s)
- J Stuart Elborn
- Medicine, Health and Life Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Francesco Blasi
- Department of Internal Medicine, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Charles S Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital and Department of Medicine, University of Cambridge, Cambridge, UK
| | - Manfred Ballmann
- University Medicine Rostock, Rostock, Mecklenburg-Vorpommern, Germany
| | - Harm A W M Tiddens
- Erasmus Medical Center Sophia Children's Hospital, Department of Pediatric Pulmonology and Allergology, Department of Radiology and Nuclear Medicine, Rotterdam, the Netherlands
| | - Marlène Murris-Espin
- Department of Pulmonology, Adult Cystic Fibrosis Center, Larrey Hospital, Toulouse University Hospital, Toulouse, France
| | - James D Chalmers
- Molecular and Clinical Medicine, University of Dundee, Nethergate, Dundee, Scotland, UK
| | - André M Cantin
- Pulmonary Research Unit, Faculty of Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada
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Brooke-Hollidge A, Conway J, Lewis A. Gender differences in non-cystic fibrosis bronchiectasis severity and bacterial load: the potential role of hormones. Ther Adv Respir Dis 2021; 15:17534666211035311. [PMID: 34520299 PMCID: PMC8445533 DOI: 10.1177/17534666211035311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Non cystic-fibrosis bronchiectasis (NCFB) is a complex chronic respiratory disease, characterised by excessive sputum production and abnormal permanent dilation of bronchi. Mucus accumulation leads to recurrent bacterial infections and increased bacterial load, causing vicious cycles of structural damage and decreased lung function. Respiratory physiotherapy management of NCFB includes airway clearance techniques and use of nebulised, hypertonic saline. Despite advances in treatment, a consistent relationship has been observed between gender and disease occurrence, with a higher prevalence amongst females. Furthermore, NCFB presents most aggressively amongst post-menopausal females, a group likely exposed to higher levels of progesterone (P4) over a longer period of time. The effects of gender-specific hormones on bacterial load and physiotherapy management of people living with NCFB remain unknown. The aim of this narrative review was to discuss the potential influence of gender specific hormones on NCFB disease progression and influence on physiotherapy, medical management and future research. SCOPUS and PUBMED electronic databases were used to conduct searches for relevant studies using specific inclusion and exclusion criteria. Secondary inclusion of relevant literature was obtained from primary paper references. Previous literature suggests that P4 may impair Cilia Beat Frequency (CBF) in airway epithelium. Reduction in CBF may further reduce ability to expectorate amongst individuals with NCFB, increasing bacterial load and likelihood of exacerbations, negatively impacting on disease progression. Furthermore, coadministration of Estrogen has been suggested to offer opposing effects to that of P4 only. These findings question whether hormonal levels may be monitored, controlled and optimised within management and treatment of females with NCFB to improve airway clearance, reduce exacerbations and improve quality of life. Larger scale, long-term trials are required to further explore the effects of gender specific hormones on NCFB and the viability of treatment with hormone replacement therapy. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
| | | | - Adam Lewis
- College of Health, Medicine and Life Sciences, Brunel University London, Mary Seacole Building, Kingston Lane, Uxbridge, UB8 3PH, UK
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Nicolini A, Grecchi B, Banfi P. Effectiveness of two high frequency chest wall oscillation techniques in patients with bronchiectasis: a randomized controlled preliminary study. Panminerva Med 2020; 64:235-243. [PMID: 32192317 DOI: 10.23736/s0031-0808.20.03735-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Chest physiotherapy is an important tool in the treatment of bronchiectasis. High frequency chest wall oscillation (HFCWO) is a technique designed to create a global percussion of the lung which moves secretions and probably clears the peripheral bronchial tree. We propose the comparison between an existing device (SmartVest) and a new device (RespIn 11). METHODS Sixty patients were randomized into three groups: a group was treated with SmartVest, a group with RespIn 11, and a group with pharmacological therapy alone. Primary outcome measures included exacerbations at 3, 6 and 12 months after the end of treatment. Secondary outcome measures were pulmonary function testing, arterial blood gas analysis (ABG), and hematological examinations, cough, dyspnea, health and quality of life scores (Bronchiectasis Health Questionnaire [BHQ], Breathlessness, Cough, and Sputum Scale [BCSS], COPD Assessment Test [CAT], Leicester Cough Questionnaire [LCT]). A 5-point Likert scale was used to evaluate patient's preference. RESULTS Both patients in the HFCWO groups showed a significant improvement in the tests of dyspnea, cough and health and quality of life score evaluations (BHQ, BCSS, CAT, LCT) compared to the control group, but not in pulmonary function tests and ABG. Only RespIn 11 significantly reduced exacerbations in comparison with the control group. RespIn 11 also had a higher score regarding patients' preference. CONCLUSIONS The two machines have improved health and quality of life scores in patients with bronchiectasis. RespIn 11 also demonstrated a significant lowering of exacerbations and a better patient acceptance.
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Affiliation(s)
- Antonello Nicolini
- Respiratory Diseases Unit, General Hospital, Sestri Levante, Genova, Italy -
| | - Bruna Grecchi
- Rehabilitation Unit, General Hospital, Sestri Levante, Genova, Italy
| | - Paolo Banfi
- Pulmonary Rehabilitation Department, Don Gnocchi Foundation, IRCCS, Milan, Italy
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Handley E, Nicolson CH, Hew M, Lee AL. Prevalence and Clinical Implications of Chronic Rhinosinusitis in People with Bronchiectasis: A Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2004-2012.e1. [PMID: 30836230 DOI: 10.1016/j.jaip.2019.02.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/23/2019] [Accepted: 02/12/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is an extrapulmonary manifestation in some individuals with bronchiectasis, but the prevalence of CRS in this population and its clinical impact has not been systematically reviewed. OBJECTIVE To systematically review the prevalence of CRS in bronchiectasis and identify its clinical implications. METHODS Four databases were searched from inception to August 2018 for studies reporting the prevalence and/or clinical impact of CRS in individuals with bronchiectasis. Clinical outcomes included health-related quality of life (HRQOL), severity of bronchiectasis, lung function, clinical and psychological symptoms, exacerbation frequency, and health care utilization. Two independent reviewers rated the quality of evidence using the risk of bias for prevalence trials tool. RESULTS Of 80 studies identified, 8 studies with 797 participants (all adults) were included. Mean FEV1 % predicted was 77.7%. Overall, 5 studies were classed as low risk of bias and 3 were of moderate risk of bias. The pooled prevalence of clinical and/or radiological CRS was 62% (95% CI, 50%-74%). CRS was associated with a greater degree of bronchiectasis severity, poorer HRQOL, reduction in smell detection, elevated levels of inflammatory markers, and reduced time to first exacerbation. However, the association with airflow obstruction was inconsistent and there was no impact on anxiety or depression. CONCLUSIONS CRS is present in 62% of adults with bronchiectasis. Its presence is associated with poorer HRQOL, greater degree of disease severity, and more extensive radiological bronchiectasis.
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Affiliation(s)
- Emma Handley
- Alfred Health Hospital Admission Risk Program - Pulmonary Rehabilitation, Caulfield Hospital, Caulfield, Victoria, Australia
| | - Caroline H Nicolson
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Mark Hew
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Annemarie L Lee
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Physiotherapy, Rehabilitation, Nutrition and Sport, La Trobe University, Bundoora, Victoria, Australia.
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McDonnell M, O'Toole D, Ward C, Pearson J, Lordan J, De Soyza A, Loebinger M, Chalmers J, Laffey J, Rutherford R. A qualitative synthesis of gastro-oesophageal reflux in bronchiectasis: Current understanding and future risk. Respir Med 2018; 141:132-143. [DOI: 10.1016/j.rmed.2018.06.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 06/17/2018] [Accepted: 06/29/2018] [Indexed: 12/15/2022]
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