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Takeuchi K, Abo M, Date H, Gotoh S, Kamijo A, Kaneko T, Keicho N, Kodama S, Koinuma G, Kondo M, Masuda S, Mori E, Morimoto K, Nagao M, Nakano A, Nakatani K, Nishida N, Nishikido T, Ohara H, Okinaka Y, Sakaida H, Shiraishi K, Suzaki I, Tojima I, Tsunemi Y, Kainuma K, Ota N, Takeno S, Fujieda S. Practical guide for the diagnosis and management of primary ciliary dyskinesia. Auris Nasus Larynx 2024; 51:553-568. [PMID: 38537559 DOI: 10.1016/j.anl.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/30/2023] [Accepted: 02/01/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Primary ciliary dyskinesia (PCD) is a relatively rare genetic disorder that affects approximately 1 in 20,000 people. Approximately 50 genes are currently known to cause PCD. In light of differences in causative genes and the medical system in Japan compared with other countries, a practical guide was needed for the diagnosis and management of Japanese PCD patients. METHODS An ad hoc academic committee was organized under the Japanese Rhinologic Society to produce a practical guide, with participation by committee members from several academic societies in Japan. The practical guide including diagnostic criteria for PCD was approved by the Japanese Rhinologic Society, Japanese Society of Otolaryngology-Head and Neck Surgery, Japanese Respiratory Society, and Japanese Society of Pediatric Pulmonology. RESULTS The diagnostic criteria for PCD consist of six clinical features, six laboratory findings, differential diagnosis, and genetic testing. The diagnosis of PCD is categorized as definite, probable, or possible PCD based on a combination of the four items above. Diagnosis of definite PCD requires exclusion of cystic fibrosis and primary immunodeficiency, at least one of the six clinical features, and a positive result for at least one of the following: (1) Class 1 defect on electron microscopy of cilia, (2) pathogenic or likely pathogenic variants in a PCD-related gene, or (3) impairment of ciliary motility that can be repaired by correcting the causative gene variants in iPS cells established from the patient's peripheral blood cells. CONCLUSION This practical guide provides clinicians with useful information for the diagnosis and management of PCD in Japan.
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Affiliation(s)
- Kazuhiko Takeuchi
- Department of Otorhinolaryngology, Head & Neck Surgery, Mie University, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
| | - Miki Abo
- Kanazawa University Health Service Center Respiratory Medicine, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University, Japan
| | - Shimpei Gotoh
- Department of Clinical Application, Center for iPS Cell, Research and Application, Kyoto University, Japan
| | | | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University, Japan
| | - Naoto Keicho
- The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Japan
| | | | - Goro Koinuma
- Department of Medical Subspecialties, Division of Pulmonology, National Center for Child Health and Development, Japan
| | - Mitsuko Kondo
- Department of Respiratory Medicine, Tokyo Women's Medical University, Japan
| | - Sawako Masuda
- Department of Otorhinolaryngology, National Hospital Organization Mie National Hospital, Japan
| | - Eri Mori
- Department of Otorhinolaryngology, Jikei University, Japan
| | - Kozo Morimoto
- Fukujuji Hospital, Japan Anti-Tuberculosis Association, Japan
| | - Mizuho Nagao
- National Hospital Organization Mie National Hospital, Japan
| | - Atsuko Nakano
- Department of Otorhinolaryngology, Chiba Children's Hospital, Japan
| | | | - Naoya Nishida
- Department of Otolaryngology, Ehime University, Japan
| | - Tomoki Nishikido
- Department of Pediatric Pulmonology and Allergy, Osaka Women's and Children's Hospital, Japan
| | - Hirotatsu Ohara
- Department of Otorhinolaryngology, Mito Kyodo General Hospital, Japan
| | - Yosuke Okinaka
- Department of Otorhinolaryngology, Yamaguchi University, Japan
| | - Hiroshi Sakaida
- Department of Otorhinolaryngology, Head & Neck Surgery, Mie University, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | | | - Isao Suzaki
- Department of Otorhinolaryngology, Head and Neck Surgery, Showa University, Japan
| | - Ichiro Tojima
- Department of Otorhinolaryngology-Head and Neck Surgery, Shiga University of Medical Science, Japan
| | - Yasuhiro Tsunemi
- Department of Otorhinolaryngology, Dokkyo Medical University, Japan
| | | | - Nobuo Ota
- Department of Otorhinolaryngology, Tohoku Medical and Pharmaceutical University, Japan
| | - Sachio Takeno
- Department of Otolaryngology, Head and Neck Surgery, Hiroshima University, Japan
| | - Shigeharu Fujieda
- Department of Otorhinolaryngology Head and Neck Surgery, University of Fukui, Japan
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Motta H, Reuwsaat JCV, Lopes FC, Viezzer G, Volpato FCZ, Barth AL, de Tarso Roth Dalcin P, Staats CC, Vainstein MH, Kmetzsch L. Comparative microbiome analysis in cystic fibrosis and non-cystic fibrosis bronchiectasis. Respir Res 2024; 25:211. [PMID: 38762736 PMCID: PMC11102160 DOI: 10.1186/s12931-024-02835-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/04/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Bronchiectasis is a condition characterized by abnormal and irreversible bronchial dilation resulting from lung tissue damage and can be categorized into two main groups: cystic fibrosis (CF) and non-CF bronchiectasis (NCFB). Both diseases are marked by recurrent infections, inflammatory exacerbations, and lung damage. Given that infections are the primary drivers of disease progression, characterization of the respiratory microbiome can shed light on compositional alterations and susceptibility to antimicrobial drugs in these cases compared to healthy individuals. METHODS To assess the microbiota in the two studied diseases, 35 subjects were recruited, comprising 10 NCFB and 13 CF patients and 12 healthy individuals. Nasopharyngeal swabs and induced sputum were collected, and total DNA was extracted. The DNA was then sequenced by the shotgun method and evaluated using the SqueezeMeta pipeline and R. RESULTS We observed reduced species diversity in both disease cohorts, along with distinct microbial compositions and profiles of antimicrobial resistance genes, compared to healthy individuals. The nasopharynx exhibited a consistent microbiota composition across all cohorts. Enrichment of members of the Burkholderiaceae family and an increased Firmicutes/Bacteroidetes ratio in the CF cohort emerged as key distinguishing factors compared to NCFB group. Staphylococcus aureus and Prevotella shahii also presented differential abundance in the CF and NCFB cohorts, respectively, in the lower respiratory tract. Considering antimicrobial resistance, a high number of genes related to antibiotic efflux were detected in both disease groups, which correlated with the patient's clinical data. CONCLUSIONS Bronchiectasis is associated with reduced microbial diversity and a shift in microbial and resistome composition compared to healthy subjects. Despite some similarities, CF and NCFB present significant differences in microbiome composition and antimicrobial resistance profiles, suggesting the need for customized management strategies for each disease.
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Affiliation(s)
- Heryk Motta
- Laboratório de Biologia Molecular de Patógenos, Centro de Biotecnologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Júlia Catarina Vieira Reuwsaat
- Laboratório de Biologia Molecular de Patógenos, Centro de Biotecnologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernanda Cortez Lopes
- Departamento de Biofísica, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Programa de Pós-Graduação em Biologia Celular e Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Graciele Viezzer
- Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Fabiana Caroline Zempulski Volpato
- Laboratório de Pesquisa em Resistência Bacteriana, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Afonso Luís Barth
- Laboratório de Pesquisa em Resistência Bacteriana, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Paulo de Tarso Roth Dalcin
- Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Charley Christian Staats
- Programa de Pós-Graduação em Biologia Celular e Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marilene Henning Vainstein
- Programa de Pós-Graduação em Biologia Celular e Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Laboratório de Microrganismos de Importância Médica e Biotecnológica, Centro de Biotecnologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lívia Kmetzsch
- Laboratório de Biologia Molecular de Patógenos, Centro de Biotecnologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- Programa de Pós-Graduação em Biologia Celular e Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Chotirmall SH, Mac Aogáin M, Tiew PY, Jaggi TK, Narayana JK, Singh S, Hansbro PM, Segal LN. Targeting respiratory microbiomes in COPD and bronchiectasis. Expert Rev Respir Med 2024. [PMID: 38743428 DOI: 10.1080/17476348.2024.2355155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/10/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION This review summarizes our current understanding of the respiratory microbiome in COPD and Bronchiectasis. We explore the interplay between microbial communities, host immune responses, disease pathology and treatment outcomes. AREAS COVERED We detail the dynamics of the airway microbiome, its influence in chronic respiratory diseases, and analytical challenges. Relevant articles from PubMed and Medline searches between Jan 2010 and March 2024 were retrieved and summarized. The review examines clinical correlations of the microbiome in COPD and bronchiectasis, assessing how current therapies impact upon it. The potential of emerging immunotherapies, anti-inflammatories and antimicrobial strategies are discussed, with focus on the pivotal role of commensal taxa in maintaining respiratory health and the promising avenue of microbiome remodeling for disease management. EXPERT OPINION Given the heterogeneity in microbiome composition and its pivotal role in disease development and progression, a shift toward microbiome-directed therapeutics is appealing. This transition, from traditional 'pathogen-centric' diagnostic and treatment modalities to those acknowledging the microbiome, can be enabled by evolving cross-disciplinary platforms which have the potential to accelerate microbiome-based interventions into routine clinical practice. Bridging the gap between comprehensive microbiome analysis and clinical application, however, remains challenging, necessitating continued innovation in research, diagnostics, trials and therapeutic development pipelines.
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Affiliation(s)
- Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Micheál Mac Aogáin
- Department of Biochemistry, St. James's Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Pei Yee Tiew
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Tavleen Kaur Jaggi
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Shivani Singh
- Division of Pulmonary Critical Care & Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, NY
| | - Philip M Hansbro
- Centre for Inflammation, Centenary Institute and University of Technology Sydney, Sydney, Australia
| | - Leopoldo N Segal
- Division of Pulmonary Critical Care & Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, NY
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Chang AB, Yerkovich ST, Baines KJ, Burr L, Champion A, Chatfield MD, Eg KP, Goyal V, Marsh RL, McCallum GB, McElrea M, McPhail S, Morgan LC, Morris PS, Nathan AM, O'Farrell H, Sanchez MO, Parsons M, Schultz A, Torzillo PJ, West NP, Versteegh L, Marchant JM, Grimwood K. Erdosteine in children and adults with bronchiectasis (BETTER trial): study protocol for a multicentre, double-blind, randomised controlled trial. BMJ Open Respir Res 2024; 11:e002216. [PMID: 38719503 PMCID: PMC11086403 DOI: 10.1136/bmjresp-2023-002216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Bronchiectasis is a worldwide chronic lung disorder where exacerbations are common. It affects people of all ages, but especially Indigenous populations in high-income nations. Despite being a major contributor to chronic lung disease, there are no licensed therapies for bronchiectasis and there remain relatively few randomised controlled trials (RCTs) conducted in children and adults. Our RCT will address some of these unmet needs by evaluating whether the novel mucoactive agent, erdosteine, has a therapeutic role in children and adults with bronchiectasis.Our primary aim is to determine in children and adults aged 2-49 years with bronchiectasis whether regular erdosteine over a 12-month period reduces acute respiratory exacerbations compared with placebo. Our primary hypothesis is that people with bronchiectasis who regularly use erdosteine will have fewer exacerbations than those receiving placebo.Our secondary aims are to determine the effect of the trial medications on quality of life (QoL) and other clinical outcomes (exacerbation duration, time-to-next exacerbation, hospitalisations, lung function, adverse events). We will also assess the cost-effectiveness of the intervention. METHODS AND ANALYSIS We are undertaking an international multicentre, double-blind, placebo-RCT to evaluate whether 12 months of erdosteine is beneficial for children and adults with bronchiectasis. We will recruit 194 children and adults with bronchiectasis to a parallel, superiority RCT at eight sites across Australia, Malaysia and Philippines. Our primary endpoint is the rate of exacerbations over 12 months. Our main secondary outcomes are QoL, exacerbation duration, time-to-next exacerbation, hospitalisations and lung function. ETHICS AND DISSEMINATION The Human Research Ethics Committees (HREC) of Children's Health Queensland (for all Australian sites), University of Malaya Medical Centre (Malaysia) and St. Luke's Medical Centre (Philippines) approved the study. We will publish the results and share the outcomes with the academic and medical community, funding and relevant patient organisations. TRIAL REGISTRATION NUMBER ACTRN12621000315819.
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Affiliation(s)
- Anne B Chang
- Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- The Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia
- Child and Maternal Health Division and andand NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Stephanie T Yerkovich
- The Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia
- Child and Maternal Health Division and andand NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Katherine J Baines
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
- Immune Health Research Program, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Lucy Burr
- Mater Health Services, South Brisbane, Queensland, Australia
| | - Anita Champion
- Department of Pharmacy, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | | | - Kah P Eg
- Department of Paediatrics, Universiti Malaya Faculty of Medicine, Kuala Lumpur, Malaysia
| | - Vikas Goyal
- The Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Robyn L Marsh
- Child and Maternal Health Division and andand NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Northern Territory, Australia
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Gabrielle B McCallum
- Child and Maternal Health Division and andand NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Margaret McElrea
- The Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Steven McPhail
- The Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Brisbane, Queensland, Australia
- Metro South Health, Clinical Informatics Directorate, Woollongabba, Queensland, Australia
| | - Lucy C Morgan
- Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Peter S Morris
- Child and Maternal Health Division and andand NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Anne M Nathan
- Department of Paediatrics, Universiti Malaya Faculty of Medicine, Kuala Lumpur, Malaysia
| | - Hannah O'Farrell
- The Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia
- Child and Maternal Health Division and andand NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Marion O Sanchez
- Section of Pediatric Pulmonology, Institute of Pulmonary Medicine, St. Luke's Medical Center, Quezon City, Philippines
| | - Marianne Parsons
- Parent Advisory Group, Cough, Asthma and Airways Group, Queensland University of Technology Faculty of Health, Kelvin Grove, Queensland, Australia
| | - André Schultz
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- Wal-yan Respiratory Research Centre, Telethon Kids Institute & Division of Paediatrics, Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Paul J Torzillo
- Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Sydney Medical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Nicholas P West
- School of Medicine and Dentistry, Griffith University Griffith Health, Gold Coast, Queensland, Australia
| | - Lesley Versteegh
- Child and Maternal Health Division and andand NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Julie M Marchant
- Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- The Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Keith Grimwood
- School of Medicine and Dentistry, Griffith University Griffith Health, Gold Coast, Queensland, Australia
- Departments of Infectious Disease and Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia
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Burgel PR, Ballmann M, Drevinek P, Heijerman H, Jung A, Mainz JG, Peckham D, Plant BJ, Schwarz C, Taccetti G, Smyth A. Considerations for the use of inhaled antibiotics for Pseudomonas aeruginosa in people with cystic fibrosis receiving CFTR modulator therapy. BMJ Open Respir Res 2024; 11:e002049. [PMID: 38702073 PMCID: PMC11086488 DOI: 10.1136/bmjresp-2023-002049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 04/11/2024] [Indexed: 05/06/2024] Open
Abstract
The major cause of mortality in people with cystic fibrosis (pwCF) is progressive lung disease characterised by acute and chronic infections, the accumulation of mucus, airway inflammation, structural damage and pulmonary exacerbations. The prevalence of Pseudomonas aeruginosa rises rapidly in the teenage years, and this organism is the most common cause of chronic lung infection in adults with cystic fibrosis (CF). It is associated with an accelerated decline in lung function and premature death. New P. aeruginosa infections are treated with antibiotics to eradicate the organism, while chronic infections require long-term inhaled antibiotic therapy. The prevalence of P. aeruginosa infections has decreased in CF registries since the introduction of CF transmembrane conductance regulator modulators (CFTRm), but clinical observations suggest that chronic P. aeruginosa infections usually persist in patients receiving CFTRm. This indicates that pwCF may still need inhaled antibiotics in the CFTRm era to maintain long-term control of P. aeruginosa infections. Here, we provide an overview of the changing perceptions of P. aeruginosa infection management, including considerations on detection and treatment, the therapy burden associated with inhaled antibiotics and the potential effects of CFTRm on the lung microbiome. We conclude that updated guidance is required on the diagnosis and management of P. aeruginosa infection. In particular, we highlight a need for prospective studies to evaluate the consequences of stopping inhaled antibiotic therapy in pwCF who have chronic P. aeruginosa infection and are receiving CFTRm. This will help inform new guidelines on the use of antibiotics alongside CFTRm.
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Affiliation(s)
- Pierre-Régis Burgel
- Université Paris Cité, Institut Cochin, Inserm U1016, Paris, France
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- ERN-lung CF Network, Frankfurt, Germany
| | - Manfred Ballmann
- Kinder- und Jugendklinik der Universitätsmedizin Rostock, Rostock, Germany
| | - Pavel Drevinek
- Department of Medical Microbiology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Harry Heijerman
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andreas Jung
- Division of Respiratory Medicine, University Children's Hospital, Zurich, Switzerland
| | - Jochen G Mainz
- Medizinische Hochschule Brandenburg (MHB) University, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - Daniel Peckham
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Barry J Plant
- Cork Adult Cystic Fibrosis Centre, Cork University Hospital, University College, Cork, Republic of Ireland
| | - Carsten Schwarz
- HMU-Health and Medical University Potsdam, Internal Medicine and Pneumology, Clinic Westbrandenburg, Division of Cystic Fibrosis, CF Center Westbrandenburg, Campus Potsdam, Potsdam, Germany
| | - Giovanni Taccetti
- Meyer Children's Hospital IRCCS, Cystic Fibrosis Regional Reference Centre, Department of Paediatric Medicine, Florence, Italy
| | - Alan Smyth
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Gu Y, Zhang T, Peng M, Han Y, Zhang W, Shi J. Latent class analysis of chest CT abnormalities to define subphenotypes in patients with MPO-ANCA-positive microscopic polyangiitis. Respir Med 2024; 226:107613. [PMID: 38548141 DOI: 10.1016/j.rmed.2024.107613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Patients with microscopic polyangiitis (MPA) and positive myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) may present with various abnormalities in chest computed tomography (CT). This study aimed to identify subphenotypes using latent class analysis (LCA) and to explore the relationship between the subphenotypes and clinical patterns, as well as compare the clinical characteristics of these subphenotypes in patients with MPO-ANCA-positive MPA (MPO-MPA). METHODS The study identified subphenotypes using LCA based on chest CT findings in 178 patients with MPO-MPA and pulmonary involvement from June 2014 to August 2022. RESULTS LCA identified 27 participants (15.2%) in class 1, 43 (24.1%) in class 2, 35 (19.7%) in class 3, and 73 (41.0%) in class 4. Class 1 was characterized by prominent inflammatory exudation, class 2 by fibrosis and architectural distortion, class 3 by predominantly bronchiectasis, and class 4 by lesions mixed with inflammation and fibrosis. Class 1 had the highest level of extrapulmonary disease activity, with 77.8% of patients experiencing diffuse alveolar hemorrhage. Class 2 had the lowest level of extrapulmonary disease activity, with 41.9% of patients showing usual interstitial pneumonia. Class 3 patients were more likely to have complications involving the ear, nose, and throat, as well as pulmonary infections before treatment, and they exhibited the best outcomes. The characteristics and outcomes of class 4 were intermediate among the four classes. CONCLUSIONS These findings suggest that bronchiectasis may represent a unique pattern of pulmonary involvement in MPO-MPA, highlighting the importance of screening for bronchiectasis in MPO-MPA and identifying optimal management strategies.
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Affiliation(s)
- Yu Gu
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No. 1 Shuai Fu Yuan Street, Dongcheng-Qu, Beijing, 100730, China
| | - Ting Zhang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No. 1 Shuai Fu Yuan Street, Dongcheng-Qu, Beijing, 100730, China.
| | - Min Peng
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No. 1 Shuai Fu Yuan Street, Dongcheng-Qu, Beijing, 100730, China
| | - Yang Han
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No. 1 Shuai Fu Yuan Street, Dongcheng-Qu, Beijing, 100730, China
| | - Weihong Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No. 1 Shuai Fu Yuan Street, Dongcheng-Qu, Beijing, 100730, China
| | - Juhong Shi
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No. 1 Shuai Fu Yuan Street, Dongcheng-Qu, Beijing, 100730, China.
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8
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Hussein MM, Fouda EM, Shehab Y, Nabih ES, Osman AM, Ishak SR. Association between arachidonate lipoxygenase 15,c.-292 C > T gene polymorphism and non-cystic fibrosis bronchiectasis in children: a pilot study on the effects on airway lipoxin A4 and disease phenotype. Ital J Pediatr 2024; 50:90. [PMID: 38685084 PMCID: PMC11059722 DOI: 10.1186/s13052-024-01654-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 04/07/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Persistent airway inflammation is a central feature of bronchiectasis. Arachidonate 15-lipoxygenase (ALOX-15) controls production of endogenous lipid mediators, including lipoxins that regulate airway inflammation. Mutations at various positions in ALOX-15 gene can influence airway disease development. We investigated association between ALOX-15,c.-292 C > T gene polymorphism and bronchiectasis unrelated to cystic fibrosis in Egyptian children. Also, lipoxin A4 (LXA4) level in bronchoalveolar lavage (BAL) was studied in relation to polymorphism genotypes and disease phenotypes determined by clinical, pulmonary functions, and radiological severity parameters. METHODS This was an exploratory study that included 60 participants. Thirty children with non-cystic fibrosis bronchiectasis (NCFB) were compared with 30 age and sex-matched controls. ALOX-15,c.-292 C > T polymorphism was genotyped using TaqMan-based Real-time PCR. LXA4 was measured in BAL using ELISA method. RESULTS There was no significant difference between patients and controls regarding ALOX-15,c.-292 C > T polymorphism genotypes and alleles (OR = 1.75; 95% CI (0.53-5.7), P = 0.35) (OR = 1; 95% CI (0.48-2), p = 1). BAL LXA4 level was significantly lower in patients, median (IQR) of 576.9 (147.6-1510) ng/ml compared to controls, median (IQR) of 1675 (536.8-2542) (p = 0.002). Patients with severe bronchiectasis had a significantly lower LXA4 level (p < 0.001). There were significant correlations with exacerbations frequency (r=-0.54, p = 0.002) and FEV1% predicted (r = 0.64, p = 0.001). Heterozygous CT genotype carriers showed higher LXA4 levels compared to other genotypes(p = 0.005). CONCLUSIONS Low airway LXA4 in children with NCFB is associated with severe disease phenotype and lung function deterioration. CT genotype of ALOX-15,c.-292 C > T polymorphism might be a protective genetic factor against bronchiectasis development and/or progression due to enhanced LXA4 production.
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Affiliation(s)
| | - Eman Mahmoud Fouda
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Yasmine Shehab
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Enas Samir Nabih
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Mohamed Osman
- Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sally Raafat Ishak
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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9
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Huang WY, Hong KK, He RQ, Luo J, Huang ZG, Zhang CY, Xu Y, Bao CX, Zhang LM, Chen G, Kong JL. Clinical significance and potential pathogenesis of VCAN in adult non-cystic fibrosis bronchiectasis: a retrospective study. BMC Pulm Med 2024; 24:209. [PMID: 38685004 PMCID: PMC11059678 DOI: 10.1186/s12890-024-03027-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/19/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND The pathogenesis of adult non-cystic fibrosis (CF) bronchiectasis is complex, and the relevant molecular mechanism remains ambiguous. Versican (VCAN) is a key factor in inflammation through interactions with adhesion molecules. This study constructs a stable panoramic map of mRNA, reveals the possible pathogenesis of bronchiectasis, and provides new ideas and methods for bronchiectasis. METHODS Peripheral blood and tissue gene expression data from patients with bronchiectasis and normal control were selected by bioinformatics analysis. The expression of VCAN in peripheral blood and bronchial tissues of bronchiectasis were obtained by transcriptome sequencing. The protein expression levels of VCAN in serums were verified by the enzyme-linked immunosorbent assay (ELISA). The mRNA expression levels of VCAN in co-culture of Pseudomonas aeruginosa and bronchial epithelial cells were verified by real-time quantitative polymerase chain reaction (RT-qPCR). In addition, the biological function of VCAN was detected by the transwell assay. RESULTS The expression of VCAN was upregulated in the bronchiectasis group by sequencing analysis (P < 0.001). The expression of VCAN in the bronchial epithelial cell line BEAS-2B was increased in P. aeruginosa (P.a), which was co-cultured with BEAS-2B cells (P < 0.05). The concentration of VCAN protein in the serum of patients with bronchiectasis was higher than that in the normal control group (P < 0.05). Transwell experiments showed that exogenous VCAN protein induced the migration of neutrophils (P < 0.0001). CONCLUSIONS Our findings indicate that VCAN may be involved in the development of bronchiectasis by increasing the migration of neutrophils and play an important role in bronchial pathogenesis.
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Affiliation(s)
- Wan-Ying Huang
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Kang-Kang Hong
- Ward of Pulmonary and Critical Care Medicine, Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Rong-Quan He
- Department of Medical Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jing Luo
- Ward of Pulmonary and Critical Care Medicine, Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zhi-Guang Huang
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Chu-Yue Zhang
- Ward of Pulmonary and Critical Care Medicine, Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yang Xu
- Ward of Pulmonary and Critical Care Medicine, Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Chong-Xi Bao
- Ward of Pulmonary and Critical Care Medicine, Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Liang-Ming Zhang
- Ward of Pulmonary and Critical Care Medicine, Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Gang Chen
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
| | - Jin-Liang Kong
- Ward of Pulmonary and Critical Care Medicine, Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
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10
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Xu HD, Yang L, Hu SB. Embosphere microspheres size for bronchial artery embolization in patients with hemoptysis caused by bronchiectasis: a retrospective comparative analysis of 500-750 versus 700-900 μm microspheres. BMC Pulm Med 2024; 24:203. [PMID: 38658883 PMCID: PMC11044458 DOI: 10.1186/s12890-024-03019-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/16/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Bronchial arterial embolization (BAE) has been accepted as an effective treatment for bronchiectasis-related hemoptysis. However, rare clinical trials compare different sizes of specific embolic agents. This study aims to evaluate whether different Embosphere microsphere sizes change the outcome of BAE. METHODS A retrospective review was conducted on consecutive patients with bronchiectatic hemoptysis who were scheduled to undergo BAE treatment during a period from January 2018 to December 2022. The patients received BAE using microspheres of different sizes: group A patients were treated with 500-750 μm microspheres, and group B patients were treated with 700-900 μm microspheres. The cost of embolic microspheres (Chinese Yuan, CNY), duration of hospitalization, complications, and hemoptysis-free survival were compared between patients in group A and those in group B. A Cox proportional hazards regression model was used to identify predictors of recurrent hemoptysis. RESULTS Median follow-up was 30.2 months (range, 20.3-56.5 months). The final analysis included a total of 112 patients (49-77 years of age; 45 men). The patients were divided into two groups: group A (N = 68), which received 500-750 μm Embosphere microspheres, and group B (N = 44), which received 700-900 μm Embosphere microspheres. Except for the cost of embolic microspheres(group A,5314.8 + 1301.5 CNY; group B, 3644.5 + 1192.3 CNY; p = 0.042), there were no statistically significant differences in duration of hospitalization (group A,7.2 + 1.4 days; group B, 8 + 2.4days; p = 0.550), hemoptysis-free survival (group A, 1-year, 2-year, 3-year, 85.9%, 75.8%, 62.9%; group B, 1-year, 2-year, 3-year, 88.4%, 81.2%,59.4%;P = 0.060), and complications(group A,26.5%; group B, 38.6%; p = 0.175) between the two groups. No major complications were observed. The multivariate analysis results revealed that the presence of cystic bronchiectasis (OR 1.61, 95% CI 1.12-2.83; P = 0.001) and systemic arterial-pulmonary shunts (SPSs) (OR 1.52, 95% CI 1.10-2.72; P = 0.028) were independent risk factors for recurrent bleeding. CONCLUSIONS For the treatment of BAE in patients with bronchiectasis-related hemoptysis, 500-750 μm diameter Embosphere microspheres have a similar efficacy and safety profile compared to 700-900 μm diameter Embosphere microspheres, especially for those without SPSs or cystic bronchiectasis. Furthermore, the utilization of large-sized (700-900 μm) Embosphere microspheres is associated with the reduced cost of an embolic agent.
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Affiliation(s)
- Hong-Dou Xu
- Department of Interventional Radiology, Gaochun Peoples Hospital Affiliated to Jiangsu University, 53 Maoshan Road, Gaochun District, Nanjing, 211302, Jiangsu, China
| | - Liang Yang
- Department of Interventional Radiology, Gaochun Peoples Hospital Affiliated to Jiangsu University, 53 Maoshan Road, Gaochun District, Nanjing, 211302, Jiangsu, China
| | - Shi-Bing Hu
- Department of Interventional Radiology, Gaochun Peoples Hospital Affiliated to Jiangsu University, 53 Maoshan Road, Gaochun District, Nanjing, 211302, Jiangsu, China.
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11
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Pan CX, He ZF, Lin SZ, Yue JQ, Chen ZM, Guan WJ. Clinical Characteristics and Outcomes of the Phenotypes of COPD- Bronchiectasis Association. Arch Bronconeumol 2024:S0300-2896(24)00110-8. [PMID: 38714385 DOI: 10.1016/j.arbres.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/16/2024] [Accepted: 04/03/2024] [Indexed: 05/09/2024]
Abstract
INTRODUCTION Although COPD may frequently co-exist with bronchiectasis [COPD-bronchiectasis associated (CBA)], little is known regarding the clinical heterogeneity. We aimed to identify the phenotypes and compare the clinical characteristics and prognosis of CBA. METHODS We conducted a retrospective cohort study involving 2928 bronchiectasis patients, 5158 COPD patients, and 1219 patients with CBA hospitalized between July 2017 and December 2020. We phenotyped CBA with a two-step clustering approach and validated in an independent retrospective cohort with decision-tree algorithms. RESULTS Compared with patients with COPD or bronchiectasis alone, patients with CBA had significantly longer disease duration, greater lung function impairment, and increased use of intravenous antibiotics during hospitalization. We identified five clusters of CBA. Cluster 1 (N=120, CBA-MS) had predominantly moderate-severe bronchiectasis, Cluster 2 (N=108, CBA-FH) was characterized by frequent hospitalization within the previous year, Cluster 3 (N=163, CBA-BI) had bacterial infection, Cluster 4 (N=143, CBA-NB) had infrequent hospitalization but no bacterial infection, and Cluster 5 (N=113, CBA-NHB) had no hospitalization or bacterial infection in the past year. The decision-tree model predicted the cluster assignment in the validation cohort with 91.8% accuracy. CBA-MS, CBA-BI, and CBA-FH exhibited higher risks of hospital re-admission and intensive care unit admission compared with CBA-NHB during follow-up (all P<0.05). Of the five clusters, CBA-FH conferred the worst clinical prognosis. CONCLUSION Bronchiectasis severity, recent hospitalizations and sputum culture findings are three defining variables accounting for most heterogeneity of CBA, the characterization of which will help refine personalized clinical management.
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Affiliation(s)
- Cui-Xia Pan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Respiratory and Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhen-Feng He
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Respiratory and Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Sheng-Zhu Lin
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Respiratory and Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jun-Qing Yue
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Respiratory and Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhao-Ming Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Respiratory and Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wei-Jie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Respiratory and Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China; Guangzhou National Laboratory, Guangzhou, Guangdong, China.
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12
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Kwok WC, Tsui CK, Leung SHI, Wong CKE, Tam TCC, Ho JCM. Cardiovascular outcomes following hospitalisation for exacerbation of bronchiectasis: a territory-wide study. BMJ Open Respir Res 2024; 11:e001804. [PMID: 38637114 PMCID: PMC11029341 DOI: 10.1136/bmjresp-2023-001804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 04/05/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Although bronchiectasis is reported to be associated with cardiovascular disease, evidence for an association with cardiovascular events (CVEs) is lacking. METHODS A territory-wide retrospective cohort study was conducted in Hong Kong involving all patients who had bronchiectasis diagnosed in public hospitals and clinics between 1 January 1993 and 31 December 2017 were included. Patients were allocated to be exacerbator or non-exacerbator group based on hospitalzied bronchiecsis history and CVEs over the next 5 years determined. Propensity score matching was used to balance baseline characteristics. RESULTS 10 714 bronchiectasis patients (mean age 69.6±14.4 years, 38.9% men), including 1230 in exacerbator group and 9484 in non-exacerbator group, were analysed. At 5 years, 113 (9.2%) subjects in the exacerbator group and 87 (7.1%) in the non-exacerbator group developed composite CVEs. After adjustment for age, sex, smoking and risk factors for cardiovascular disease, bronchiectasis exacerbation was associated with increased risks for acute myocardial infarction (AMI), congestive heart failure (CHF) and CVE compared with those in the non-exacerbator group with adjusted HR of 1.602 (95% CI 1.006-2.552, p value=0.047), 1.371 (95% CI 1.016-1.851, p value=0.039) and 1.238 (95% CI 1.001-1.532, p=0.049) in the whole cohort. Findings were similar for the propensity score-matched cohort for AMI and CVE. CONCLUSION Patients who were hospitalised for exacerbation of bronchiectasis were at significantly increased risk of AMI, CHF and CVE over a 5-year follow-up period.
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Affiliation(s)
- Wang Chun Kwok
- Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Chung Ki Tsui
- Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Sze Him Isaac Leung
- Department of Statistics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | | | - James Chung-Man Ho
- Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
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13
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Girón R, Golpe R, Martínez-García MÁ. Bronchiectasis not due to cystic fibrosis. Med Clin (Barc) 2024:S0025-7753(24)00145-3. [PMID: 38637217 DOI: 10.1016/j.medcli.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/11/2024] [Accepted: 01/14/2024] [Indexed: 04/20/2024]
Abstract
Bronchiectasis is a clinical-radiological condition composed of irreversible bronchial dilation due to inflammation and infection of the airways, which causes respiratory symptoms, usually productive cough and infectious exacerbations. Bronchiectasis can have multiple causes, both pulmonary and extrapulmonary, and its clinical presentation is very heterogenous. Its prevalence is unknown, although up to 35-50% of severe COPD and 25% of severe asthma present them, so their underdiagnosis is evident. Chronic bacterial bronchial infection is common, and Pseudomonas aeruginosa is the pathogen that has been found to imply a worse prognosis. Treatment of bronchiectasis has three fundamental characteristics: it must be multidisciplinary (involvement of several specialties), pyramidal (from primary care to the most specialized units) and multidimensional (management of all aspects that make up the disease).
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Affiliation(s)
- Rosa Girón
- Servicio de Neumología, Hospital Universitario La Princesa, Madrid, España
| | - Rafael Golpe
- Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, España
| | - Miguel Ángel Martínez-García
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, España; CIBER de Enfermedades Respiratorias. ISCIII, Madrid, España.
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14
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Lee HW, Lee JK, Kim Y, Jang AS, Hwang YI, Lee JH, Jung KS, Yoo KH, Yoon HK, Kim DK. Differential decline of lung function in COPD patients according to structural abnormality in chest CT. Heliyon 2024; 10:e27683. [PMID: 38560191 PMCID: PMC10980934 DOI: 10.1016/j.heliyon.2024.e27683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 03/02/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Background Different progressions or prognoses of chronic obstructive pulmonary disease (COPD) have been reported according to structural abnormalities based on chest computed tomography (CT). This study aimed to investigate whether different structural abnormalities independently affect annual lung function changes and clinical prognosis in patients with COPD. Methods This longitudinal multicenter observational study was conducted using the KOCOSS cohort (NCT02800499) database in Korea from January 2012 to December 2019. For COPD patients with chest CT findings at baseline enrolment and longitudinal spirometric data, annual forced expiratory volume in 1 s (FEV1) decline rate (mL/year) and clinical outcomes were compared according to structural abnormalities, including emphysema, bronchiectasis (BE), and tuberculosis-destroyed lung (TDL). We estimated the adjusted annual FEV1 changes using a mixed-effect linear regression model. Results Among the enrolled 237 patients, 152 showed structural abnormalities. Emphysema, BE, and TDL were observed in 119 (78.3%), 28 (18.4%), and 27 (17.8%) patients, respectively. The annual decline in FEV1 was faster in COPD patients with structural abnormalities than those without (β = -70.6 mL/year, P-value = 0.039). BE/TDL-dominant or emphysema-dominant structural abnormality contributed to an accelerated annual FEV1 decline compared to no structural abnormality (BE/TDL-dominant, β = -103.7 mL/year, P-value = 0.043; emphysema-dominant, β = -84.1 mL/year, P-value = 0.018). Structural abnormalities made no significant differences in acute exacerbation rate and mortality. Conclusion The lung function decline rate in COPD differed according to structural abnormalities on CT. These findings may suggest that more focus should be placed on earlier intervention or regular follow-up with spirometry in COPD patients with BE or TDL on chest CT.
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Affiliation(s)
- Hyun Woo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Kyu Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Youlim Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University Hospital, School of Medicine, Konkuk University, Seoul, South Korea
| | - An-Soo Jang
- Department of Pulmonology and Allergy, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Yong il Hwang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Jae Ha Lee
- Division of Pulmonology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, University of Inje College of Medicine, Busan, South Korea
| | - Ki-Suck Jung
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Kwang Ha Yoo
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University Hospital, School of Medicine, Konkuk University, Seoul, South Korea
| | - Hyoung Kyu Yoon
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Deog Kyeom Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
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15
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Dean SG, Blakney RA, Ricotta EE, Chalmers JD, Kadri SS, Olivier KN, Prevots DR. Bronchiectasis-associated infections and outcomes in a large, geographically diverse electronic health record cohort in the United States. BMC Pulm Med 2024; 24:172. [PMID: 38600466 PMCID: PMC11008033 DOI: 10.1186/s12890-024-02973-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/19/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Bronchiectasis is a pulmonary disease characterized by irreversible dilation of the bronchi and recurring respiratory infections. Few studies have described the microbiology and prevalence of infections in large patient populations outside of specialized tertiary care centers. METHODS We used the Cerner HealthFacts Electronic Health Record database to characterize the nature, burden, and frequency of pulmonary infections among persons with bronchiectasis. Chronic infections were defined based on organism-specific guidelines. RESULTS We identified 7,749 patients who met our incident bronchiectasis case definition. In this study population, the organisms with the highest rates of isolate prevalence were Pseudomonas aeruginosa with 937 (12%) individuals, Staphylococcus aureus with 502 (6%), Mycobacterium avium complex (MAC) with 336 (4%), and Aspergillus sp. with 288 (4%). Among persons with at least one isolate of each respective pathogen, 219 (23%) met criteria for chronic P. aeruginosa colonization, 74 (15%) met criteria for S. aureus chronic colonization, 101 (30%) met criteria for MAC chronic infection, and 50 (17%) met criteria for Aspergillus sp. chronic infection. Of 5,795 persons with at least two years of observation, 1,860 (32%) had a bronchiectasis exacerbation and 3,462 (60%) were hospitalized within two years of bronchiectasis diagnoses. Among patients with chronic respiratory infections, the two-year occurrence of exacerbations was 53% and for hospitalizations was 82%. CONCLUSIONS Patients with bronchiectasis experiencing chronic respiratory infections have high rates of hospitalization.
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Affiliation(s)
- Samantha G Dean
- Epidemiology and Population Studies Unit, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, USA
| | - Rebekah A Blakney
- Epidemiology and Population Studies Unit, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, USA
| | - Emily E Ricotta
- Epidemiology and Population Studies Unit, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, USA
| | - James D Chalmers
- University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Sameer S Kadri
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, USA
| | - Kenneth N Olivier
- Laboratory of Chronic Airway Infection, Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, USA
- Department of Medicine, Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, USA
| | - D Rebecca Prevots
- Epidemiology and Population Studies Unit, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, USA.
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16
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Lestelle F, Beigelman C, Rotzinger D, Si-Mohamed S, Nasser M, Wemeau L, Hirschi S, Prevot G, Roux A, Bunel V, Gomez E, Sohier L, Pradier HM, Gaubert MR, Gondouin A, Lazor R, Glerant JC, Bejui FT, Colombat M, Cottin V. Phenotypes and outcome of diffuse pulmonary non-amyloid light chain deposition disease. Respir Res 2024; 25:159. [PMID: 38600600 PMCID: PMC11005206 DOI: 10.1186/s12931-024-02798-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/01/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Light chain deposition disease (LCDD) is a very rare entity. Clinical manifestations of LCDD vary according to the organs involved. Data on pulmonary LCDD are scarce and limited to small series or case reports. This study aimed to describe the characteristics and outcome of diffuse pulmonary non-amyloid LCDD localized to the lungs. STUDY DESIGN AND METHODS A multicenter retrospective cohort study was conducted. Clinical characteristics were collected, and chest CTs were centrally reviewed. The diagnosis of pulmonary non-amyloid LCDD was confirmed by immunohistochemistry. RESULTS Thirty-one cases were identified (68% female), with a median age at diagnosis of 50 years (IQR 20). Baseline FEV1/FVC was < 0.70 in 45% of patients. Mean (± SD) FEV1 and DLCO were 86% ± 26.2 and 52% ± 23.9, respectively. CT revealed peculiar patterns of thin-walled cysts (58%) and thin-walled cystic bronchiectases (27%). Increased serum kappa light chain was found in 87% of patients. Histological analysis showed kappa light chain deposits in all patients, except one with lambda chain deposits. Median annual FEV1 decline was 127 ml (IQR 178) and median DLCO decline was 4.3% (IQR 4.3). Sixteen patients received immunomodulatory treatment or chemotherapy; serum light chain levels decreased in 9 cases (75%), without significant improvement in FEV1 (p = 0.173). Overall, 48% of patients underwent bilateral lung transplantation. Transplant-free survival at 5 and 10 years were 70% and 30%, respectively. An annual FEV1 decline greater than 127 ml/year was associated with increased risk of death or transplantation (p = 0.005). CONCLUSIONS Diffuse pulmonary LCDD is characterised by female predominance, a peculiar imaging pattern with bronchiectasis and/or cysts, progressive airway obstruction and severe DLCO impairment, and poor outcome. Lung transplantation is a treatment of choice.
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Affiliation(s)
- François Lestelle
- Hospices Civils de Lyon, Centre de Référence Coordinateur Des Maladies Pulmonaires Rares (OrphaLung), Hôpital Louis Pradel, Service de Pneumologie, 69677, Lyon, France
| | - Catherine Beigelman
- Service de Radiologie Et de Radiologie Interventionnelle, Hôpital Universitaire de Lausanne, Université de Lausanne, Lausanne, Suisse
| | - David Rotzinger
- Service de Radiologie Et de Radiologie Interventionnelle, Hôpital Universitaire de Lausanne, Université de Lausanne, Lausanne, Suisse
| | - Salim Si-Mohamed
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service de Radiologie, Lyon 69677U1206, Université de Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS, UMR 5220, F-69621, 7 Avenue Jean Capelle O, 69100, Villeurbanne, France
| | - Mouhamad Nasser
- Hospices Civils de Lyon, Centre de Référence Coordinateur Des Maladies Pulmonaires Rares (OrphaLung), Hôpital Louis Pradel, Service de Pneumologie, 69677, Lyon, France
| | - Lidwine Wemeau
- Centre de Référence Constitutif Des Maladies Pulmonaires Rares (OrphaLung), CHU Lille, Service de Pneumologie, Lille, France
| | - Sandrine Hirschi
- Centre de Compétence Des Maladies Pulmonaires Rares (OrphaLung), CHU Strasbourg, Service de Pneumologie, Strasbourg, France
| | - Grégoire Prevot
- Centre de Compétence Des Maladies Pulmonaires Rares (OrphaLung), CHU Toulouse, Hôpital LarreyUniversité Paul Sabatier, Toulouse, France
| | - Antoine Roux
- Service de Pneumologie Et de Transplantation Pulmonaire, Hopital Foch, Suresnes, France
| | - Vincent Bunel
- Service de Pneumologie B Et de Transplantation Pulmonaire, AP-HP, Hôpital Bichat Claude-Bernard, Inserm U1152, Paris, France
| | - Emmanuel Gomez
- Centre de Compétence Des Maladies Pulmonaires Rares (OrphaLung), CHU Nancy, Service de Pneumologie, Nancy, France
| | - Laurent Sohier
- Centre Hospitalier Bretagne Sud, Service de Pneumologie, Lorient, France
| | - Helene Morisse Pradier
- Centre de Compétence Des Maladies Pulmonaires Rares (OrphaLung), CHU Rouen, Service de Pneumologie, Rouen, France
| | - Martine Reynaud Gaubert
- Service de Pneumologie Et Transplantation Pulmonaire, CHU Marseille Nord, Aix-Marseille Université Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Anne Gondouin
- Centre de Compétence Des Maladies Pulmonaires Rares (OrphaLung), CHU Besançon, Service de Pneumologie, Besançon, France
| | - Romain Lazor
- Service de Pneumologie, Centre Hospitalier Universitaire Vaudois, Lausanne, CH, Suisse
| | - Jean-Charles Glerant
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'explorations Fonctionnelles Respiratoires, 69677, Lyon, France
| | | | - Magali Colombat
- CHU Toulouse, Institut Universitaire du Cancer de Toulouse, Service d'anatomie Et Cytologie Pathologiques, Toulouse, France
| | - Vincent Cottin
- Hospices Civils de Lyon, Centre de Référence Coordinateur Des Maladies Pulmonaires Rares (OrphaLung), Hôpital Louis Pradel, Service de Pneumologie, 69677, Lyon, France.
- UMR754, INRAE; Member of RespiFil and ERN-LUNG, Université, Claude Bernard Lyon 1, Lyon, France.
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17
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Chen YF, Chien JY, Wang HC, Yu CJ. Reexamining COPD in Bronchiectasis: Elucidating Overdiagnosis and Outcomes from EMBARC's ROSE Criteria. Am J Respir Crit Care Med 2024. [PMID: 38579279 DOI: 10.1164/rccm.202402-0289le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/04/2024] [Indexed: 04/07/2024] Open
Affiliation(s)
- Yen-Fu Chen
- National Taiwan University Hospital Yun Lin Branch, 37999, Douliou, Yunlin, Taiwan
| | - Jung-Yien Chien
- National Taiwan University Hospital, 38006, Internal medicine, Taipei, Taiwan
| | - Hao-Chien Wang
- Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
| | - Chong-Jen Yu
- National Taiwan University Hospital, Internal Medicine, Taipei, Taiwan;
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18
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Hussain A, Khurana AK, Goyal A, Kothari SY, Soman RK, Tej S, Pakhare A. Effect of pulmonary rehabilitation in patients with post-tuberculosis sequelae with functional limitation. Indian J Tuberc 2024; 71:123-129. [PMID: 38589115 DOI: 10.1016/j.ijtb.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/23/2023] [Accepted: 04/10/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND Pulmonary rehabilitation improves dyspnea, functional limitation and quality of life in patients with chronic respiratory disease especially Chronic obstructive pulmonary disease (COPD). Whether Pulmonary rehabilitation (PR) will have similar effect in patients with post-tuberculosis sequelae or not and whether the two morphological variants will respond similarly or not was the purpose of our study. METHODS Adult patients fulfilling the inclusion criteria of a diagnosis of post-tuberculosis sequelae with functional limitation (modified medical research council [mMRC] grade 1 or more) were recruited over a period of two years. A baseline health assessment in the different domains of health was done at the beginning and repeated just after the completion of the rehabilitation program at 6 weeks. RESULTS 26 patients completed the PR protocol of our study. Dyspnea improved from an mMRC grade of 1.5 to 0.7 post-PR (p < 0.001). 6MWD increased by 34 meters from a baseline value of 408.6 meters to 442.7 meters post-PR. (p-value 0.3) St. George's Respiratory Questionnaire (SGRQ) symptom score decreased by 13 points, SGRQ activity score decreased by 18 points, SGRQ impact score decreased by 18 and SGRQ total score decreased by 17 points with p-values of 0.037, 0.002, 0.004 and 0.002 for SGRQ symptom score, SGRQ activity score, SGRQ impact score, SGRQ total score respectively. Depression Anxiety Stress Scale (DASS) Stress score decreased by 6.7, DASS Anxiety score decreased by 6.6, and DASS Depression score decreased by 5.5 points. Intergroup comparison revealed both bronchiectasis predominant group and fibrosis predominant group responded similarly to PR. CONCLUSION PR improved parameters assessing dyspnea, quality of life and mental health indices significantly. Improvement in functional capacity was not statically significant. Both the morphological variants responded similarly to the PR.
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Affiliation(s)
- Aqeel Hussain
- Pulmonary, Critical Care & Sleep Medicine, AIIMS Bhopal, India.
| | | | - Abhishek Goyal
- Pulmonary, Critical Care & Sleep Medicine, AIIMS Bhopal, India.
| | - S Y Kothari
- Physical Medicine & Rehabilitation, AIIMS Bhopal, India.
| | | | - Sai Tej
- Pulmonary, Critical Care & Sleep Medicine, AIIMS Bhopal, India.
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19
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Batton R, Le Guen P, Cazes A, Debray MP, Taillé C. [Bronchial involvement in granulomatosis with polyangiitis]. Rev Mal Respir 2024; 41:325-328. [PMID: 38461090 DOI: 10.1016/j.rmr.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 03/11/2024]
Affiliation(s)
- R Batton
- Service de pneumologie et centre de référence pour les maladies respiratoires rares, hôpital Bichat, AP-HP Nord-université Paris Cité, 46, rue Henri-Huchard, 75018 Paris, France
| | - P Le Guen
- Service de pneumologie et centre de référence pour les maladies respiratoires rares, hôpital Bichat, AP-HP Nord-université Paris Cité, 46, rue Henri-Huchard, 75018 Paris, France
| | - A Cazes
- Service de pathologie, hôpital Bichat, AP-HP Nord-université Paris Cité, Paris, France
| | - M-P Debray
- Service de radiologie, hôpital Bichat, AP-HP Nord-université Paris Cité, Paris, France
| | - C Taillé
- Service de pneumologie et centre de référence pour les maladies respiratoires rares, hôpital Bichat, AP-HP Nord-université Paris Cité, 46, rue Henri-Huchard, 75018 Paris, France.
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20
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García Mullor MM, Arenas-Jiménez JJ, Ureña Vacas A, Gayá García-Manso I, Pérez Pérez JL, Serra Serra N, García Sevila R. Prevalence and prognostic meaning of interstitial lung abnormalities in remote CT scans of patients with interstitial lung disease treated with antifibrotic therapy. Radiologia (Engl Ed) 2024; 66 Suppl 1:S10-S23. [PMID: 38642956 DOI: 10.1016/j.rxeng.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/29/2023] [Indexed: 04/22/2024]
Abstract
OBJECTIVES To describe the prevalence and characteristics of interstitial lung abnormalities (ILA) in CT scans performed prior to the initiation of antifibrotics in a series of patients with interstitial lung disease (ILD), and to identify characteristics apparent on early CT scans that could help to predict outcomes. METHODS We conducted a retrospective observational study. The original cohort consisted of 101 patients diagnosed with ILD and treated with antifibrotics in a tertiary hospital. Patients were included if they had a thoracic CT scan performed at least one year before initiation of therapy. They were classified radiologically in three groups: without ILA, with radiological ILA and extensive abnormalities. ILA were classified as subpleural fibrotic, subpleural non-fibrotic and non-subpleural. The initial scan and the latest CT scan performed before treatment were read for assessing progression. The relationship between CT findings of fibrosis and the radiological progression rate and mortality were analyzed. RESULTS We included 50 patients. Only 1 (2%) had a normal CT scan, 25 (50%) had extensive alterations and 24 (48%) had radiological criteria for ILA, a median of 98.2 months before initiation of antifibrotics, of them 18 (75%) had a subpleural fibrotic pattern. Significant bronchiectasis and obvious honeycombing in the lower zones were associated with shorter survival (p = 0.04). Obvious honeycombing in the lower zones was also significantly (p < 0.05) associated with a faster progression rate. CONCLUSIONS Fibrotic ILAs are frequent in remote scans of patients with clinically relevant ILD, long before they require antifibrotics. Findings of traction bronchiectasis and honeycombing in the earliest scans, even in asymptomatic patients, are related to mortality and progression later on.
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Affiliation(s)
- M M García Mullor
- Servicio de Neumología, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - J J Arenas-Jiménez
- Servicio de Radiodiagnóstico, Hospital General Universitario Dr. Balmis, Alicante, Spain; Departamento de Patología y Cirugía, Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
| | - A Ureña Vacas
- Servicio de Radiodiagnóstico, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - I Gayá García-Manso
- Servicio de Neumología, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - J L Pérez Pérez
- Servicio de Neumología, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - N Serra Serra
- Servicio de Radiodiagnóstico, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - R García Sevila
- Servicio de Neumología, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, Spain
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21
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Perluk T, Abu Bandora E, Freund O, Jacob T, Friedman Regev I, Kleinhendler E, Shteinberg M, Bar-Shai A, Oestriecher-Kedem Y. Asymptomatic Dysphagia and Aspiration in Patients with Idiopathic Bronchiectasis. Lung 2024; 202:189-195. [PMID: 38499811 PMCID: PMC11009759 DOI: 10.1007/s00408-024-00683-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/12/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Although considered contributors to idiopathic bronchiectasis (IB), neither dysphagia nor silent aspiration have been systematically evaluated in IB patients. We aimed to explore the prevalence of asymptomatic dysphagia and silent aspiration in IB patients and to identify parameters predictive of their presence. METHODS This prospective cohort study included IB patients from our Pulmonary Institute without prior history of dysphagia and without prior dysphagia workup. Swallowing function was assessed by the Eating Assessment Tool (EAT-10) questionnaire and by the Fiberoptic Endoscopic Evaluation of Swallowing (FEES) test. RESULTS Forty-seven patients (31 females, mean age 67 ± 16 years) were recruited. An EAT-10 score ≥ 3 (risk for swallowing problems) was present in 21 patients (44.6%). Forty-two patients (89.3%) had at least one abnormal swallowing parameter in the FEES test. Six patients (12.7%) had a penetration aspiration score (PAS) in the FEES of at least 6, indicating aspiration. An EAT-10 score of 3 was found to be the ideal cutoff to predict aspiration in the FEES, with a good level of accuracy (area under the curve = 0.78, 95% CI 0.629-0.932, p = 0.03) and sensitivity of 83%. This cutoff also showed a trend towards a more severe disease using the FACED (forced expiratory volume, age, colonization with pseudomonas, extension of lung involvement, dyspnea) score (p = 0.05). CONCLUSION Dysphagia is prevalent in IB and may be undiagnosed if not specifically sought. We recommend screening all patients with IB for dysphagia by the EAT-10 questionnaire and referring all those with a score of ≥ 3 to formal swallowing assessment.
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Affiliation(s)
- Tal Perluk
- Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center, School of Medicine, Tel-Aviv University, 6 Weizman St., 6423906, Tel Aviv-Yafo, Israel.
| | - Eiman Abu Bandora
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, School of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Ophir Freund
- Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center, School of Medicine, Tel-Aviv University, 6 Weizman St., 6423906, Tel Aviv-Yafo, Israel
| | - Tommy Jacob
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, School of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Inbal Friedman Regev
- Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center, School of Medicine, Tel-Aviv University, 6 Weizman St., 6423906, Tel Aviv-Yafo, Israel
| | - Eyal Kleinhendler
- Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center, School of Medicine, Tel-Aviv University, 6 Weizman St., 6423906, Tel Aviv-Yafo, Israel
| | - Michal Shteinberg
- Pulmonology Institute and CF Center, Carmel Medical Center, Haifa, Israel
- The B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amir Bar-Shai
- Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center, School of Medicine, Tel-Aviv University, 6 Weizman St., 6423906, Tel Aviv-Yafo, Israel
| | - Yael Oestriecher-Kedem
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, School of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv-Yafo, Israel
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22
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Ibrahim T, Thomas M, Rasheed I, Mobayed H, Sattar HA, Al-Khal A, Al-Nesf M. Etiology of bronchiectasis in Qatar: A retrospective study. Qatar Med J 2024; 2024:23. [PMID: 38680397 PMCID: PMC11046134 DOI: 10.5339/qmj.2024.qitc.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/05/2024] [Indexed: 05/01/2024] Open
Affiliation(s)
- Tayseer Ibrahim
- Allergy and Immunology Division, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Merlin Thomas
- Pulmonary Division, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ibrahim Rasheed
- Pulmonary Division, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Mobayed
- Allergy and Immunology Division, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Hisham Abdul Sattar
- Pulmonary Division, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Maryam Al-Nesf
- Allergy and Immunology Division, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
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23
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Gu L, Liu W, Huang JA, Zhu L, Hu X, Yue J, Lin J. The role of Neutrophil counts, infections and Smoking in mediating the Effect of Bronchiectasis on Chronic Obstructive Pulmonary Disease: a mendelian randomization study. BMC Pulm Med 2024; 24:144. [PMID: 38509541 PMCID: PMC10953251 DOI: 10.1186/s12890-024-02962-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/11/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The causality of the relationship between bronchiectasis and chronic obstructive pulmonary disease (COPD) remains unclear. This study aims to investigate the potential causal relationship between them, with a specific focus on the role of airway inflammation, infections, smoking as the mediators in the development of COPD. METHODS We conducted a two-sample Mendelian randomization (MR) analysis to assess: (1) the causal impact of bronchiectasis on COPD, sex, smoking status, infections, eosinophil and neutrophil counts, as well as the causal impact of COPD on bronchiectasis; (2) the causal effect of smoking status, infections and neutrophil counts on COPD; and (3) the extent to which the smoking status, infections and neutrophil counts might mediate any influence of bronchiectasis on the development of COPD. RESULTS COPD was associated with a higher risk of bronchiectasis (OR 1.28 [95% CI 1.05, 1.56]). Bronchiectasis was associated with a higher risk of COPD (OR 1.08 [95% CI 1.04, 1.13]), higher levels of neutrophil (OR 1.01 [95% CI 1.00, 1.01]), higher risk of respiratory infections (OR 1.04 [95% CI 1.02, 1.06]) and lower risk of smoking. The causal associations of higher neutrophil cells, respiratory infections and smoking with higher COPD risk remained after performing sensitivity analyses that considered different models of horizontal pleiotropy, with OR 1.17, 1.69 and 95.13, respectively. The bronchiectasis-COPD effect was 0.99, 0.85 and 122.79 with genetic adjustment for neutrophils, respiratory infections and smoking. CONCLUSION COPD and bronchiectasis are mutually causal. And increased neutrophil cell count and respiratory infections appears to mediate much of the effect of bronchiectasis on COPD.
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Affiliation(s)
- Lei Gu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
- Institute of Respiratory Diseases, Soochow University, Suzhou, 215006, China
- Respiratory Diseases, Suzhou Key Laboratory, Suzhou, 215006, China
| | - Wei Liu
- Department of Respiratory and Critical Care Medicine, The 900th Hospital of Joint Logistic Support Force, People's Liberation Army, Fujian Medical University, Fuzhou, 350025, China
| | - Jian-An Huang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
- Institute of Respiratory Diseases, Soochow University, Suzhou, 215006, China
- Respiratory Diseases, Suzhou Key Laboratory, Suzhou, 215006, China
| | - Lujian Zhu
- Department of Infectious Diseases, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, China
| | - Xiaowen Hu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Jian Yue
- The People's Hospital of Gaozhou, Gaozhou, 525200, China.
| | - Jing Lin
- Department of Infectious Diseases, The First Affiliated Hospital of Soochow University, Suzhou,Jiangsu Province, 215006, China.
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Han Y, Cheng M, Li Z, Chen H, Xia S, Zhao Y, Wang Y, He W, Wang W. Clinical characteristics and drug resistance of Nocardia in Henan, China, 2017-2023. Ann Clin Microbiol Antimicrob 2024; 23:23. [PMID: 38449006 PMCID: PMC10919010 DOI: 10.1186/s12941-024-00677-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/06/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The aim of this study was to investigate the clinical features of Nocardia infections, antibiotic resistance profile, choice of antibiotics and treatment outcome, among others. In addition, the study compared the clinical and microbiological characteristics of nocardiosis in bronchiectasis patients and non-bronchiectasis patients. METHODS Detailed clinical data were collected from the medical records of 71 non-duplicate nocardiosis patients from 2017 to 2023 at a tertiary hospital in Zhengzhou, China. Nocardia isolates were identified to the species level using MALDI-TOF MS and 16S rRNA PCR sequencing. Clinical data were collected from medical records, and drug susceptibility was determined using the broth microdilution method. RESULTS Of the 71 cases of nocardiosis, 70 (98.6%) were diagnosed as pulmonary infections with common underlying diseases including bronchiectasis, tuberculosis, diabetes mellitus and chronic obstructive pulmonary disease (COPD). Thirteen different strains were found in 71 isolates, the most common of which were N. farcinica (26.8%) and N. cyriacigeorgica (18.3%). All Nocardia strains were 100% susceptible to both TMP-SMX and linezolid, and different Nocardia species showed different patterns of drug susceptibility in vitro. Pulmonary nocardiosis is prone to comorbidities such as bronchiectasis, diabetes mellitus, COPD, etc., and Nocardia is also frequently accompanied by co-infection of the body with pathogens such as Mycobacterium and Aspergillus spp. Sixty-one patients underwent a detailed treatment regimen, of whom 32 (52.5%) received single or multi-drug therapy based on TMP-SMX. Bronchiectasis was associated with a higher frequency of Nocardia infections, and there were significant differences between the bronchiectasis and non-bronchiectasis groups in terms of age distribution, clinical characteristics, identification of Nocardia species, and antibiotic susceptibility (P < 0.05). CONCLUSIONS Our study contributes to the understanding of the species diversity of Nocardia isolates in Henan, China, and the clinical characteristics of patients with pulmonary nocardiosis infections. Clinical and microbiologic differences between patients with and without bronchiectasis. These findings will contribute to the early diagnosis and treatment of patients.
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Affiliation(s)
- Yungang Han
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Meijin Cheng
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Zheng Li
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Huihui Chen
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Shuang Xia
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Yue Zhao
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Yali Wang
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Wenyi He
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Wei Wang
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China.
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China.
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Kawanobe T, Yamaguchi T, Johkoh T, Kono C, Sawahata M, Shijubo N, Konno S, Tatsumi K. Central Bronchial Deformity in Pulmonary Sarcoidosis: A Finding Suggestive of an Upper Lobe Fibrotic Phenotype on Chest Images. Acad Radiol 2024; 31:1160-1167. [PMID: 37743162 DOI: 10.1016/j.acra.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023]
Abstract
RATIONALE AND OBJECTIVES Bronchial and lung parenchymal structural remodeling may occur due to disease progression in patients with pulmonary sarcoidosis; however, its mechanisms remain unclear. Central bronchial deformity (CBD) associated with shrinkage in the upper lobe (SUL) is often observed in such patients. This study aimed to examine the association between CBD and structural remodeling to identify features indicating disease severity on chest images. MATERIALS AND METHODS This retrospective cohort study included 72 patients with pulmonary sarcoidosis, excluding patients with only bilateral hilar lymphadenopathy. The participants were divided into with and without CBD groups to examine the association between CBD and other structural remodeling, including SUL, cyst and/or low attenuation area-like emphysema (Cyst/LAA), pleural/sub-pleural thickening (PT), and traction bronchiectasis (TrBE), in the upper lobe on chest images. The association of CBD phenotype with respiratory dysfunction was also examined. RESULTS CBD was highly associated with SUL (81.4% vs. 8.9%), Cyst/LAA (44.4% vs. 6.7%), and PT (59.2% vs. 3.7%). The respective odds ratios in the univariable and multivariable analyses were as follows: SUL, 45.1 and 39.9; Cyst/LAA, 11.2 and 14.2; and PT, 64.0 and 68.7. TrBE was frequently associated with CBD (22.25% vs. 4.4%); the odds ratio was 6.14 in the univariable analysis. Furthermore, participants with CBD exhibited lower %FVC and %DLCO. CONCLUSION CBD is significantly associated with lung remodeling (SUL, Cyst/LAA, TrBE, and PT) and respiratory dysfunction. CBD may be a crucial clinical phenotype to identify upper lobe fibrotic changes.
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Affiliation(s)
- Takeshi Kawanobe
- Department of Respiratory Medicine, JR Tokyo General Hospital, Shibuya-ku, Japan (T.K., C.K.).
| | - Tetsuo Yamaguchi
- Department of Respiratory Medicine, Shinjuku Tsurukame Clinic, Shibuya-ku, Japan (T.Y.)
| | - Takeshi Johkoh
- Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.)
| | - Chiyoko Kono
- Department of Respiratory Medicine, JR Tokyo General Hospital, Shibuya-ku, Japan (T.K., C.K.)
| | - Michiru Sawahata
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Shimotsuke, Japan (M.S.)
| | - Noriharu Shijubo
- Department of Respiratory Medicine, JR Sapporo Hospital, Sapporo, Japan (N.S.)
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan (S.K.)
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan (K.T.)
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Basavaraj A, Choate R, Becker BC, Aksamit TR, Metersky ML. Severity of bronchiectasis predicts use of and adherence to high frequency chest wall oscillation therapy - Analysis from the United States Bronchiectasis and NTM research registry. Respir Med 2024; 223:107555. [PMID: 38307319 DOI: 10.1016/j.rmed.2024.107555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/30/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND High frequency chest wall oscillation (HFCWO) is a form of airway clearance therapy that has been available since the mid-1990s and is routinely used by patients suffering from retained pulmonary secretions. Patients with cystic fibrosis (CF), neuromuscular disease (NMD), and other disorders, including bronchiectasis (BE) and COPD (without BE), are commonly prescribed this therapy. Limited evidence exists describing HFCWO use in the BE population, its impact on long-term management of disease, and the specific patient populations most likely to benefit from this therapy. This study sought to characterize the clinical characteristics of patients with BE who have documented use of HFCWO at baseline and 1-year follow-up. METHODS An analysis from a large national database registry of patients with BE was performed. Demographic and clinical characteristics of all patients receiving HFCWO therapy at baseline are reported. Patients were stratified into two groups based on continued or discontinued use of HFCWO therapy at 1-year follow-up. RESULTS Over half (54.8 %) of patients who reported using HFCWO therapy had a Modified Bronchiectasis Severity Index (m-BSI) classified as severe, and the majority (81.4 %) experienced an exacerbation in the prior two years. Of patients with 1-year follow-up data, 73 % reported continued use of HFCWO. Compared to patients who discontinued therapy, these patients were more severe at baseline and at follow-up suggesting that patients with more severe disease are more likely to continue HFCWO therapy. CONCLUSIONS Patients who have more severe disease and continue to experience exacerbations and hospitalizations are more likely to continue HFCWO therapy. CLINICAL TRIAL REGISTRATION NA.
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Affiliation(s)
- Ashwin Basavaraj
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine, 462 First Avenue, Administration Building OBV, A601, New York, NY, 10016, USA.
| | - Radmila Choate
- University of Kentucky College of Public Health, Lexington, KY, USA
| | - Brian C Becker
- Department of Medical Affairs, Baxter, St. Paul, Minnesota, USA
| | - Timothy R Aksamit
- Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mark L Metersky
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
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27
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Jayaram L, King PT, Hunt J, Lim M, Park C, Hu E, Dousha L, Ha P, Bartlett JB, Southcott AM, Muruganandan S, Vogrin S, Rees MA, Dean OM, Wong CA. Evaluation of high dose N- Acetylcysteine on airway inflammation and quality of life outcomes in adults with bronchiectasis: A randomised placebo-controlled pilot study. Pulm Pharmacol Ther 2024; 84:102283. [PMID: 38141851 DOI: 10.1016/j.pupt.2023.102283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/09/2023] [Accepted: 12/11/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND High dose N acetylcysteine (NAC), a mucolytic, anti-inflammatory and antioxidant agent has been shown to significantly reduce exacerbations, and improve quality of life in placebo controlled, double blind randomised (RCT) studies in patients with COPD, and in an open, randomised study in bronchiectasis. In this pilot, randomised, double-blind, placebo-controlled study, we wished to investigate the feasibility of a larger clinical trial, and the anti-inflammatory and clinical benefits of high dose NAC in bronchiectasis. AIMS Primary outcome: to assess the efficacy of NAC 2400 mg/day at 6 weeks on sputum neutrophil elastase (NE), a surrogate marker for exacerbations. Secondary aims included assessing the efficacy of NAC on sputum MUC5B, IL-8, lung function, quality of life, and adverse effects. METHODS Participants were randomised to receive 2400 mg or placebo for 6 weeks. They underwent 3 visits: at baseline, week 3 and week 6 where clinical and sputum measurements were assessed. RESULTS The study was stopped early due to the COVID pandemic. In total 24/30 patients were recruited, of which 17 completed all aspects of the study. Given this, a per protocol analysis was undertaken: NAC (n = 9) vs placebo (n = 8): mean age 72 vs 62 years; male gender: 44% vs 50%; baseline median FEV11.56 L (mean 71.5 % predicted) vs 2.29L (mean 82.2% predicted). At 6 weeks, sputum NE fell by 47% in the NAC group relative to placebo (mean fold difference (95%CI: 0.53 (0.12,2.42); MUC5B increased by 48% with NAC compared with placebo. Lung function, FVC improved significantly with NAC compared with placebo at 6 weeks (mean fold difference (95%CI): 1.10 (1.00, 1.20), p = 0.045. Bronchiectasis Quality of life measures within the respiratory and social functioning domains demonstrated clinically meaningful improvements, with social functioning reaching statistical significance. Adverse effects were similar in both groups. CONCLUSION High dose NAC exhibits anti-inflammatory benefits, and improvements in aspects of quality of life and lung function measures. It is safe and well tolerated. Further larger placebo controlled RCT's are now warranted examining its role in reducing exacerbations.
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Affiliation(s)
- L Jayaram
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia; University of Melbourne, Parkville, VIC, 3010, Australia.
| | - P T King
- Monash Medical Centre, Clayton Road, Clayton, VIC, 3068, Australia; Monash University, Wellington Road, Clayton, VIC, 3068, Australia
| | - J Hunt
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia
| | - M Lim
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia
| | - C Park
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia
| | - E Hu
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia
| | - L Dousha
- Monash Medical Centre, Clayton Road, Clayton, VIC, 3068, Australia; Monash University, Wellington Road, Clayton, VIC, 3068, Australia
| | - P Ha
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia
| | - J B Bartlett
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia; University of Melbourne, Parkville, VIC, 3010, Australia
| | - A M Southcott
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia; University of Melbourne, Parkville, VIC, 3010, Australia
| | - S Muruganandan
- University of Melbourne, Parkville, VIC, 3010, Australia; Northern Health, Epping, VIC, 3076 Australia
| | - S Vogrin
- University of Melbourne, Parkville, VIC, 3010, Australia
| | - M A Rees
- University of Melbourne, Parkville, VIC, 3010, Australia; Royal Melbourne Hospital, Gratten St, VIC, 3050, Australia
| | - O M Dean
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, 3220 Australia; Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, VIC , 3010, Australia
| | - C A Wong
- Middlemore Hospital, Te Whatu Ora, Otahuhu, Auckland, 1025, New Zealand; University of Auckland, Park Road, Auckland, 1010, New Zealand
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28
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Lei C, Zeng Z, Chen F, Guo Y, Liu Y. Eosinophilic bronchiectasis increases length and cost of hospitalization: a retrospective analysis in a hospital of southern China from 2012 to 2020. BMC Pulm Med 2024; 24:98. [PMID: 38408986 PMCID: PMC10895853 DOI: 10.1186/s12890-024-02912-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/16/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND The concept of eosinophilic bronchiectasis has received clinical attention recently, but the association between blood eosinophil count (BEC) and hospital characteristics has rarely been reported yet. We aim to investigate the clinical impact of BEC on patients with acute bronchiectasis exacerbation. METHODS A total of 1332 adult patients diagnosed with acute exacerbation of bronchiectasis from January 2012 to December 2020 were included in this retrospective study. A propensity-matched analysis was performed by matching age, sex and comorbidities in patients with high eosinophil count (≥ 300 cell/µL) and low eosinophil count (< 300 cell/µL). Clinical characteristics, length of hospital stay (LOS), hospitalization cost and inflammatory markers were compared between the two groups. RESULTS Eosinophilic bronchiectasis occurred in approximately 11.7% of all patients. 156 propensity score-matched pairs were identified with and without high eosinophil count. Eosinophilic bronchiectasis presented with a longer LOS [9.0 (6.0-12.5) vs. 5.0 (4.0-6.0) days, p < 0.0001] and more hospitalization cost [15,011(9,753-27,404) vs. 9,109(6,402-12,287) RMB, p < 0.0001] compared to those in non-eosinophilic bronchiectasis. The median white blood cell (WBC), lymphocyte, platelet (PLT) and C-reactive protein (CRP) levels in eosinophilic bronchiectasis were significantly increased. Multivariate logistic regression analysis confirmed that the high levels of eosinophil count (OR = 13.95, p < 0.0001), worse FEV1% predicted (OR = 7.80, p = 0.0003) and PLT (OR = 1.01, p = 0.035) were independent prognostic factors for length of hospital (LOS) greater than 7 days. CONCLUSION Eosinophilic bronchiectasis patients had longer length of hospital stay and more hospitalization cost compared to those in non-eosinophilic bronchiectasis group, which might be associated with the stronger inflammatory reaction.
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Affiliation(s)
- Chengcheng Lei
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong, 510080, China
- Institute of Respiratory Diseases, Sun Yat-Sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong, 510080, China
| | - Zhimin Zeng
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong, 510080, China
- Institute of Respiratory Diseases, Sun Yat-Sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong, 510080, China
| | - Fengjia Chen
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong, 510080, China
- Institute of Respiratory Diseases, Sun Yat-Sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong, 510080, China
| | - Yubiao Guo
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong, 510080, China.
- Institute of Respiratory Diseases, Sun Yat-Sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong, 510080, China.
| | - Yangli Liu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong, 510080, China.
- Institute of Respiratory Diseases, Sun Yat-Sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong, 510080, China.
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Kanaujia R, Arora A, Chakrabarti A, Rudramurthy SM, Agarwal R. Polymorphisms in Innate and Adaptive Immune Genes in Subjects with Allergic Bronchopulmonary Aspergillosis Complicating Asthma. Mycopathologia 2024; 189:23. [PMID: 38407762 DOI: 10.1007/s11046-024-00834-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/29/2024] [Indexed: 02/27/2024]
Abstract
Innate and adaptive immunity play a crucial role in allergic bronchopulmonary aspergillosis (ABPA) pathogenesis. We performed next-generation sequencing using the Illumina TruSight One panel (4,811 human disease-associated genes, at least 20 × coverage) and selected 22 known immune genes (toll-like receptors (TLRs), C-type lectin, interleukin-4 receptor, and others). We included ABPA (n = 18), asthma without ABPA (n = 12), and healthy controls (n = 8). We analyzed 3011 SNPs from 22 genes and identified 145 SNPs (13 genes) that were present only in the disease groups and absent in controls. The SNP frequency overall was significantly higher in ABPA than in asthmatics (89/145 [61.4%] vs. 56/145 [38.6%], p = 0.0001). The SNP frequency in the TLR10 gene was also significantly higher in ABPA than in asthma (p = 0.017). Association analysis further revealed three genes having significant associations. Of these, NOS3 and HLA-DQB1 are associated with antimicrobial activity and adaptive immunity. More extensive studies are required to confirm our findings.
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Affiliation(s)
- Rimjhim Kanaujia
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, India
| | - Amit Arora
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, India.
| | | | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, India.
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30
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Liao KM, Lee CS, Wu YC, Shu CC, Ho CH. Association between statin use and tuberculosis risk in patients with bronchiectasis: a retrospective population-based cohort study in Taiwan. BMJ Open Respir Res 2024; 11:e002077. [PMID: 38387995 PMCID: PMC10884254 DOI: 10.1136/bmjresp-2023-002077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Chronic airway diseases have been associated with an increased risk of tuberculosis (TB); however, data in patients with bronchiectasis is limited. Statins have been shown to exhibit anti-inflammatory effects by modulating the inflammatory response. This study investigated whether statin treatment could reduce the risk of TB in patients with bronchiectasis. METHODS We conducted a retrospective cohort study using a nationwide population database of patients with bronchiectasis who did or did not receive statin treatment. The defined daily dose (DDD) of statin, current or past statin user and statin exposure time were measured for the impact of statin use. The primary outcome was the incidence of new-onset TB. Considering of potential immortal time bias due to stain exposure time, Cox regression models with time-dependent covariates were employed to estimate HRs with 95% CIs for TB incidence among patients with bronchiectasis. RESULTS Patients with bronchiectasis receiving statin treatment had a decreased risk of TB. After adjusting for age, sex, income, comorbidities and Charlson Comorbidity Index, statin users had a 0.59-fold lower risk of TB incidence compared with non-statin users (95% CI 0.40 to 0.88; p=0.0087). Additionally, compared with non-statin users, statin treatment was a protective factor against TB in users with a cumulative DDD greater than 180 per year, with an HR of 0.32 (95% CI 0.12 to 0.87; p=0.0255). CONCLUSIONS Statin treatment demonstrated a dose-dependent protective effect and was associated with a reduced risk of TB in patients with bronchiectasis. These findings suggest that statins may play a role in lowering TB risk by modulating airway inflammation in this patient population.
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Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center Chiali Branch, Tainan, Taiwan
- Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Chung-Shu Lee
- Department of Pulmonary and Critical Care Medicine, New Taipei Municipal Tu Cheng Hospital, New Taipei City, Taiwan
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan
| | - Yu-Cih Wu
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chin-Chung Shu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- National Taiwan University, Taipei, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
- Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- Cancer Center, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan
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31
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Abelson D, Di Michiel J, Frater C, Pearson M, Russo R, Wechselberger M, Cottee A, Morgan L. Mucus clears from the trachea in a helix: a new twist to understanding airway diseases. Thorax 2024:thorax-2023-221052. [PMID: 38378235 DOI: 10.1136/thorax-2023-221052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/21/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Mucociliary clearance (MCC) is critical to lung health and is impaired in many diseases. The path of MCC may have an important impact on clearance but has never been rigorously studied. The objective of this study is to assess the three-dimensional path of human tracheal MCC in disease and health. METHODS Tracheal MCC was imaged in 12 ex-smokers, 3 non-smokers (1 opportunistically imaged during acute influenza and repeated after recovery) and 5 individuals with primary ciliary dyskinesia (PCD). Radiolabelled macroaggregated albumin droplets were injected into the trachea via the cricothyroid membrane. Droplet movement was tracked via scintigraphy, the path of movement mapped and helical and axial models of tracheal MCC were compared. MEASUREMENTS AND MAIN RESULTS In 5/5 participants with PCD and 1 healthy participant with acute influenza, radiolabelled albumin coated the trachea and did not move. In all others (15/15), mucus coalesced into globules. Globule movement was negligible in 3 ex-smokers, but in all others (12/15) ascended the trachea in a helical path. Median cephalad tracheal MCC was 2.7 mm/min ex-smokers vs 8.4 mm/min non-smokers (p=0.02) and correlated strongly to helical angle (r=0.92 (p=0.00002); median 18o ex-smokers, 47o non-smokers (p=0.036)), but not to actual speed on helical path (r=0.26 (p=0.46); median 13.6 mm/min ex-smokers vs 13.9 mm/min non-smokers (p=1.0)). CONCLUSION For the first time, we show that human tracheal MCC is helical, and impairment in ex-smokers is often caused by flattened helical transit, not slower movement. Our methodology provides a simple method to map tracheal MCC and speed in vivo.
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Affiliation(s)
- David Abelson
- Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- School of Medicine, University of Sydney, Sydney, NSW, Australia
| | - James Di Michiel
- Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Clayton Frater
- School of Medicine, University of Sydney, Sydney, NSW, Australia
- Department of Nuclear Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Mark Pearson
- Department of Nuclear Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Robert Russo
- Department of Nuclear Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Martin Wechselberger
- School of Mathematics & Statistics, The University of Sydney, Sydney, New South Wales, Australia
| | - Alice Cottee
- Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Lucy Morgan
- Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Mulette P, Perotin JM, Muggeo A, Guillard T, Brisebarre A, Meyer H, Hagenburg J, Ancel J, Dormoy V, Vuiblet V, Launois C, Lebargy F, Deslee G, Dury S. Bronchiectasis in renal transplant patients: a cross-sectional study. Eur J Med Res 2024; 29:120. [PMID: 38350996 PMCID: PMC10863148 DOI: 10.1186/s40001-024-01701-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/29/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Bronchiectasis is a chronic airway disease characterized by permanent and irreversible abnormal dilatation of bronchi. Several studies have reported the development of bronchiectasis after renal transplantation (RT), but no prospective study specifically assessed bronchiectasis in this population. This study aimed to compare features of patients with bronchiectasis associated with RT to those with idiopathic bronchiectasis. METHODS Nineteen patients with bronchiectasis associated with RT (RT-B group) and 23 patients with idiopathic bronchiectasis (IB group) were prospectively included in this monocentric cross-sectional study. All patients underwent clinical, functional, laboratory, and CT scan assessments. Sputum was collected from 25 patients (n = 11 with RT-B and n = 14 with IB) and airway microbiota was analyzed using an extended microbiological culture. RESULTS Dyspnea (≥ 2 on mMRC scale), number of exacerbations, pulmonary function tests, total bronchiectasis score, severity and prognosis scores (FACED and E-FACED), and quality of life scores (SGRQ and MOS SF-36) were similar in the RT-B and IB groups. By contrast, chronic cough was less frequent in the RT-B group than in the IB group (68% vs. 96%, p = 0.03). The prevalence and diversity of the airway microbiota in sputum were similar in the two groups. CONCLUSION Clinical, functional, thoracic CT scan, and microbiological characteristics of bronchiectasis are overall similar in patients with IB and RT-B. These results highlight that in RT patients, chronic respiratory symptoms and/or airway infections should lead to consider the diagnosis of bronchiectasis. Further studies are required to better characterize the pathophysiology of RT-B including airway microbiota, its incidence, and impact on therapeutic management.
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Affiliation(s)
- Pauline Mulette
- Department of Respiratory Diseases, Reims University Hospital, Maison Blanche University Hospital, 45, Rue de Cognacq-Jay, 51 092, Reims Cedex, France.
| | - Jeanne-Marie Perotin
- Department of Respiratory Diseases, Reims University Hospital, Maison Blanche University Hospital, 45, Rue de Cognacq-Jay, 51 092, Reims Cedex, France
- Inserm UMR-S 1250, P3Cell, SFR CAP-Santé, University of Reims Champagne-Ardenne, Reims, France
| | - Anaëlle Muggeo
- Inserm UMR-S 1250, P3Cell, SFR CAP-Santé, University of Reims Champagne-Ardenne, Reims, France
- Laboratory of Bacteriology, Virology and Hygiene, Reims University Hospital, Reims, France
| | - Thomas Guillard
- Inserm UMR-S 1250, P3Cell, SFR CAP-Santé, University of Reims Champagne-Ardenne, Reims, France
- Laboratory of Bacteriology, Virology and Hygiene, Reims University Hospital, Reims, France
| | - Audrey Brisebarre
- Inserm UMR-S 1250, P3Cell, SFR CAP-Santé, University of Reims Champagne-Ardenne, Reims, France
| | - Hélène Meyer
- Department of Respiratory Diseases, Valenciennes Hospital Center, Valenciennes, France
| | - Jean Hagenburg
- Department of Respiratory Diseases, Reims University Hospital, Maison Blanche University Hospital, 45, Rue de Cognacq-Jay, 51 092, Reims Cedex, France
| | - Julien Ancel
- Department of Respiratory Diseases, Reims University Hospital, Maison Blanche University Hospital, 45, Rue de Cognacq-Jay, 51 092, Reims Cedex, France
| | - Valérian Dormoy
- Inserm UMR-S 1250, P3Cell, SFR CAP-Santé, University of Reims Champagne-Ardenne, Reims, France
| | - Vincent Vuiblet
- Department of Nephrology and Renal Transplantation, Reims University Hospital, Reims, France
| | - Claire Launois
- Department of Respiratory Diseases, Reims University Hospital, Maison Blanche University Hospital, 45, Rue de Cognacq-Jay, 51 092, Reims Cedex, France
- Inserm UMR-S 1250, P3Cell, SFR CAP-Santé, University of Reims Champagne-Ardenne, Reims, France
| | - François Lebargy
- Department of Respiratory Diseases, Reims University Hospital, Maison Blanche University Hospital, 45, Rue de Cognacq-Jay, 51 092, Reims Cedex, France
| | - Gaëtan Deslee
- Department of Respiratory Diseases, Reims University Hospital, Maison Blanche University Hospital, 45, Rue de Cognacq-Jay, 51 092, Reims Cedex, France
- Inserm UMR-S 1250, P3Cell, SFR CAP-Santé, University of Reims Champagne-Ardenne, Reims, France
| | - Sandra Dury
- Department of Respiratory Diseases, Reims University Hospital, Maison Blanche University Hospital, 45, Rue de Cognacq-Jay, 51 092, Reims Cedex, France
- EA7509 IRMAIC, University of Reims Champagne-Ardenne, Reims, France
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Kwok WC, Teo KC, Lau KK, Ho JCM. High-sensitivity C-reactive protein level in stable-state bronchiectasis predicts exacerbation risk. BMC Pulm Med 2024; 24:80. [PMID: 38350918 PMCID: PMC10863114 DOI: 10.1186/s12890-024-02888-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/28/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Elevation of systemic inflammatory markers were found to correlate with increased disease extent, reduced lung function and higher risk of future severe exacerbations in patients with bronchiectasis. Although a significant correlation of circulating hs-CRP levels with HRCT scores and resting oxygen saturation in patients with stable-state non-cystic fibrosis (CF) bronchiectasis was suggested, there is little data on the relationship between hs-CRP and the prognosis of bronchiectasis and a lack of data on the role of hs-CRP in predicting bronchiectasis exacerbation. METHODS A prospective study was conducted on Chinese patients with non- CF bronchiectasis from 1st October to 31st December 2021. Baseline serum hs-CRP were obtained at stable-state. The follow-up period lasted for one year. Co-primary endpoints were the development of any bronchiectasis exacerbation and hospitalized bronchiectasis exacerbation. RESULTS Totally 123 patients were included. Higher hs-CRP was associated with increased risk to develop any bronchiectasis exacerbation, adjusted odds ratio (aOR) of 2.254 (95% CI = 1.040-4.885, p = 0.039), and borderline significantly increased hospitalized bronchiectasis exacerbation with aOR of 1.985 (95% CI = 0.922-4.277, p = 0.080). CONCLUSION Baseline serum hs-CRP level at stable-state can predict risk of bronchiectasis exacerbation, which is reflecting chronic low-grade inflammation in bronchiectasis.
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Affiliation(s)
- Wang Chun Kwok
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F, Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China
| | - Kay Cheong Teo
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F, Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China
| | - Kui Kai Lau
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F, Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China
| | - James Chung-Man Ho
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F, Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China.
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Chang CH, Chang CH, Huang SH, Lee CS, Ko PC, Lin CY, Hsieh MH, Huang YT, Lin HC, Li LF, Chung FT, Wang CH, Huang HY. Epidemiology and outcomes of multidrug-resistant bacterial infection in non-cystic fibrosis bronchiectasis. Ann Clin Microbiol Antimicrob 2024; 23:15. [PMID: 38350983 PMCID: PMC10865664 DOI: 10.1186/s12941-024-00675-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 02/04/2024] [Indexed: 02/15/2024] Open
Abstract
PURPOSE Multidrug-resistant (MDR) bacteria impose a considerable health-care burden and are associated with bronchiectasis exacerbation. This study investigated the clinical outcomes of adult patients with bronchiectasis following MDR bacterial infection. METHODS From the Chang Gung Research Database, we identified patients with bronchiectasis and MDR bacterial infection from 2008 to 2017. The control group comprised patients with bronchiectasis who did not have MDR bacterial infection and were propensity-score matched at a 1:2 ratio. The main outcomes were in-hospital and 3-year mortality. RESULTS In total, 554 patients with both bronchiectasis and MDR bacterial infection were identified. The types of MDR bacteria that most commonly affected the patients were MDR- Acinetobacter baumannii (38.6%) and methicillin-resistant Staphylococcus aureus (18.4%), Extended-spectrum-beta-lactamases (ESBL)- Klebsiella pneumoniae (17.8%), MDR-Pseudomonas (14.8%), and ESBL-E. coli (7.5%). Compared with the control group, the MDR group exhibited lower body mass index scores, higher rate of chronic bacterial colonization, a higher rate of previous exacerbations, and an increased use of antibiotics. Furthermore, the MDR group exhibited a higher rate of respiratory failure during hospitalization (MDR vs. control, 41.3% vs. 12.4%; p < 0.001). The MDR and control groups exhibited in-hospital mortality rates of 26.7% and 7.6%, respectively (p < 0.001); 3-year respiratory failure rates of 33.5% and 13.5%, respectively (p < 0.001); and 3-year mortality rates of 73.3% and 41.5%, respectively (p < 0.001). After adjustments were made for confounding factors, the infection with MDR and MDR bacteria species were determined to be independent risk factors affecting in-hospital and 3-year mortality. CONCLUSIONS MDR bacteria were discovered in patients with more severe bronchiectasis and were independently associated with an increased risk of in-hospital and 3-year mortality. Given our findings, we recommend that clinicians identify patients at risk of MDR bacterial infection and follow the principle of antimicrobial stewardship to prevent the emergence of resistant bacteria among patients with bronchiectasis.
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Affiliation(s)
- Chih-Hao Chang
- Department of Thoracic Medicine, New Taipei City Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa North Road, Taipei, Taiwan
| | - Chiung-Hsin Chang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa North Road, Taipei, Taiwan
| | - Shih-Hao Huang
- Department of Thoracic Medicine, New Taipei City Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa North Road, Taipei, Taiwan
| | - Chung-Shu Lee
- Department of Thoracic Medicine, New Taipei City Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa North Road, Taipei, Taiwan
| | - Po-Chuan Ko
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Yu Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa North Road, Taipei, Taiwan
| | - Meng-Heng Hsieh
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa North Road, Taipei, Taiwan
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Horng-Chyuan Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa North Road, Taipei, Taiwan
| | - Li-Fu Li
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa North Road, Taipei, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Fu-Tsai Chung
- Department of Thoracic Medicine, New Taipei City Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa North Road, Taipei, Taiwan
| | - Chun-Hua Wang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa North Road, Taipei, Taiwan
| | - Hung-Yu Huang
- Department of Thoracic Medicine, New Taipei City Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei City, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa North Road, Taipei, Taiwan.
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Xu X, Dai J, Jin K, Liu X, Yang Y, Ge T, Li Q, Jiang C, He W, Wang H, Zhang P, Jiang G. Surgery for bronchiectasis-destroyed lung: feasibility of video-assisted thoracoscopic surgery, and surgical outcomes. Interdiscip Cardiovasc Thorac Surg 2024; 38:ivad175. [PMID: 37930040 DOI: 10.1093/icvts/ivad175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/12/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES To provide the experience of surgical treatment for bronchiectasis-destroyed lung (BDL) and evaluate the feasibility of video-assisted thoracoscopic surgery (VATS). METHODS BDL patients underwent surgical treatment between January 2013 and June 2018 were included. Logistic regression was performed to assess factors for major complications, and Cox's regression was performed to assess factors affected symptomatic outcome. RESULTS Totally, 143 patients were treated by VATS (n = 64) and thoracotomy (n = 79). Nine (14.1%) cases scheduled for VATS were converted to thoracotomy for dense adhesions (n = 6) and frozen hilum (n = 3). The VATS group had a median chest tube duration, hospitalization and a time of returning to full activity of 4 days, 5 days and 1.5 months, respectively. Major complications occurred in 28 (19.6%) of all patients, 50.0% after pneumonectomy and 13.4% after lobectomy/extensive lobectomy. Multivariable analysis identified pneumonectomy [odds ratio, 3.64; 95% confidence interval (CI), 1.18-11.21] as a significant predictor for major complications. Overall, 141 (98.6%) patients benefitted from surgery (completely asymptomatic, n = 109; acceptable alleviation, n = 32). Thirty-four patients experienced relapse of the disease, including 13 with productive cough, 11 with haemoptysis and 10 with recurrent infections. Pseudomonas aeruginosa infection [hazard ratio (HR), 3.07; 95% CI, 1.38-6.83] and extent of remanent bronchiectatic areas (HR, 1.03; 95% CI, 1.00-1.05) were independent risk factors for shorter relapse free interval. CONCLUSIONS VATS for BDL is feasible in well-selected patients. Pneumonectomy increased the risk of postoperative major complications. Removing all BDL lesions contributed to satisfactory prognosis.
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Affiliation(s)
- Xinnan Xu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Jie Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Kaiqi Jin
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Xiaogang Liu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Yang Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Tao Ge
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Qiuyuan Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Chao Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Wenxin He
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Haifeng Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Peng Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, People's Republic of China
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Chen W, Ran S, Li C, Li Z, Wei N, Li J, Li N. Elevated Eosinophil Counts in Acute Exacerbations of Bronchiectasis: Unveiling a Distinct Clinical Phenotype. Lung 2024; 202:53-61. [PMID: 38228883 PMCID: PMC10896926 DOI: 10.1007/s00408-023-00668-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/18/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Non-cystic fibrosis bronchiectasis is a chronic respiratory disease characterized by bronchial dilation. However, the significance of elevated eosinophil counts in acute exacerbations of bronchiectasis remains unclear. METHODS This retrospective case-control study included 169 hospitalized patients with acute exacerbations of non-cystic fibrosis bronchiectasis. Based on blood eosinophil levels, patients were categorized into eosinophilic and non-eosinophilic bronchiectasis groups. Various clinical variables, including lung function, comorbidities and clinical features were collected for analysis. The study aimed to examine the differences between these groups and their clinical phenotypes. RESULTS Eosinophilic bronchiectasis (EB) was present in approximately 22% of all hospitalized patients with bronchiectasis, and it was more prevalent among male smokers (P < 0.01). EB exhibited greater severity of bronchiectasis, including worse airway obstruction, higher scores in the E-FACED (FACED combined with exacerbations) and bronchiectasis severity index (BSI), a high glucocorticoids medication possession ratio, and increased hospitalization cost (P < 0.05 or P < 0.01). Furthermore, we observed a significant positive correlation between blood eosinophil count and both sputum eosinophils (r = 0.49, P < 0.01) and serum total immunoglobulin E levels (r = 0.21, P < 0.05). Additional analysis revealed that patients with EB had a higher frequency of shortness of breath (P < 0.05), were more likely to have comorbid sinusitis (P < 0.01), and exhibited a greater number of lung segments affected by bronchiectasis (P < 0.01). CONCLUSIONS These findings suggest that EB presents a distinct pattern of bronchiectasis features, confirming the notion that it is a specific phenotype.
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Affiliation(s)
- Weixin Chen
- Department of Chinese and Western Medicine in Clinical Medicine, The Clinical School of Chinese and Western Medicine of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Siyi Ran
- Department of Chinese and Western Medicine in Clinical Medicine, The Clinical School of Chinese and Western Medicine of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Chenchang Li
- Department of Chinese and Western Medicine in Clinical Medicine, The Clinical School of Chinese and Western Medicine of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Zhixin Li
- Department of Chinese and Western Medicine in Clinical Medicine, The Clinical School of Chinese and Western Medicine of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Nili Wei
- State Key Laboratory of Respiratory Disease, Department of Allergy and Clinical Immunology, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Jing Li
- State Key Laboratory of Respiratory Disease, Department of Allergy and Clinical Immunology, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Naijian Li
- State Key Laboratory of Respiratory Disease, Department of Allergy and Clinical Immunology, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.
- Johns Hopkins Asthma & Allergy Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Mac Aogáin M, Xaverius Ivan F, Jaggi TK, Richardson H, Shoemark A, Narayana JK, Dicker AJ, Koh MS, Lee KCH, Thun How O, Poh ME, Chin KK, Hou ALY, Ser Hon P, Low TB, Abisheganaden JA, Dimakou K, Digalaki A, Kosti C, Gkousiou A, Hansbro PM, Blasi F, Aliberti S, Chalmers JD, Chotirmall SH. Airway 'Resistotypes' and Clinical Outcomes in Bronchiectasis. Am J Respir Crit Care Med 2024. [PMID: 38271608 DOI: 10.1164/rccm.202306-1059oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/24/2024] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Application of whole-genome shotgun metagenomics to the airway microbiome in bronchiectasis highlights a diverse pool of antimicrobial resistance genes: the 'resistome', the clinical significance of which remains unclear. METHODS Individuals with bronchiectasis were prospectively recruited into cross-sectional and longitudinal cohorts (n=280) including the international multicentre cross-sectional Cohort of Asian and Matched European Bronchiectasis 2 study (CAMEB 2; n=251) and two independent cohorts, one describing patients experiencing acute exacerbation and a further cohort of patients undergoing P. aeruginosa eradication treatment. Sputum was subjected to metagenomic sequencing and the bronchiectasis resistome evaluated in association with clinical outcomes and underlying host microbiomes. RESULTS The bronchiectasis resistome features a unique resistance gene profile and elevated counts of aminoglycoside, bicyclomycin, phenicol, triclosan and multi-drug resistance genes. Longitudinally, it exhibits within-patient stability over time and during exacerbations despite between-patient heterogeneity. Proportional differences in baseline resistome profiles including increased macrolide and multi-drug resistance genes associate with shorter intervals to next exacerbation, while distinct resistome archetypes associate with frequent exacerbations, poorer lung function, geographic origin, and the host microbiome. Unsupervised analysis of resistome profiles identified two clinically relevant 'resistotypes' RT1 and RT2, the latter characterized by poor clinical outcomes, increased multi-drug resistance and P. aeruginosa. Successful targeted eradication in P. aeruginosa-colonized individuals mediated reversion from RT2 to RT1, a more clinically favourable resistome profile demonstrating reduced resistance gene diversity. CONCLUSION The bronchiectasis resistome associates with clinical outcomes, geographic origin, and the underlying host microbiome. Bronchiectasis 'resistotypes' link to clinical disease and are modifiable through targeted antimicrobial therapy. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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Affiliation(s)
- Micheál Mac Aogáin
- Saint James's Hospital, 58024, Biochemistry, Dublin, Ireland
- Trinity College Dublin, 8809, Clinical Biochemistry Unit, Dublin, Ireland
| | - Fransiskus Xaverius Ivan
- Lee Kong Chian School of Medicine, Translational Respiratory Research Laboratory, Singapore, Singapore
| | - Tavleen K Jaggi
- Lee Kong Chian School of Medicine, Translational Respiratory Research Laboratory, Singapore, Singapore
| | - Hollian Richardson
- University of Dundee School of Medicine, 85326, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Amelia Shoemark
- Royal Brompton Hospital, EM Unit, London, United Kingdom of Great Britain and Northern Ireland
- University of Dundee, 3042, Clinical and molecular medicine, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Jayanth Kumar Narayana
- Lee Kong Chian School of Medicine, Translational Respiratory Research Laboratory, Singapore, Singapore
| | - Alison J Dicker
- University of Dundee, Scottish Centre for Respiratory Research, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Mariko Siyue Koh
- Singapore General Hospital, 37581, Department of Respiratory and Critical Care Medicine, Singapore, Singapore
| | - Ken Cheah Hooi Lee
- Singapore General Hospital, 37581, Respiratory and Critical Care Medicine, Singapore, Singapore
| | - Ong Thun How
- Singapore General Hospital, 37581, Department of Respiratory and Critical Care Medicine, Singapore, Singapore
| | - Mau Ern Poh
- University of Malaya, 37447, Department of Medicine, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Ka Kiat Chin
- University of Malaya, 37447, Department of Medicine, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Albert Lim Yick Hou
- Tan Tock Seng Hospital, 63703, Respiratory and Critical Care Medicine, Singapore, Singapore
| | - Puah Ser Hon
- Tan Tock Seng Hospital, 63703, Singapore, Singapore
| | - Teck Boon Low
- Changi General Hospital, 26674, Respiratory and Critical Care Medicine, Singapore, Singapore
| | | | - Katerina Dimakou
- "Sotiria" Chest Hospital, 5th Pulmonary Department, Athens, Greece
| | - Antonia Digalaki
- "Sotiria" Chest Hospital, 5th Pulmonary Department, Athens, Greece
| | - Chrysavgi Kosti
- National and Kapodistrian University of Athens - Faculty of Medicine, 68989, 1st department of Critical care and pulmonary medicine, Athens, Greece
| | - Anna Gkousiou
- "Sotiria" Chest Hospital, 5th Pulmonary Department, Athens, Greece
| | - Philip M Hansbro
- University of Technology Sydney, 1994, Sydney, New South Wales, Australia
| | - Francesco Blasi
- University of Milano, Dipartimento Toraco-Polmonare e Cardiovascolare, Milan, Italy
| | - Stefano Aliberti
- Humanitas University, 437807, Department of Biomedical Sciences, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, 9268, Respiratory Unit, Rozzano, Italy
| | - James D Chalmers
- University of Dundee, 3042, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Translational Respiratory Research Laboratory, Singapore, Singapore;
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Lee HJ, Lee JK, Park TY, Heo EY, Kim DK, Lee HW. Clinical outcomes of long-term inhaled combination therapies in patients with bronchiectasis and airflow obstruction. BMC Pulm Med 2024; 24:49. [PMID: 38263115 PMCID: PMC10804611 DOI: 10.1186/s12890-024-02867-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/17/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Few studies have reported which inhaled combination therapy, either bronchodilators and/or inhaled corticosteroids (ICSs), is beneficial in patients with bronchiectasis and airflow obstruction. Our study compared the efficacy and safety among different inhaled combination therapies in patients with bronchiectasis and airflow obstruction. METHODS Our retrospective study analyzed the patients with forced expiratory volume in 1 s (FEV1)/forced vital capacity < 0.7 and radiologically confirmed bronchiectasis in chest computed tomography between January 2005 and December 2021. The eligible patients underwent baseline and follow-up spirometric assessments. The primary endpoint was the development of a moderate-to-severe exacerbation. The secondary endpoints were the change in the annual FEV1 and the adverse events. Subgroup analyses were performed according to the blood eosinophil count (BEC). RESULTS Among 179 patients, the ICS/long-acting beta-agonist (LABA)/long-acting muscarinic antagonist (LAMA), ICS/LABA, and LABA/LAMA groups were comprised of 58 (32.4%), 52 (29.1%), and 69 (38.5%) patients, respectively. ICS/LABA/LAMA group had a higher severity of bronchiectasis and airflow obstruction, than other groups. In the subgroup with BEC ≥ 300/uL, the risk of moderate-to-severe exacerbation was lower in the ICS/LABA/LAMA group (adjusted HR = 0.137 [95% CI = 0.034-0.553]) and the ICS/LABA group (adjusted HR = 0.196 [95% CI = 0.045-0.861]) compared with the LABA/LAMA group. The annual FEV1 decline rate was significantly worsened in the ICS/LABA group compared to the LABA/LAMA group (adjusted β-coefficient=-197 [95% CI=-307--87]) in the subgroup with BEC < 200/uL. CONCLUSION In patients with bronchiectasis and airflow obstruction, the use of ICS/LABA/LAMA and ICS/LABA demonstrated a reduced risk of exacerbation compared to LABA/LAMA therapy in those with BEC ≥ 300/uL. Conversely, for those with BEC < 200/uL, the use of ICS/LABA was associated with an accelerated decline in FEV1 in comparison to LABA/LAMA therapy. Further assessment of BEC is necessary as a potential biomarker for the use of ICS in patients with bronchiectasis and airflow obstruction.
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Affiliation(s)
- Hyo Jin Lee
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jung-Kyu Lee
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Tae Yeon Park
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Eun Young Heo
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Deog Kyeom Kim
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Hyun Woo Lee
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea.
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea.
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Lee E, Kim K, Jeon YH, Sol IS, Kim JD, Min TK, Hwang YH, Cho HJ, Suh DI, Kim HS, Kim YH, Woo SI, Lee YJ, Jung S, Yang HJ, Jang GC. Evidence-based management guidelines for noncystic fibrosis bronchiectasis in children and adolescents. Clin Exp Pediatr 2024:cep.2023.00871. [PMID: 38271987 DOI: 10.3345/cep.2023.00871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/04/2023] [Indexed: 01/27/2024] Open
Abstract
Noncystic fibrosis bronchiectasis is a chronic respiratory disease that carries high socioeconomic and medical burdens and is caused by diverse respiratory illnesses. To improve clinical outcomes, early recognition, active treatment of exacerbations, and prevention of further exacerbations are essential. However, evidence for the treatment and prevention of acute exacerbation of noncystic fibrosis bronchiectasis, especially in children, is lacking. Therefore, the evidence- and consensus-based guidelines for medical and nonmedical treatment strategies for noncystic fibrosis bronchiectasis in children and adolescents were developed by the Korean Academy of Pediatric Allergy and Respiratory Disease using the methods recommended by the Grading of Recommendations Assessment, Development, and Evaluation working group with evidence published through July 2, 2020. This guideline encompasses evidence-based treatment recommendations as well as expert opinions, addressing crucial aspects of the treatment and management of noncystic fibrosis bronchiectasis in children. This includes considerations for antibiotics and airway clearance strategies, particularly in areas where evidence may be limited. Large, well-designed, and controlled studies are required to accumulate further evidence of management strategies for noncystic fibrosis bronchiectasis in children and adolescents.
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Affiliation(s)
- Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Kyunghoon Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - You Hoon Jeon
- Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - In Suk Sol
- Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Deok Kim
- Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Taek Ki Min
- Pediatric Allergy and Respiratory Center, Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yoon Ha Hwang
- Department of Pediatrics, Busan St. Mary's Hospital, Busan, Korea
| | - Hyun-Ju Cho
- Department of Pediatrics, International St. Mary's hospital, Catholic Kwandong University, Incheon, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hwan Soo Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Hee Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Il Woo
- Department of Pediatrics, Chungbuk National University Hospital & College of Medicine, Cheongju, Korea
| | - Yong Ju Lee
- Department of Pediatrics, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Sungsu Jung
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyeon-Jong Yang
- Pediatric Allergy and Respiratory Center, Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Gwang Cheon Jang
- Department of Pediatrics, National Health Insurance Service, Ilsan Hospital, Ilsan, Korea
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Horati H, Margaroli C, Chandler JD, Kilgore MB, Manai B, Andrinopoulou ER, Peng L, Guglani L, Tiddens HAMW, Caudri D, Scholte BJ, Tirouvanziam R, Janssens H. Key inflammatory markers in bronchoalveolar lavage predict bronchiectasis progression in young children with CF. J Cyst Fibros 2024:S1569-1993(24)00002-X. [PMID: 38246828 DOI: 10.1016/j.jcf.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/23/2024]
Abstract
INTRODUCTION Inflammation appears early in cystic fibrosis (CF) pathogenesis, with specific elevated inflammatory markers in bronchoalveolar lavage fluid (BALF) correlating with structural lung disease. Our aim was to identify markers of airway inflammation able to predict bronchiectasis progression over two years with high sensitivity and specificity. METHODS Children with CF with two chest computed tomography (CT) scans and bronchoscopies at a two-year interval were included (n= 10 at 1 and 3 years and n= 27 at 3 and 5 years). Chest CTs were scored for increase in bronchiectasis (Δ%Bx), using the PRAGMA-CF score. BALF collected with the first CT scan were analyzed for neutrophil% (n= 36), myeloperoxidase (MPO) (n= 25), neutrophil elastase (NE) (n= 26), and with a protein array for inflammatory and fibrotic markers (n= 26). RESULTS MPO, neutrophil%, and inducible T-cell costimulator ligand (ICOSLG), but not clinical characteristics, correlated significantly with Δ%Bx. Evaluation of neutrophil%, NE, MPO, interleukin-8 (IL-8), ICOSLG, and hepatocyte growth factor (HGF), for predicting an increase of > 0.5% of Δ%Bx in two years, showed that IL-8 had the best sensitivity (82%) and specificity (73%). Neutrophil%, ICOSLG and HGF had sensitivities of 85, 82, and 82% and specificities of 59, 67 and 60%, respectively. The odds ratio for risk of >0.5% Δ%Bx was higher for IL-8 (12.4) than for neutrophil%, ICOSLG, and HGF (5.9, 5.3, and 6.7, respectively). Sensitivity and specificity were lower for NE and MPO). CONCLUSIONS High levels of IL-8, neutrophil%, ICOSGL and HGF in BALF may be good predictors for progression of bronchiectasis in young children with CF.
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Affiliation(s)
- Hamed Horati
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC-Sophia Children's Hospital, University Hospital Rotterdam, I-BALL program, office Sp3456 Dr. Molewaterplein 40, 3015 GD Rotterdam, Postal address: Box 2060, Rotterdam 3000 CB, The Netherlands
| | - Camilla Margaroli
- Department of Pediatrics, Emory University School of Medicine & Center for CF and Airways Disease Research, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Joshua D Chandler
- Department of Pediatrics, Emory University School of Medicine & Center for CF and Airways Disease Research, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Matthew B Kilgore
- Department of Pediatrics, Emory University School of Medicine & Center for CF and Airways Disease Research, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Badies Manai
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC-Sophia Children's Hospital, University Hospital Rotterdam, I-BALL program, office Sp3456 Dr. Molewaterplein 40, 3015 GD Rotterdam, Postal address: Box 2060, Rotterdam 3000 CB, The Netherlands
| | - Eleni-Rosalina Andrinopoulou
- Department of Biostatistics and Bioinformatics, Erasmus MC, University Hospital Rotterdam, Rotterdam, The Netherlands
| | - Limin Peng
- Department of Biostatistics and Bioinformatics, Emory University School of Public Health, Atlanta, GA, USA
| | - Lokesh Guglani
- Department of Pediatrics, Emory University School of Medicine & Center for CF and Airways Disease Research, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Harm A M W Tiddens
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC-Sophia Children's Hospital, University Hospital Rotterdam, I-BALL program, office Sp3456 Dr. Molewaterplein 40, 3015 GD Rotterdam, Postal address: Box 2060, Rotterdam 3000 CB, The Netherlands; Department of radiology, Erasmus MC, University Hospital Rotterdam, Rotterdam, The Netherlands; Thirona, Nijmegen, The Netherlands
| | - Daan Caudri
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC-Sophia Children's Hospital, University Hospital Rotterdam, I-BALL program, office Sp3456 Dr. Molewaterplein 40, 3015 GD Rotterdam, Postal address: Box 2060, Rotterdam 3000 CB, The Netherlands
| | - Bob J Scholte
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC-Sophia Children's Hospital, University Hospital Rotterdam, I-BALL program, office Sp3456 Dr. Molewaterplein 40, 3015 GD Rotterdam, Postal address: Box 2060, Rotterdam 3000 CB, The Netherlands; Department of Cell Biology, Erasmus MC, University Hospital Rotterdam, Rotterdam, The Netherlands
| | - Rabindra Tirouvanziam
- Department of Pediatrics, Emory University School of Medicine & Center for CF and Airways Disease Research, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - HettieM Janssens
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC-Sophia Children's Hospital, University Hospital Rotterdam, I-BALL program, office Sp3456 Dr. Molewaterplein 40, 3015 GD Rotterdam, Postal address: Box 2060, Rotterdam 3000 CB, The Netherlands.
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Wang X, Wang J, He S, Li J, Chen X, Ma T, Liu L, Zhang L, Bu X. The clinical characteristics of non-cystic fibrosis bronchiectasis patients with positive serum tumor markers: a retrospective study. BMC Pulm Med 2024; 24:20. [PMID: 38191360 PMCID: PMC10775564 DOI: 10.1186/s12890-023-02816-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/14/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Serum tumor markers (STM), extensively used for the diagnosis, monitoring and prognostic assessment of tumors, can be increased in some non-malignant lung diseases. To date, there is a paucity of studies regarding the clinical characteristics of non-cystic fibrosis bronchiectasis patients with positive STMs. OBJECTIVE To investigate the clinical characteristics and indicators of bronchiectasis with positive STMs. METHODS The clinical data of 377 bronchiectasis patients was retrospectively collected from January 2017 to December 2019 from Beijing Chaoyang Hospital. Patients were divided into the STM negative group, the single STM positive group and the ≥2 STMs positive group according to the number of the positive STMs. The clinical characteristics are described and compared separately. The multivariate logistic regression analysis model was used to investigate the indicators regarding positive STMs. RESULTS Patients in the ≥2 STMs positive group were older (P = 0.015), had higher mMRC scores (P < 0.001) and developed higher fever (P = 0.027). Additionally, these patients also had lower Albumin/Globulin Ratio (A/G), albumin (ALB), prealbumin (PAB) (P < 0.001, P < 0.001, P < 0.001, respectively) and higher CRP, ESR and Fbg (P < 0.001, P < 0.001 and P < 0.001, respectively). Age (OR 1.022, 95%CI 1.003-1.042; P = 0.026) and the number of affected lobes (OR 1.443, 95%CI 1.233-1.690; P < 0.001) were independently associated with one and ≥ 2 positive STMs in bronchiectasis patients. CONCLUSION The ≥2 positive STMs are associated with a higher inflammation status and severer radiologic manifestations in bronchiectasis patients.
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Affiliation(s)
- Xiaoyue Wang
- Department of Respiratory and Critical Care Medicine, Chuiyangliu Hospital affiliated to Tsinghua University, Beijing, China
| | - Juan Wang
- Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Siqi He
- Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing Li
- Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoting Chen
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Tianyuan Ma
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lu Liu
- Department of Respiratory and Critical Care Medicine, Fengtai rehabilitation hospital of Beijing Municipality (Tieying hospital), Beijing, China
| | - Lei Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Fangshan Liangxiang Hospital, Beijing, China
| | - Xiaoning Bu
- Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Martínez-García MA, Olveira C, Girón R, García-Clemente M, Máiz L, Sibila O, Golpe R, Rodríguez-Hermosa JL, Barreiro E, Méndez R, Prados C, Rodríguez-López J, Oscullo G, de la Rosa D. Reliability of blood eosinophil count in steady-state bronchiectasis. Pulmonology 2024:S2531-0437(23)00204-0. [PMID: 38182470 DOI: 10.1016/j.pulmoe.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/14/2023] [Accepted: 11/21/2023] [Indexed: 01/07/2024] Open
Abstract
RATIONALE The baseline value of eosinophils in peripheral blood (BEC) has been associated with different degrees of severity, prognosis and response to treatment in patients with bronchiectasis. It is not known, however, if this basal value remains constant over time. OBJECTIVES The aim of this study was to assess whether the BEC remains stable in the long term in patients with bronchiectasis. METHODS AND MEASUREMENTS Patients from the RIBRON registry of bronchiectasis diagnosed by computed tomography with at least 2 BEC measurements one year apart were included in the study. Patients with asthma and those taking anti-eosinophilic drugs were excluded. Reliability was assessed using the intra-class correlation coefficient (ICC). A patient with a BEC of at least 300 cells/uL or less than 100 cells/uL was considered eosinophilic or eosinopenic, respectively. Group changes over time were also calculated. MAIN RESULTS Seven hundred and thirteen patients were finally included, with a mean age of 66.5 (13.2) years (65.8 % women). A total of 2701 BEC measurements were performed, with a median number of measurements per patient of 4 (IQR: 2-5) separated by a median of 12.1 (IQR: 10.5-14.3) months between two consecutive measurements. The ICC was good (>0.75) when calculated between two consecutive measurements (approximately one year apart) but had dropped significantly by the time of the next annual measurements. Similarly, the change from an eosinophilic or eosinopenic patient to a non-eosinophilic or non-eosinopenic patient, respectively, was less than 30 % during the first year with respect to the baseline value but was close to 50 % in later measurements. CONCLUSIONS Given the significant changes observed in the baseline value of the BEC over time, its monitoring is necessary in patients with bronchiectasis in order to more reliably assess its usefulness.
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Affiliation(s)
- M A Martínez-García
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; CIBERES de Enfermedades Respiratorias. ISCIII. Madrid. Spain.
| | - C Olveira
- Servicio de Neumología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Universidad de Málaga, Málaga, Spain
| | - R Girón
- Servicio de Neumología, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
| | - M García-Clemente
- Servicio de Neumología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - L Máiz
- Servicio de Neumología, Hospital Ramón y Cajal, Madrid, Spain
| | - O Sibila
- Servicio de Neumología, Hospital Clínico, Barcelona, Spain
| | - R Golpe
- Servicio de Neumología, Hospital Lucus Augusti, Lugo, Spain
| | | | - E Barreiro
- Servicio de Neumología, Hospital del Mar-IMIM, UPF, CIBERES, Barcelona, Spain; CIBERES de Enfermedades Respiratorias. ISCIII. Madrid. Spain
| | - Raúl Méndez
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; CIBERES de Enfermedades Respiratorias. ISCIII. Madrid. Spain
| | - C Prados
- Servicio de Neumología, Hospital La Paz, Madrid, Spain
| | - J Rodríguez-López
- Servicio de Neumología, Hospital San Agustín, Avilés, Asturias, Spain
| | - G Oscullo
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - D de la Rosa
- Servicio de Neumología, Hospital Santa Creu i Sant Pau, Barcelona, Spain
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Yang SH, Song MJ, Kim YW, Kwon BS, Lim SY, Lee YJ, Park JS, Cho YJ, Lee JH, Lee CT, Kim HJ. Understanding the effects of Haemophilus influenzae colonization on bronchiectasis: a retrospective cohort study. BMC Pulm Med 2024; 24:7. [PMID: 38166950 PMCID: PMC10759404 DOI: 10.1186/s12890-023-02823-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Bacterial colonization is an essential aspect of bronchiectasis. Although Haemophilus influenzae is a frequent colonizer in some regions, its clinical impacts are poorly understood. This study aimed to elucidate the impact of H. influenzae colonization in patients with bronchiectasis. METHODS This retrospective study screened adult patients diagnosed with bronchiectasis at a tertiary referral center between April 1, 2003, and May 16, 2021, in South Korea. Propensity score matching was used to match patients with and without H. influenzae colonization. We assessed the severity of bronchiectasis as per the bronchiectasis severity index, the incidence of exacerbation, differences in lung function, and all-cause mortality. RESULTS Out of the 4,453 patients with bronchiectasis, 79 (1.8%) were colonized by H. influenzae. After 1:2 propensity score matching, 78 and 154 patients were selected from the H. influenzae colonizer and non-colonizer groups, respectively. Although there were no significant differences between the groups regarding baseline demographics, patients colonized with H. influenzae had a higher bronchiectasis severity index (median 6 [interquartile range 4-8] vs. 4 [2-7], p = 0.002), associated with extensive radiographic involvement (52.2% vs. 37.2%, p = 0.045) and mild exacerbation without hospitalization (adjusted incidence rate ratio 0.15; 95% confidence interval 0.12-0.24). Lung function and mortality rates did not reveal significant differences, regardless of H. influenzae colonization. CONCLUSION H. influenzae colonization in bronchiectasis was associated with more severe disease and greater incidence of mild exacerbation, but not lung function and mortality. Attention should be paid to patients with bronchiectasis with H. influenzae colonization.
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Affiliation(s)
- Seo-Hee Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Veterans Hospital, 53, Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul, 05368, Republic of Korea
| | - Myung Jin Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yeon Wook Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Byoung Soo Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Sung Yoon Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yeon-Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jong Sun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jae Ho Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Choon-Taek Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyung-Jun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea.
- Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Seo W, Kim HW, Kim JS, Min J. Long term management of people with post-tuberculosis lung disease. Korean J Intern Med 2024; 39:7-24. [PMID: 38225822 PMCID: PMC10790047 DOI: 10.3904/kjim.2023.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/24/2023] [Accepted: 11/08/2023] [Indexed: 01/17/2024] Open
Abstract
Post-tuberculosis lung disease (PTLD) is emerging as a significant area of global interest. As the number of patients surviving tuberculosis (TB) increases, the subsequent long-term repercussions have drawn increased attention due to their profound clinical and socioeconomic impacts. A primary obstacle to its comprehensive study has been its marked heterogeneity. The disease presents a spectrum of clinical manifestations which encompass tracheobronchial stenosis, bronchiectasis, granulomas with fibrosis, cavitation with associated aspergillosis, chronic pleural diseases, and small airway diseases-all persistent consequences of PTLD. The spectrum of symptoms a patient may experience varies based on the severity of the initial infection and the efficacy of the treatment received. As a result, the long-term management of PTLD necessitates a detailed and specific approach, addressing each manifestation individually-a tailored strategy. In the immediate aftermath (0-12 months after anti-TB chemotherapy), there should be an emphasis on monitoring for relapse, tracheobronchial stenosis, and smoking cessation. Subsequent management should focus on addressing hemoptysis, managing infection including aspergillosis, and TB-associated chronic obstructive pulmonary disease or restrictive lung function. There remains a vast expanse of knowledge to be discovered in PTLD. This review emphasizes the pressing need for comprehensive, consolidated guidelines for management of patients with PTLD.
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Affiliation(s)
- Wan Seo
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Hyung Woo Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Ju Sang Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Jinsoo Min
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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Moorhead WJ, Mai W, Reetz JA, Hecht S, Noel PG. CT features of feline cystic bronchiectasis forming mass lesions. JFMS Open Rep 2024; 10:20551169231217866. [PMID: 38250625 PMCID: PMC10799599 DOI: 10.1177/20551169231217866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
Case series summary Cystic bronchiectasis was diagnosed in three cats with known histories of chronic coughing using CT and histopathology. CT of the lungs revealed large space-occupying lesions that compressed and displaced unaffected pulmonary parenchyma and vessels. The masses were soft tissue attenuating in two cases and gas-cavitated with areas of dependent fluid in one case. All three cats were found to have mineral attenuating material in lesions and in other dilatated airways. Generalized bronchial wall thickening was also present and indicative of chronic lower airway disease. These findings were supported by histopathology showing inflammatory changes and dilatated airways in the collected tissues. In the two cases in which post-contrast CT series were acquired, the lesions had rim-enhancement. Relevance and novel information Cystic bronchiectasis is a rare presentation of bronchiectasis in cats and may mimic a pulmonary mass lesion, which could be mistaken for neoplasia or abscessation. The lack of central enhancement or presence of gas cavitation on CT, concurrent presence of diffuse bronchial wall thickening, other areas of bronchiectasis and the presence of broncholithiasis may alert the clinician to the possibility of cystic bronchiectasis related to chronic lower airway disease.
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Affiliation(s)
- William J Moorhead
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Wilfried Mai
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer A Reetz
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Silke Hecht
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - Peter G Noel
- Parallax Teleradiology, Hastings-on-Hudson, NY, USA
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Yarham R, Goh R, Raith EP, Sundararajan K, Kleinig T. Disseminated Aspergillosis with Mediastinal Invasion Causing Fatal Stroke in an Immunocompetent Young Man. Case Rep Neurol 2024; 16:63-70. [PMID: 38444717 PMCID: PMC10914378 DOI: 10.1159/000536594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/31/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Aspergillus flavus is a common cause of aspergillosis. Case Presentation A previously fit and well, immunocompetent 27-year-old male living in Australia developed disseminated A. flavus complex infection with mediastinal and cardiac invasion, superior vena cava obstruction and stroke, with fatal haemorrhagic transformation. Conclusion Aspergillus Flavus is a rare but important cause of serious disease in the immunocompetent.
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Affiliation(s)
- Robert Yarham
- Adelaide Medical School, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Rudy Goh
- Adelaide Medical School, Royal Adelaide Hospital, Adelaide, SA, Australia
- Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Eamon P. Raith
- Adelaide Medical School, Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Krishnaswamy Sundararajan
- Adelaide Medical School, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Timothy Kleinig
- Adelaide Medical School, Royal Adelaide Hospital, Adelaide, SA, Australia
- Department of Medicine, University of Adelaide, SA, Australia
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Salahuddin M, Shahid S, Tariq U, Aqeel M, Arif AU, Aslam M, Sattar S. Outcomes of patients with elevated pulmonary artery systolic pressure on echocardiography due to chronic lung diseases. Respir Investig 2024; 62:69-74. [PMID: 37952288 DOI: 10.1016/j.resinv.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Pulmonary hypertension is associated with increased mortality, and lung diseases are the second most common cause of pulmonary hypertension. We aimed to evaluate the prognostic value of echocardiography in low-middle income countries where right heart catheterization is difficult to perform. METHODS This retrospective chart review study included adult patients hospitalized from June 2012 to May 2021, with a pulmonary artery systolic pressure (PASP) of ≥35 mmHg on echocardiography. The control arm consisted of patients with similar lung diseases who did not have an elevated PASP. RESULTS The study and control arm consisted of 128 patients each, with both groups having similar lung diseases. Obesity hypoventilation syndrome was the most common etiology of elevated PASP (28.1 %), followed by pulmonary embolism (20.3 %). The overall 1-year mortality of the study cohort, after diagnosis of elevated PASP, was 20.3 %. The control cohort with normal PASP had a 1-year mortality of 4.7 %. In the study cohort, patients with bronchiectasis had the highest cause-specific 1-year mortality (45.5 %). In the normal PASP cohort, the highest cause-specific 1-year mortality was observed in patients with interstitial lung disease (13.0 %). One-year hospital readmission was observed in 46.9 % and 33.6 % of patients in the study and control arms, respectively. On multivariate analysis, increased odds of 1-year mortality were observed in patients with elevated PASP, patients with 1-year hospital readmission, and in patients with interstitial lung disease or bronchiectasis. CONCLUSION Elevated PASP on echocardiography may be a prognostic factor for mortality in patients with chronic lung diseases.
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Affiliation(s)
- Moiz Salahuddin
- Department of Medicine, Aga Khan University, Karachi, Pakistan.
| | - Shayan Shahid
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Umar Tariq
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Masooma Aqeel
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Ali Usman Arif
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Mehwish Aslam
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Saadia Sattar
- Department of Medicine, Aga Khan University, Karachi, Pakistan
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Albtoosh AS, Altarawneh T, Toubasi AA, Malek M, Albulbol DM, Alnugaimshi SF, Altarawneh A, Alsurkhi RH, Al Oweidat K, Farah RI, Obeidat N, Salem Albtoush ES. Clinical, Radiological, and Microbiologic Characteristics of Patients with Noncystic Fibrosis Bronchiectasis in a Tertiary Center at Jordan. Curr Med Imaging 2024; 20:1-8. [PMID: 38389348 DOI: 10.2174/0115734056255925231108052743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/20/2023] [Accepted: 08/28/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Only a small number of the investigations that were carried out in the Middle East attempted to characterize patients with NCFB. In order to characterize patients with NCFB, as well as their etiologies, microbiological profiles, and outcomes, we therefore carried out this investigation. METHODS This retrospective cohort study was carried out at the Jordan University Hospital (JUH), a tertiary facility located in Amman, Jordan. Non-cystic Fibrosis Bronchiectasis (NCFB) was defined as an HRCT scan typical for bronchiectasis along with a negative sweat chloride test to rule out cystic fibrosis. Patients' data were collected by the use of Electronic Medical Records (EMR) at our institution. Frequent exacerbation was defined as more than 2 exacerbations in 1 year of the onset of the diagnosis. RESULTS A total of 79 patients were included, and 54.4% of them were female. The mean and standard deviation of the patient's age was 48.61 ± 19.62. The etiologies of bronchiectasis were evident in 79.7% of the sample. Asthma, Chronic Obstructive Pulmonary Diseases (COPD), and Kartagener syndrome were the most prevalent etiologies, accounting for related illnesses in 21.8%, 21.5%, and 13.9% of the patients, respectively. The most frequent bacteria cultured in our cohort were Pseudomonas and Candida Species. Moreover, 43 patients of the study cohort were frequent exacerbators, and 5 patients died. CONCLUSION Our study supports the need to identify several bronchiectasis phenotypes linked to various causes. These findings provide information to clinicians for the early detection and treatment of bronchiectasis in Jordan.
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Affiliation(s)
- Asma S Albtoosh
- Department of Internal Medicine, Respiratory and Sleep Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Tala Altarawneh
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Ahmad A Toubasi
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Mariam Malek
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | | | | | - Amro Altarawneh
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | | | - Khaled Al Oweidat
- Department of Internal Medicine, Respiratory and Sleep Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Randa I Farah
- Department of Internal Medicine, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Nathir Obeidat
- Department of Internal Medicine, Respiratory and Sleep Medicine, School of Medicine, The University of Jordan, Amman, Jordan
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49
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Su VYF, Ding TL, Chang YL, Chou YC, Hwang HE, Chou CY, Hsu CC. Comparative effectiveness and safety of inhaled corticosteroid plus long-acting β2-agonist fixed-dose combinations vs. long-acting muscarinic antagonist in bronchiectasis. Expert Rev Clin Pharmacol 2024; 17:157-164. [PMID: 38224017 DOI: 10.1080/17512433.2024.2306218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/12/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND This study aimed to evaluate the effectiveness and safety of fixed-dose combination (FDC) inhaled corticosteroids/long-acting β2-agonists (ICS/LABA) in bronchiectasis. RESEARCH DESIGN AND METHODS A retrospective cohort study analyzed electronic medical records of bronchiectasis patients initiating ICS/LABA FDC or LAMA between 2007 and 2021. All bronchiectasis diagnoses were made by radiologists using high-resolution computed tomography. RESULTS Of the 1,736 patients, 1,281 took ICS/LABA FDC and 455 LAMA. Among the 694 propensity score matched patients, ICS/LABA FDC had comparable outcomes to LAMA, with HRs of 1.22 (95% CI 0.81-1.83) for hospitalized respiratory infection, 1.06 (95% CI 0.84-1.33) for acute exacerbation, and 1.06 (95% CI 0.66-1.02) for all-cause hospitalization. Beclomethasone/formoterol (BEC/FOR) or budesonide/formoterol (BUD/FOR) led to a lower risk of acute exacerbation compared to fluticasone/salmeterol (FLU/SAL) (BEC/FOR HR 0.59, 95% CI 0.43-0.81; BUD/FOR HR 0.68, 95% CI 0.50-0.93). BEC/FOR resulted in lower risks of hospitalized respiratory infection (HR 0.48, 95% 0.26-0.86) and all-cause hospitalization (HR 0.55, 95% 0.37-0.80) compared to FLU/SAL. CONCLUSION Our findings provide important evidence on the effectiveness and safety of ICS/LABA FDC compared with LAMA for bronchiectasis. BEC/FOR and BUD/FOR were associated with better outcomes than FLU/SAL.
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Affiliation(s)
- Vincent Yi-Fong Su
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Internal Medicine, Taipei City Hospital, Taipei City Government, Taipei, Taiwan
- Department of Exercise and Health Sciences, College of Kinesiology, University of Taipei, Taipei, Taiwan
| | - Ting-Lin Ding
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Pharmacy, School of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yuh-Lih Chang
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Pharmacy, School of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yueh-Ching Chou
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Pharmacy, School of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsuen-En Hwang
- Department of Internal Medicine, Taipei City Hospital, Taipei City Government, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chian-Ying Chou
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Pharmacy, School of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Chen Hsu
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Pharmacy, School of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
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50
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Lv Q, Gallardo-Estrella L, Andrinopoulou ER, Chen Y, Charbonnier JP, Sandvik RM, Caudri D, Nielsen KG, de Bruijne M, Ciet P, Tiddens H. Automatic analysis of bronchus-artery dimensions to diagnose and monitor airways disease in cystic fibrosis. Thorax 2023; 79:13-22. [PMID: 37734952 PMCID: PMC10803964 DOI: 10.1136/thorax-2023-220021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/11/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) lung disease is characterised by progressive airway wall thickening and widening. We aimed to validate an artificial intelligence-based algorithm to assess dimensions of all visible bronchus-artery (BA) pairs on chest CT scans from patients with CF. METHODS The algorithm fully automatically segments the bronchial tree; identifies bronchial generations; matches bronchi with the adjacent arteries; measures for each BA-pair bronchial outer diameter (Bout), bronchial lumen diameter (Bin), bronchial wall thickness (Bwt) and adjacent artery diameter (A); and computes Bout/A, Bin/A and Bwt/A for each BA pair from the segmental bronchi to the last visible generation. Three datasets were used to validate the automatic BA analysis. First BA analysis was executed on 23 manually annotated CT scans (11 CF, 12 control subjects) to compare automatic with manual BA-analysis outcomes. Furthermore, the BA analysis was executed on two longitudinal datasets (Copenhagen 111 CTs, ataluren 347 CTs) to assess longitudinal BA changes and compare them with manual scoring results. RESULTS The automatic and manual BA analysis showed no significant differences in quantifying bronchi. For the longitudinal datasets the automatic BA analysis detected 247 and 347 BA pairs/CT in the Copenhagen and ataluren dataset, respectively. A significant increase of 0.02 of Bout/A and Bin/A was detected for Copenhagen dataset over an interval of 2 years, and 0.03 of Bout/A and 0.02 of Bin/A for ataluren dataset over an interval of 48 weeks (all p<0.001). The progression of 0.01 of Bwt/A was detected only in the ataluren dataset (p<0.001). BA-analysis outcomes showed weak to strong correlations (correlation coefficient from 0.29 to 0.84) with manual scoring results for airway disease. CONCLUSION The BA analysis can fully automatically analyse a large number of BA pairs on chest CTs to detect and monitor progression of bronchial wall thickening and bronchial widening in patients with CF.
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Affiliation(s)
- Qianting Lv
- Department of Paediatric Pulmonology and Allergology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Yuxin Chen
- Department of Paediatric Pulmonology and Allergology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Rikke Mulvad Sandvik
- CF Center Copenhagen, Paediatric Pulmonary Service, Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Graduate School of Health and Medical Sciences, Copenhagen, Denmark
| | - Daan Caudri
- Department of Paediatric Pulmonology and Allergology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Kim Gjerum Nielsen
- CF Center Copenhagen, Paediatric Pulmonary Service, Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Marleen de Bruijne
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Pierluigi Ciet
- Department of Paediatric Pulmonology and Allergology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Pediatric Pulmonology, Erasmus Medical Center- Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Harm Tiddens
- Department of Paediatric Pulmonology and Allergology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Thirona, Nijmegen, The Netherlands
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