An Investigation into Causative Factors in Patients with Bronchiectasis

Pasteur, Mark C.; Helliwell, Sharon M.; Houghton, Sally J.; Webb, Susannah C.; Foweraker, Juliet; Coulden, Richard; Flower, C. D. R.; Bilton, Diana; Keogan, M.

doi:10.1164/ajrccm.162.4.9906120

Cited by 623 publications

(551 citation statements)

References 40 publications

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“…Investigations included: a 1 -antitrypsin levels; CF genetics and subsequent sweat-testing if positive; immunoglobulin levels (including specific antibody responses); microscopic examination of the nasal cilia; and fibreoptic bronchoscopy. These investigations were performed according to methodologies previously described [7].…”

Section: Subjectsmentioning

confidence: 99%

Nontuberculous mycobacteria in bronchiectasis: prevalence and patient characteristics

Fowler¹,

French²,

Screaton³

et al. 2006

Eur Respir J

147

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The aim of the current study was to investigate the prevalence and clinical associations of nontuberculous mycobacteria (NTM) in a well-characterised cohort of patients with adult-onset bronchiectasis.The sputum of all patients attending a tertiary referral bronchiectasis clinic between April 2002 and August 2003 was examined for mycobacteria as part of an extensive diagnostic work-up. NTM-positive patients subsequently had further sputa examined. A modified bronchiectasis scoring system was applied to all high-resolution computed tomography (HRCT) scans from NTM-positive patients, and a matched cohort without NTM.Out of 98 patients attending the clinic, 10 had NTM in their sputum on first culture; of those, eight provided multiple positive cultures. Three patients were treated for NTM infection. A higher proportion of NTM-positive than -negative patients were subsequently diagnosed with cystic fibrosis (two out of nine versus two out of 75). On HRCT scoring, more patients in the NTMpositive group had peripheral mucus plugging than in the NTM-negative group.In the current prospective study of a large cohort of patients with bronchiectasis, 10% cultured positive for nontuberculous mycobacteria in a random clinic sputum sample. Few clinical parameters were helpful in discriminating between groups, except for a higher prevalence of previously undiagnosed cystic fibrosis and of peripheral mucus plugging on high-resolution computed tomography in the nontuberculous mycobacteria group.

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Section: Subjectsmentioning

confidence: 99%

Nontuberculous mycobacteria in bronchiectasis: prevalence and patient characteristics

Fowler¹,

French²,

Screaton³

et al. 2006

Eur Respir J

147

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“…The maximum score is 18 and minimum score is 1. This score has been used previously in studies of bronchiectasis (13)(14)(15)(16).…”

Section: Radiological Severitymentioning

confidence: 99%

The Bronchiectasis Severity Index. An International Derivation and Validation Study

Chalmers

Goeminne²,

Aliberti

et al. 2014

Am J Respir Crit Care Med

843

836

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Rationale: There are no risk stratification tools for morbidity and mortality in bronchiectasis. Identifying patients at risk of exacerbations, hospital admissions, and mortality is vital for future research.Objectives: This study describes the derivation and validation of the Bronchiectasis Severity Index (BSI).Methods: Derivation of the BSI used data from a prospective cohort study (Edinburgh, UK, 2008 enrolling 608 patients. Cox proportional hazard regression was used to identify independent predictors of mortality and hospitalization over 4-year follow-up. The score was validated in independent cohorts from Dundee, UK (n = 218); Leuven, Belgium (n = 253); Monza, Italy (n = 105); and Newcastle, UK (n = 126).Measurements and Main Results: Independent predictors of future hospitalization were prior hospital admissions, Medical Research Council dyspnea score greater than or equal to 4, FEV 1 , 30% predicted, Pseudomonas aeruginosa colonization, colonization with other pathogenic organisms, and three or more lobes involved on high-resolution computed tomography. Independent predictors of mortality were older age, low FEV 1 , lower body mass index, prior hospitalization, and three or more exacerbations in the year before the study. The derived BSI predicted mortality and hospitalization: area under the receiver operator characteristic curve (AUC) 0.80 (95% confidence interval, 0.74-0.86) for mortality and AUC 0.88 (95% confidence interval, 0.84-0.91) for hospitalization, respectively.There was a clear difference in exacerbation frequency and quality of life using the St. George's Respiratory Questionnaire between patients classified as low, intermediate, and high risk by the score (P , 0.0001 for all comparisons). In the validation cohorts, the AUC for mortality ranged from 0.81 to 0.84 and for hospitalization from 0.80 to 0.88. Conclusions:The BSI is a useful clinical predictive tool that identifies patients at risk of future mortality, hospitalization, and exacerbations across healthcare systems.

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“…DB is a pathological description of lung disease characterized by an abnormal and irreversible dilatation of thick-walled bronchi. Affected areas are inflamed and easily collapsible resulting in air flow obstruction and impaired clearance of secretions (Pasteur et al 2000). …”

Section: Cftr Mutations and Disseminated Bronchiectasismentioning

confidence: 99%