Assessing response to treatment of exacerbations of bronchiectasis in adults

Abstract

The present study aimed to assess the effect of intravenous antibiotic therapy on clinical and laboratory end-points in exacerbations of noncystic fibrosis bronchiectasis and to determine whether the outcomes were influenced by the pathogenic organism isolated.A prospective cohort study was conducted from November 2006 to March 2008 of exacerbations requiring intravenous antibiotics. End-points included 24-h sputum volume, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), incremental shuttle walk test, qualitative sputum microbiology, white cell count, erythrocyte sedimentation rate, C-reactive protein (CRP) and St George's Respiratory Questionnaire (SGRQ). Exacerbations due to Pseudomonas aeruginosa were compared with exacerbations due to other potential pathogenic organisms.In total, 32 exacerbations were studied. Following 14 days of intravenous antibiotics, all outcomes significantly improved independent of a pathogenic organism, except FEV1 and FVC. The most responsive markers were: 24-h sputum volume (reduced in all patients and 80% had o50% reduction); sputum bacterial clearance (78.1%); CRP (o75% reduction in 62.5%) and SGRQ (o4 unit improvement in 89.7%). CRP, 24-h sputum volume and SGRQ improved independent of microbial clearance.In the current study, 24-h sputum volume, microbial clearance, C-reactive protein and St George's Respiratory Questionnaire were the most useful parameters to assess response to treatment of exacerbations of bronchiectasis. Outcomes were similar independent of the pathogenic organism with the exception of forced expiratory volume in one second and forced vital capacity.

Inflammatory Responses, Spirometry, and Quality of Life in Subjects With Bronchiectasis Exacerbations

“…The increased systemic inflammation during exacerbations could be abrogated by antibiotics. In the study by Murray et al, 11 24-h sputum volume, C-reactive protein, and SGRQ scores were responsive to therapeutic outcomes, but were unrelated to bacterial clearance. Courtney et al 12 reported a notable decline in serum C-reactive protein, sputum inflammatory cell counts, and biomarkers (TNF-␣, CXCL8, and neutrophil elastase), but not spirometry or SGRQ scores, at day 14 following antibiotic therapy.…”

“…C-reactive protein has been reported to be a useful parameter in reflecting the efficacy of antibiotic therapy following bronchiectasis exacerbations; therefore, we calculated the sample size according to the pre-and posttreatment C-reactive protein based on the study of Murray et al 11 It has been shown that antibiotics lead to a significant reduction in C-reactive protein levels (6.7 Ϯ 7.1 vs 0.7 Ϯ 1.1 mg/dL). By assuming the levels of ␣ and ␤ to be 0.05 and 0.10 (2-sided tests), respectively, we estimated that 15 subjects…”

“…Murray et al 11 reported high bacterial clearance rates and improved quality of life following intravenous antibiotic therapy. Courtney et al 12 documented substantial reduction in C-reactive protein, sputum inflammatory cell count, sputum inflammatory mediators (eg, tumor necrosis factor-␣ [TNF-␣] and interleukin-8 [CXCL8]), and quality of life after antibiotic treatment.…”

Quality of Life and Bronchial Hyper-Responsiveness in Subjects With Bronchiectasis: Validation of the Seattle Obstructive Lung Disease Questionnaire in Bronchiectasis

“…Additionally, several studies concluded that exacerbations in subjects with bronchiectasis can adversely affect HRQOL, and treatment of exacerbations might lead to improvement in quality of life. [22][23][24] It is clear that this issue needs more study. People live with chronic diseases that can adversely affect their HRQOL.…”

Non-cystic fibrosis bronchiectasis

“…Bacterial clearance, 24-hour sputum volume, C-reactive protein and the St George's Respiratory Questionnaire (an HRQL questionnaire) are useful markers of treatment response, although the latter questionnaire is predominantly a research tool. 31,32 …”