Cystic Fibrosis: Management of Haemoptysis

Hurt, Katharine; Simmonds, N.J.

doi:10.1016/j.prrv.2012.01.003

Cited by 32 publications

(13 citation statements)

References 30 publications

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“…There are acute complications attributable to the airways infection and inflammation, including hemoptysis, which can range from minor streaking of blood in the sputum to massive bleeding that can be life-threatening. [4] The pathogenesis of hemoptysis is multi-factorial [5], although there are risk factors shown to be associated with massive hemoptysis, such as older age, more severe pulmonary impairment, and the presence of Staphylococcus aureus in sputum cultures. [6]…”

Section: Introductionmentioning

confidence: 99%

Risk of hemoptysis in cystic fibrosis clinical trials: A retrospective cohort study

Thompson¹,

Mayer-Hamblett

Kloster³

et al. 2015

Journal of Cystic Fibrosis

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Background Cystic fibrosis (CF) is characterized by airways infection and inflammation resulting in respiratory complications including hemoptysis. The objectives of this study were to characterize risk of hemoptysis attributable to the underlying disease and in the presence of standard of care therapy. Methods This retrospective cohort study estimated hemoptysis rates overall and by relevant risk factors utilizing adverse event data from longitudinal prospective CF clinical trials. Results Of the 1008 participants, 73% were ≤18 years old; of 929 with available spirometry, 27% had an FEV1 < 70% predicted. During the average 8.2 months of follow-up, 8% experienced ≥1 hemoptysis events (95% CI: 6%, 10%). Of the 125 events, 76% were mild in severity and only 9% were serious. Hemoptysis rates were greater among adults than children, those with FEV1 < 70% predicted, and participants infected with P. aeruginosa but not with S. aureus. Conclusions Hemoptysis is a common adverse event among CF clinical trial participants, and particularly in adults with more severe lung disease. These results can be used to predict event occurrence in future clinical trials.

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Section: Introductionmentioning

confidence: 99%

Risk of hemoptysis in cystic fibrosis clinical trials: A retrospective cohort study

Thompson¹,

Mayer-Hamblett

Kloster³

et al. 2015

Journal of Cystic Fibrosis

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“…Based on information from the interventional radiology literature, bronchial arteries undergo both hypertrophy and angiogenesis, presumably the result of chronic inflammation (Holsclaw et al . ; Hurt & Simmonds, ). Most cystic fibrosis patients have recurrent haemoptysis because embolized vessels open back up, but most times the bleeding region gets new collateral supplies from proximal bronchial or other systemic arteries (subclavian, lateral thoracic, thoracoacromial arteries).…”

Section: Angiogenesis In Lung Pathologiesmentioning

confidence: 99%

Angiogenesis in the lung

Eldridge

Wagner

2018

The Journal of Physiology

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Both systemic (tracheal and bronchial) and pulmonary circulations perfuse the lung. However, documentation of angiogenesis of either is complicated by the presence of the other. Well-documented angiogenesis of the systemic circulations have been identified in asthma, cystic fibrosis, chronic thromboembolism and primary carcinomas. Angiogenesis of the vasa vasorum, which are branches of bronchial arteries, is seen in the walls of large pulmonary vessels after a period of chronic hypoxia. Documentation of increased pulmonary capillaries has been shown in models of chronic hypoxia, after pneumonectomy and in some carcinomas. Although endothelial cell proliferation may occur as part of the repair process in several pulmonary diseases, it is separate from the unique establishment of new functional perfusing networks defined as angiogenesis. Identification of the mechanisms driving the expansion of new vascular beds in the adult needs further investigation. Yet the growth factors and molecular mechanisms of lung angiogenesis remain difficult to separate from underlying disease sequelae.

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“…Bronchial artery embolization for haemoptysis control presents a unique anaesthetic challenge. Embolization is effective in gaining short-term control of haemoptysis, even massive haemoptysis, but does not affect overall disease course [31,32]. Massive haemoptysis often necessitates single-lung ventilation and transfusion, but a grey area exists for more stable patients.…”

Section: Embolization For Haemorrhagementioning

confidence: 99%