Effect of Azithromycin Maintenance Treatment on Infectious Exacerbations Among Patients With Non–Cystic Fibrosis Bronchiectasis

Altenburg, Josje; Graaff, Casper S. de; Stienstra, Ymkje; Sloos, J. H.; Haren, E. H. J. Van; Koppers, Ralph J. H.; Werf, Tjip S. van der; Boersma, Wim

doi:10.1001/jama.2013.1937

Cited by 449 publications

(440 citation statements)

References 37 publications

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“…No such tool exists for bronchiectasis. New treatments are increasingly available for patients with bronchiectasis, with growing evidence for the efficacy of long-term macrolide therapy and inhaled antibiotics (8)(9)(10)(11). However, these therapies have attendant risks (e.g., antimicrobial resistance and toxicity) as well as significant healthcare costs and treatment burdens (22).…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…There is a need to define which patients are most likely to benefit from new treatments, with an increasing number of clinical trials of inhaled and oral therapies in bronchiectasis (8)(9)(10)(11). A severity classification system could theoretically allow targeting of therapies to the patients most likely to benefit.…”

mentioning

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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“…Finally, the Bronchiectasis and Long-term Azithromycin Treatment (BAT) trial in the Netherlands randomized patients to receive 250 mg azithromycin (n = 43) versus placebo (n = 40) given daily (27). Azithromycin use was associated with a lower median number of exacerbations than placebo (2 versus 0, P , 0.001).…”

Section: ])mentioning

confidence: 99%

“…In the BAT trial, 85% of those on azithromycin acquired macrolide resistance in bacterial pathogens versus 26% of those on placebo (27). The clinical importance of this resistance is not yet known; however, macrolides are used to treat many of the organisms that are typically isolated in patients with bronchiectasis, such as H. influenzae, Moraxella catarrhalis, S. pneumonia, Staphylococcus aureus, and nontuberculous mycobacteria (NTM) (25)(26)(27)(28).…”

Section: ])mentioning

confidence: 99%

Infections in “Noninfectious” Lung Diseases

et al. 2014

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Many chronic pulmonary diseases, including those that are not primarily infectious in etiology, have some aspects of their pathogenesis that are influenced by infectious organisms. Microorganisms may contribute to chronic lung diseases, either directly (i.e., overt infection) or indirectly, via the amplification of inflammatory pathways that are critical to host defense. As techniques for detecting and characterizing microorganisms have advanced, investigations of both infecting and colonizing organisms have yielded new insights into mechanisms of pulmonary disease. In addition, changes in patterns of infection and microbial resistance have important implications for treatment. Examples of these infectious-pulmonary associations, including Haemophilus influenzae infection and chronic obstructive pulmonary disease, nontuberculous mycobacteria and bronchiectasis, and human immunodeficiency virus and obstructive lung disease, are reviewed.

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“…In the BAT randomized controlled trial, 43 non-CF bronchiectasis patients receiving azithromycin 250 mg daily and 40 patients receiving placebo for 12 months [8]. At the end of the study, patients receiving azithromycin had a median number of exacerbations of 0, (interquartile range [IQR], 0-1) compared with 2 (IQR, 1-3) in the placebo group (P<0.001).…”

mentioning

confidence: 99%

Long-term Use of Macrolides for Non-cystic Fibrosis Bronchiectasis: The Benefits and Defects

Xu¹

2013

J Pulm Respir Med

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Effect of Azithromycin Maintenance Treatment on Infectious Exacerbations Among Patients With Non–Cystic Fibrosis Bronchiectasis

Cited by 449 publications

References 37 publications

The Bronchiectasis Severity Index. An International Derivation and Validation Study

The Bronchiectasis Severity Index. An International Derivation and Validation Study

Infections in “Noninfectious” Lung Diseases

Long-term Use of Macrolides for Non-cystic Fibrosis Bronchiectasis: The Benefits and Defects

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