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

Abstract

BACKGROUND: Bronchiectasis exacerbations are critical events characterized by worsened symptoms and signs (ie, cough frequency, sputum volume, malaise). Objectives: Our goal was to examine variations in airway and systemic inflammation, spirometry, and quality of life during steady state, bronchiectasis exacerbations, and convalescence (1 week following a 2-week antibiotic treatment) to determine whether potentially pathogenic microorganisms, including Pseudomonas aeruginosa, were associated with poorer conditions during bronchiectasis exacerbations. METHODS: Peripheral blood and sputum were sampled to detect inflammatory mediators and bacterial densities. Spirometry and quality of life (St George Respiratory Questionnaire [SGRQ]) were assessed during the 3 stages. RESULTS: Forty-eight subjects with bronchiectasis (43.2 ؎ 14.2 y of age) were analyzed. No notable differences in species and density of potentially pathogenic microorganisms were found during bronchiectasis exacerbations. Except for CXCL8 and tumor necrosis factor alpha (TNF-␣), serum inflammation was heightened during bronchiectasis exacerbations and recovered during convalescence. Even though sputum TNF-␣ was markedly higher during bronchiectasis exacerbations and remained heightened during convalescence, the variations in miscellaneous sputum markers were unremarkable. Bronchiectasis exacerbations were associated with notably higher SGRQ symptom and total scores, which recovered during convalescence. FVC, FEV 1 , and maximum mid-expiratory flow worsened during bronchiectasis exacerbations (median change from baseline of ؊2.2%, ؊0.8%, and ؊1.3%) and recovered during convalescence (median change from baseline of 0.6%, 0.7%, and ؊0.7%). Compared with no bacterial isolation, potentially pathogenic microorganism or P. aeruginosa isolation at baseline did not result in poorer clinical condition during bronchiectasis exacerbations. CONCLUSIONS: Bronchiectasis exacerbations are characterized by heightened inflammatory responses and poorer quality of life and spirometry, but not by increased bacterial density, which applies for subjects with and without potentially pathogenic microorganism isolation when clinically stable. (ClinicalTrials.gov registration NCT01761214.)

Pathogenesis, imaging and clinical characteristics of CF and non-CF bronchiectasis

“…Bacterial load in non-CF bronchiectasis has been correlated with increases in airway (NE, IL-8, IL-1β and TNF-α) and systemic (ICAM-1, E-selectin) derived inflammatory markers, phenomena confirmed in vitro using bronchial epithelial cell lines treated with sputum from bronchiectasis patients [103,104]. Exacerbations of both CF and non-CF bronchiectasis increases inflammation irrespective of bacterial, viral or fungal causation [43,105,106]. Interestingly, sTREM-1 a novel inflammatory marker described in a variety of pulmonary disease states including COPD, has also been identified in children with both CF-and HIV-related bronchiectasis although concentrations in the latter setting are highest.…”

Pletismografía en pacientes con bronquiectasias secundarias a tuberculosis en un hospital público de Lima, Perú

“…En esta investigación se encontró una mejora, estadísticamente significativa, en los valores de la CPT, VR, y VR/CPT luego de la aplicación de broncodilatadores. Esto concuerda con lo observado por Guan Wei-Jie et al [8] donde el 34% de su población respondieron positivamente a los broncodilatadores. Esto se explicaría porque las bronquiectasias se comportan como una enfermedad crónica y progresiva que comprende un grado de obstrucción crónica del flujo aéreo [9,10] , lo que demostraría cierto grado de reversibilidad de dicha obstrucción bronquial, quizá parecido a lo que ocurre en la EPOC.…”

Suspecting non-cystic fibrosis bronchiectasis: What the busy primary care clinician needs to know

“…It is important to note that spirometry may not significantly differ between the stable and exacerbation states 35. Although one study showed a statistically significant decline of both FEV1 and FVC by 3% ( P ≤.01) between the stable and exacerbation states, this is unlikely to be clinically significant 59. Spirometry should be performed at least annually in patients with bronchiectasis to detect progression of the disease 1.…”

“…35 Although one study showed a statistically significant decline of both FEV1 and FVC by 3% (P≤.01) between the stable and exacerbation states, this is unlikely to be clinically significant. 59 Spirometry should be performed at least annually in patients with bronchiectasis to detect progression of the disease. 1 Pulmonary function testing may help detect and determine the severity of other underlying conditions such as interstitial lung disease, asthma and pulmonary hypertension.…”