Inhaled Corticosteroids in Adults with Non-cystic Fibrosis Bronchiectasis: From Bench to Bedside. A Narrative Review

Martínez‐García, Miguel Ángel; Oscullo, Grace; García-Ortega, Alberto; Matera, Maria Gabriella; Rogliani, Paola; Cazzola, Mario

doi:10.1007/s40265-022-01785-1

Cited by 19 publications

(14 citation statements)

References 132 publications

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“…Further studies may be useful to investigate the beneficial effects of therapeutic modalities such as inhaled antibiotics, including N- Acetylcysteine in Indigenous patients ( 45 ). Use of ICS among patients with bronchiectasis is controversial ( 46 , 47 ). Nonetheless, in our study more than half of the patients recorded an ICS prescription.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing survival and mortality among adult Aboriginal Australians with bronchiectasis—A 10-year retrospective study

Heraganahally,

Gibbs,

Ravichandran

et al. 2024

Front. Med.

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BackgroundThe prevalence of bronchiectasis among adult Aboriginal Australians is higher than that of non-Aboriginal Australians. However, despite evidence to suggest higher prevalence of bronchiectasis among Aboriginal people in Australia, there is sparce evidence in the literature assessing clinical parameters that may predict survival or mortality in this population.MethodsAboriginal Australians residing in the Top End Health Service region of the Northern Territory of Australia aged >18 years with chest computed tomography (CT) confirmed bronchiectasis between 2011 and 2020 were included. Demographics, body mass index (BMI), medical co-morbidities, lung function data, sputum microbiology, chest CT scan results, hospital admissions restricted to respiratory conditions and all-cause mortality were assessed.ResultsA total of 459 patients were included, of whom 146 were recorded deceased (median age at death 59 years). Among the deceased cohort, patients were older (median age 52 vs. 45 years, p = 0.023), had a higher prevalence of chronic obstructive pulmonary disease (91 vs. 79%, p = 0.126), lower lung function parameters (median percentage predicted forced expiratory volume in 1 s 29 vs. 40%, p = 0.149), a significantly greater proportion cultured non-Aspergillus fungi (65 vs. 46%, p = 0.007) and pseudomonas (46 vs. 28%, p = 0.007) on sputum microbiology and demonstrated bilateral involvement on radiology. In multivariate models advancing age, prior pseudomonas culture and Intensive care unit (ICU) visits were associated with increased odds of mortality. Higher BMI, better lung function on spirometry, prior positive sputum microbiology for Haemophilus and use of inhaled long-acting beta antagonist/muscarinic agents may have a favourable effect.ConclusionThe results of this study may be of use to stratify high risk adult Aboriginal patients with bronchiectasis and to develop strategies to prevent future mortality.

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Section: Discussionmentioning

confidence: 99%

Factors influencing survival and mortality among adult Aboriginal Australians with bronchiectasis—A 10-year retrospective study

Heraganahally,

Gibbs,

Ravichandran

et al. 2024

Front. Med.

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“…However, among patients prescribed ICS, we observed a higher proportion had an admission related to ICD code J44 compared to patients with no ICS prescription. Utilisation of ICS among patients with bronchiectasis is controversial and may be detrimental [ 65 ]. Previous studies from our centre had reported higher use of ICS among Indigenous patients with bronchiectasis and to have a significant decline in lung function parameters with ICS [ 66 , 67 ].…”

Section: Discussionmentioning

confidence: 99%

Hospital admission rates and related outcomes among adult Aboriginal australians with bronchiectasis – a ten-year retrospective cohort study

Howarth,

Gibbs,

Heraganahally

et al. 2024

BMC Pulm Med

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Background This study assessed hospitalisation frequency and related clinical outcomes among adult Aboriginal Australians with bronchiectasis over a ten-year study period. Method This retrospective study included patients aged ≥ 18 years diagnosed with bronchiectasis between 2011 and 2020 in the Top End, Northern Territory of Australia. Hospital admissions restricted to respiratory conditions (International Classification of Diseases (ICD) code J) and relevant clinical parameters were assessed and compared between those with and without hospital admissions. Results Of the 459 patients diagnosed to have bronchiectasis, 398 (87%) recorded at least one respiratory related (ICD-J code) hospitalisation during the 10-year window. In comparison to patients with a recorded hospitalisation against those without—hospitalised patients were older (median 57 vs 53 years), predominantly females (54 vs 46%), had lower body mass index (23 vs 26 kg/m2) and had greater concurrent presence of chronic obstructive pulmonary disease (COPD) (88 vs 47%), including demonstrating lower spirometry values (forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) (median FVC 49 vs 63% & FEV1 36 vs 55% respectively)). The total hospitalisations accounted for 3,123 admissions (median 4 per patient (IQR 2, 10)), at a median rate of 1 /year (IQR 0.5, 2.2) with a median length of 3 days (IQR 1, 6). Bronchiectasis along with COPD with lower respiratory tract infection (ICD code-J44) was the most common primary diagnosis code, accounting for 56% of presentations and 46% of days in hospital, which was also higher for patients using inhaled corticosteroids (81 vs 52%, p = 0.007). A total of 114 (29%) patients were recorded to have had an ICU admission, with a higher rate, including longer hospital stay among those patients with bronchiectasis and respiratory failure related presentations (32/35, 91%). In multivariate regression model, concurrent presence of COPD or asthma alongside bronchiectasis was associated with shorter times between subsequent hospitalisations (-423 days, p = 0.007 & -119 days, p = 0.02 respectively). Conclusion Hospitalisation rates among adult Aboriginal Australians with bronchiectasis are high. Future interventions are required to explore avenues to reduce the overall morbidity associated with bronchiectasis among Aboriginal Australians.

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“…Inhaled corticosteroids must be avoided since they can increase the frequency of exacerbations and the risk of mycobacterial diseases. 41 , 42 However, following the recommendations applied to noncystic bronchiectasis, in cases of PTLD associated with asthma, inhaled corticosteroid therapy may be justified. 24 Similarly, for chronic inflammation in patients with noncystic fibrosis bronchiectasis, the use of macrolides is recommended for a minimum period of 6-12 months in patients with bronchiectasis and at least two exacerbations per year.…”

Section: Management Of Ptldmentioning

confidence: 99%

Brazilian Thoracic Association recommendations for the management of post-tuberculosis lung disease

Rossato Silva1,

Paula Santos2,3,

Visca4,5

et al. 2023

J Bras Pneumol.

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Historically, all efforts against tuberculosis were focused on rapid diagnosis and effective treatment to break the chain of transmission of Mycobacterium tuberculosis. However, in the last few years, more and more evidence has been found on the dramatic consequences of the condition defined as post-tuberculosis lung disease (PTLD). Approximately one third of patients surviving pulmonary tuberculosis face considerable ongoing morbidities, including respiratory impairment, psychosocial challenges, and reduced health-related quality of life after treatment completion. Given the important global and local burden of tuberculosis, as well as the estimated burden of PTLD, the development of a consensus document by a Brazilian scientific society-Sociedade Brasileira de Pneumologia e Tisiologia (SBPT)-was considered urgent for the prevention and management of this condition in order to allocate resources to and within tuberculosis services appropriately and serve as a guide for health care professionals. A team of eleven pulmonologists and one methodologist was created by the SBPT to review the current evidence on PTLD and develop recommendations adapted to the Brazilian context. The expert panel selected the topics on the basis of current evidence and international guidelines. During the first phase, three panel members drafted the recommendations, which were divided into three sections: definition and prevalence of PTLD, assessment of PTLD, and management of PTLD. In the second phase, all panel members reviewed, discussed, and revised the recommendations until a consensus was reached. The document was formally approved by the SBPT in a special session organized during the 2023 SBPT Annual Conference.

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Inhaled Corticosteroids in Adults with Non-cystic Fibrosis Bronchiectasis: From Bench to Bedside. A Narrative Review

Cited by 19 publications

References 132 publications

Factors influencing survival and mortality among adult Aboriginal Australians with bronchiectasis—A 10-year retrospective study

Factors influencing survival and mortality among adult Aboriginal Australians with bronchiectasis—A 10-year retrospective study

Hospital admission rates and related outcomes among adult Aboriginal australians with bronchiectasis – a ten-year retrospective cohort study

Brazilian Thoracic Association recommendations for the management of post-tuberculosis lung disease

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