Medical management of bronchiectasis

O’Donnell, Anne E.

doi:10.21037/jtd.2018.09.39

Cited by 12 publications

(9 citation statements)

References 47 publications

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“…Vaccination is an important consideration in the preventative care of children and adults with bronchiectasis. Expert opinion recommends giving the seasonal influenza vaccination, as well as ensuring maintenance of vaccination against S. pneumonia, H. influenzae, and Bordetella pertussis when appropriate for the patient and not otherwise contraindicated (94)(95)(96)(97). Most patients with antibody deficiencies are maintained on IgRT and are receiving antibody protection passively.…”

Section: Immune-modulating and Anti-inflammatory Medicationsmentioning

confidence: 99%

Bronchiectasis in Primary Antibody Deficiencies: A Multidisciplinary Approach

2020

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Bronchiectasis, the presence of bronchial wall thickening with airway dilatation, is a particularly challenging complication of primary antibody deficiencies. While susceptibility to infections may be the primary factor leading to the development of bronchiectasis in these patients, the condition may develop in the absence of known infections. Once bronchiectasis is present, the lungs are subject to a progressive cycle involving both infectious and non-infectious factors. If bronchiectasis is not identified or not managed appropriately, the cycle proceeds unchecked and yields advanced and permanent lung damage. Severe symptoms may limit exercise tolerance, require frequent hospitalizations, profoundly impair quality of life (QOL), and lead to early death. This review article focuses on the appropriate identification and management of bronchiectasis in patients with primary antibody deficiencies. The underlying immune deficiency and the bronchiectasis need to be treated from combined immunology and pulmonary perspectives, reflected in this review by experts from both fields. An aggressive multidisciplinary approach may reduce exacerbations and slow the progression of permanent lung damage.

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Section: Immune-modulating and Anti-inflammatory Medicationsmentioning

confidence: 99%

Bronchiectasis in Primary Antibody Deficiencies: A Multidisciplinary Approach

2020

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“…As corticosteroid use may reflect the severity of the underlying disease, the susceptibility of corticosteroid-treated males to nocardiosis may merely be a surrogate for their poorer physical condition, exposing them to nocardiosis. In our study, most of the chronic lung patients had either chronic obstructive pulmonary disease or bronchiectasis, diseases that require systemic corticosteroid therapy for acute exacerbations 34,35 , and which carry a poorer prognosis in males 36,37 . Further research is required to elucidate this issue.…”

Section: Discussionmentioning

confidence: 72%

Clinical correlates of nocardiosis

Margalit

Goldberg

Ari

et al. 2020

Sci Rep

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Nocardia is an opportunistic pathogen that most frequently affects the lungs. Evidence is limited regarding the risk factors for nocardiosis. The current study assessed clinical correlates of nocardiosis. A retrospective study was conducted based on medical records of consecutive adult patients (N = 60) with nocardiosis hospitalized during 2007-2018 at a tertiary hospital in central Israel. A matched comparison group of 120 patients was randomly selected among hospitalized patients with community-acquired pneumonia. Multivariable conditional logistic regression models were fitted. Immunosuppressive pharmacotherapy was positively associated with nocardiosis (matched odds ratio [OR] 4.40, 95% confidence interval [CI] 2.25-8.62, p < 0.001), particularly corticosteroid therapy (matched OR 4.69, 95% CI 2.45-8.99, p < 0.001). Systemic corticosteroid therapy was strongly associated with pulmonary nocardiosis (matched OR 5.90, 95% CI 2.75-12.66, p < 0.001). The positive association between solid organ transplantation and nocardiosis was attenuated following adjustment for systemic corticosteroids in a multivariable model. The association between corticosteroid therapy and nocardiosis appeared stronger in patients with chronic pulmonary disease (OR 5.74, 95% CI 2.75-12.66, p < 0.001) than in the pooled analysis of all nocardiosis cases. In conclusion, corticosteroid therapy was strongly correlated with nocardiosis, particularly among individuals with chronic pulmonary disease and in pulmonary nocardiosis. Nocardiosis is an opportunistic infection that typically occurs in individuals with a history of solid organ transplantation (SOT) 1 , malignancy 2 , human immunodeficiency virus infection 3 or chronic pulmonary diseases 4. Evidence on the independent contribution of each of these conditions to nocardiosis risk remains limited, since most studies were case-series and lacked a comparison group. It is also unclear if the likelihood of nocardiosis is related to the underlying disease itself or to the immunosuppression therapy administered against it. Corticosteroid therapy is prevalent amongst individuals diagnosed with nocardiosis 5,6. A European multicenter case-control study conducted among SOT recipients (SOTR) showed that corticosteroid dosage was related to the risk of nocardiosis (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.03-1.22 for each milligram increase in corticosteroid dose), and a strong positive association was found between high calcineurin inhibitor and nocardiosis (OR 6.11, 95% CI 2.58-14.51) 1. As corticosteroid therapy is the standard of care for many conditions that might be also associated with nocardiosis, such as SOT, chronic pulmonary diseases and cancer, the independent role of each factor, warrant further investigation. As Nocardia is mostly transmitted by inhalation or aspiration 7 , the lungs are the primary site of infection in more than two-thirds of the nocardiosis cases 3. However, evidence on the risk factors for nocardiosis, beyond the general propensity to develop bacterial pne...

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“…El plan de tratamiento debe incluir los siguientes elementos: corrección de cualquier trastorno subyacente, atención a los cuidados generales (incluida la nutrición), estilo de vida saludable, vacunación adecuada (contra la influenza e infecciones neumocócicas), terapias de limpieza de las vías respiratorias, terapias antiinflamatorias, antibióticos de mantenimiento (en caso de ser necesarios) y tratamiento de las exacerbaciones. 46 Las BQ son causadas por una inflamación principalmente neutrofílica, en tanto que el asma bronquial se genera por una inflamación, principalmente eosinofílica. Esta puede ser controlada con un tratamiento de corticoides, mientras que los macrólidos pueden reducir el número de exacerbaciones en la forma neutrofílica.…”

Section: Tratamientounclassified

Abordaje diagnóstico del asma difícil de tratar y asma grave

Venancio-Hernández

Mendieta-Flores

Mendiola-Marín

et al. 2022

RAM

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El asma difícil de tratar es la que no se controla a pesar de las dosis altas o medias de esteroides inhalados o la que requiere altas porciones para mantener un control adecuado de los síntomas y reducir el riesgo de exacerbaciones. Se deben tener en cuenta las fallas en la técnica del uso del inhalador, la pobre adherencia al tratamiento, el tabaquismo, las comorbilidades o el diagnóstico incorrecto. En el asma grave, a pesar de la adherencia al tratamiento con dosis optimizadas y el manejo de los factores contribuyentes, se requieren múltiples medicamentos en dosis máximas para tener un adecuado control, si no es así este no se logra. La dirección de estos pacientes implica un proceso minucioso, dados los múltiples factores que pueden influir en el mal control del asma y que pueden llevar a una inadecuada clasificación de la enfermedad, cuando en realidad puedan estar cursando con diferentes comorbilidades cuyo tratamiento puede disminuir la severidad de los síntomas del asma y modificar el pronóstico. El objetivo de esta investigación es dar a conocer el manejo de los pacientes con asma difícil de tratar y asma grave, así como las comorbilidades más frecuentes. Se realizó una búsqueda en Pubmed con el propósito de identificar las principales patologías que puedan estar presentes y, con base en la literatura, proponer un abordaje diagnóstico. Se incluyeron 100 estudios, incluidas las guías clínicas GINA, GEMA y ERS/ATS.

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Medical management of bronchiectasis

Cited by 12 publications

References 47 publications

Bronchiectasis in Primary Antibody Deficiencies: A Multidisciplinary Approach

Bronchiectasis in Primary Antibody Deficiencies: A Multidisciplinary Approach

Clinical correlates of nocardiosis

Abordaje diagnóstico del asma difícil de tratar y asma grave

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