Mucociliary clearance techniques for treating non-cystic fibrosis bronchiectasis: Is there evidence?

Snijders, Deborah; Dominguez, B Fernandez; Calgaro, Serena; Bertozzi, Ilaria; Montaner, Amparo Escribano; Perilongo, Giorgio; Barbato, Angelo

doi:10.1177/0394632015584724

Cited by 38 publications

(27 citation statements)

References 37 publications

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“…Airway clearance, including removal of mucus plugs, by methods such as direct hydration, physiotherapy or CFTR modulation is, therefore, often a necessary first step prior to delivery of antibiotic to the site of infection . Cough has also received attention as a means of facilitating removal of secretions from the airways so that it can be easily expectorated, especially in patients with impaired mucociliary clearance . The air flow produced during a forceful cough may generate shear forces to loosen up the mucus plugs before they can be discharged from the airways.…”

Section: Resultsmentioning

confidence: 99%

“…80 Cough has also received attention as a means of facilitating removal of secretions from the airways so that it can be easily expectorated, especially in patients with impaired mucociliary clearance. 81 The air flow produced during a forceful cough may generate shear forces to loosen up the mucus plugs before they can be discharged from the airways. Incorporation of cough sessions into the treatment regimen has been shown to be as effective as therapist-administered physiotherapy in removing airway secretions.…”

Section: Mucus Plugsmentioning

confidence: 99%

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Clinical implications ofPseudomonas aeruginosalocation in the lungs of patients with cystic fibrosis

Moore

Mastoridis

2017

J Clin Pharm Ther

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SummaryWhat is known and objective: Pseudomonas aeruginosa is the leading cause of lung infection in patients with cystic fibrosis (CF) and is associated with significant morbidity and mortality. Antibiotics are regarded as the foundational pharmacological treatment for the suppressive management of chronic P. aeruginosa infections and to eradicate the first infection by P. aeruginosa. Inhalation remains a preferred route for drug administration, providing direct access to the site of infection while minimizing systemic side effects. Effective suppressive management of P. aeruginosa infections, however, requires an understanding of the location of the bacteria in the lungs and consideration of the factors that could limit access of the inhaled antibiotic to the infected area. This review provides a systematic assessment of the scientific literature to gain insight into the location of P. aeruginosa in the lungs of patients with CF and its clinical implications. The characteristics of antibiotic inhalation systems are also discussed in this context. Methods:We reviewed evidence-based literature from both human and animal studies in which P. aeruginosa lung location was reported. Relevant publications were identified through a screening strategy and summarized by reported P. aeruginosa location.Results and discussion: Most areas of the conductive and respiratory zones of the lungs are susceptible to P. aeruginosa colonization. Deposition of an inhaled antibiotic is dependent on the device and formulation characteristics, as well as the ability of the patient to generate sufficient inhaled volume. As patients with CF often experience a decline in lung function, the challenge is to ensure that the inhaled antibiotic can be delivered throughout the bronchial tree.

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Section: Resultsmentioning

confidence: 99%

Section: Mucus Plugsmentioning

confidence: 99%

Clinical implications ofPseudomonas aeruginosalocation in the lungs of patients with cystic fibrosis

Moore

Mastoridis

2017

J Clin Pharm Ther

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“…Although there is a lack of randomized controlled trials in children, airway clearance techniques (ACTs) seem to have beneficial effects in patients with non‐CF bronchiectasis. They decrease sputum volume and improve sputum clearance …”

Section: Non‐cystic Fibrosis Bronchiectasismentioning

confidence: 99%

A review of non‐cystic fibrosis bronchiectasis in children with a focus on the role of long‐term treatment with macrolides

Boustany¹,

Gachelin²,

Colomban³

et al. 2019

Pediatric Pulmonology

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Bronchiectasis is a rare chronic airway disease arising from several respiratory and systemic diseases. The grade of evidence for specific treatment of childhood bronchiectasis unrelated to cystic fibrosis (CF) is low with very few randomized controlled trials. Treatment has been based mainly on evidence from studies in adults with non-cystic fibrosis bronchiectasis and patients with cystic fibrosis. Recently, longterm treatment with macrolides has been proposed. These molecules offer the advantage of anti-inflammatory and immunomodulatory properties in addition to their antibacterial properties. A total of three randomized double-blind placebo-controlled trials conducted in adults showed that macrolides taken for 6-12 months led to a significant reduction in exacerbation rates. Only one long-term, randomized doubleblind placebo-controlled trial was conducted in the pediatric population. It showed that azithromycin administered weekly for up to 24 months reduced pulmonary exacerbations. Further randomized controlled studies are needed to determine the optimal dose and duration of treatment with macrolides. The clinical profile of children who would benefit from this treatment also needs to be determined. K E Y W O R D S macrolides, non-cystic-fibrosis bronchiectasis, pulmonary exacerbations

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“…However, multicentre randomized control trials are necessary to evaluate the different techniques of ACTs, especially in children (39). …”

Section: Possible Treatment Determinants Of Qolmentioning

confidence: 99%

Review: Quality of Life in Children with Non-cystic Fibrosis Bronchiectasis

Nathan

Bruyne

et al. 2017

Front. Pediatr.

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Non-cystic fibrosis bronchiectasis (NCFB) has gained renewed interest, due to its increasing health-care burden. Annual mortality statistics in England and Wales showed that under 1,000 people die from bronchiectasis each year, and this number is increasing by 3% yearly. Unfortunately, there is a severe lack of well-powered, randomized controlled trials to guide clinicians how to manage NCFB effectively. Quality-of-life (QOL) measures in NCFB are an important aspect of clinical care that has not been studied well. Commonly used disease-specific questionnaires in children with NCFB are the St George’s Respiratory Questionnaire, Short Form-36, the Leicester Cough Questionnaire, and the Parent Cough-Specific Quality of Life questionnaire (PC-QOL). Of these, only the PC-QOL can be used in young children, as it is a parent-proxy questionnaire. We reviewed pediatric studies looking at QOL in children with NCFB and cystic fibrosis. All types of airway clearance techniques appear to be safe and have no significant benefit over each other. Number of exacerbations and hospitalizations correlated with QOL scores, while symptom subscales correlated with lung function, worse QOL, frequent antibiotic requirements, and duration of regular follow-up in only one study. There was a correlation between QOL and age of diagnosis in children with primary ciliary dyskinesia. Other studies have shown no relationship between QOL scores and etiology of NCFB as well as CT changes. As for treatments, oral azithromycin and yoga have demonstrated some improvement in QOL scores. In conclusion, more studies are required to accurately determine important factors contributing to QOL.

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Mucociliary clearance techniques for treating non-cystic fibrosis bronchiectasis: Is there evidence?

Cited by 38 publications

References 37 publications

Clinical implications ofPseudomonas aeruginosalocation in the lungs of patients with cystic fibrosis

Clinical implications ofPseudomonas aeruginosalocation in the lungs of patients with cystic fibrosis

A review of non‐cystic fibrosis bronchiectasis in children with a focus on the role of long‐term treatment with macrolides

Review: Quality of Life in Children with Non-cystic Fibrosis Bronchiectasis

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