New therapies for the prevention and treatment of exacerbations of bronchiectasis

Abo-Leyah, Hani; Chalmers, James D.

doi:10.1097/mcp.0000000000000368

Cited by 7 publications

(7 citation statements)

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“…Bronchiectasis patients were treated with oral or parenteral corticosteroids during a hospitalised exacerbation [39]. Oral corticosteroid treatment is known to cause loss of bone density and the cumulative corticosteroid dose can be a major significant predictor for bone loss [40].…”

Section: Discussionmentioning

confidence: 99%

“…In light of our observations, overuse systemic corticosteroid or cumulative steroid loading during acute exacerbations that may predispose to diminished bone density is warning. Nebulized or oral antibiotics combined with airway clearance instead of oral systemic steroids are mandatory for treatment of bronchiectasis exacerbation [39], thus attenuating the potential aggravation of osteoporosis in non-CF bronchiectasis.…”

Section: Discussionmentioning

confidence: 99%

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Oxygen desaturation during the 6-min walk test as a risk for osteoporosis in non-cystic fibrosis bronchiectasis

et al. 2019

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BackgroundOsteoporosis is a common comorbidity in non-cystic fibrosis (non-CF) bronchiectasis patients. We determined whether desaturation during 6-min walk test (6MWT) can be a predictor for osteoporosis risk.MethodsThis was a retrospective cross-sectional study. Sixty-six non-CF bronchiectasis patients were enrolled. Lung function, walking distance, the lowest oxygen saturation (SpO2), the fall in SpO2 (ΔSpO2), and the distance–saturation product (DSP) were determined during the 6MWT. Desaturators (n = 45) were defined as those with ΔSpO2 > 10% or the lowest SpO2 < 88%. Bone mineral density (BMD) was determined through dual-energy X-ray absorptiometry. The severity of non-CF bronchiectasis was evaluated using high-resolution computed tomography.ResultsOsteoporosis was evident in more desaturators (82%) than non-desaturators (43%, p < 0.01). BMD at the level of the femoral neck was significantly lower in desaturators than in non-desaturators (− 3.6 ± 1.1 vs. − 2.4 ± 0.9, p < 0.01). BMD was correlated positively with the lowest SpO2 and negatively with ΔSpO2 and severe exacerbations. In multivariate linear regression analysis, desaturation during 6MWT was the most significant predictive factor for osteoporosis (95% confidence interval − 1.60 to − 0.26, p = 0.01). Other risk factors included old age, low body mass index and severe exacerbation.ConclusionsExertional desaturation during the 6MWT was a significant predictive factor for osteoporosis in Asian non-CF bronchiectasis patients. The 6MWT may be useful in identifying the osteoporotic phenotype of non-CF bronchiectasis and increasing clinician awareness to promote early intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Oxygen desaturation during the 6-min walk test as a risk for osteoporosis in non-cystic fibrosis bronchiectasis

et al. 2019

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“…If available, previous airway culture and sensitivity results should guide antibiotic choice, otherwise empirical therapy is commenced while culture results are awaited. Box 7 and Box 8 outline a suggested approach to empirical therapy 17 , 30 …”

Section: Antibioticsmentioning

confidence: 99%

“…† There is no evidence at this time that dual therapy for Pseudomonas is superior to monotherapy. Consider dual therapy if the patient has drug‐resistant Pseudomonas and no contraindications or interactions 30 …”

Section: Antibioticsmentioning

confidence: 99%

Management of bronchiectasis in adults

Visser

Bye

Morgan

2018

Medical Journal of Australia

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Once neglected in research and underappreciated in practice, there is renewed interest in bronchiectasis unrelated to cystic fibrosis. Bronchiectasis is a chronic lung disease characterised by chronic cough, sputum production and recurrent pulmonary exacerbations. It is diagnosed radiologically on high resolution computed tomography chest scan by bronchial dilatation (wider than the accompanying artery). The causes of bronchiectasis are diverse and include previous respiratory tract infections, chronic obstructive pulmonary disease, asthma, immunodeficiency and connective tissue diseases. A large proportion of cases are idiopathic, reflecting our incomplete understanding of disease pathogenesis. Progress in the evidence base is reflected in the 2017 European management guidelines and the 2015 update to the Australian guidelines. Effective airway clearance remains the cornerstone of bronchiectasis management. This should be personalised and reviewed regularly by a respiratory physiotherapist. There is now robust evidence for the long term use of oral macrolide antibiotics in selected patients to reduce exacerbation frequency. The routine use of long term inhaled corticosteroids and/or long-acting bronchodilators should be avoided, unless concomitant chronic obstructive pulmonary disease or asthma exists. The evidence for nebulised agents including hypertonic saline, mannitol and antibiotics is evolving; however, access is challenging outside tertiary clinics, and nebulising equipment is required. Smokers should be supported to quit. All patients should receive influenza and pneumococcal vaccination. Patients with impaired exercise capacity should attend pulmonary rehabilitation. There is an important minority of patients for whom aetiology-specific treatment exists. The prevalence of bronchiectasis is increasing worldwide; however, the burden of disease within Australia is not well defined. To this end, the Australian Bronchiectasis Registry began recruitment in 2016 and is interoperable with the European and United States bronchiectasis registries to enable collaborative research. The recent addition of a bronchiectasis diagnosis-related group to the Australian Refined Diagnostic Related Group classification system will allow definition of the disease burden within the Australian hospital system.

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“…If the comorbid BE is not recognized, the management of the COPD-related exacerbation may be compromised resulting in a suboptimal response to treatment, a prolonged hospitalization, and a greater risk for readmission following hospital discharge. 17…”

Section: Introductionmentioning

confidence: 99%

Health-care utilization and expenditures among patients with comorbid bronchiectasis and chronic obstructive pulmonary disease in US clinical practice

Seifer

Hansen²,

Weycker

2019

Chron Respir Dis

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Recent research suggests that bronchiectasis (BE) may be more common than previously believed and that comorbid chronic obstructive pulmonary disease (COPD) is widespread in this patient population. Little is known about the economic burden among patients with BE, and less is known about the burden among those with comorbid BE + COPD. A retrospective matched-cohort design and data from a US health-care claims repository were employed. From the source population comprising adults who had comprehensive medical/drug benefits for ≥1 day in 2013 (i.e. the referent year) and evidence of BE and/or COPD at any time from 2009 to 2013, patients with BE + COPD were age/sex-matched (1:1:1) to patients with BE only and patients with COPD only. For each matched subgroup, annualized levels of respiratory-related and all-cause health-care utilization and expenditures in 2013 were summarized. Source population included 679,679 patients; among those with BE ( n = 31,027), 50% had comorbid COPD. Mean (95% CI) annual levels of respiratory-related utilization and expenditures among matched patients with BE + COPD ( n = 11,685) were higher by 2.4–3.5 times versus patients with BE only and 2.0–2.5 times versus patients with COPD only: hospitalizations, 0.39 (0.37–0.41) versus 0.11 (0.09–0.12) and 0.16 (0.14–0.17); ambulatory encounters, 16.5 (16.1–16.9) versus 6.8 (6.6–7.0) and 8.2 (7.9–8.4); and total expenditures, US$15,685 (14,693–16,678) versus US$5605 (5059–6150) and US$6262 (5655–6868). Respiratory-related utilization and expenditures are high among patients with BE or COPD receiving medical care in US clinical practice and are especially high among those with comorbid BE + COPD receiving medical care, emphasizing the importance of identifying and treating this unique patient population. Funding for this research was provided by RespirTech to Policy Analysis Inc. (PAI).

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New therapies for the prevention and treatment of exacerbations of bronchiectasis

Cited by 7 publications

References 65 publications

Oxygen desaturation during the 6-min walk test as a risk for osteoporosis in non-cystic fibrosis bronchiectasis

Oxygen desaturation during the 6-min walk test as a risk for osteoporosis in non-cystic fibrosis bronchiectasis

Management of bronchiectasis in adults

Health-care utilization and expenditures among patients with comorbid bronchiectasis and chronic obstructive pulmonary disease in US clinical practice

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