Short- and Long-Term Antibiotic Treatment Reduces Airway and Systemic Inflammation in Non–Cystic Fibrosis Bronchiectasis

Chalmers, James D.; Smith, M. A.; McHugh, Brian J.; Doherty, Cathy; Govan, John R. W.; Hill, Adam T.

doi:10.1164/rccm.201203-0487oc

Cited by 363 publications

(344 citation statements)

References 31 publications

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“…The former analysis of differential leukocyte count, CRP, erythrocyte sedimentation rate and serum immunoglobulins in 87 patients reported significant associations between systemic 14 inflammation and bronchiectasis severity as assessed both by CT scan and lung function. It was subsequently shown that systemic inflammation is elevated in patients with high airway bacterial load, and that this effect can be modified with antibiotic therapy [11]. We now recognise bronchiectasis as a complex disease which is best assessed using multicomponent scores [2,3].…”

Section: Discussionmentioning

confidence: 99%

The heterogeneity of systemic inflammation in bronchiectasis

Saleh

Chalmers

Soyza

et al. 2017

Respiratory Medicine

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Section: Discussionmentioning

confidence: 99%

The heterogeneity of systemic inflammation in bronchiectasis

Saleh

Chalmers

Soyza

et al. 2017

Respiratory Medicine

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“…All bacteriology was performed on spontaneous early-morning sputum samples as previously described (2). Chronic colonization was defined by the isolation of potentially pathogenic bacteria in sputum culture on two or more occasions, at least 3 months apart in a 1-year period (14,16,17).…”

Section: Bacteriologymentioning

confidence: 99%

“…Pathologically, patients have abnormally dilated bronchi leading to impairment of host defense, chronic colonization with bacteria, and airways inflammation (2,3).…”

mentioning

confidence: 99%

The Bronchiectasis Severity Index. An International Derivation and Validation Study

Chalmers

Goeminne²,

Aliberti

et al. 2014

Am J Respir Crit Care Med

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Rationale: There are no risk stratification tools for morbidity and mortality in bronchiectasis. Identifying patients at risk of exacerbations, hospital admissions, and mortality is vital for future research.Objectives: This study describes the derivation and validation of the Bronchiectasis Severity Index (BSI).Methods: Derivation of the BSI used data from a prospective cohort study (Edinburgh, UK, 2008 enrolling 608 patients. Cox proportional hazard regression was used to identify independent predictors of mortality and hospitalization over 4-year follow-up. The score was validated in independent cohorts from Dundee, UK (n = 218); Leuven, Belgium (n = 253); Monza, Italy (n = 105); and Newcastle, UK (n = 126).Measurements and Main Results: Independent predictors of future hospitalization were prior hospital admissions, Medical Research Council dyspnea score greater than or equal to 4, FEV 1 , 30% predicted, Pseudomonas aeruginosa colonization, colonization with other pathogenic organisms, and three or more lobes involved on high-resolution computed tomography. Independent predictors of mortality were older age, low FEV 1 , lower body mass index, prior hospitalization, and three or more exacerbations in the year before the study. The derived BSI predicted mortality and hospitalization: area under the receiver operator characteristic curve (AUC) 0.80 (95% confidence interval, 0.74-0.86) for mortality and AUC 0.88 (95% confidence interval, 0.84-0.91) for hospitalization, respectively.There was a clear difference in exacerbation frequency and quality of life using the St. George's Respiratory Questionnaire between patients classified as low, intermediate, and high risk by the score (P , 0.0001 for all comparisons). In the validation cohorts, the AUC for mortality ranged from 0.81 to 0.84 and for hospitalization from 0.80 to 0.88. Conclusions:The BSI is a useful clinical predictive tool that identifies patients at risk of future mortality, hospitalization, and exacerbations across healthcare systems.

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“…Chalmers et al 24 showed a direct correlation between airway bacterial load, airway and systemic inflammation, and greater risk of exacerbations. They demonstrated that shortterm (14 d) and long-term (up to 12 months) antibiotic therapy reduced markers of airway and systemic inflammation.…”

Section: Non-cystic Fibrosis Bronchiectasismentioning

confidence: 99%

“…24 We discuss the most relevant literature regarding the clinical application of aerosolized antibiotics for patients with CF, NCFB, and VAP infected with difficult-to-treat pathogens. 4,10,[25][26][27][28][29] …”

Section: Clinical Indications For Aerosolized Antibioticsmentioning

confidence: 99%

Aerosolized Antibiotics

2015

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Administration of medications via aerosolization is potentially an ideal strategy to treat airway diseases. This delivery method ensures high concentrations of the medication in the targeted tissues, the airways, with generally lower systemic absorption and systemic adverse effects. Aerosolized antibiotics have been tested as treatment for bacterial infections in patients with cystic fibrosis (CF), non-CF bronchiectasis (NCFB), and ventilator-associated pneumonia (VAP). The most successful application of this to date is treatment of infections in patients with CF. It has been hypothesized that similar success would be seen in NCFB and in difficult-to-treat hospital-acquired infections such as VAP. This review summarizes the available evidence supporting the use of aerosolized antibiotics and addresses the specific considerations that clinicians should recognize when prescribing an aerosolized antibiotic for patients with CF, NCFB, and VAP.

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Short- and Long-Term Antibiotic Treatment Reduces Airway and Systemic Inflammation in Non–Cystic Fibrosis Bronchiectasis

Abstract: High airway bacterial loads in non-CF bronchiectasis are associated with airway and systemic inflammation and a greater risk of exacerbations. Short- and long-term antibiotic therapy reduce markers of airways and systemic inflammation.

Cited by 363 publications

References 31 publications

The heterogeneity of systemic inflammation in bronchiectasis

The heterogeneity of systemic inflammation in bronchiectasis

The Bronchiectasis Severity Index. An International Derivation and Validation Study

Aerosolized Antibiotics

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