The effect ofPseudomonas aeruginosaon pulmonary function in patients with bronchiectasis

Abstract

Bronchiectasis patients are susceptible to infection with Pseudomonas aeruginosa. Isolation is associated with increased severity of disease, greater airflow obstruction and poorer quality of life. It is not known whether infection by P. aeruginosa is a marker of disease severity or contributes to disease progression.Consecutive non-cystic fibrosis adult bronchiectasis outpatients (n5163) with multiple sputum cultures and follow-up pulmonary function tests were designated, according to isolation of P. aeruginosa, as ''never infected'' (group 1; n567), ''intermittently isolated'' (group 2; n582) and ''chronically infected'' (group 3; n514). Based upon change in forced expiratory volume in one second (FEV1) % predicted levels at o2 yrs after presentation, longitudinal behaviour was characterised as ''improvement'' (o10% rise), ''decline'' (o10% fall) or ''stability''. Baseline pulmonary-function tests and longitudinal behaviour were examined in relation to pseudomonas status.There was no difference between the groups in age, sex, smoking habit or length of follow-up. Baseline FEV1 levels were highest in group 1 (mean¡SD: 77.4¡24.3) and higher in group 2 (67.3¡25.7) than in group 3 (55.2¡18.5). The same significant trends were seen for baseline FEV1/forced vital capacity ratios and diffusing capacity of the lung for carbon monoxide levels. Subsequent longitudinal behaviour was linked to baseline FEV1 levels, which were lowest in patients with improvement and lower in association with decline than with stability. However, longitudinal behaviour did not differ between groups 1, 2 and 3, either before or after adjustment for baseline FEV1 levels.Infection by Pseudomonas aeruginosa occurs in bronchiectasis patients with more severe impairment of pulmonary function but does not influence rate of decline in pulmonary function either before or after adjustment for baseline disease severity. Thus, Pseudomonas aeruginosa is a marker of bronchiectasis severity but is not linked to an accelerated decline in pulmonary function.

Bronchiectasis as a Comorbidity of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis

“…In this meta-analysis, we found that the presence of bronchiectasis in COPD patients was also related to isolation of PPMs and poor lung function. Chronic bacterial infection, especially by P. aeruginosa, was associated with more advanced disease and mortality in both COPD and bronchiectasis patients [32][33][34][35]. The presence of bacteria in the lower airways in COPD impairs host defense mechanisms, which results in epithelial cell integrity disruption and inflammation, further airway structural damage, which could be the mechanism for longer and more severe COPD exacerbations [19].…”

Multidimensional approach to non-cystic fibrosis bronchiectasis: the FACED score

“…Neither the presence of chronic colonisation by multiresistant Gramnegative bacilli nor the isolation of Staphylococcus aureus, atypical mycobacteria and fungi, presented any significant independent predictive power for mortality. Therefore, it was finally decided to include only chronic colonisation by P. aeruginosa in the score, as this is the only microorganism that has been related in the current literature with an increase in mortality and a poorer functional evolution in patients with non-CF bronchiectasis [5,29,30].…”

The impact of chronic pseudomonal infection on pulmonary function testing in individuals with cystic fibrosis in Pretoria, South Africa

“…In a study by Davies et al, [23] PA infection in patients with non-CF bronchiectasis was shown to be a marker of disease severity, but was not linked to an accelerated decline in pulmonary function.…”