Effectiveness and Safety of Inhaled Antibiotics in Patients With Chronic Obstructive Pulmonary Disease. A Multicentre Observational Study

BackgroundWe aimed to describe the effectiveness and safety of inhaled antibiotics in chronic obstructive pulmonary disease (COPD) patients, as well as the patient profile in which they are usually prescribed and the patient groups that can most benefit from this treatment.MethodsMulticentre retrospective observational cohort study in COPD patients who had received ≥1 dose of inhaled antibiotics in the last 5 years. Clinical data from the two years prior to and subsequent to the start of the treatment were compared. Primary outcome: COPD exacerbations. Secondary outcomes: side effects, symptomatology (sputum purulence, dyspnoea), microbiological profile and pathogen eradication.ResultsOf 693 COPD patients analyzed (aged 74.1; 86.3% men; mean FEV₁ = 43.7%), 71.7% had bronchiectasis and 46.6% presented chronic bronchial infection (CBI) by Pseudomonas aeruginosa (PA). After 1 year of treatment with inhaled antibiotics, there was a significant decrease in the number of exacerbations (?33.3%; P < .001), hospital admissions (?33.3%; P < .001) and hospitalization days (?26.2%; P = .003). We found no difference in effectiveness between patients with or without associated bronchiectasis. Positive patient outcomes were more pronounced in PA-eradicated patients. We found a significant reduction in daily expectoration (?33.1%; P = .024), mucopurulent/purulent sputum (?53.9%; P < .001), isolation of any potentially pathogenic microorganisms (PPM) (?16.7%; P < .001), CBI by any PPM (?37.4%; P < .001) and CBI by PA (?49.8%; P < .001). CBI by any PPM and ≥three previous exacerbations were associated with a better treatment response. 25.4% of patients presented non-severe side-effects, the most frequent of these being bronchospasm (10.5%), dyspnoea (8.8%) and cough (1.7%).ConclusionsIn COPD patients with multiple exacerbations and/or CBI by any PPM (especially PA), inhaled antibiotics appear to be an effective and safe treatment, regardless of the presence of bronchiectasis.     

Post-viral atopic airway disease: pathogenesis and potential avenues for intervention

Introduction: In early childhood, wheezing due to lower respiratory tract illness is often associated with infection by commonly known respiratory viruses such as respiratory syncytial virus (RSV) and human rhinovirus (RV). How respiratory viral infections lead to wheeze and/or asthma is an area of active research.

Areas covered: This review provides an updated summary of the published information on the development of post-viral induced atopy and asthma and the mechanisms involved. We focus on the contribution of animal models in identifying pathways that may contribute to atopy and asthma following respiratory virus infection, different polymorphisms that have been associated with asthma development, and current options for disease management and potential future interventions.

Expert commentary: Currently there are no prophylactic therapies that prevent infants infected with respiratory viruses from developing asthma or atopy. Neither are there curative therapies for patients with asthma. Therefore, a better understanding of genetic factors and other associated biomarkers in respiratory viral induced pathogenesis is important for developing effective personalized therapies.     

基于血管内皮功能相关多生物标记物的哮喘预后研究

目的 分析哮喘儿童血清中血管内皮功能相关标记物的变化情况及其与疾病预后的关系,为儿童哮喘预后的评估提供依据。方法 收集2016年10月-2017年12月在南通大学附属常州儿童医院就诊的89例5～14岁哮喘患儿在哮喘发作期的血清样本和92例健康儿童的血清样本,运用ELISA和其他商用测试盒检测其中内皮功能相关标志物血管内皮生长因子(VEGF)、精氨酸酶I(Arg I)、骨膜蛋白(POSTN)、脂联素(APN)和瘦素的浓度以及诱导型一氧化氮合酶(iNOS)活性,并用高效液相串联质谱(HPLC-MS/MS)检测L-精氨酸、甲基化精氨酸ADMA和SDMA的浓度。此后对哮喘组患儿进行为期1年的随访,记录在此期间出现喘息发作的次数。运用正交偏最小二乘法-判别分析(OPLS-DA)分析数据,筛选对哮喘疾病预后有关键影响的血管内皮功能相关标记物。结果 哮喘组儿童血清中Arg I、POSTN、VEGF和瘦素的含量显著增加,iNOS活性显著增高,L-精氨酸浓度显著下降(P<0.05)。OPLS-DA模型显示,基于内皮功能多标记物哮喘组可以和对照组显著区分,且Arg I、iNOS活性以及VEGF水平的变量重要性因子(VIP)值分别为2.11、1.23、1.09,是区分哮喘组和对照组的关键内皮标记物。随访后1年,随访成功70例,其中反复喘息组(n=27)与非反复喘息组(n=43)相比,血清ADMA和Arg I的含量显著增加,POSTN和APN含量显著减少(P<0.05)。OPLS-DA模型的S-plot图和VIP值排序都表明区分两组的关键内皮标记物是APN、POSTN和Arg I。结论 哮喘儿童血清中多种内皮功能相关的生物标记物稳态失衡,其中APN、POSTN和Arg I对儿童哮喘的疾病预后有较高的预测价值。     

健康管理对高危哮喘儿童家庭单元治疗依从性作用及肺功能指标的影响

目的 分析健康管理对提高以家庭为单位的高危哮喘儿童病情控制及肺功能指标的改善作用,为儿童哮喘防治提供新的思路。方法 选取2014年1月－2016年5月在山东省立医院就诊的93例高危哮喘儿童并随机分为实验组和对照组。实验组给予常规临床治疗加全程健康管理和定期随访;对照组只给予常规临床治疗,未贯穿健康管理,嘱定期随访。结果 实验组患儿的病情控制及各项肺功能指标较之于对照组有明显改善,差异有统计学意义(P<0.05)。结论 加强高危哮喘儿童的家庭单元的防控意识,进行系统、持续的健康管理,定期随访和监测,能明显减少患儿病情发作,提高治疗依从性。