Effectiveness and Safety of Inhaled Antibiotics in Patients With Chronic Obstructive Pulmonary Disease. A Multicentre Observational Study |
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| Institution: | 1. Pneumology Service, Hospital de la Santa Creu i Sant Pau, C. Sant Quintí 89, 08041, Barcelona, Spain;2. Pneumology Service, Hospital Universitario y Politécnico La Fe, Av. de Fernando Abril Martorell 106, 46026, Valencia, Spain;3. Pulmonology Department, Hospital del MAR-IMIM, CEXS (UPF), CIBERES, Passeig Marítim de la Barceloneta 25-29, 08003, Barcelona, Spain;4. Pneumology Service, Hospital de Cruces, Cruces Plaza, s/n, 48903, Barakaldo, Bizkaia, Spain;5. Pneumology Service, Hospital Mutua de Terrassa, Plaça del Doctor Robert 5, 08221, Terrassa, Barcelona, Spain;6. Pneumology Service, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011, Oviedo, Spain;7. Pneumology Service, Hospital de Viladecans, Av. de Gavà 38, 08840, Viladecans, Barcelona, Spain;8. Pneumology Service, Hospital Universitario Germans Trias i Pujol, Carretera de Canyet, s/n, 08916, Badalona, Barcelona, Spain;9. Pneumology Service, Hospital Universitario Virgen del Rocio, Av. Manuel Siurot, s/n, 41013, Sevilla, Spain;10. Pneumology Service, Hospital Clínico San Carlos, School of Medicine, Universidad Complutense de Madrid, Calle del Profesor Martín Lagos, s/n, 28040, Madrid, Spain;11. Pneumology Service, Hospital Universitario Lucus Augusti, Rúa Dr. Ulises Romero 1, 27003, Lugo, Spain;12. Pneumology Service, Complexo Hospitalario Universitario de Ourense, Calle Ramon Puga Noguerol 54, 32005, Ourense, Spain;13. Pneumology Service, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este 80, 28031, Madrid, Spain;14. Pneumology Service, Hospital Fundación Alcorcón, Calle Budapest 1, 28922, Alcorcón, Madrid, Spain;15. Pneumology Service, Complexo Hospitalario Universitario A Coruña, Xubias de Arriba 84, 15006, A Coruña, Spain;p. Pneumology Service, Hospital Universitario Virgen de la Macarena, Calle Dr. Fedriani 3, 41009, Sevilla, Spain;q. Pneumology Service, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorios (CIBERES), Passeig de la Vall d’Hebron 119, 08035, Barcelona, Spain;11. Hospital Universitario Mutua de Terrassa, Terrassa;12. Hospital del MAR-IMIM, Barcelona, Spain;13. Hospital Universitari Germas Trias i Pujol, Badalona;14. Hospital Clínico San Carlos, Madrid;15. Hospital Fundación Alcorcón, Alcorcón;16. Hospital Fundación Alcorcón, Alcorcón;17. Hospital Plató, Barcelona;18. Hospital 12 de Octubre, Madrid;19. Hospital 12 de Octubre, Madrid;110. Hospital de Castellón, Castellón;111. Hospital de Castellón, Castellón;112. Hospital Universitario Araba-Txagorritxu, Vitoria;113. Hospital Universitario Regional de Málaga, Málaga;114. Hospital Universitario Regional de Málaga, Málaga;115. Hospital Universitario de Ciudad Real, Ciudad Real;1p. Hospital Universitario La Princesa, Madrid;1q. Hospital Dos de Maig, Barcelona;1r. Hospital Infanta Sofía, San Sebastián de los Reyes;1s. Hospital Universitario La Paz, Madrid;1t. Hospital Universitari Vall d’Hebron, Barcelona;1u. Pneumology Service, Hospital Universitario de Basurto, Bilbao;1v. Hospital de Jarrio, Asturias;1w. Hospital Sant Jaume de Calella, Barcelona;1x. Hospital Universitario Marqués de Valdecilla, Santander;1y. Hospital Universitario de Torrejón, Torrejón de Ardoz;1z. Hospital Clínico, Valladolid;21. Hospital Universitario Fundación Jiménez Díaz, Madrid;22. Hospital Gregorio Marañón, Madrid;23. Hospital Gregorio Marañón, Madrid;24. Hospital Sant Joan de Déu, Manresa;25. Hospital Sant Joan de Déu, Manresa;26. Hospital Universitario Virgen de las Nieves, Granada;27. Hospital Universitario Virgen de la Macarena, Sevilla, Spain |
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| Abstract: | 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. |
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| Keywords: | Chronic obstructive pulmonary disease Chronic bronchial infection Inhaled antibiotics Bronchiectasis Exacerbations Enfermedad pulmonar obstructiva crónica Infección bronquial crónica Antibióticos inhalados Bronquiectasia Exacerbaciones |
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