Bronchodilator response in adults with bronchiectasis: correlation with clinical parameters and prognostic implications

Background

Bronchial dilation testing is an important tool to assess airway reversibility in adults with bronchiectasis. This study aims to investigate the association of bronchodilator response (BDR) and clinical parameters in bronchiectasis, and the utility of BDR to indicate lung function decline and risks of bronchiectasis exacerbations (BEs).

Methods

We recruited 129 patients with clinically stable bronchiectasis. Baseline measurements included assessment of sputum inflammation and matrix metalloproteinase-8 and -9, sputum bacterial culture, spirometry, bronchial dilation test (for baseline FEV₁ less than 80% predicted only) and chest high-resolution computed tomography (HRCT). Bronchiectasis patients were followed-up for 1 year to determine the incidence of BEs and lung function trajectories. Significant BDR was defined as FEV₁ improvement from pre-dose value by at least 200 mL and 12%. Clinical trial registry No.: {"type":"clinical-trial","attrs":{"text":"NCT01761214","term_id":"NCT01761214"}}NCT01761214; URL: www.clinicaltrials.gov.

Results

BDR was negatively correlated with baseline FEV₁ percentage predicted, but not blood or sputum eosinophil count. Significant BDR was not associated with greater proportion of never-smokers, poorer past history, greater HRCT scores, poorer diffusing capacity or increased sputum matrix metalloproteinases (all P>0.05). There was a trend towards higher bronchiectasis severity index (BSI) and greater proportion of patients with Pseudomonas aeruginosa isolation or infection. Significant BDR at baseline was linked to poorer spirometry, but not more rapid lung function decline, throughout follow-up. Patients with significant BDR demonstrated non-significantly lower risks of experiencing the first BEs than those without (P=0.09 for log-rank test).

Conclusions

Significant BDR is associated with poorer lung function compared with non-significant BDR. Whether BDR predicts future risks of BEs needs to be tested in a larger cohort.     

Bronchiectasis exacerbations: The role of atypical bacteria and respiratory syncytial virus

BACKGROUND:

Aside from the known role of common bacteria, there is a paucity of data regarding the possible role of atypical bacteria and viruses in exacerbations of non-cystic fibrosis bronchiectasis.

OBJECTIVE:

To explore the possible role of atypical bacteria (namely, Mycoplasma pneumoniae and Chlamydophila pneumoniae) and respiratory syncytial virus (RSV) as causative agents of bronchiectasis exacerbations.

METHODS:

A cohort of 33 patients was studied over a two-year period (one year follow-up for each patient). Polymerase chain reaction for the detection of M pneumoniae, C pneumoniae and RSV in bronchoalveolar lavage samples were performed during all visits. Antibody titres (immunoglobulin [Ig]M and IgG) against the aforementioned pathogens were also measured. In addition, cultures for common bacteria and mycobacteria were performed from the bronchoalveolar lavage samples.

RESULTS:

Fifteen patients experienced a total of 19 exacerbations during the study period. Although RSV was detected by polymerase chain reaction during stable visits in four patients, it was never detected during an exacerbation. M pneumoniae and C pneumoniae were never detected at stable visits or during exacerbations. IgM antibody titres for these three pathogens were negative in all patient visits.

CONCLUSIONS:

Atypical pathogens and RSV did not appear to be causative agents of bronchiectasis exacerbations.     

吸入沙美特罗替卡松治疗支气管扩张合并不可逆气流受限患者的疗效与安全性研究

目的 评价吸入沙美特罗替卡松治疗支气管扩张症合并不可逆的气流受限患者的疗效和安全性.方法 这项临床试验是一项6个月的随机、对照、前瞻性研究,收集的患者从2010年6月至2012年6月.80例支气管扩张症伴有不可逆的气流受限患者都要经过高分辨率CT、肺功能检查确诊.随机分为两组:治疗组接受沙美特罗替卡松治疗(50/250 μg吸入,2次/d)+常规治疗;对照组接受常规治疗.分别于治疗3个月、6个月观察临床状况、健康相关生活质量、急性发作次数、肺功能、β2肾上腺素能激动剂(沙丁胺醇)使用量、病原微生物的菌株、药物不良反应等.结果 ①治疗组在呼吸困难评分、咳嗽次数、使用β2肾上腺素受体激动剂的剂量方面与对照组差异有统计学意义.②HRQL的改善方面差异有统计学意义.③治疗组急性发作次数明显少于对照组.④两组肺功能、可能的致病微生物的分离差异无统计学意义,虽然治疗组在肺功能方面有一定的改善.⑤两组不良反应差异无统计学意义.结论 对支气管扩张合并不可逆的气流受限患者联合吸入沙美特罗替卡松治疗是有效和安全的.     

支气管动脉栓塞治疗支气管扩张大咯血的技术探讨

目的:探讨支气管动脉栓塞(BAE)治疗支气管扩张大咯血的疗效。方法:31例支气管扩张大咯血患者,选择性支气管动脉造影明确咯血病灶后,对靶血管用明胶海绵颗粒及小条进行栓塞治疗,其中11例同时加用弹簧钢圈行多重栓塞治疗。所有病例门诊随访。结果:31例患者BAE术后30例咯血完全停止,即时止血率96.77%(30/31)。3例在栓塞术后1周内复发大咯血,1例再次行BAE治疗后咯血停止,2例改行手术治疗,近期复发率9.68%(3/31)。中、远期复发少量咯血2例,复发率为6.45%(2/31),总有效率93.55%(29/31)。结论:支气管动脉栓塞术治疗支气管扩张大咯血是一种安全、高效、简便、损伤小的治疗方法,采用多重栓塞可有效降低复发率。     

Bronchiectasis in childhood Comparison of chest roentgenograms,bronchography and lung scintigraphy

In 76 children, 102 unilateral bronchograms were compared with the results of chest radiography and Tc-99m perfusion scintigraphy to assess the presence of bronchiectasis. Additional Kr-81m ventilation lung scintigraphy was obtained in 16 patients. For the chest radiograph the sensitivity was 73% and the specificity was 76%. For lung scintigraphy the sensitivity was 92% and the specificity 60%. When both chest radiography and lung scintigraphy were considered, sensitivity reached 96% and specificity fell to 53%. Forty per cent of the bronchograms which were performed might have been avoided on the basis of the normal chest radiograph and lung scintigraphy. The combination of lung scintigraphy and chest radiography is an excellent screening method when a decision on the advisability of bronchography is being taken in children.     

Imaging evaluation of hemoptysis in children

Hemoptysis is an uncommon but distressing symptom in children. It poses a diagnostic challenge as it is difficult to elicit a clear history and perform thorough physical examination in a child. The cause of hemoptysis in children can vary with the child’s age. It can range from infection, milk protein allergy and congenital heart disease in early childhood, to vasculitis, bronchial tumor and bronchiectasis in older children. Acute lower respiratory tract infections are the most common cause of pediatric hemoptysis. The objective of imaging is to identify the source of bleeding, underlying primary cause, and serve as a roadmap for invasive procedures. Hemoptysis originates primarily from the bronchial arteries. The imaging modalities available for the diagnostic evaluation of hemoptysis include chest radiography, multi-detector computed tomography (MDCT), magnetic resonance imaging (MRI) and catheter angiography. Chest radiography is the initial screening tool. It can help in lateralizing the bleeding with high degree of accuracy and can detect several parenchymal and pleural abnormalities. However, it may be normal in up to 30% cases. MDCT is a rapid, non-invasive multiplanar imaging modality. It aids in evaluation of hemoptysis by depiction of underlying disease, assessment of consequences of hemorrhage and provides panoramic view of the thoracic vasculature. The various structures which need to be assessed carefully include the pulmonary parenchyma, tracheobronchial tree, pulmonary arteries, bronchial arteries and non-bronchial systemic arteries. Since the use of MDCT entails radiation exposure, optimal low dose protocols should be used so as to keep radiation dose as low as reasonably achievable. MRI and catheter angiography have limited application.     

Successful control of exacerbation of Allergic Bronchopulmonary Aspergillosis due to Aspergillus terreus in a cystic fibrosis patient with short-term adjunctive therapy with voriconazole: A case report

A 12-year-old boy with cystic fibrosis (CF) and a history of glucocorticoid-dependent allergic bronchopulmonary aspergillosis (ABPA) was referred to our hospital. The ABPA was diagnosed when he was 8 years old and he had been treated with several course of oral glucocorticoids for recurrent exacerbations. He was readmitted when aged 12 with a history of worsening shortness of breath and chest tightness. A recurrence of ABPA was diagnosed based on eosinophilia and elevation of Aspergillusspecific IgE and IgG, and total IgE. Thoracic high-resolution computed tomography (HRCT) showed central bronchiectasis with parenchymal infiltrates. The treatment started with itraconazole and oral corticosteroid. After 2 months of treatment, he was re-admitted to the hospital due to a progressive worsening of respiratory symptoms. Chest HRCT revealed the a sub segmental atelectasis in the left lung. Microscopic examination of sputum and BAL samples demonstrated septate hyphae consistent with Aspergillus species. Sputum and BAL culture yielded Aspergillus ochraceus and Aspergillus terreus, which were both sensitive to itraconazole and voriconazole. The treatment was switched to voriconazole and the patient showed significant clinical, serological and mycological improvement after three months. This case shows that voriconazole may be used as an alternative for treatment of ABPA due to Aspergillus terreus.