Effect of airway Pseudomonas aeruginosa isolation and infection on steady-state bronchiectasis in Guangzhou,China

Background

Current status of Pseudomonas aeruginosa (PA) infection in clinically stable bronchiectasis in mainland China remains unclear.

Objective

To compare the inflammation and lung function impairment in bronchiectasis patients isolated or infected with PA, potentially pathogenic microorganisms (PPMs) and commensals, and to identify factors associated with PA isolation and infection.

Methods

Patients with steady-state bronchiectasis and healthy subjects were recruited. Peripheral blood and sputum were sampled to determine inflammatory markers and bacterial loads in steady-state bronchiectasis and health. Spirometry and diffusing capacity were also measured.

Results

We enrolled 144 bronchiectasis patients and 23 healthy subjects. PA isolation and infection accounted for 44 and 39 patients, who demonstrated significant inflammatory responses and markedly impaired spirometry, but not diffusing capacity, compared with healthy subjects and patients isolated with other PPMs and commensals (all P<0.05). Except for heightened sputum inflammatory responses, there were no notable differences in serum inflammation and lung function as with the increased density of PA. Female gender [odds ratio (OR): 3.10 for PA isolation; OR: 3.74 for PA infection], 4 or more exacerbations within 2 years (OR: 3.74 for PA isolation, OR: 2.95 for PA infection) and cystic bronchiectasis (OR: 3.63 for PA isolation, OR: 4.47 for PA infection) were the factors consistently associated with PA isolation and infection.

Conclusions

PA elicits intense inflammation and lung function impairment in steady-state bronchiectasis. The density of PA does not correlate with most clinical indices. PA infection is associated with females, frequent exacerbations and cystic bronchiectasis.     

Stabilization of Lung Function and Clinical Symptoms in a Patient with Cystic Fibrosis (CF) After Institution of Infliximab: A Monoclonal Antibody that Binds Tumor Necrosis Factor alpha

The most characteristic feature of airway inflammation in cystic fibrosis (CF) is the persistent infiltration of massive numbers of neutrophils. Although inflammation is primarily a protective response to injury, it has the potential to cause considerable harm when it is excessive. Recent recognition of the prominent role of inflammation has prompted the investigation of treatments designed to control inflammation in the CF lung. We report a 35-year-old man with abrupt stabilization of his rapidly progressive CF and forced expiratory volume (FEV1) after starting infliximab for his rheumatoid arthritis. This effect was sustained for 8 years while continuing to use twice-monthly infliximab.     

Spanish Guidelines on Treatment of Bronchiectasis in Adults

In 2008, the Spanish Society of Pulmonology (SEPAR) published the first guidelines in the world on the diagnosis and treatment of bronchiectasis. Almost 10 years later, considerable scientific advances have been made in both the treatment and the evaluation and diagnosis of this disease, and the original guidelines have been updated to include the latest therapies available for bronchiectasis. These new recommendations have been drafted following a strict methodological process designed to ensure quality of content, and are linked to a large amount of online information that includes a wealth of references. The guidelines are focused on the treatment of bronchiectasis from both a multidisciplinary perspective, including specialty areas and the different healthcare levels involved, and a multidimensional perspective, including a comprehensive overview of the specific aspects of the disease. A series of recommendations have been drawn up, based on an in-depth review of the evidence for treatment of the underlying etiology, the bronchial infection in its different forms of presentation using existing therapies, bronchial inflammation, and airflow obstruction. Nutritional aspects, management of secretions, muscle training, management of complications and comorbidities, infection prophylaxis, patient education, home care, surgery, exacerbations, and patient follow-up are addressed.     

支气管扩张症合并肺出血的HRCT表现

目的：探讨支气管扩张症合并肺出血的HRCT表现及病理学基础。方法：对25例支扩合并急性咯血患者行CT及HRCT检查。结果：25例HRCT诊断支扩，其中柱状型12例，静脉曲张型9例，囊状型8例，诊断为支扩合并肺出血12例。结论：HRCT显示支扩合并肺出血敏感，可以为临床诊断和治疗提供极有价值的影像学资料。     

支气管扩张症患者不同程度肺功能受损的临床研究

目的探讨不同程度肺功能受损的支气管扩张症患者临床特点,为临床治疗寻找新的思路。方法对76例支气管扩张症并肺功能受损的患者资料进行回顾性分析。结果与轻度阻塞性通气功能障碍者的一般资料相比较,中重度阻塞性通气功能障碍者病程长,吸烟人次多,肺部听诊哮鸣音者、临床表现气促者所占比率大,病灶多累及2个肺叶以上。结论支气管扩张症一旦确立诊断,应及早给予抗感染、对症治疗,若常规治疗效果不好时应想到是否存在合并症,加强通气治疗,改善肺功能。     

酚妥拉明联合垂体后叶素治疗支气管扩张咯血的疗效观察

目的探讨酚妥拉明联合垂体后叶素治疗支气管扩张咯血的临床疗效。方法将72例患者随机分为观察组和对照组（各36例）,对照组在综合性基础治疗上给予垂体后叶素治疗,观察组在对照组治疗的基础上加用酚妥拉明治疗。结果观察组总有效率为97．2％,明显优于对照组的77．8％,两组总有效率比较差异具有统计学意义（P〈0．05）。结论应用酚妥拉明联合垂体后叶素治疗支气管扩张咯血疗效显著,具有起效快、安全可靠、不良反应少等优点,值得临床推广。     

Bronchiectasis and COVID-19 infection: a two-way street

Bronchiectasis (BE) has been linked to past viral infections such as influenza, measles, or adenovirus. Two years ago, a new pandemic viral infection severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) broke out and it still persists today, and a significant proportion of surviving patients have radiological and clinical sequelae, including BE. Our aim was to thoroughly review the information available in the literature on the bidirectional relationship between SARS-CoV-2 infection and the development of BE, as well as the impact of this infection on patients already suffering from BE. Available information indicates that only a small percentage of patients in the acute phase of coronavirus disease 2019 (COVID-19) pneumonia develop BE, although the latter is recognized as one of the radiological sequelae of COVID-19 pneumonia, especially when it is caused by traction. The severity of the initial pneumonia is the main risk factor for the development of future BE, but during the COVID-19 pandemic, exacerbations in BE patients were reduced by approximately 50%. Finally, the impact of BE on the prognosis of patients with COVID-19 pneumonia is not yet known.