ObjectiveTo explorer the risk factors for acute exacerbation in patients with bronchiectasis within one year.MethodsFour hundred and twenty-two patients with non-cystic fibrosis bronchiectasis hospitalized were enrolled in The East Region of the People’s hospital of Sichuan between October 2014 and October 2016. The patients’ clinical data were collected, and follow-up began at the time of discharged. The study endpoint was the first acute exacerbation, all patients were followed-up for one year after discharged. The patients were classified into two groups by the occurrence of acute exacerbation or no occurrence. Logistic regression analysis was used to explore the risk factors for acute exacerbation with bronchiectasis.ResultsThe age, sick time, body mass index (BMI) less than 18.5 kg/m2, smoking index, expectoration, hemoptysis, dyspnea, moist sounds, wheezing sounds, types of imaging, CT scores, lung lesion site, sputum culture, whether infected Pseudomonas aeruginosa, level of serum C-reactive protein (CRP), level of serum PCT, serum albumin, arterial carbon dioxide partial pressure, types of respiratory failure, combined with chronic cor pulmonale differed significantly between the two groups (P<0.05), while gender, history of Infection, smoking, cough, chest pain, fever, clubbed-finger, white blood cell counts, neutrophil counts, erythrocyte sedimentation rate, serum globulins, arterial oxygen partial pressure did not significantly differ (P>0.05). Multivariate Logistic regression analysis found that infection with Pseudomonas aeruginosa, BMI<18.5 kg/m2, high level of serum CRP, high level of arterial carbon dioxide partial pressure (PaCO2), high CT score with bronchiectasis, combination with chronic cor pulmonale were risk factors for acute exacerbation in patients with bronchiectasis (P<0.05).ConclusionsInfection with pseudomonas aeruginosa, BMI < 18.5 kg/m2, high serum CRP level, high arterial blood PaCO2 level, high CT score with bronchiectasis and combination of chronic cor pulmonale are risk factors for acute aggravation within 1 year for patients with bronchiectasis. Doctors can identify these risk factors and intervene early, so as to reduce the acute exacerbation of bronchiectasis.
Objective To evaluate the efficacy of long-term inhaled salmeterol / fluticasone combined with low-dose oral erythromycin in patients with bronchiectasis. Methods Sixty-two patients with bronchiectasis after exacerbation and maintained stable were randomly divided into three groups. Group A was treated with low-dose oral erythromycin, group B inhaled salmeterol/fluticasone, and group C inhaled salmeterol/fluticasone plus low-dose oral erythromycin. The study duration lasted for 6 months. The clinical symptoms, dyspnea scale, exacerbation frequency, and pulmonary function parameters were measured and compared. Results Fifty-four patients completed the whole study and 8 cases withdrew. The results showed that 6 months of low-dose erythromycin therapy can improve the clinical symptoms, whille exacerbation frequency was also decreased. Inhaled salmeterol/fluticasone improved lung function, however, had no effect on cough, expectoration and exacerbation frequency. Inhaled salmeterol/fluticasone combined with erythromycin was more significantly effective in improving lung functions as well as symptoms. Conclusions Long-terminhaled salmeterol/fluticasone combined with low-dose oral erythromycin can improve the clinical symptoms and lung function, decrease the frequency of exacerbation in patients with bronchiectasis. It may be as an alternative to the maintenance treatment of bronchiectasis.
Objective To investigate the cardiovascular events (CVE) and survival status of patients with bronchiectasis (BE) during follow-up after acute exacerbation. Methods Prospective cohort study was used. Clinical data of 134 BE patients with acute exacerbation who were hospitalized from July 2016 to September 2020 were collected. The patients were followed up after discharge by phone or respiratory clinic every 3 months until November 2022. CVE or death was the endpoint event. Result During the follow-up period, 41 patients developed CVE, while 93 patients did not. Fifty-one patients died during the follow-up period, with a mortality rate of 38.06%. Among them, 41 cases of CVE resulted in 21 deaths, with a mortality rate of 51.22%; 30 cases died in 93 non-CVE patients, with a mortality rate of 32.26%. Logistic regression results showed significant influencing factors for CVE in BE patients were age, hypertension, chronic obstructive pulmonary disease (COPD), and moderate to severe illness. The significant influencing factors for the death of BE patients were age, COPD, moderate and severe illness, and CVE events. The significant influencing factors for the death of CVE patients were age and receiving CVE treatment. The area under ROC curve (AUC) and 95%CI was 0.858 (0.729 - 0.970) for the warning model for CVE in BE patients. The AUC (95%CI) was 0.867 (0.800 - 0.927) for the warning model for death in BE patients. The AUC (95%CI) was 0.811 (0.640 - 0.976) for the warning model for death of CVE patients. Conclusions Population factors and comorbidities are risk factors for CVE in BE patients after acute exacerbation. The appearance of CVE worsens the long-term prognosis of BE patients. The corresponding warning models have high warning effectiveness with AUC>0.8.
Objective To study the correlation of preoperative hemoglobin amount with venous thromboembolism (VTE) after surgical treatment of bronchiectasis and the clinical significance. Methods A retrospective study was performed on patients with bronchiectasis who underwent surgical treatment in our center from June 2017 to November 2021. The differences in blood parameters between the VTE patients and non-VTE patients were compared. The relationship between preoperative hemoglobin and VTE was confirmed by quartile grouping and receiver operating characteristic (ROC) curve. Results A total of 122 patients were enrolled, including 50 males and 72 females, with a mean age of 52.52±12.29 years. The overall incidence of VTE after bronchiectasis was 9.02% (11/122). Preoperative hemoglobin amount (OR=0.923, 95%CI 0.870-0.980, P=0.008) and D-dimer amount (OR=1.734, 95%CI 1.087-2.766, P=0.021) were independent influencing factors for VTE after bronchiectasis. The incidence of VTE after bronchiectasis decreased gradually with the increase of preoperative hemoglobin amount. The area under the ROC curve (AUC) of postoperative D-dimer alone was 0.757, whereas the AUC of postoperative D-dimer combined with preoperative hemoglobin amount was 0.878. Conclusion Low preoperative hemoglobin is an independent risk factor for postoperative VTE. Postoperative D-dimer combined with preoperative hemoglobin amount has a better predictive performance compared with postoperative D-dimer alone for postoperative VTE.
ObjectiveTo describe the clinical characteristics of pulmonary nocardiosis associated with bronchiectasis and to evaluate the methods of diagnosis and treatment.MethodsClinical data of two patients with pulmonary nocardiosis and bronchiectasis were analyzed and the literature on the subject were reviewed.ResultsTwo female patients with bronchiectasis were respectively 55 and 62 years old, both of them presented with fever, cough, expectoration, and leukocytosis. Case 1 also complicated with respiratory failure and leukemoid reaction. Chest CT showed bilateral pulmonary multi-patchy consolidations with cavities in case 1 and unilateral pulmonary local consolidation without cavities in case 2. Sputum smears on modified Ziehl-Neelsen staining of both patients showed typical Nocardia hyphe. Sputum culture of case 1 showed Nocardia otitidiscaviarum, which was sensitive to sulfamethoxazole/trimethoprim (SMZ/TMP), amikacin and moxifloxacin while resistant to ceftriaxone, imipenem and meropenem. Sputum culture of case 2 was negative. Case 1 was treated with SMZ/TMP + moxifloxacin + amikacin for 6 months, and case 2 treated with SMZ/TMP for 3 months. Both patients were clinically cured. Six case reports including 7 patients were searched, including 4 Chinese reports and 2 English reports. Most of them were reported individually. ConclusionsBronchiectasis is a risk factor for pulmonary nocardiosis, and the treatment of nocardiosis should accord with drug susceptibilities and severities of diseases. The prognoses of patients with pulmonary nocardiosis and bronchiectasis are relatively good.
Objective To describe the underlying conditions of chronic pulmonary aspergillosis (CPA). Methods A retrospective study was performed. Details of the clinical, imaging features, and the underlying conditions of CPA patients admitted to a tertiary university teaching hospital from January 2009 to December 2016 were extracted from clinical records. The classification distribution of CPA, and underlying conditions were analyzed. Results Among the 108 CPA patients, 87 cases had underlying conditions, 21 cases had no underlying conditions. Seventy two (66.7%) patients were engaged in agriculture, the proportion of which was significantly higher in the cases without underlying conditions (85.7% vs. 62.1%). Chronic necrotizing pulmonary aspergillosis (CNPA) was the most common type of these CPA cases. The cases without underlying conditions had significantly more proportion of CNPA than the cases with underlying conditions (85.7% vs. 62.1%). The cases with systemic underlying conditions had significantly more proportion of CNPA than the cases only with pulmonary underlying conditions (82.8% vs. 51.7%). Chronic cavity pulmonary aspergillosis (24/108, 22.2%) only existed in the cases with pulmonary underlying conditions. Underlying conditions were identified in 87 cases of CPA, with 85.1% (74/87) pulmonary and 33.3% (29/87) systemic underlying diseases. Previous tuberculosis mycobacterial infection, bronchiectasis and chronic obstructive pulmonary disease were the most common pulmonary underlying conditions (40.2%, 39.1% and 35.6%, respectively). Diabetes (16.1%) and glucocorticoid using (13.8%) were the most two common systemic underlying conditions. Conclusions CPA can occur in patients with and without underlying diseases. CNPA is the most common type of these CPA, the proportion of which is higher in cases without underlying conditions and cases with systemic underlying conditions. Farming maybe the risk factors of CPA. Chronic pulmonary primary diseases are the most common underlying conditions. The most common systemic factors are diabetes and glucocorticoid using.
Objective Allergic bronchopulmonary aspergillosis (ABPA) is characterized by anexaggerated reaction to airway colonization aspergillus which affects patients with underlying diseases such asbronchial asthma, cystic fibrosis or other respiratory diseases. ABPA exhibit significant heterogeneity due to theunderlying diseases. The clinical features of patients with ABPA were analyzed retrospectively, so as to explore theimpact of underlying diseases on clinical characteristics. Methods The clinical data of hospitalized patients diagnosed with ABPA from January 2010 to September 2019 in Peking University People's Hospital were reviewed for retrospective analysis. Results A total of 40 ABPA patients were enrolled. Of which 8 cases (20.0%) were previously diagnosed as chronic obstructive pulmonary disease and/or bronchiectasis, named non-asthma group; while the other 32 cases met the diagnosis criteria of asthma, named asthma group. The non-asthma ABPA patients had a shorter course [78 (6 - 300) months vs. 192 (39 - 480) months, P=0.02], a higher percentage of peripheral blood neutrophils (79.9%±12.5% vs. 68.1%±18.1%, P=0.01) and higher score of emphysema [2 (0 - 2) vs. 0 (0 - 1), P=0.02] than the asthma group. Conclusions There is no significant difference in clinical and radiological characteristics between ABPA patients without asthma and those with asthma. The diagnosis of ABPA should also be considered when patients with chronic pulmonary diseases such as chronic obstructive pulmonary disease and bronchiectasis have aggravation of dyspnea, increase of eosinophils in peripheral blood and typical imaging features such as mucus attenuation.
Objective To explore the effect of leukotriene receptor antagonist montelukast on physicochemical property of sputum and airway mucus hypersecretion in patients with acute exacerbation of bronchiectasis. Methods Eighty-four inpatients with acute exacerbation of bronchiectasis were randomly divided into a control group and an experiment group, with 42 cases in each group. The control group received conventional therapy and the experiment group took orally montelukast 10 mg before sleep every day based on conventional therapy for two weeks. At admission and 15 days after admission, the amount in 24 hours, dry/wet weight ratio and viscosity of sputum were observed while the levels of neutrophil elastase (NE) and mucin MUC5ac in sputum were determined by ELISA. The pulmonary ventilation function, airway resistance and blood gas analysis were also measured. Results The sputum amount in 24 hours, dry/wet weight ratio and viscosity of sputum, NE and MUC5ac of sputum, pulmonary ventilation function, blood gas analysis and airway resistance were declined or improved remarkably after treatment compared with before treatment in two groups (P<0.05). Meanwhile, the sputum amount in 24 hours [(5.62±1.83) g vs. (7.53±2.32) g], NE [(3.85±0.97) μg/ml vs. (4.54±1.03) μg/ml], MUC5ac [(0.65±0.21) μg/ml vs. (0.82± 0.29) μg/ml] and the airway resistance [(119.16±11.76)% vs. (128.37±12.08)%] were declined remarkably in the experiment group compare with the control group after treatment (all P<0.05). The viscosity of sputum between the two groups after treatment showed no significant difference. Conclusion In patients with acute exacerbation of bronchiectasis, montelukast can reduce amount of sputum and airway resistance, reduce expression of mucin MUC5ac through down-regulation of NE, thus inhibit airway mucus hypersecretion.
ObjectiveTo investigate the application value of fibrinogen and other serological indicators in the management of patients with bronchiectasis. Methods Basic information, serological indicators such as blood routine items, biochemical, blood coagulation, and inflammation index of 121 patients with bronchiectasis in Nanjing Jinling Hospital and Nanjing Drum Tower Hospital from July 2021 to June 2023 were collected. The value of fibrinogen and other serological indicators in identifying patients with acute exacerbation and severely impaired lung function (FEV1%pred<60%) was evaluated. Results The levels of leukocytes, neutrophils, platelets, C-reactive protein and fibrinogen were higher in the patients with acute exacerbation and in the FEV1%pred<60% group, negatively correlated with FEV1%pred. While the level of albumin was higher in the patients of the stable group and FEV1%pred≥60% group, and positively correlated with FEV1%pred. Compared with leukocytes, neutrophils, platelets, C-reactive protein and albumin, fibrinogen demonstrated the best recognition ability for the patients with FEV1%pred<60% (AUC=0.839). The sensitivity of identifying patients with FEV1%pred<60% was 91.18% and the specificity was 71.26% when the level of fibrinogen was over 3.35 g/L. Conclusions Leukocytes, neutrophils, platelets, C-reactive protein, albumin and fibrinogen have shown certain application value in recognition of patients with bronchiectasis in acute exacerbation stage and FEV1%pred<60%. These serological indicators may be helpful in precision treatment and individual management of patients with bronchiectasis.
ObjectiveTo analyze the microbiological characteristics of airway bacteria in adult patients with bronchiectasis and to analyze their correlation with the clinical features. MethodsPatients diagnosed with bronchiectasis in the Department of Respiratory and Critical Care Medicine of West China Hospital of Sichuan University from October 2017 to April 2018 were classified into the bronchiectasis group, while the control group was those who were found to have pulmonary nodules (diameter less than 10 mm) requiring bronchoscopy by physical examination. All subjects in both groups had not used antibiotics or hormones within 4 weeks and had no other respiratory diseases. Bronchoalveolar lavage fluid (BALF) from the lesion site of the branchial expansion group was collected, and BALF from the basal segment of the contralateral inferior bronchial lobe of the pulmonary nodule was collected in the control group. Bacterial culture and 16S rRNA gene sequencing were performed in both groups. ResultsSeventeen cases and six controls were enrolled in this study and the BALF specimens were collected. Eight cases were in stable period and nine cases were in acute period. The case group was divided into the bacteria-positive group and negative group based on bacterial culture of BALF. Shannon index in the bacteria-positive group was significantly lower than the bacteria-negative group and the control group. And Shannon index showed a negative correlation with positive bacterial culture in BALF. When Shannon index ≤4.5 was used to predict positive bacterial culture, the sensitivity and specificity were 83.3% and 90.9% respectively. The average relative abundance of bacteria was higher and the average sample distribution uniformity was lower in patients with acute period, compared with those in patients with stable period. Shannon index was negatively correlated with the acute exacerbation in patients. When Shannon index <5.0 was used to predict acute exacerbation, the sensitivity and specificity were 77.8% and 100.0%, respectively. ConclusionsShannon index in 16S rRNA gene sequencing results has certain predictive value for acute exacerbation stage. 16S rRNA gene sequencing combined with bacterial culture results can help guide clinicians to provide more precise treatment plans.