Introduction
Quality of life (QoL) is known to be impaired in patients with bronchiectasis, which is generally attributed to exacerbations and chronic pulmonary symptoms. The aim of this study was to determine if aetiology and disease severity are associated with QoL in bronchiectasis.
Methods
We conducted a retrospective analysis of clinical stable patients with bronchiectasis. Diagnostic workup into the aetiology of bronchiectasis was conducted according to the current guidelines. QoL was measured by QoL‐B questionnaire (QoL‐B), data on sputum microbiology, pulmonary function tests and the disease severity were obtained.
Results
The aetiology of bronchiectasis was investigated in the total of 200 patients. The most commonly identified aetiologies were post‐infective (39.5%) and idiopathic (12.5%). Patients with chronic obstructive pulmonary disease (COPD)‐related bronchiectasis showed a significant lower QoL (P < .05) as compared to the other aetiologies. In the total population, an increasing disease severity as measured by FACED, E‐FACED and the bronchiectasis severity index was correlated with a lower QoL.
Conclusions
Our results showed that QoL in bronchiectasis is related both to aetiology, with worse QoL in COPD‐related bronchiectasis, and to disease severity, which suggests more attention in advance for these specific patient groups with bronchiectasis.
Background
Use of long-term tobramycin inhalation solution (TIS) has been shown beneficial in cystic fibrosis (CF) and earlier findings also suggest a benefit in non-CF bronchiectasis. We investigated the efficacy and safety of maintenance TIS once daily (OD) in frequent exacerbating bronchiectasis patients chronically infected by different pathogens sensitive for tobramycin.
Objective
The primary outcome was the frequency of exacerbations during the 12-month study period. Secondary outcomes were time to first exacerbation, change in lung function and quality of life (QoL), bacterial analysis and safety.
Materials/patients
In this multicenter RCT patients aged ≥ 18-year-old were included with confirmed bronchiectasis and ≥ 2 exacerbations in the preceding year. Patients were assigned (1:1) to receive TIS or placebo OD for 1-year.
Results
58 patients were included of which 52 were analyzed in the mITT analysis. TIS reduced exacerbation frequency with a RR of 0.74 (95% CI 0.49–1.14) (p = 0.15). Within the TIS population a decrease in number of exacerbations was found (2; p = 0.00), which was also seen in the placebo-treated patients (1.5; p = 0.00). In the TIS-treated patients the QoL improved (LRTI-VAS p = 0.02 Leicester Cough p = 0.02) without additional safety concerns. No differences were found for the other secondary outcomes.
Conclusion
Long-term TIS OD is a safe treatment modality and showed a non-significant reduced exacerbation frequency of 0.74 as compared to placebo in bronchiectasis patients chronically infected by tobramycin sensitive pathogens. TIS OD may be a potential therapeutic strategy in selected patients with bronchiectasis suffering from a high burden of disease.
Trail registration number: The BATTLE study was registered at Clinical trials.gov number: NCT02657473. Date: 13 august 2016.
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