A Novel Microbiota Stratification System Predicts Future Exacerbations in Bronchiectasis

Rogers, Geraint B.; Zain, Nur Masirah M.; Bruce, Kenneth D.; Burr, Lucy; Chen, Alice C.; Rivett, Damian W.; McGuckin, Michael A.; Serisier, David J.

doi:10.1513/annalsats.201310-335oc

Cited by 201 publications

(211 citation statements)

References 19 publications

Supporting

Mentioning

199

Contrasting

Order By: Relevance

“…Clinical translation to date suggests that loss of diversity, with dominance of one or a few species, is associated with worse lung function and more exacerbations, and that loss of diversity may occur during exacerbations [25][26][27][28]. Overall these studies are consistent with data from culture based studies, with Pseudomonas aeruginosa dominance being associated with worse lung function and more exacerbations whether by molecular-or culture-based means and high bacterial loads of "classical" bronchiectasis pathogens being associated with higher neutrophilic inflammation and more exacerbations [28].…”

Section: The Pathophysiology Of Bronchiectasis and The Goals Of Treatmentioning

confidence: 99%

Management of bronchiectasis in adults

2015

View full text Add to dashboard Cite

Formerly regarded as a rare disease, bronchiectasis is now increasingly recognised and a renewed interest in the condition is stimulating drug development and clinical research. Bronchiectasis represents the final common pathway of a number of infectious, genetic, autoimmune, developmental and allergic disorders and is highly heterogeneous in its aetiology, impact and prognosis.The goals of therapy should be: to improve airway mucus clearance through physiotherapy with or without adjunctive therapies; to suppress, eradicate and prevent airway bacterial colonisation; to reduce airway inflammation; and to improve physical functioning and quality of life.Fortunately, an increasing body of evidence supports interventions in bronchiectasis. The field has benefited greatly from the introduction of evidence-based guidelines in some European countries and randomised controlled trials have now demonstrated the benefit of long-term macrolide therapy, with accumulating evidence for inhaled therapies, physiotherapy and pulmonary rehabilitation.This review provides a critical update on the management of bronchiectasis focussing on emerging evidence and recent randomised controlled trials. @ERSpublications Bronchiectasis is a rapidly developing field: review of recent RCTs and progress towards developing new therapies

show abstract

Section: The Pathophysiology Of Bronchiectasis and The Goals Of Treatmentioning

confidence: 99%

Management of bronchiectasis in adults

2015

View full text Add to dashboard Cite

show abstract

“…Whereas bronchiectasis can result from a variety of recognised aetiologies, it is often considered idiopathic. Recent studies have revealed a substantial and diverse bacterial microbiota (Tunney et al, 2013;Rogers et al, 2013bRogers et al, , 2014van der Gast et al, 2014), which are typically dominated by either Haemophilus influenzae or Pseudomonas aeruginosa. Perhaps unsurprisingly given its colonisation of the upper airways in healthy individuals, H. influenzae is detectable in lower airway secretions from almost all bronchiectasis patients and is commonly the numerically dominant species (Rogers et al, 2013b.…”

Section: Introductionmentioning

confidence: 99%

“…Perhaps unsurprisingly given its colonisation of the upper airways in healthy individuals, H. influenzae is detectable in lower airway secretions from almost all bronchiectasis patients and is commonly the numerically dominant species (Rogers et al, 2013b. In contrast, P. aeruginosa-dominated infections occur in a smaller number of patients but are associated with an accelerated decline in lung function, more frequent pulmonary exacerbations, greater sputum production and a higher requirement for antibiotic therapy (Evans et al, 1996;Ho et al, 1998;Shoemark et al, 2007;Rogers et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Predominant pathogen competition and core microbiota divergence in chronic airway infection

2014

View full text Add to dashboard Cite

Chronic bacterial lung infections associated with non-cystic fibrosis bronchiectasis represent a substantial and growing health-care burden. Where Pseudomonas aeruginosa is the numerically dominant species within these infections, prognosis is significantly worse. However, in many individuals, Haemophilus influenzae predominates, a scenario associated with less severe disease. The mechanisms that determine which pathogen is most abundant are not known. We hypothesised that the distribution of H. influenzae and P. aeruginosa would be consistent with strong interspecific competition effects. Further, we hypothesised that where P. aeruginosa is predominant, it is associated with a distinct 'accessory microbiota' that reflects a significant interaction between this pathogen and the wider bacterial community. To test these hypotheses, we analysed 16S rRNA gene pyrosequencing data generated previously from 60 adult bronchiectasis patients, whose airway microbiota was dominated by either P. aeruginosa or H. influenzae. The relative abundances of the two dominant species in their respective groups were not significantly different, and when present in the opposite pathogen group the two species were found to be in very low abundance, if at all. These findings are consistent with strong competition effects, moving towards competitive exclusion. Ordination analysis indicated that the distribution of the core microbiota associated with each pathogen, readjusted after removal of the dominant species, was significantly divergent (analysis of similarity (ANOSIM), R ¼ 0.07, P ¼ 0.019). Taken together, these findings suggest that both interspecific competition and also direct and/or indirect interactions between the predominant species and the wider bacterial community may contribute to the predominance of P. aeruginosa in a subset of bronchiectasis lung infections.

show abstract

“…Clinical symptoms, history of exacerbations and microbiological data are frequently used to stratify the severity of patients with NCFB; however, the incorporation of imaging abnormalities into these classifications may allow for a more complete picture of the impact of the disease 52, 53. Therefore, there is great interest in the evaluation of the extent and severity of bronchiectasis more objectively using CT.…”

Section: Diagnostic Approachmentioning

confidence: 99%

Suspecting non-cystic fibrosis bronchiectasis: What the busy primary care clinician needs to know

et al. 2017

View full text Add to dashboard Cite

SummaryAimsNon‐cystic fibrosis bronchiectasis (NCFB) is a chronic, progressive respiratory disorder characterised by irreversibly and abnormally dilated airways, persistent cough, excessive sputum production and recurrent pulmonary infections. In the last several decades, its prevalence has increased, making it likely to be encountered in the primary care setting. The aim was to review the clinical presentation and diagnosis of NCFB, with an emphasis on the role of computed tomography (CT).MethodsFor this review, trials and reports were identified from PubMed/Medline and ClinicalTrials.gov from the US NIH and the Cochrane Register of Controlled Trials. The search used keywords: bronchiectasis, non‐cystic fibrosis bronchiectasis, chronic pulmonary infection and computed tomography. No date/language restrictions were used.ResultsNon‐cystic fibrosis bronchiectasis often coexists with other respiratory conditions, such as chronic obstructive pulmonary disease. The prevalence of NCFB is increasing, particularly in women and older individuals, possibly as a result of increased physician awareness and widespread use of CT, which is the gold standard for the diagnosis of NCFB. CT can assist in identifying an underlying cause of NCFB and determining the extent and severity of the disease.DiscussionNon‐cystic fibrosis bronchiectasis should be suspected in the primary care setting in patients with chronic cough, purulent sputum and frequent respiratory infections that tend to resolve slowly or partially. Early diagnosis and determination of the extent and severity of the disease by CT and other tests are critical to establish therapy to improve quality of life and potentially slow progressive decline of lung function in patients with NCFB .

show abstract

A Novel Microbiota Stratification System Predicts Future Exacerbations in Bronchiectasis

Cited by 201 publications

References 19 publications

Management of bronchiectasis in adults

Management of bronchiectasis in adults

Predominant pathogen competition and core microbiota divergence in chronic airway infection

Suspecting non-cystic fibrosis bronchiectasis: What the busy primary care clinician needs to know

Contact Info

Product

Resources

About