Airway clearance techniques for bronchiectasis

Lee, Annemarie L.; Burge, Angela T; Holland, Anne E

doi:10.1002/14651858.cd008351.pub2

Cited by 57 publications

(66 citation statements)

References 79 publications

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“…Even at baseline, bronchiectasis-related symptoms overlap significantly with MAC lung disease symptoms and a variety of measures, especially airway clearance strategies, can impact the bronchiectasisrelated symptoms (12)(13)(14)(15)(16)(17)(18)(19). With the exception of universal macrolide administration, however, the approach to bronchiectasis management in this patient cohort was not uniform because many patients were treated by referring physicians for their bronchiectasis.…”

Section: Discussionmentioning

confidence: 94%

Semiquantitative Culture Analysis during Therapy for Mycobacterium avium Complex Lung Disease

Griffith

Adjemian

Brown‐Elliott

et al. 2015

Am J Respir Crit Care Med

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Rationale: Microbiologically based criteria such as sputum culture conversion to negative have traditionally been used to define treatment success for mycobacterial diseases. There are, however, limited data regarding whether nontuberculous mycobacterial sputum culture conversion or semiquantitative culture analysis correlates with subjective or nonmicrobiologic objective indices of treatment response.Objectives: To determine whether a semiquantitative mycobacterial culture scale correlated with clinical disease status and was predictive of long-term sputum mycobacterial culture conversion to negative in a cohort of patients with nodular/ bronchiectatic Mycobacterium avium complex lung disease undergoing therapy.Methods: One hundred and eighty patients undergoing standard macrolide-based therapy for M. avium complex lung disease were monitored at standard frequent intervals with symptomatic, radiographic, and microbiologic data collected, including semiquantitative mycobacterial culture analysis. Analyses were used to evaluate clinical and microbiologic predictors of longterm sputum conversion to culture negative.Measurements and Main Results: After 12 months of therapy, 148 (82%) patients had sputum conversion to culture negative. Baseline semiquantitative sputum culture scores did not differ between patients with sputum conversion and those without. The change in sputum culture semiquantitative score from baseline to Month 3 was highly predictive of subsequent sputum long-term conversion status indicative of treatment success, as was improvement in cough, and especially early radiographic improvement.Conclusions: Early semiquantitative sputum agar plate culture results can be used to predict symptomatic and radiographic improvement as well as long-term sputum culture conversion to negative in this population. We suggest that semiquantitative sputum culture scores can be a useful tool for evaluating new nontuberculous mycobacterial lung disease therapies.

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Section: Discussionmentioning

confidence: 94%

Semiquantitative Culture Analysis during Therapy for Mycobacterium avium Complex Lung Disease

Griffith

Adjemian

Brown‐Elliott

et al. 2015

Am J Respir Crit Care Med

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“…The effect on quality of life (7.8 points on the SGRQ) was excellent and well above the clinically important difference of 4 points [46]. The poor state of evidence in this area, however, is illustrated by the associated Cochrane review [47]). This review found the body of evidence for physiotherapy in bronchiectasis constituted five trials with 51 participants [47].…”

Section: Airway Clearancementioning

confidence: 91%

“…27 patients were randomised to gentamicin 80 mg twice daily and 30 patients to 0.9% saline twice daily. After 12 months there was a significant reduction in bacterial density in the gentamicin group (2.96 (1.0-5.9) log10 CFU·mL −1 versus 7.67 (7.34-8.17) log10 CFU·mL ; p<0.0001) [47]. Four out of 13 patients colonised with P. aeruginosa at baseline were negative at follow-up, and 92.8% of patients colonised with other pathogens were negative by quantitative sputum culture at the end of treatment.…”

Section: Inhaled Antibioticsmentioning

confidence: 92%

“…The poor state of evidence in this area, however, is illustrated by the associated Cochrane review [47]). This review found the body of evidence for physiotherapy in bronchiectasis constituted five trials with 51 participants [47]. They concluded that airway clearance techniques were safe and that the limited data suggested improvements in sputum expectoration, reduced hyperinflation and improved health-related quality of life in stable patients.…”

Section: Airway Clearancementioning

confidence: 99%

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Management of bronchiectasis in adults

2015

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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

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“…(Experts) Interventions aimed at promoting clearance of excess mucus are a mainstay of bronchiectasis management [1]. Although few studies have explored the impact of physiotherapy in bronchiectasis, airway clearance techniques seem to be safe and allow a better sputum expectoration with an increase in patients' quality of life [20]. Evidence on pulmonary rehabilitation is scarce; however, most of the studies demonstrated an increase in patients' performance and quality of life, and an increase of the time to the next exacerbation [21][22][23].…”

Section: Consensus Statementmentioning

confidence: 99%

Research priorities in bronchiectasis: a consensus statement from the EMBARC Clinical Research Collaboration

et al. 2016

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Bronchiectasis is a disease of renewed interest in light of an increase in prevalence and increasing burden on international healthcare systems. There are no licensed therapies, and large gaps in knowledge in terms of epidemiology, pathophysiology and therapy. The European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) is a European Respiratory Society (ERS) Clinical Research Collaboration, funded by ERS to promote high-quality research in bronchiectasis. The objective of this consensus statement was to define research priorities in bronchiectasis. From 2014 to 2015, EMBARC used a modified Delphi process among European bronchiectasis experts to reach a consensus on 55 key research priorities in this field. During the same period, the European Lung Foundation collected 711 questionnaires from adult patients with bronchiectasis and their carers from 22 European countries reporting important research priorities from their perspective. This consensus statement reports recommendations for bronchiectasis research after integrating both physicians and patients priorities, as well as those uniquely identified by the two groups. Priorities identified in this consensus statement provide the clearest possible roadmap towards improving our understanding of the disease and the quality of care for patients with bronchiectasis. @ERSpublications EMBARC consensus statement identifies research priorities in bronchiectasis as determined by physicians and patients

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Airway clearance techniques for bronchiectasis

Cited by 57 publications

References 79 publications

Semiquantitative Culture Analysis during Therapy for Mycobacterium avium Complex Lung Disease

Semiquantitative Culture Analysis during Therapy for Mycobacterium avium Complex Lung Disease

Management of bronchiectasis in adults

Research priorities in bronchiectasis: a consensus statement from the EMBARC Clinical Research Collaboration

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