Bronchiectasis

Chang, Anne B.; Redding, Gregory J.

doi:10.1016/b978-0-7216-3695-5.50033-x

Cited by 6 publications

(2 citation statements)

References 160 publications

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“…‘Symptoms’ include persistent ‘moist’ cough, mucopurulent sputum, haemoptysis, and breathlessness [2,12]. The current ‘gold standard’ for diagnosis is confirmation by a high-resolution computed tomography (HRCT) scan of the chest [13].…”

Section: Introductionmentioning

confidence: 99%

“…Bronchiectasis is a disease characterized by abnormal irreversible bronchial dilatation, which is associated with chronic bacterial infection and inflammation. ‘Symptoms’ include persistent ‘moist’ cough, mucopurulent sputum, haemoptysis, and breathlessness [ 2 , 12 ]. The current ‘gold standard’ for diagnosis is confirmation by a high-resolution computed tomography (HRCT) scan of the chest [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Azithromycin for Indigenous children with bronchiectasis: study protocol for a multi-centre randomized controlled trial

et al. 2012

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BackgroundThe prevalence of chronic suppurative lung disease (CSLD) and bronchiectasis unrelated to cystic fibrosis (CF) among Indigenous children in Australia, New Zealand and Alaska is very high. Antibiotics are a major component of treatment and are used both on a short or long-term basis. One aim of long-term or maintenance antibiotics is to reduce the frequency of acute pulmonary exacerbations and symptoms. However, there are few studies investigating the efficacy of long-term antibiotic use for CSLD and non-CF bronchiectasis among children. This study tests the hypothesis that azithromycin administered once a week as maintenance antibiotic treatment will reduce the rate of pulmonary exacerbations in Indigenous children with bronchiectasis.Methods/designWe are conducting a multicentre, randomised, double-blind, placebo controlled clinical trial in Australia and New Zealand. Inclusion criteria are: Aboriginal, Torres Strait Islander, Maori or Pacific Island children aged 1 to 8 years, diagnosed with bronchiectasis (or probable bronchiectasis) with no underlying disease identified (such as CF or primary immunodeficiency), and having had at least one episode of pulmonary exacerbation in the last 12 months. After informed consent, children are randomised to receive either azithromycin (30 mg/kg once a week) or placebo (once a week) for 12–24 months from study entry. Primary outcomes are the rate of pulmonary exacerbations and time to pulmonary exacerbation determined by review of patient medical records. Secondary outcomes include length and severity of pulmonary exacerbation episodes, changes in growth, school loss, respiratory symptoms, forced expiratory volume in 1-second (FEV1; for children ≥6 years), and sputum characteristics. Safety endpoints include serious adverse events. Antibiotic resistance in respiratory bacterial pathogens colonising the nasopharynx is monitored. Data derived from medical records and clinical assessments every 3 to 4 months for up to 24 months from study entry are recorded on standardised forms.DiscussionShould this trial demonstrate that azithromycin is efficacious in reducing the number of pulmonary exacerbations, it will provide a much-needed rationale for the use of long-term antibiotics in the medical management of bronchiectasis in Indigenous children.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12610000383066

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Azithromycin for Indigenous children with bronchiectasis: study protocol for a multi-centre randomized controlled trial

et al. 2012

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Primary Ciliary Dyskinesia and Bronchiectasis

Bravo¹,

Bhandari²

2011

Nursing Care in Pediatric Respiratory Disease

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Chronic wet cough: Protracted bronchitis, chronic suppurative lung disease and bronchiectasis

Chang

Redding

Everard

2008

Pediatric Pulmonology

251

246

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The role of persistent and recurrent bacterial infection of the conducting airways (endobronchial infection) in the causation of chronic respiratory symptoms, particularly chronic wet cough, has received very little attention over recent decades other than in the context of cystic fibrosis (CF). This is probably related (at least in part) to the (a) reduction in non-CF bronchiectasis in affluent countries and, (b) intense focus on asthma. In addition failure to characterize endobronchial infections has led to under-recognition and lack of research. The following article describes our current perspective of inter-related endobronchial infections causing chronic wet cough; persistent bacterial bronchitis (PBB), chronic suppurative lung disease (CSLD) and bronchiectasis. In all three conditions, impaired muco-ciliary clearance seems to be the common risk factor that provides organisms the opportunity to colonize the lower airway. Respiratory infections in early childhood would appear to be the most common initiating event but other conditions (e.g., tracheobronchomalacia, neuromuscular disease) increases the risk of bacterial colonization. Clinically these conditions overlap and the eventual diagnosis is evident only with further investigations and long term follow up. However whether these conditions are different conditions or reflect severity as part of a spectrum is yet to be determined. Also misdiagnosis of asthma is common and the diagnostic process is further complicated by the fact that the co-existence of asthma is not uncommon. The principles of managing PBB, CSLD and bronchiectasis are the same. Further work is required to improve recognition, diagnosis and management of these causes of chronic wet cough in children.

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Bronchiectasis

Cited by 6 publications

References 160 publications

Azithromycin for Indigenous children with bronchiectasis: study protocol for a multi-centre randomized controlled trial

Azithromycin for Indigenous children with bronchiectasis: study protocol for a multi-centre randomized controlled trial

Primary Ciliary Dyskinesia and Bronchiectasis

Chronic wet cough: Protracted bronchitis, chronic suppurative lung disease and bronchiectasis

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