Bronchiectasis: new findings in the pathogenesis and treatment of this disease

Ilowite, Jonathan S.; Spiegler, Peter; Chawla, Shalinee

doi:10.1097/qco.0b013e3282f4f237

Cited by 36 publications

(25 citation statements)

References 23 publications

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“…Our study confirms IPV's cardiovascular safety in patients with bronchiectasis. Similar to the study by Van Ginderdeuren et al, 22 we observed no change in S pO 2 .…”

Section: Discussionsupporting

confidence: 81%

“…Bronchiectasis is usually associated with chronic cough, increasing secretions, and recurrent airway and pulmonary infections that might result in loss of lung function and lead to early death. 2 The goals of bronchiecDrs Paneroni, Simonelli, Bianchi, and Vitacca are affiliated with Servizio di Riabilitazione Cardio-Respiratoria, Salvatore Maugeri Foundation, Istituto di Ricovero e Cura a Carattere Scientifico, Institute of Lumezzane, Lumezzane, Italy. Drs Clini and Degli Antoni are affiliated with the University of Modena, and with L'unità Operativa di Pneumologia e Riabilitazione Respiratoria, Ospedale Privato Accreditato Villa Pineta, Gaiato, Italy.…”

Section: Introductionmentioning

confidence: 99%

“…1 This can favor recurrent infections, affect ventilatory function, and create a vicious circle of infections and inflammation that can ultimately lead to airway and lung parenchyma destruction. 1 Bronchiectasis, a disease that is being diagnosed with increasing frequency, 2 consists of segmental dilatation of medium-size bronchi, due to loss of the muscle and elastic components of the bronchial wall in patients without cystic fibrosis (CF). Bronchiectasis is usually associated with chronic cough, increasing secretions, and recurrent airway and pulmonary infections that might result in loss of lung function and lead to early death.…”

Section: Introductionmentioning

confidence: 99%

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Safety and Efficacy of Short-Term Intrapulmonary Percussive Ventilation in Patients With Bronchiectasis

et al. 2011

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BACKGROUND: Treatment of bronchiectasis includes drugs, oxygen therapy, and bronchialclearance maneuvers. OBJECTIVE: To assess the safety and efficacy of intrapulmonary percussive ventilation (IPV) compared to traditional standard chest physical therapy in patients with bronchiectasis and productive cough. METHODS: In a randomized crossover study, 22 patients underwent, on consecutive days, IPV and chest physical therapy. Before each treatment session, immediately after the session, 30 min after the session, and 4 hours after the session we measured S pO 2 , heart rate, respiratory rate, and (with a visual analog scale) the patient's subjective sensation of phlegm encumbrance and dyspnea. Immediately after each treatment session we also measured (via visual analog scale) the patient's discomfort. We also measured the volume and wet and dry weight of collected sputum. RESULTS: No adverse effects were so severe as to require discontinuation of treatment, and the incidence of adverse effects was similar in the groups (27%). Heart rate (P ‫؍‬ .002) and respiratory rate (P ‫؍‬ .047) decreased during treatment, and sensation of phlegm encumbrance improved (P ‫؍‬ .03) with both treatments. Only IPV improved (P ‫؍‬ .004) the sensation of dyspnea. The patients found IPV more comfortable than our traditional standard chest physical therapy (P ‫؍‬ .03). Both treatments caused important phlegm production, but there were no differences in sputum volume, wet weight, or dry weight. CONCLUSIONS: In patients with bronchiectasis and productive cough, short-term IPV was as safe and effective as traditional chest physical therapy, with less discomfort.

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“…Our study confirms IPV's cardiovascular safety in patients with bronchiectasis. Similar to the study by Van Ginderdeuren et al, 22 we observed no change in S pO 2 .…”

Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Safety and Efficacy of Short-Term Intrapulmonary Percussive Ventilation in Patients With Bronchiectasis

et al. 2011

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“…One aspiration event can produce lung irritation and subsequent infl ammation. Recurrent LPR with aspiration may manifest itself with many different pulmonary problems, such as refractory asthma, 6 ground-glass infi ltrates, 13 interstitial lung disease, 14 bronchiectasis, 15,16 and aspiration pneumonitis. 17 Although it is important to use well-established GI studies to document and elucidate specifi c pathophysiologic problems, false-positives and false-negatives may occur.…”

Section: Discussionmentioning

confidence: 99%

An Index to Objectively Score Supraglottic Abnormalities in Refractory Asthma

Good

Rollins

Curran‐Everett

et al. 2014

Chest

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ASTHMAOriginal Research ways of patients with refractory asthma, which allows for better phenotyping of these individuals and, thus, specifi c patient-oriented therapy. 6 This approach has led to improved outcomes. 6 Laryngopharyngeal refl ux (LPR) can occur in association with gastroesophageal refl ux (GER) or independent from GER. LPR can be injurious to the supraglottic area and lower airway, with potential aspiration. To better evaluate potential supraglottic injury resulting from LPR, a supraglottic index (SGI) was developed and used to give objective, applicable, and reproducible data for use in patients with asthma. 6 To R efractory 1 or severe asthma has a high associated morbidity and economic cost. 2,3 Even with asthma guideline therapy, 4 up to 50% of patients have asthma that is not well controlled or is refractory to treatment. 5 Fiber-optic bronchoscopy has been shown to be useful in evaluating both the upper and lower airBackground: Patients with refractory asthma frequently have elements of laryngopharyngeal refl ux (LPR) with potential aspiration contributing to their poor control. We previously reported on a supraglottic index (SGI) scoring system that helps in the evaluation of LPR with potential aspiration. However, to further the usefulness of this SGI scoring system for bronchoscopists, a teaching system was developed that included both interobserver and intraobserver reproducibility. Methods: Five pulmonologists with expertise in fi ber-optic bronchoscopy but novice to the SGI participated. A training system was developed that could be used via Internet interaction to make this learning technique widely available. Results: By the fi nal testing, there was excellent interreader agreement ( k of at least 0.81), thus documenting reproducibility in scoring the SGI. For the measure of intrareader consistency, one reader was arbitrarily selected to rescore the fi nal test 4 weeks later and had a k value of 0.93, with a 95% CI of 0.79 to 1.00. Conclusions: In this study, we demonstrate that with an organized educational approach, bronchoscopists can develop skills to have highly reproducible assessment and scoring of supraglottic abnormalities. The SGI can be used to determine which patients need additional intervention to determine causes of LPR and gastroesophageal refl ux. Identifi cation of this problem in patients with refractory asthma allows for personal, individual directed therapy to improve asthma control. CHEST 2014; 145(3):486-491Abbreviations: GER 5 gastroesophageal refl ux; LPR 5 laryngopharyngeal refl ux; RFS 5 refl ux fi nding score; SGI 5 supraglottic index

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“…Eventually, the inflammation can lead to bronchiectasis characterized by permanent dilation of the airway and thickening of the bronchial wall. Because of these changes, areas like this can function as a seedbed for future infections (Bilton, 2008;Ilowite et al, 2008;Javidan-Nejad & Bhalla, 2009;King, 2009;Goeminne & Dupont, 2010). Recurring infections are thought to be the main reason why, in time, these patients develop a decrease in lung function.…”

Section: Clinical Aspectsmentioning

confidence: 99%

Mucociliary clearance: pathophysiological aspects

Munkholm

Mortensen

2013

Clin Physio Funct Imaging

159

129

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SummaryMucociliary clearance has long been known to be a significant innate defence mechanism against inhaled microbes and irritants. Important knowledge has been gathered regarding the anatomy and physiology of this system, and in recent years, extensive studies of the pathophysiology related to lung diseases characterized by defective mucus clearance have resulted in a variety of therapies, which might be able to enhance clearance from the lungs. In addition, ways to study in vivo mucociliary clearance in humans have been developed. This can be used as a means to assess the effect of different pharmacological interventions on clearance rate, to study the importance of defective mucus clearance in different lung diseases or as a diagnostic tool in the work‐up of patients with recurrent airway diseases. The aim of this review is to provide an overview of the anatomy, physiology, pathophysiology, and clinical aspects of mucociliary clearance and to present a clinically applicable test that can be used for in vivo assessment of mucociliary clearance in patients. In addition, the reader will be presented with a protocol for this test, which has been validated and used as a diagnostic routine tool in the work‐up of patients suspected for primary ciliary dyskinesia at Rigshospitalet, Denmark for over a decade.

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Bronchiectasis: new findings in the pathogenesis and treatment of this disease

Cited by 36 publications

References 23 publications

Safety and Efficacy of Short-Term Intrapulmonary Percussive Ventilation in Patients With Bronchiectasis

Safety and Efficacy of Short-Term Intrapulmonary Percussive Ventilation in Patients With Bronchiectasis

An Index to Objectively Score Supraglottic Abnormalities in Refractory Asthma

Mucociliary clearance: pathophysiological aspects

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