Inhaled corticosteroids for bronchiectasis

Kapur, Nitin; Petsky, Helen; Bell, Scott C.; Kolbe, John; Chang, Anne B.

doi:10.1002/14651858.cd000996.pub3

Cited by 31 publications

(43 citation statements)

References 71 publications

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“…A recent Cochrane review included seven studies with 380 adults describing no significant differences from baseline in FEV 1 , average exacerbation frequency or QoL when used for 6 months or less. 64 A single study similarly showed no significant difference in FEV 1 or other clinical parameters after 12 months. One trial in 40 adults used high-dose inhaled budesonide for 3 months and then randomized to 3 months continued high-dose budesonide or medium-dose budesonide with a longacting beta-agonist.…”

Section: Who Should Receive Macrolides and Which One For How Long?mentioning

confidence: 92%

“…There is an overlap of patients with asthma, COPD and bronchiectasis but with airway inflammation present in all and many having asthma‐like symptoms, inhaled corticosteroids may be potentially useful in all. A recent Cochrane review included seven studies with 380 adults describing no significant differences from baseline in FEV 1 , average exacerbation frequency or QoL when used for 6 months or less . A single study similarly showed no significant difference in FEV 1 or other clinical parameters after 12 months.…”

Section: Long‐term Treatments Of Bronchiectasismentioning

confidence: 99%

“…In patients admitted to hospital with an exacerbation of bronchiectasis, the use of systemic steroids was associated with a threefold increased risk of mortality . A recent review determined no studies on the use of inhaled corticosteroids with acute exacerbations . However, a small study in children looked at withdrawing inhaled corticosteroids over 12 weeks resulting in increased bronchial hyper‐reactivity and a decrease in neutrophil apoptosis but no change in sputum inflammatory markers .…”

Section: Definition and Treatment Of Exacerbations In Bronchiectasismentioning

confidence: 99%

“…63 A recent review determined no studies on the use of inhaled corticosteroids with acute exacerbations. 64 However, a small study in children looked at withdrawing inhaled corticosteroids over 12 weeks resulting in increased bronchial hyper-reactivity and a decrease in neutrophil apoptosis but no change in sputum inflammatory markers. 65 In adults, inhaled corticosteroids did improve HRQoL and reduce symptoms in those in 'steady-state' bronchiectasis.…”

Section: Corticosteroidsmentioning

confidence: 99%

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Bronchiectasis: Treatment decisions for pulmonary exacerbations and their prevention

2018

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Interest in bronchiectasis has increased over the past two decades, as shown by the establishment of disease-specific registries in several countries, the publication of management guidelines and a growing number of clinical trials to address evidence gaps for treatment decisions. This review considers the evidence for defining and treating pulmonary exacerbations, the approaches for eradication of newly identified airway pathogens and the methods to prevent exacerbations through long-term treatments from a pragmatic practice-based perspective. Areas for future studies are also explored. Watch the video abstract.

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Section: Who Should Receive Macrolides and Which One For How Long?mentioning

confidence: 92%

Section: Long‐term Treatments Of Bronchiectasismentioning

confidence: 99%

Section: Definition and Treatment Of Exacerbations In Bronchiectasismentioning

confidence: 99%

Section: Corticosteroidsmentioning

confidence: 99%

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Bronchiectasis: Treatment decisions for pulmonary exacerbations and their prevention

2018

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“…376 Recently, the role of ICS alone for preventing exacerbations was reviewed using the same Cochrane methodology. 377 It concluded that there is insufficient evidence to support the routine use of ICS in adults with stable state bronchiectasis.…”

mentioning

confidence: 99%

Advancing the knowledge, understanding and management of respiratory exacerbations of bronchiectasis in children

Goyal¹

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IntroductionBronchiectasis unrelated to cystic fibrosis (CF) remains an under-researched area and is often labelled a "neglected disease". Yet, worldwide it is more common than CF and causes substantial morbidity and mortality in both children and adults.To reduce morbidity and premature mortality from bronchiectasis in adults, interventions should begin in childhood. Diagnosing bronchiectasis early and providing effective treatment, including treating exacerbations, can prevent significant morbidity. Although the importance of recognising and treating exacerbations effectively is well-accepted, there have been no prior randomised trials for managing exacerbations of bronchiectasis in children. The studies in my PhD address several important clinical and research gaps relating to children with bronchiectasis, including its early identification and antibiotic treatment of exacerbations. AimsThe overarching aim of my thesis is to improve knowledge of bronchiectasis, the pre-bronchiectasis state and management of bronchiectasis exacerbations in children.The specific main objectives were to: 1. Identify whether children with a poor response to at least 4-weeks of oral antibiotics predict an increased risk of finding bronchiectasis on a multi-detector computed-tomography (MDCT) scan of the chest. 2. Describe the clinical characteristics, investigations and treatment outcomes for children with chronic suppurative lung disease (CSLD) without radiographic evidence of bronchiectasis. 3. Determine in children with bronchiectasis the effect of oral azithromycin and oral amoxicillinclavulanate (each compared to placebo) on symptom resolution after 14-days treatment of nonsevere (non-hospitalised) acute respiratory exacerbations. 4. Asses in children with bronchiectasis whether oral azithromycin was non-inferior (within a 20% margin) to oral amoxicillin-clavulanate at achieving symptom resolution after 21-days treatment of non-severe (non-hospitalised) acute respiratory exacerbations. iv Vikas Goyal -August 2019 5. Estimate the cost of hospitalised bronchiectasis exacerbations. 6. Undertake a systematic review using Cochrane methodology to assess the effects of inhaled longacting beta-2-agonists (LABA) combined with inhaled corticosteroids (ICS) in children and adults with bronchiectasis during (a) acute exacerbations and (b) stable state.An overview of the major findings for each objective is detailed below:Objective-1 was addressed by studying 144 children undergoing chest CT scans for a chronic wet cough.Among the 105 children with persistent cough despite at least 4-weeks of antibiotics, 88 (83.8%) had bronchiectasis. In contrast, of the 24 children whose cough resolved after 4-weeks of antibiotics, only six (25.0%) received this diagnosis (adjusted OR 20.9; 95%CI 5.36 to 81.8). 1 The study addressing objective-2 is the first to describe children with CSLD. These 22 children lacked features of bronchiectasis on CT scans but had a wet cough unresponsive to oral antibiotics, which resolved with intravenous antibiotics an...

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Gastrointestinal factors associated with risk of bronchiectasis in children

Duncan

Cohen

Golden

et al. 2022

Pediatric Pulmonology

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Objective To evaluate gastrointestinal (GI) risk factors for bronchiectasis in children. We hypothesized that upper GI tract dysmotility would be associated with increased risk of bronchiectasis. Study design Subjects in this retrospective cohort study included those evaluated for persistent pulmonary symptoms in the Aerodigestive Center at Boston Children's Hospital who underwent chest computed tomography (CT) between 2002 and 2019. To determine gastrointestinal predictors of bronchiectasis, baseline characteristics, comorbidities, enteral tube status, medications received, gastroesophageal reflux burden, adequacy of swallow function, esophageal dysmotility, gastric dysmotility, and neutrophil count on bronchoalveolar lavage (BAL) were compared between patients with and without bronchiectasis. Proportions were compared with Fisher's exact test and binary logistic regression with stepwise selection was used for multivariate analysis. ROC analyses were utilized to compare BAL neutrophils and bronchiectasis. Results Of 192 subjects, 24% were found to have evidence of bronchiectasis on chest CT at age 7.9 ± 0.5 years. Enteral tubes (OR 5.77, 95% CI 2.25–14.83, p < 0.001) and increased BAL neutrophil count (OR 5.79, 95% CI 1.87–17.94, p = 0.002) were associated with increased risk while neurologic comorbidities were associated with decreased risk (OR 0.24, 95% CI 0.09–0.66, p = 0.006). Gastroesophageal reflux was not found to be a significant risk factor. Neutrophil counts >10% had 72% sensitivity and 60% specificity for identifying bronchiectasis. Conclusions Enteral tubes were associated with significantly increased risk of bronchiectasis but gastroesophageal reflux was not. Providers should consider obtaining chest CT to evaluate for bronchiectasis in children found to have unexplained elevated BAL neutrophil count.

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Inhaled corticosteroids for bronchiectasis

Abstract: Editorial group: Cochrane Airways Group. Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 5, 2018.

Cited by 31 publications

References 71 publications

Bronchiectasis: Treatment decisions for pulmonary exacerbations and their prevention

Bronchiectasis: Treatment decisions for pulmonary exacerbations and their prevention

Advancing the knowledge, understanding and management of respiratory exacerbations of bronchiectasis in children

Gastrointestinal factors associated with risk of bronchiectasis in children

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