Inhaled steroids for bronchiectasis

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

doi:10.1002/14651858.cd000996.pub2

Cited by 66 publications

(57 citation statements)

References 31 publications

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“…As pointed out in a recent Cochrane review, the absence of high-quality evidence means that decisions to use or discontinue combined ICS and long-acting β-adrenoceptor agonist (LABA) in people with bronchiectasis may need to take account of the presence or absence of co-existing airway hyper-responsiveness and consideration of potential adverse events associated with combined ICS-LABA [71,72]. These adverse effects include the recently noted increase in pneumonia risk in COPD patients [73].…”

Section: Inhaled Corticosteroids and Bronchodilatorsmentioning

confidence: 99%

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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Section: Inhaled Corticosteroids and Bronchodilatorsmentioning

confidence: 99%

Management of bronchiectasis in adults

2015

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“…A 2009 review showed insufficient evidence to recommend the routine use of inhaled corticosteroids in adults with stable bronchiectasis 47. Our analysis only included 163 eligible patients for the efficacy of inhaled corticosteroids, showing no effect on exacerbations, hospitalisation or mortality.…”

Section: Discussionmentioning

confidence: 99%

Prevention of exacerbations in patients with stable non-cystic fibrosis bronchiectasis: a systematic review and meta-analysis of pharmacological and non-pharmacological therapies

Dabrh

Hill

Dobler

et al. 2018

BMJ EBM

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BackgroundSeveral pharmacological and non-pharmacological therapies are used to treat stable bronchiectasis of non-cystic fibrosis (CF) aetiology.ObjectiveWe conducted a systematic review and meta-analysis to assess the evidence of the effectiveness of pharmacological and non-pharmacological treatment options in patients with stable non-CF bronchiectasis with a focus on reducing exacerbations.Study selectionMultiple databases were searched through September 2017. Outcomes included the number of patients with exacerbation events, mean number of exacerbations, hospitalisations, mortality, quality of life measures, and safety and adverse effects. Meta-analysis was conducted using the random effects model.Findings30 randomised controlled trials enrolled subjects with non-CF bronchiectasis using different interventions. Moderate-quality evidence supported the effect of long-term antibiotics (≥3 months) on lowering the number of patients experiencing exacerbation events (relative risk 0.77 (95% CI 0.68 to 0.89)), reducing number of exacerbations (incidence rate ratio 0.62 (95% CI 0.49 to 0.78)), improving forced expiratory volume (litre) in the first second (FEV1) (weighted mean difference (WMD); 0.02 (95% CI 0.00 to 0.04)), decreasing sputum purulence scores (numerical scale of 1-8) (WMD −0.90 (95% CI −1.58 to −0.22)) and improving quality of life scores assessed by the St George’s Respiratory Questionnaire (WMD −6.07 (95% CI −10.7 to −1.43)). Bronchospasm increased with inhaled antibiotics while diarrhoea increased particularly with oral macrolide therapy.ConclusionsModerate-quality evidence supports long-term antibiotic therapy for preventing exacerbations in stable non-CF bronchiectasis. However, data about the optimum agent, mode of therapy and length of treatment are limited. There is paucity of high-quality evidence to support the management of stable non-CF bronchiectasis including prevention of exacerbations.

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“…Studies by He et al have suggested that cumulative doses of corticosteroids exceeding 350 mg are highly related to IPA occurrence in COPD patients (14,15), and some reports have even evoked a plausible role for inhaled steroids in its emergence (16)(17)(18). It has also been shown that immune dysfunction and bacterial persistence in NCFB are associated with the use of antiinflammatory agents, such as inhaled corticosteroids (19), and long-term antibiotic treatment (20,21).…”

Section: Discussionmentioning

confidence: 99%

Immunity status of invasive pulmonary aspergillosis patients with structural lung diseases in Chinese adults

Liang

Jiang

et al. 2017

J. Thorac. Dis.

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Background: Invasive pulmonary aspergillosis (IPA) is a fungal infection frequently observed in patients with immune dysfunction, such as those suffering from structural lung diseases. Nevertheless, studies assessing IPA combined with other common respiratory diseases remain scarce, particularly those regarding the immune status of its patients. Different structural lung diseases are known to differently affect patient immune status; however, the mechanisms by which this is conferred have yet to be determined. Thus, our study aims to compare the immune status of IPA patients with the structural lung diseases chronic obstructive pulmonary diseases (COPD), interstitial lung disease (ILD) and non-cystic fibrosis bronchiectasis (NCFB). IPA is well-recognized as a severe fungal lung infection, frequently observed in patients following procedures such as allogeneic bone marrow transplantation and solid organ transplantation, as well as alongside conditions including hematologic malignancies, late-stage HIV infection, and chronic granulomatosis (1-3). The disease has also grown in prevalence as a comorbidity in patients with structural lung diseases such as chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), and noncystic fibrosis bronchiectasis (NCFB)-all of which confer different immune dysfunctions to their patients.Due to the significance of immunology in fungal infection, IPA has been an area of focus for many experts. Several studies have described an increase of IPA incidence in COPD patients (3-7); however, IPA assessments in relation to other common respiratory diseases remain scarce, particularly those evaluating patient immune status. Therefore, this study aims to assess the immune status of IPA patients with COPD, ILD, and NCFB while excluding the presence of basic diseases. Methods Study design and diagnostic procedureOur study retrospectively assessed patients treated at Shanghai Pulmonary Hospital, Tongji University, between 2004 and 2013. Diagnosis of IPA was classified as proven, probable, or possible in accordance with the revised EORTC and MSG criteria (8,9). Consequently, a diagnosis of "proven IPA" was established by both (I) the presence of hyphae compatible with Aspergillus in specimens collected from a pulmonary lesion sample; and (II) isolation of Aspergillus species in cultures from any lower respiratory tract (LRT) sample, mainly sputum and bronchial secretions, including bronchial brush and bronchial alveolar lavage fluid, etc. combined with evidence of associated tissue damage or two sequential positive serum galactomannan (GM) tests.COPD diagnosis was established according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria (10). In patients with COPD, Bulpa criteria were used for IPA diagnosis (5). NCFB diagnosed routinely and confirmed through high-resolution computed tomography (HRCT) chest imaging and patient history of the syndrome (11,12). ILD diagnosis was established according to the American Thoracic Society Clinical Practice Gu...

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Inhaled steroids for bronchiectasis

Abstract: Edwards 2003 Edwards EA, Asher MI, Byrnes CA. Paediatric bronchiectasis in the twenty-first century: experience of a tertiary children's hospital in New Zealand.

Cited by 66 publications

References 31 publications

Management of bronchiectasis in adults

Management of bronchiectasis in adults

Prevention of exacerbations in patients with stable non-cystic fibrosis bronchiectasis: a systematic review and meta-analysis of pharmacological and non-pharmacological therapies

Immunity status of invasive pulmonary aspergillosis patients with structural lung diseases in Chinese adults

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