Inhaled steroids improve quality of life in patients with steady-state bronchiectasis

Martínez‐García, Miguel Ángel; Perpiñá-Tordera, Miguel; Román-Sánchez, Pilar; Soler-Cataluña, Juan José

doi:10.1016/j.rmed.2005.12.002

Cited by 92 publications

(73 citation statements)

References 25 publications

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“…However, patients receiving inhaled corticosteroids (41.4%) were included. Inhaled corticosteroids over 4 weeks have been shown to reduce sputum inflammatory indices but long-term studies have not shown them to affect sputum purulence or microbiological profile [19][20][21]. Our study did not observe any association between purulence and systemic inflammation but we did not use a highly sensitive CRP assay (,10 mg?L -1 was considered normal).…”

Section: Discussionmentioning

confidence: 54%

Sputum colour: a useful clinical tool in non-cystic fibrosis bronchiectasis

Murray¹,

Pentland²,

Turnbull³

et al. 2009

Eur Respir J

108

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This study explored the utility of sputum colour in clinically stable patients with bronchiectasis.Interpretation of sputum colour between the doctor and the patient was reliable (intraclass correlation coefficient 0.83 (95% confidence interval 0.76-0.89). Sputum colour predicted bacterial colonisation (5% in mucoid sputum; 43.5% in mucopurulent sputum; 86.4% in purulent sputum; p,0.0001). On multivariate logistic regression analysis, independent factors associated with purulent sputum were bacterial colonisation, varicose or cystic bronchiectasis, forced expiratory volume in 1 s ,80% predicted and diagnosis of bronchiectasis aged ,45 yrs.

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Section: Discussionmentioning

confidence: 54%

Sputum colour: a useful clinical tool in non-cystic fibrosis bronchiectasis

Murray¹,

Pentland²,

Turnbull³

et al. 2009

Eur Respir J

108

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“…A number of parameters such as lung function, systemic inflammatory response, QoL, bacteriology, and sputum cellular and soluble markers of infection were studied. Several studies have examined stable bronchiectasis, 7,9,20,[25][26][27][28] but the only other previous published study examining exacerbations of bronchiectasis was by Watt, et al, 21 using the same group of patients as our study comparing levels of neutrophil apoptosis and necrosis and inflammatory mediators before and after intravenous antibiotics. Patients presenting with acute pulmonary exacerbations were studied at the beginning and end of exacerbations and 4 weeks after completion of intravenous antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Quality of life and inflammation in exacerbations of bronchiectasis

Courtney

Kelly²,

Watt³

et al. 2008

Chron Respir Dis

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Patients with bronchiectasis often have impaired quality of life (QoL), which deteriorates with exacerbations. The aim of this study was to investigate changes in QoL and how these were influenced by changes in airway physiology and inflammation in patients with bronchiectasis before and after resolution of an exacerbation. Sputum induction and a QoL questionnaire were undertaken on the first day, day 14, and 4 weeks after completion of intravenous antibiotics (day 42). Eighteen patients (12 female) were recruited, median (IQ range) age of 54 (47-60) years. There was a trend towards an improvement in lung function from visit 1 to visit 2, but this was not statistically significant. C-reactive protein (CRP) [mean (SEM)] reduced between visit 1 and visit 2 [55.4 (21.5) vs 9.4 (3.1) mg/L, P = 0.03] but did not increase significantly on visit 3 [44.4 (32.9) mg/L, P = 0.27]. The median (interquartile range) sputum cell count (x10(6) cells/g of sputum) decreased from visit 1 to visit 2 [21.6 (11.8-37.6)-13.3 (6.7-22.9) x 10(6) cells/g, respectively, P = 0.008] and increased from visit 2 to visit 3 [26.3 (14.1-33.6) x 10(6) cells/g, P = 0.03]. All soluble markers of inflammation significantly reduced from visit 1 to visit 2 but increased on visit 3 with the exception of TNF-alpha. Regarding QoL, three of the four domains (dyspnoea, emotional, mastery) significantly improved from visit 1 to visit 2 but did not change between visit 2 and visit 3. The improvements in QoL scores could not be explained by the improvements in lung function or inflammatory markers.

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“…They have an established role in asthma and COPD, and are used in patients with bronchiectasis complicating these two disorders [68]. Some studies have shown that regular high-dose inhaled steroids reduce 24-h sputum volume, reduce inflammatory markers in sputum and improve quality of life [69]. However, they have not shown any significant improvement in lung function, or exacerbation frequency.…”

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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Inhaled steroids improve quality of life in patients with steady-state bronchiectasis

Abstract: Inhalatory FP 500 microg bid is effective from the first month of treatment for controlling the symptoms of patients with steady-state bronchiectasis-thus ensuring a significant improvement in HRQoL.

Cited by 92 publications

References 25 publications

Sputum colour: a useful clinical tool in non-cystic fibrosis bronchiectasis

Sputum colour: a useful clinical tool in non-cystic fibrosis bronchiectasis

Quality of life and inflammation in exacerbations of bronchiectasis

Management of bronchiectasis in adults

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