Interventions for bronchiectasis: an overview of Cochrane systematic reviews

Abstract

BackgroundBronchiectasis is a chronic respiratory disease characterised by abnormal dilatation of the bronchi, and presents typically with a chronic productive cough (or chronic wet cough in children) and recurrent infective exacerbations. It significantly impacts daily activities and quality of life, and can lead to recurrent hospitalisations, severe lung function impairment, respiratory failure and even death. ObjectivesTo provide an overview of the efficacy and safety of interventions for adults and children with bronchiectasis from Cochrane reviews.To identify gaps in the evidence base that will inform recommendations for new research and reviews, and to summarise information on reported outcomes and make recommendations for the reporting of standard outcomes in future trials and reviews. MethodsWe included Cochrane reviews of non-cystic fibrosis (CF) bronchiectasis. We searched the Cochrane Database of Systematic Reviews. The search is current to 11 February 2015. We also identified trials that were potentially eligible for, but not currently included in, published reviews to make recommendations for new Cochrane reviews. We assessed the quality of included reviews using the AMSTAR criteria. We presented an evidence synthesis of data from reviews alongside an evidence map of clinical trials and guideline data. The primary outcomes were exacerbations, lung function and quality of life. Main resultsWe included 21 reviews but extracted data from, and rated the quality of, only nine reviews that reported results for people with bronchiectasis alone. Of the reviews with no usable data, two reviews included studies with mixed clinical populations where data were not reported separately for people with bronchiectasis and 10 reviews did not contain any trials. Of the 40 studies included across the nine reviews, three (number of participants nine to 34) included children. The studies ranged from single session to year-long studies. Each review included from one to 11 trials and 28 (70%) trials in the overview included 40 or fewer participants. The total number of participants included in reviews ranged from 40 to 1040. The age range of adult participants was from 36 to 73 years and children Interventions for bronchiectasis: an overview of Cochrane systematic reviews (Review) ranged from six to 16 years. The proportion of male participants ranged from 21% to 72%. Where reported, mean baseline forced expiratory volume in one second (FEV 1 ) ranged from 1.17 L to 1.66 L and from 47% to 88% predicted. Most of the reviews had search dates older than two years.We have summarised the published evidence as outlined in Cochrane reviews, but it was not possible to draw definitive conclusions. There was inconclusive evidence on the use of long-term antibiotics and nebulised hypertonic saline for reducing exacerbation frequency and evidence that human deoxyribonuclease (RhDNase) increases exacerbation frequency. Improvements in lung function were reported for inhaled corticosteroids (ICS) though this was small and not clinically...

Bronchiectasis and Chronic Suppurative Lung Disease

“…196 An umbrella Cochrane review on the interventions for bronchiectasis has been published. 197 density of known bacterial pathogens in sputum. The single prospective study in children that evaluated the point prevalence of viruses associated with exacerbations reported that respiratory viruses were detected during 37 of 77 (48%) exacerbations.…”

“…104 In adults, high doses of bromhexine (not available in some countries) used with antibiotics eased difficulty in expectoration and reduced sputum production. 197 Recombinant deoxyribonuclease (rhDNAse) is efficacious in CF but is contraindicated in non-CF bronchiectasis. In a double-blind, RCT, multicenter study for 24-weeks in 349 adults with bronchiectasis, those given rhDNAse had higher exacerbation and hospitalization rates and more rapid pulmonary decline (decrease in FEV 1 3.6% in rhDNase group; 1.6% in placebo group).…”

“…Short-and long-acting β-2 agonists also have an indeterminate role in the management of bronchiectasis, 197 and their use must be individualized. Although the presence of asthma is associated with advanced bronchiectasis and a worse prognosis, treatment of asthma to alter long-term outcomes has not been studied.…”

Dornase alfa during lower respiratory tract infection post-lung transplantation: a randomized controlled trial

“…There have been reports of atelectasis and sputum plugging resolution in acute, non-CF adults, and pediatrics [14][15][16][17]; however, robust trials in pediatric bronchiolitis and tracheomalacia [18,19], as well as mechanically ventilated adults [20][21][22][23][24] report no benefit. Dornase alfa may also be detrimental, negatively affecting lung function and exacerbations in non-CF bronchiectasis [22,25,26]. Prospective safety and efficacy of dornase alfa following LTx has not been studied.…”

PESQUISA EM SAÚDE:experiências do centro de saúde escola do Marco

“…A bronquiectasia é uma doença pulmonar estrutural crônica caracterizada pela dilatação anormal, permanente e irreversível dos brônquios, decorrente da destruição dos seus componentes elásticos e musculares (MENÉNDEZ et al, 2017;LOPES et al, 2015). Clinicamente, a bronquiectasia se manifesta por tosse crônica produtiva, déficit no transporte mucociliar e frequentes exacerbações infecciosas (WEYCKER et al, 2017;, repercutindo em hospitalizações recorrentes e comprometimento da função pulmonar, o que afeta as atividades diárias e a qualidade de vida (WELSH et al, 2015).…”