Non-cystic fibrosis bronchiectasis in the elderly: current perspectives

Quinn, Tom; Hill, Adam T.

doi:10.2147/cia.s143139

Cited by 10 publications

(7 citation statements)

References 53 publications

(66 reference statements)

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“…Moreover, the distribution of pulmonary structural changes associated with ageing that we find in our cohort is very similar to what is reported in other cohorts with different genetic backgrounds, living at sea level, and in less polluted areas. Thus, for example, we have found the presence of interstitial lung abnormalities, bronchiectasis, loss of elasticity of the peripheral airways and air-trapping equivalent to that published in other populations [34][35][36][37].…”

Section: Discussionsupporting

confidence: 83%

Determination of the phenotypic age in residents of Mexico City: effect of accelerated ageing on lung function and structure

et al. 2020

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IntroductionPhenotypic age better represents age-related biological dysregulation than chronological age. Recently, a multisystem-based ageing measure, which integrates chronological age and nine biomarkers, was proposed.MethodsPhenotypic age was determined in 774 residents of Mexico City over 60 years old and without respiratory problems. We arbitrarily classified as “accelerated” ageing, those showing >4 years compared with their chronological age, and “slowed” ageing, those with <4 years compared with chronological age. Demographic risk factors were analysed with structured questionnaires. Lung structure was evaluated by high-resolution computed tomography and functional competence was analysed by forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), diffusion capacity of carbon monoxide (DLCO), and the 6-minute walk test (6MWT).ResultsOverall, 13% of this cohort showed accelerated ageing, which was corroborated with four independent biomarkers of ageing, 42% had normal ageing and 46% had slowed ageing. Risk factors associated with accelerated ageing were male sex (OR 4.4, 95% CI 2.4–7.9; p<0.01), diabetes mellitus (OR 9.7, 95% CI 5.5–17.2; p<0.01), and long-term sleep duration (OR 2.9 95% CI 1.34–6.35, p<0.01). Among smokers, there was a slight but significant association with the number of pack-years. Subjects with accelerated ageing showed decreased FVC (p<0.0001), FEV1 (p<0.0001), DLCO (p<0.02) and walking distance in the 6MWT (p=0.0001). Slowed-ageing subjects presented less frequently with emphysematous lesions compared with those with accelerated ageing.ConclusionsA small but significant proportion of residents of Mexico City age rapidly, which is associated with male sex, diabetes, and long-term sleep duration. They exhibit lower levels of lung function and develop emphysema more frequently.

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Section: Discussionsupporting

confidence: 83%

Determination of the phenotypic age in residents of Mexico City: effect of accelerated ageing on lung function and structure

et al. 2020

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“…First of all, both primary and secondary immunoglobulin deficiency (in particular IgG deficiency) should be tested because it can be associated with bronchiectasis and the frequency of infections can often be reduced by immunoglobulin replacement therapy. All patients should undergo testing for allergic bronchopulmonary aspergillosis(ABPA), depending on radiological features (temporary infiltrates are seen initially and it can eventually lead to proximal bronchiectasis) and tests to confirm aspergillus hypersensitivity (raised peripheral blood eosinophils, total IgE, Aspergillus specific IgE or positive skin test with or without aspergillus precipitins) (26).…”

Section: Investigationsmentioning

confidence: 99%

“…Comorbidities are more likely in the elderly and clinical suspicion will warrant relevant screening such as ANCA, anti-CCP, fecal calprotectin etc. Bronchiectasis associated with a connective disease such as rheumatoid arthritis is often more aggressive and carries a worse prognosis (26). In addition, several other pathologies may occur at any stage of bronchiectasis and are likely major contributors to increased hospitalisations, healthcare utilisation and socioeconomic costs (27).These include COPD, cardiovascular disorders, gastroesophageal reflux disease (GERD), psychological illnesses, pulmonary hypertension, obstructive apnea syndrome(OSA), cognitive impairment, lung, oesophageal and hematological malignancies (20,(28)(29).…”

Section: Comorbiditiesmentioning

confidence: 99%

Non Cystic Fibrosis Bronchiectasis-new clinical approach, management of treatment and pulmonary rehabilitation

Maierean

Alexescu

Motoc

et al. 2019

BALNEO

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Non-Cystic Fibrosis Bronchiectasis (NCFB) are characterised by abnormal, permanently damaged and dilated bronchi due to the innapropiate clearence of various microorganisms and recurrent chronic infections.The diagnosis is suggested by the clinical presentation and is confirmed by multiple investigations. There are some comorbidities associated with bronhciectasis, such as chronic obstructive pulmonary disease (COPD), cardiovascular disorders, gastro-esophageal reflux disease (GERD), psychological illnesses, pulmonary hypertension, obstructive apnea syndrome(OSA). The condition has a substantial socioeconomic impact because it requests a multidisciplinary management and periods of exacerbations are common. The aims of the management of bronchiectasis are to reduce symptoms (such as sputum volume and purulence, cough and dyspnea), reduce the frequency and severity of exacerbations, preserve lung function and improve health-related quality of life. The multidisciplinary approach of bronchiectasis patients require along with the medical treatment, a specific plan of nonphamarcological strategies, including balneological intervention. There are a lot of techniques improving the airway clearence, such as: active cycle of breathing techniques (which include breathing control, thoracic expansion exercises, forced expiratory technique), oscilatting possitive expiratory pressure, autogenic drainage, gravity-assisted-positioning, modified postural drainage. Together with specific medication, these techniques can diminuate symptoms and improve the quality of life. Key words: NCFB, airway clearence, physiotherapy,

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“…Patients usually suffer from a persistent cough, chronic daily sputum expectoration, recurrent chest infections and poor health-related quality of life (HRQoL) [1,2]. Current estimates suggest around 5 in 1000 people in the UK have BE [3,4] with higher numbers of patients being diagnosed with BE due to increased use of high-resolution computed tomography (HRCT) [5]. Mortality in the 52 weeks after a BErelated exacerbation is as high as 30% [6].…”

Section: Background Informationmentioning

confidence: 99%

A 2x2 factorial, randomised, open-label trial to determine the clinical and cost- effectiveness of hypertonic saline (HTS 6%) and carbocisteine for airway clearance versus usual care over 52 weeks in adults with bronchiectasis: A protocol for the CLEAR clinical trial

Bradley

Anand

O’Neill

et al. 2019

Preprint

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Background Current guidelines for the management of bronchiectasis (BE) highlight the lack of evidence to recommend mucoactive agents, such as hypertonic saline (HTS) and carbocisteine, to aid sputum-removal as part of standard care. We hypothesise that mucoactive agents (HTS or cabocisteine, or a combination) are effective in reducing exacerbations over a 52-week period, compared to usual care. Methods A 52-week, 2x2 factorial randomised open label trial to determine the clinical and cost-effectiveness of HTS 6% and carbocisteine for airway clearance versus usual care: CLEAR (clinical and cost-effectiveness of hypertonic saline (HTS 6%) and carbocisteine for airway clearance versus usual care). Patients will be randomised to either (i) Standard care and twice daily nebulised HTS (6%), (ii) Standard care and carbocisteine (750mg three times per day until visit 3 reducing to 750mg twice per day), (iii) Standard care and combination of twice-daily nebulised HTS and carbocisteine, or (iv) Standard care. The primary outcome is the mean number of exacerbations over 52 weeks. Key inclusion criteria: adults with a diagnosis of BE on computed tomography scans, BE as the primary respiratory diagnosis, two or more pulmonary exacerbations in the last year requiring antibiotics and production of daily sputum. Discussion This trial’s pragmatic research design avoids the significant costs associated with double-blind trials whilst optimising rigor in other areas of trial-delivery. CLEAR will provide evidence as to whether HTS, carbocisteine or both are effective and cost-effective for BE patients.

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Non-cystic fibrosis bronchiectasis in the elderly: current perspectives

Cited by 10 publications

References 53 publications

Determination of the phenotypic age in residents of Mexico City: effect of accelerated ageing on lung function and structure

Determination of the phenotypic age in residents of Mexico City: effect of accelerated ageing on lung function and structure

Non Cystic Fibrosis Bronchiectasis-new clinical approach, management of treatment and pulmonary rehabilitation

A 2x2 factorial, randomised, open-label trial to determine the clinical and cost- effectiveness of hypertonic saline (HTS 6%) and carbocisteine for airway clearance versus usual care over 52 weeks in adults with bronchiectasis: A protocol for the CLEAR clinical trial

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