Predictors of mortality in hospitalized patients with acute exacerbation of bronchiectasis

Finklea, James D.; Khan, Gul; Thomas, Sheree; Song, Juhee; Myers, Dennis; Arroliga, Alejandro C.

doi:10.1016/j.rmed.2009.11.021

Cited by 51 publications

(49 citation statements)

References 28 publications

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“…Thirty [5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34] of the thirty-six reported series [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39] are smaller than ours. Half of them were retrospective.…”

Section: Discussionmentioning

confidence: 99%

Phenotyping Adults with Non-Cystic Fibrosis Bronchiectasis: A 10-Year Cohort Study in a French Regional University Hospital Center

et al. 2016

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Background: Data concerning phenotypes in bronchiectasis are scarce. Objective: The aim of this study was to describe the clinical, functional and microbiological phenotypes of patients with bronchiectasis. Methods: A monocentric retrospective study in a university hospital in France was conducted over 10 years (2002-2012). Non-cystic fibrosis patients with tomographic confirmation of bronchiectasis were included. The clinical, functional and microbiological data of patients were analyzed relying on the underlying etiology. Results: Of the311 included patients, an etiology was found for 245 of them. At the time of diagnosis, the median age was 61 years and the mean FEV₁ was 63% of predicted. The main causes of bronchiectasis were post-infectious (50%, mostly related to tuberculosis), chronic obstructive pulmonary disease (COPD; 13%) and idiopathic (11%). Other causes were immune deficiency (6%), asthma (4%), autoimmunity (3%), tumor (2%) and other causes (4%). The comparison of phenotypic traits shows significant differences between COPD, congenital and idiopathic groups in term of sex (p = 0.0175), tobacco status (p < 0.0001), FEV₁ (p = 0.0412) and age at diagnosis (p < 0.001), Pseudomonas aeruginosa (PA) colonization (p = 0.0276) and lobectomy (0.0093). Functional follow-up was available in 30% of patients with a median duration of 2.7 years. Presence of PA was associated with a lower median FEV₁ at diagnosis (43% p < 0.003) but not with a faster rate of decline in FEV₁. Conclusion: Distinctive clinical, functional and microbiological features were found for idiopathic, congenital and COPD-related bronchiectasis. A prospective follow-up of these subgroups is necessary to validate their relevance in the management of bacterial colonization and specific complications of these bronchiectases.

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Section: Discussionmentioning

confidence: 99%

Phenotyping Adults with Non-Cystic Fibrosis Bronchiectasis: A 10-Year Cohort Study in a French Regional University Hospital Center

et al. 2016

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“…Clinical symptoms, history of exacerbations and microbiological data are frequently used to stratify the severity of patients with NCFB; however, the incorporation of imaging abnormalities into these classifications may allow for a more complete picture of the impact of the disease 52, 53. Therefore, there is great interest in the evaluation of the extent and severity of bronchiectasis more objectively using CT.…”

Section: Diagnostic Approachmentioning

confidence: 99%

Suspecting non-cystic fibrosis bronchiectasis: What the busy primary care clinician needs to know

et al. 2017

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SummaryAimsNon‐cystic fibrosis bronchiectasis (NCFB) is a chronic, progressive respiratory disorder characterised by irreversibly and abnormally dilated airways, persistent cough, excessive sputum production and recurrent pulmonary infections. In the last several decades, its prevalence has increased, making it likely to be encountered in the primary care setting. The aim was to review the clinical presentation and diagnosis of NCFB, with an emphasis on the role of computed tomography (CT).MethodsFor this review, trials and reports were identified from PubMed/Medline and ClinicalTrials.gov from the US NIH and the Cochrane Register of Controlled Trials. The search used keywords: bronchiectasis, non‐cystic fibrosis bronchiectasis, chronic pulmonary infection and computed tomography. No date/language restrictions were used.ResultsNon‐cystic fibrosis bronchiectasis often coexists with other respiratory conditions, such as chronic obstructive pulmonary disease. The prevalence of NCFB is increasing, particularly in women and older individuals, possibly as a result of increased physician awareness and widespread use of CT, which is the gold standard for the diagnosis of NCFB. CT can assist in identifying an underlying cause of NCFB and determining the extent and severity of the disease.DiscussionNon‐cystic fibrosis bronchiectasis should be suspected in the primary care setting in patients with chronic cough, purulent sputum and frequent respiratory infections that tend to resolve slowly or partially. Early diagnosis and determination of the extent and severity of the disease by CT and other tests are critical to establish therapy to improve quality of life and potentially slow progressive decline of lung function in patients with NCFB .

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“…Smoking is destructive to the integrity of the already damaged airway walls, and an independent risk factor for mortality. 29,30 All patients should be advised to stop smoking. Limiting infective insults to the airways through prompt management of exacerbations is important and patients should be educated to recognise any deterioration in their symptoms and know to seek help.…”

Section: Educationmentioning

confidence: 99%

CME: Non-cystic fibrosis bronchiectasis

2011

J R Coll Physicians Edinb

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Bronchiectasis is a chronic debilitating condition. Pathologically, a vicious cycle of infection and inflammation exists in the permanently damaged airways with patients suffering a persistent cough, chronic daily sputum production and recurrent chest infections. Once termed an 'orphan disease', the prevalence of bronchiectasis has become increasingly recognised over the past few decades. The associated burden of disease in terms of respiratory morbidity, effect on patients' healthrelated quality of life and the economic cost of long term management is significant and it has become apparent that more research into its causes and management is urgently needed. This article reviews what is currently known about bronchiectasis, its pathophysiology, aetiology and management strategies.

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Predictors of mortality in hospitalized patients with acute exacerbation of bronchiectasis

Abstract: Male gender, elevated creatinine, decreased FEV(1.0)% predicted, mechanical ventilation, history of smoking, and acute use of systemic steroids during the hospitalization were associated with an increased risk of mortality.

Cited by 51 publications

References 28 publications

Phenotyping Adults with Non-Cystic Fibrosis Bronchiectasis: A 10-Year Cohort Study in a French Regional University Hospital Center

Phenotyping Adults with Non-Cystic Fibrosis Bronchiectasis: A 10-Year Cohort Study in a French Regional University Hospital Center

Suspecting non-cystic fibrosis bronchiectasis: What the busy primary care clinician needs to know

CME: Non-cystic fibrosis bronchiectasis

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