Asthma-Like Features and Anti-Asthmatic Drug Prescription in Children with Non-CF Bronchiectasis.

Konstantinos Douros,Spyridon Prountzos,Dafni Moriki,Efthymia Alexopoulou,Angeliki Galani,Olympia Sardeli,Kostas N Priftis

doi:10.3390/jcm9124009

Konstantinos Douros, Spyridon Prountzos + Show 5 more

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https://doi.org/10.3390/jcm9124009

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Abstract

Bronchiectasis and asthma may share some characteristics and some patients may have both conditions. The present study aimed to examine the rationale of prophylactic inhaled corticosteroids (ICS) prescription in children with bronchiectasis. Data of children with radiologically established bronchiectasis were retrospectively reviewed. Episodes of dyspnea and wheezing, spirometric indices, total serum IgE, blood eosinophil counts, sensitization to aeroallergens, and air-trapping on expiratory CT scans, were recorded. The study included 65 children 1.5–16 years old, with non-CF bronchiectasis. Episodes of dyspnea or wheezing were reported by 22 (33.8%) and 23 (35.4%), respectively. Skin prick tests to aeroallergens (SPTs) were positive in 15 (23.0%) patients. Mosaic pattern on CT scans was observed in 37 (56.9%) patients. Dyspnea, presence of mosaic pattern, positive reversibility test, and positive SPTs were significantly correlated with the prescription of ICS. The prescription of ICS in children with bronchiectasis is more likely when there are certain asthma-like characteristics. The difficulty to set the diagnosis of real asthma in cases of bronchiectasis may justify the decision of clinicians to start an empirical trial with ICS in certain cases.

Highlights

Bronchiectasis is a complex and progressive respiratory disorder, characterized by chronic infection, inflammation, and abnormal dilatation of the bronchi
Sixty-five children 1.5–16 years old, were diagnosed with non-cystic fibrosis (CF) bronchiectasis; 46 (70.7%) of them had been referred as cases of difficult asthma
Presence of mosaic pattern, positive Skin prick tests to aeroallergens (SPTs), and positive bronchodilator response (BDR) test were significantly correlated with the prescription of inhaled corticosteroids (ICS) (Table 1)

Summary

Introduction

Bronchiectasis is a complex and progressive respiratory disorder, characterized by chronic infection, inflammation, and abnormal dilatation of the bronchi. Apart from cough, may develop wheeze and asthma symptoms. With reported rates ranging from 11 to 46% [2,3], it is not always clear if this is a consequence of coexistent asthma, or is a direct result of bronchiectasis. Dyspnea is a subjective feeling of the patient [4] and wheezing can be confused with other respiratory sounds especially when its presence is reported by patients or parents [5]. There is no doubt that asthma and bronchiectasis do coexist in some patients, and despite the absence of clear information on a mechanism linking the two conditions, the apparent implication of their overlap is a more severe disease with more frequent exacerbations [6]

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