Abstract
IntroductionNon-cystic fibrosis bronchiectasis is a respiratory health condition with many possible aetiologies, some of which are potentially reversible in childhood with early diagnosis and appropriate treatment. It is important to understand factors which contribute to progression or potential resolution of bronchiectasis. It is evident that respiratory exacerbations are a key feature of bronchiectasis disease progression. In this pilot study we document how the microbiota of the upper and lower airways presents during the course of an exacerbation and treatment.MethodsWe recruited children (aged 1-15) undergoing antibiotic treatment for bronchiectasis exacerbations at Starship Children’s Hospital and outpatient clinics. Sputum and nasal swabs were taken before and after antibiotic treatment. Sample DNA was extracted, then bacterial 16S rRNA genes amplified and sequenced via Illumina MiSeq.ResultsThirty patients were recruited into this study with 81 samples contributing to the final dataset, including 8 patients with complete sets of upper and lower airway samples at both (before and after antibiotics) timepoints. Changes in alpha-diversity over the course of an exacerbation and treatment were non-significant. However, sample composition did alter over the course of an exacerbation, with most notably a reduction in the relative abundance of amplicon sequence variants assigned to Haemophilus.Discussion Haemophilus has been associated with more severe symptoms in respiratory infections and a reduction in its relative abundance may represent a positive shift in a patient’s microbiota. Current treatments for bronchiectasis may preserve bacterial diversity while altering microbiota composition.
Highlights
Non-cystic fibrosis bronchiectasis is a respiratory health condition with many possible aetiologies, some of which are potentially reversible in childhood with early diagnosis and appropriate treatment
Exacerbations drive a vicious cycle of disease progression whereby each exacerbation makes future episodes both more likely and more severe (Cole., 1986) it is unclear what causes exacerbations, microbes may play a role via proliferation of pathogens increasing airway inflammation (Amati et al, 2019)
All included patients were given some form of antibiotic treatment, with 36% receiving oral antibiotics and 64% intravenous antibiotics for a median of 14 days. 16S rRNA gene sequence data were successfully obtained from 81 samples: this included 8 patients with complete sets of 4 samples, as well as upper/lower airway pairs and before/after treatment pairs
Summary
Non-cystic fibrosis bronchiectasis is a respiratory health condition with many possible aetiologies, some of which are potentially reversible in childhood with early diagnosis and appropriate treatment. Bronchiectasis had a reported incidence of 13.2 per 100,000 New Zealanders in 2017, some 3.5 times greater than that reported in 2002, with hospitalisations increasing by 49% in a similar timeframe (Twiss et al, 2005; Barnard and Zhang, 2018). This disease is common within disadvantaged communities and associated with environmental factors such as overcrowding (Singleton et al, 2014). Exacerbations drive a vicious cycle of disease progression whereby each exacerbation makes future episodes both more likely and more severe (Cole., 1986) it is unclear what causes exacerbations, microbes may play a role via proliferation of pathogens increasing airway inflammation (Amati et al, 2019)
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