Incidence Of Bronchiectasis Research Articles

Time to re-set our thinking about airways disease: lessons from history, the resurgence of chronic bronchitis / PBB and modern concepts in microbiology.

In contrast to significant declines in deaths due to lung cancer and cardiac disease in Westernised countries, the mortality due to 'chronic obstructive pulmonary disease' (COPD) has minimally changed in recent decades while 'the incidence of bronchiectasis' is on the rise. The current focus on producing guidelines for these two airway 'diseases' has hindered progress in both treatment and prevention. The elephant in the room is that neither COPD nor bronchiectasis is a disease but rather a consequence of progressive untreated airway inflammation. To make this case, it is important to review the evolution of our understanding of airway disease and how a pathological appearance (bronchiectasis) and an arbitrary physiological marker of impaired airways (COPD) came to be labelled as 'diseases'. Valuable insights into the natural history of airway disease can be obtained from the pre-antibiotic era. The dramatic impacts of antibiotics on the prevalence of significant airway disease, especially in childhood and early adult life, have largely been forgotten and will be revisited as will the misinterpretation of trials undertaken in those with chronic (bacterial) bronchitis. In the past decades, paediatricians have observed a progressive increase in what is termed 'persistent bacterial bronchitis' (PBB). This condition shares all the same characteristics as 'chronic bronchitis', which is prevalent in young children during the pre-antibiotic era. Additionally, the radiological appearance of bronchiectasis is once again becoming more common in children and, more recently, in adults. Adult physicians remain sceptical about the existence of PBB; however, in one study aimed at assessing the efficacy of antibiotics in adults with persistent symptoms, researchers discovered that the majority of patients exhibiting symptoms of PBB were already on long-term macrolides. In recent decades, there has been a growing recognition of the importance of the respiratory microbiome and an understanding of the ability of bacteria to persist in potentially hostile environments through strategies such as biofilms, intracellular communities, and persister bacteria. This is a challenging field that will likely require new approaches to diagnosis and treatment; however, it needs to be embraced if real progress is to be made.

Evaluating the causal association between bronchiectasis and different types of inflammatory bowel disease: a two-sample Mendelian randomization study.

Previous observational studies have established a connection between bronchiectasis and inflammatory bowel disease (IBD), but none of these studies have provided a clear explanation for the underlying cause of this relationship. The present study thus implemented Mendelian randomization (MR) design to explore possible bidirectional relationships between IBD and bronchiectasis risk, with an additional focus on Crohn's disease (CD) and ulcerative colitis (UC) as IBD subtypes. A large genome-wide association study (GWAS)-derived data pool was leveraged to examine the relationships between bronchiectasis and IBD, CD, and UC. Two-sample MR analyses were performed with an inverse variance weighted (IVW) approach supplemented with the MR-Egger and weighted median methods. Sensitivity analyses were used to further assess the reliability of the main MR study findings. The possibility of reverse causation was also evaluated using a reverse MR approach. The IVW MR analytical approach revealed that IBD (p = 0.074), UC (p = 0.094), and CD (p = 0.644) had no significant impact on the incidence of bronchiectasis, with the converse also being true (p = 0.471, p = 0.700, and p = 0.099, respectively). This MR analysis demonstrated that the higher occurrence of bronchiectasis in patients with IBD is not caused by genetic predisposition.

Incidence of bronchiectasis in patients with acromegaly: a cohort study.

Associations between acromegaly and several respiratory diseases, such as obstructive lung disease or sleep apnea, have been suggested, but the relationship between bronchiectasis and acromegaly is unclear. We investigated whether acromegaly is related to the development of bronchiectasis. Using the Korean National Health Insurance System database between 2006 and 2016, we studied the relationship between acromegaly and bronchiectasis in patients with acromegaly (n=2593) and controls (1:5 age- and sex-matched subjects without acromegaly, n=12965) with a mean follow-up period of 8.9 years. Cox proportional hazards regression analysis was used to assess the risk of bronchiectasis in patients with acromegaly compared with controls after adjusting for age, sex, household income, place, type 2 diabetes, hypertension, and dyslipidemia. The mean age of the participants was 47.65 years, and male subjects comprised 45.62% of the cohort. The incidence rate of bronchiectasis in patients with acromegaly was 3.64 per 1,000 person-years and was significantly higher than that in controls (2.47 per 1,000 person-years) (log-rank test p = 0.002). In multivariable Cox proportional hazards regression modeling, the risk of bronchiectasis was significantly higher in patients with acromegaly than that in controls (HR: 1.49; 95% CI: 1.15-1.94, p = 0.0025) after adjusting for age, sex, household income, place, type 2 diabetes, hypertension, and dyslipidemia. Our results suggest that acromegaly may be associated with bronchiectasis.

The incidence of bronchiectasis in chronic obstructive pulmonary disease.

Bronchiectasis is a common comorbidity in chronic obstructive pulmonary disease (COPD). There are limited data regarding the incidence of bronchiectasis in COPD. The purpose of the study was to use a nationwide database to evaluate the incidence of bronchiectasis in COPD in Taiwan. We used a cohort of 2,000,000 individuals followed from 2005 to 2018. Patients with COPD diagnosed between January 1, 2011, and December 31, 2017, were selected, and those with bronchiectasis before COPD were excluded. In total, 134,366 patients with COPD were enrolled, and propensity score matching was used to ensure homogeneity of baseline characteristics between the COPD and non-COPD groups. The incidence rate of bronchiectasis was higher in the COPD group than in the non-COPD group (87.83 vs 69.80 per 10,000 person-years). The adjusted hazard ratio (1.9; 95% confidence interval 1.75-2.05; P < 0.001) of bronchiectasis indicated that the risk of bronchiectasis was 1.9 times higher for patients with COPD than for patients without COPD. In the COPD group, the age-stratified incidence rates of bronchiectasis increased with age (55.01, 80.92, 101.52, and 105.23 for 40-49, 50-59, 60-69, and over 70 years, respectively). The incidence of bronchiectasis was higher in patients with COPD than in the general population, the risk of bronchiectasis increased with age in COPD, and post-tuberculosis status was an important risk factor for bronchiectasis.

Determination of the effectiveness of short-term nebulizer therapy in bronchiectasis

BACKGROUND. While the incidence of bronchiectasis is increasing every year, the treatment of this category of patients today is a real challenge for practical medicine, as the only existing guideline contain only low and medium quality data.&#x0D; OBJECTIVE. To determine the effectiveness of short-term differentiated inhalation therapy with salbutamol (Nebutamol®, “Yuria-Pharm”), hypertonic sodium chloride solution with sodium hyaluronate (Lorde® gial, “Yuria-Pharm”) and decametoxinum (Decasan®, “Yuria-Pharm”) in patients with bronchiectasis, which was separated the for four different subgroups depending on the presence of sputum colonization by pathogens and airways obstruction.&#x0D; MATERIALS AND METHODS. 99 adult patients with confirmed clinically significant bronchiectasis in a stable condition were included in a single-center prospective study lasting 12 months. The number of exacerbations in the previous year and the year after treatment, subjective assessment of the severity of cough and sputum, amount of daily sputum, serum C-reactive protein level, microbiological examination of sputum, and spirometry were performed.&#x0D; RESULTS AND DISCUSSION. Short-term personalized inhalation therapy with bronchodilators, mucolytics and antiseptics in the subgroup of patients with airway obstruction and colonization reduced the severity of the main symptoms and reduced the total bacterial load by 45.9 %, and in the subgroup of patients with airway colonization without airway obstruction reduced the severity of cough and the total bacterial load in 76.2 % of cases. Prescribed therapy was effective in statistically significant reduction in the number of exacerbations by 43 %.

Potential links between COVID-19-associated pulmonary aspergillosis and bronchiectasis as detected by high resolution computed tomography.

The aim of this observational study was to highlight high resolution CT scan characteristics of COVID-19-associated pulmonary aspergillosis (CAPA) with a focus on the detection of de-novo appeared or evolved bronchiectasis. From March 2020 to May 2021, we enrolled 350 consecutive mechanically ventilated ICU patients with COVID-19. Patients with CAPA and at least one chest CT scan performed within 15 days from the diagnosis were included. Two radiologists were asked to identify typical and atypical signs of COVID-19 pneumonia. Bronchiectasis locations were described and a modified Reiff score was calculated, as severity score. A total of 19 CAPA patients (median age 71.0, Interquartile range (IQR) 62.5-75.0; male 16, 84.2%) were included. According to the 2020 ECMM/ISHAM criteria, 18 patients had probable CAPA and one had proven CAPA. The median time between hospital admission and CT scan was 21 days (IQR 14.5-25.0). The incidence of bronchiectasis in the study population was 57.9% (n = 11). Tubular bronchiectasis was detected in 10 patients and were scored as follows: three patients had a score of 1, three patients had a score of score 2, one patient had a score of 5 and four patients had a score of 6. Eight patients had a previous CT scan (performed at hospital admission), among them: 5 patients developed de-novo bronchiectasis, while 2 patients demonstrated a volumetric increase of bronchiectasis. At the 6-months follow-up, the mortality rate for patients with CAPA was >60%. the radiologic detection of de-novo appearance or volumetric increase of bronchiectasis in COVID-19 should lead clinicians to search for fungal superinfections.

TB-INDUCED BRONCHIECTASIS IN A HISPANIC MALE WITH COMMON VARIABLE IMMUNODEFICIENCY AND CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE REGULATOR CARRIER

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Bronchiectasis is a chronic condition characterized by irreversibly dilated bronchi leading to a debilitating respiratory syndrome with excessive sputum production and recurrent infections. The presence of radiologic findings of bronchiectasis should alert clinicians to explore other causes including congenital defects, chronic inflammation, immune deficiencies, opportunistic infections and assess functional lung capacity as multiple etiologies contributed to bronchiectasis in our patient. We present the case of a middle-aged Hispanic male diagnosed with bronchiectasis in the setting of active Mycobacterium tuberculosis (MTB), common variable immunodeficiency (CVID), and cystic fibrosis carrier. CASE PRESENTATION: A 44-year-old Hispanic male with a history of SARS-CoV 2 infection presented with worsening cough and fatigue. He reported subjective fever, night sweats, weight loss, and yellowish sputum production. CT chest showed diffuse bronchial dilatation and thickening, diffuse bronchiectasis, multifocal cavitary lesions in bilateral upper lobes, and tree in bud nodularity. QuantiFERON-TB Gold was indeterminate. However, acid fast bacilli was seen on smear and culture. PCR confirmed MTB complex. He was found to have low IgG and IgM levels 661 and 26 respectively. Genetic testing showed a heterozygous cystic fibrosis transmembrane conductance regulator (CFTR) D508 gene mutation. He was treated with quadruple therapy with rifampin, isoniazid, pyrazinamide, ethambutol and referred to an immunologist for immunoglobulin therapy. DISCUSSION: Bronchiectasis is a cycle of airway damage creating an environment conductive to chronic colonization of bacteria causing an inflammatory response leading to further injury. Our biggest diagnostic challenge was to determine if bronchiectasis was due to an infection or developed due to an underlying predisposition. His clinical symptoms were worrisome for tuberculosis;however, diffuse bronchial dilation was concerning for other concurrent pathologies which warranted further work up. Bronchiectasis may be classified as cystic fibrosis induced bronchiectasis and non-cystic fibrosis bronchiectasis (NCFB). Cystic fibrosis is an autosomal recessive disorder. While bronchiectasis is classically associated in CF patients, it has also been reported in patients having one gene mutation, like our patient. Furthermore, MTB and CVID are also documented causes of bronchiectasis. Pharmacological treatment is challenging and depends on the etiology. However, non-pharmacological treatment, such as chest physiotherapy centered on mobilizing and eliminating mucosal secretion, is used to manage bronchiectasis. CONCLUSIONS: The rise in the incidence of bronchiectasis in the US annually demands the understanding of the disease's etiology and characteristic features as effective treatment is directed towards its cause. REFERENCE #1: Lesan, A., & Lamle, A. E. (2019). Short review on the diagnosis and treatment of bronchiectasis. Medicine and pharmacy reports, 92(2), 111–116. https://doi.org/10.15386/cjmed-1060 REFERENCE #2: Miller, A. C., Comellas, A. P., Hornick, D. B., Stoltz, D. A., Cavanaugh, J. E., Gerke, A. K., Welsh, M. J., Zabner, J., & Polgreen, P. M. (2020). Cystic fibrosis carriers are at increased risk for a wide range of cystic fibrosis-related conditions. Proceedings of the National Academy of Sciences of the United States of America, 117(3), 1621–1627. https://doi.org/10.1073/pnas.1914912117 REFERENCE #3: Pasteur, M. C., Bilton, D., Hill, A. T., & British Thoracic Society Bronchiectasis non-CF Guideline Group (2010). British Thoracic Society guideline for non-CF bronchiectasis. Thorax, 65 Suppl 1, i1–i58. https://doi.org/10.1136/thx.2010.136119 DISCLOSURES: No relevant relationships by Jane Parks, source=Web Response No relevant relationships by Niyanta Patel, source=Web Response No relevant relationships by Nathaniel Rodriguez, source=Web Response No relevant relationships by Joshuam Ruiz Vega, source=W b Response No relevant relationships by Zoheb Sulaiman, source=Web Response

Evaluating the Prevalence and Incidence of Bronchiectasis and Nontuberculous Mycobacteria in South Korea Using the Nationwide Population Data.

Although the prevalence and incidence of bronchiectasis are rising worldwide, basic epidemiologic data have not been reported in Korea. Therefore, this study was conducted to investigate epidemiological characteristics of bronchiectasis and NTM (nontuberculous mycobacteria) pulmonary diseases in Korea using the National Health Insurance Service-National Sample Cohort (NHIS-NSC) data. The relative risks of prevalence and incidence after adjusting for demographic characteristics were evaluated by multivariate Poisson regression. The result of this study showed the prevalence and incidence rates of bronchiectasis and NTM to be epidemiologically similar to each other with a few slight differences, while the prevalence rate of bronchiectasis was not significantly different by gender, and its incidence rate was significantly lower in women than in men. Both the prevalence and incidence of NTM were significantly higher in women than in men. Both the prevalence and incidence rates of bronchiectasis and NTM were significantly lower in the age group below 40–49 years, and significantly higher in the age groups thereafter. As there were gender differences of bronchiectasis and NTM, gender-sensitive risk management should be available. In addition, since both bronchiectasis and NTM increase in prevalence and incidence after the age of 40–49, early detection and intervention strategies targeting the appropriate age group are needed.

ФАКТОРЫ РИСКА И КЛИНИЧЕСКИЕ ПРОЯВЛЕНИЯ МИКОБАКТЕРИОЗА ЛЁГКИХ. СИСТЕМАТИЧЕСКИЙ ОБЗОР

The present study is a systematic review with a meta-analysis of risk factors for lung mycobacteriosis (LM) and diseases that influence the incidence, clinical manifestations and etiology of the infection under investigation. The authors made a selection of papers. The search for papers was carried out in English and Russian in the PubMed, Web of Science, Сochrane Library, eLibrary electronic databases with the analysis of references from the articles found. Articles published from 2000 to 2020 were selected. The following results are obtained. Regarding smoking: with the two gradations of the factor (the patient smokes or not), the incidence of LM in smokers varied from 13.8±0.03% to 71.2±0.06%. Regarding tuberculosis: the incidence of LM and tuberculosis ranged from 6.7±0.01% to 17.6±0.02%. Regarding chronic obstructive pulmonary disease (COPD): the incidence of LM in patients with COPD was determined on average at 11.2±0.01%. Regarding bronchiectasis: the incidence of bronchiectasis in patients with LM is 30.1±0.02%. Regarding diabetes mellitus: the frequency of patients with LM and diabetes mellitus in one study group was 6.7±0.01%, and in the other – 17.6±0.02%. Regarding malignancies: the frequency of such patients was determined from 17.1±0.04% to 50.0±0.07% of cases. Regarding HIV infection and LM: the incidence of detected LM in patients with HIV was determined on average at the level of 8.9±0.01%. Regarding cough in LM: the frequency of patients with this symptom in the first group was 46.2±0.07%, in the second group – 88.9±0.02%. Regarding hemoptysis in LM: the frequency of patients with this symptom ranged from 3.8±0.03% to 30.1±0.02%. X-ray manifestations of lesions in LM occurred with a frequency of 42.3±0.04% to 100%. The most significant role in etiology belongs to non-tuberculous mycobacteria species, such as slow-growing M. avium complex, and fast-growing M. abscessus complex, M. chelonae, M. fortuitum. Keywords: Lung mycobacteriosis, nontuberculous mycobacteria, clinical manifestations, risk factors.

Female Reproductive Factors and Risk of Bronchiectasis: A Nationwide Population-Based Longitudinal Study

Background: Although oestrogen level is thought to be involved in the occurrence of non-cystic fibrosis bronchiectasis (bronchiectasis), limited data is available on the relationship between female reproductive factors and the risk of bronchiectasis. Therefore, we aimed to evaluate whether female reproductive factors are associated with bronchiectasis. Methods: We performed a population-based retrospective cohort study of 959,523 premenopausal women and 1,362,401 postmenopausal women without previous history of bronchiectasis who participated in a health screening exam in 2009 in South Korea. Outcomes were measured until December 31, 2018. The exposures were female reproductive factors (age at menarche, age at menopause, parity, breastfeeding, or exogenous hormone use), and the main outcome was the incidence of bronchiectasis. Findings: The mean follow-up duration was 8.3 years in premenopausal women and 8.1 years in postmenopausal women. In premenopausal women, compared with later age at menarche (> 16 years), earlier menarche (≤ 12 years) was associated with reduced risk of bronchiectasis, with an adjusted hazard ratio (aHR [95% confidence interval (CI)]) of 0.74 [0.67–0.81]). However, there were no significant associations between other reproductive factors (breastfeeding, parity, or oral contraceptive use) and the risk of bronchiectasis. In postmenopausal women, earlier menarche (adjusted HR [95% CI] = 0.79 [0.72–0.87] for ≤12 years vs. >16 years), later menopause (0.90 [0.88–0.91] ≥ 55years vs. < 40 years), and longer reproductive period (0.90 [0.86–0.94] for ≥ 40 years vs. < 30 years) were associated with reduced risk of bronchiectasis. While breastfeeding < 1year (aHR [95% CI] = 0.93 [0.88–0.97]) and oral contraceptive use < 1year (0.97 [0.94–0.99]) reduced the risk of bronchiectasis, hormone replacement therapy ≥ 5 years increased risk of bronchiectasis (1.24 [1.18–1.30]). Interpretation: Female reproductive factors are risk factors of developing bronchiectasis, showing a higher risk associated with shorter endogenous oestrogen exposure regardless of menopausal status. Funding Information: This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Ministry of Science, Information and Communications Technologies (NRF350 2020R1F1A1070468 and 2021M3E5D1A01015176) and the Korea Medical Device Development Fund grant funded by the Korean government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (Project Number: 1711138447, KMDF_PR_20200901_0214). Declaration of Interests: All authors have no conflict of interest to disclose Ethics Approval Statement: Our study protocol was approved by the Institutional Review Board of Chungbuk National University Hospital (No. 2021-08-016). The requirement for informed consent was waived because the NHIS database uses an anonymous patient identification system

Does the Hospital Admission of Patients with Respiratory Disease Increase in Izmir When the PM10 Level is High?

Air pollution is caused by exhaust emissions from motor vehicles, fuel consumption for heating of residences, and especially emissions from industrial facilities around the world. The exposure to outdoor air pollution has been associated with acute and chronic health problems, from irritation to death. In this study, we aimed to determine whether air pollution increases the frequency of hospital admission and whether there is a difference between disease subgroups, age, and gender, in the 2-year period in Izmir province where - air pollution is increasing. Collection of health data for the project compiled by the Ministry of Health, in cooperation with the Izmir Provincial Health Directory Information Processing Department, and information obtained on the age groups, gender, admission time, and diagnosis of illness [International Classification of Diseases (ICD)10 code] on the residents of Izmir in 2016/2017. The daily numbers of patients with respiratory complaints and air pollution were found to be related. Both air pollution and the admission rate increase in the January-March period. In male patients, the risk of hospitalization increases for 1.14%. Males had a higher increase in the rate of diagnosis of chronic rhinitis (increase of 6.22%) than females who had an increase of 0.97%. It was observed that there was a 2.62% increase in the incidence of bronchiectasis, 2.53% in that of asthma, and 2.49% in that of dyspnea. There was a significant increase in respiratory diseases during the days when the air pollution was high, and this was observed as the upper respiratory tract infection and acute bronchitis in the young group and chronic respiratory diseases in the elderly group upon hospital admissions. The reduction of air pollutants and inhalation of clean air are the most important aspects in providing a healthier and longer life.

Prevalence and incidence of bronchiectasis in Italy

BackgroundThe understanding of the epidemiology of bronchiectasis is still affected by major limitations with very few data published worldwide. The aim of this study was to estimate the epidemiological burden of bronchiectasis in Italy in the adult population followed-up by primary care physicians.MethodsThis study analyzed data coming from a large primary care database with 1,054,376 subjects in the period of time 2002–2015. Patients with bronchiectasis were selected by the use of International Statistical Classification of Diseases, 9th revision, Clinical Modification codes (ICD-9-CM).ResultsPatients with bronchiectasis were more likely to have a history of tuberculosis (0.47% vs. 0.06%, p < 0.0001), had higher rates of asthma (16.6% vs. 6.2%, p < 0.0001), COPD (23.3% vs. 6.4%, p < 0.0001) and rheumatoid arthritis (1.9% vs. 0.8%, p < 0.0001). The prevalence and incidence of bronchiectasis in primary care in Italy in 2015 were 163 per 100,000 population and 16.3 per 100,000 person-years, respectively. Prevalence and incidence increased with age and overall rates were highest in men over 75 years old. Prevalence and incidence computed after the exclusion of patients with a diagnosis of either asthma or COPD is 130 per 100,000 and 11.1 cases per 100,000 person-years, respectively.ConclusionsBronchiectasis is not a rare condition in Italian adult population. Further studies are needed to confirm our results and provide a better insight on etiology of bronchiectasis in Italy.Trial registrationnot applicable.

Clinical characteristics and drug susceptibility test of nontuberculous mycobacterial lung disease

Objective: To investigate the clinical characteristics and drug susceptibility test (DST) of patients infected with different nontuberculous mycobacteria (NTM). Methods: The patients with nontuberculous mycobacterial lung disease (NMLD) in Shanghai Pulmonary Hospital from March 2014 to March 2015 were studied retrospectively by analyzing the clinical characteristics, radiological features and DST results. A total of 201 NMLD patients [male 108, age(58±15) yrs] were enrolled into this study including 48 cases of M. Kansasii [male 13, age (52±16) yrs],46 cases of M. Abscess[male 46, age (57±16) yrs], 92 cases of M. Intracellulare [male 43, age (61±13) yrs], and 15 cases of M. Avium [male 6, age (67±10) yrs]. Clinical data were collected when the diagnosis was made and Chi-square test was used to compare the differences among 4 groups of patients. Bonferroni method was used for further pairwise comparisons. Results: There were significant differences among the 4 groups in the age(χ(2)=6.42, P<0.001) and the gender(χ(2)=49.18, P<0.001) of the patients. The history of bronchiectasis in the groups of M. Kansasii, M. Abscess, M. Intracellulare and M. Avium were 2/48, 31/46, 39/92 and 4/15 cases respectively(χ(2)=41.84, P<0.001). For the Gamma-interferon release assays (ELISA) (IGRA), the positive rate of IGRA in the groups of M. Kansasii, M. Abscess, M. Intracellulare and M. Avium were 83%(40/48), 30%(14/46), 23%(21/92) and 33% (5/15) respectively(χ(2)=50.96, P<0.001). The radiological features were significantly different in tree-in-bud(8/48, 35/46, 36/92 and 4/15 cases respectively, χ(2)=36.48, P<0.001), pleural thickness or mild effusion (21/48, 36/46, 69/92 and 7/15 cases, χ(2)=19.54, P<0.001), bronchiectasis (20/48, 39/46, 78/92 and 10/15 cases, P<0.001) and cavities (38/48, 21/46, 63/92 and 10/15 cases, χ(2)=12.38, P<0.001) among the 4 groups(M. Kansasii, M. Abscess, M. Intracellulare and M. Avium). The drug resistance rates of M. Kansasii to rifampin, ethambutanol and ofloxacin were 10%(5/48), 8%(4/48) and 15%(7/48) respectively; the resistance rates of M.Intracellulare to ethambutanol was 45%(41/92), and the resistance rates of M.Abscess were all over 80% to all anti-TB drugs. The results of pairwise comparisons showed that the male proportion(46/48) and IGRAs positive rate(40/48) of patients with M. Kansasii were higher than those of other groups, and the incidence of bronchiectasis(20/48) and pleural changes(21/48) was lower than those of other groups. The female ratio(33/46), history of bronchiectasis (31/46) and tree-in-bud sign of patients(35/46) with M. Abscess were higher than those of other groups. Conclusions: There were differences in the clinical manifestations and imaging features of 4 common NMLD diseases, which were helpful for clinical differentiation. The patients with M. Kansasii infection were mainly male, with a high IGRA positive rate and fewer lesions of bronchiectasis or pleural changes. Most of the patients with M. Abscess were female, with a previous history of bronchiectasis, and with most of the lesions showing tree-in-bud signs. The NTM species had a high rate of resistance to anti-TB drugs except M. Kansasii.

National Survey on the Management of Adult Bronchiectasis in Belgium

The increasing prevalence and incidence of bronchiectasis leads to a substantial health care burden. Quality standards for the management of bronchiectasis were formulated by the British Thoracic Society following publication of guidelines in 2010. They can be used as a benchmark for quality of care. It is, however, unclear how and whether they apply outside of the UK. Between May and November 2017, we conducted an online survey among respiratory physicians caring for adult bronchiectasis patients in Belgium. About 186 cases were submitted by 117 treating physicians. Patients were mostly female (58%), of Caucasian descent (84%) with a remarkably low median age of 59.8 (IQR 47–73) years. 41% had Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus and/or Enterobacteriaceae isolated from respiratory samples in the past. 21% had three or more exacerbations, however, more than 58% were receiving long-term oral antibiotics (of which 90% azithromycin). In 40% of patients the diagnostic testing was insufficient. Surveillance of sputum bacteriology in stable patients and composing a self-management plan was missing in 53% and 68% of patients, respectively. Airway clearance techniques were implemented in 84%. Respiratory physicians complied with 60% or more to five out of the eight applicable quality standards, which is encouraging. Increasing educational act could further raise awareness and increase quality of care.

The SENSOR Study: Protocol for a Mixed-Methods Study of Self-Management Checks to Predict Exacerbations of Pseudomonas Aeruginosa in Patients with Long-Term Respiratory Conditions.

BackgroundThere are an estimated three million people in the United Kingdom with chronic obstructive pulmonary disease (COPD), and the incidence of bronchiectasis is estimated at around 0.1% but is more common in COPD and severe asthma. Both COPD and bronchiectasis are characterized by exacerbations in which bacteria play a central role. Pseudomonas aeruginosa is isolated from sputum samples from 4% to 15% of adults with COPD and is more likely to be isolated from patients with severe disease. Earlier detection of exacerbations may improve morbidity and mortality by expediting treatment. Aseptika Ltd has developed a system for patients to self-monitor important physiological measurements including levels of physical activity, peak flow, forced expiratory volume (FEV1), and biomarkers for P aeruginosa in sputum.ObjectiveWe aim to test this system in 20 participants with P aeruginosa colonization and 10 controls with Haemophilus influenzae.MethodsWe plan to recruit 30 adult participants with COPD or non-CF bronchiectasis who have cultured P aeruginosa or H influenzae during an exacerbation in the last 6 months. They must produce sputum on most days and should have been stable for 4 weeks prior to entry. Daily data collected will include symptoms, health care usage, medication, weight, FEV1, physical activity level, blood pressure, oxygen saturation, and temperature. Sputum and urine samples will be provided daily. These data will be analyzed to assess predictive value in detecting upcoming exacerbations. Qualitative data will be gathered through self-administered questionnaires and semistructured interviews to gather information on participant coping and their use of the technology involved.ResultsRecruitment has been completed and results from the study should be available at the end of 2017.ConclusionsThe SENSOR study aims to test a home-monitoring system in people with chronic airway infection and is currently underway.

Prevalence and incidence of bronchiectasis in Catalonia, Spain: A population-based study

BackgroundInsufficient epidemiological data are available on bronchiectasis in southern European populations. The aim of this study was to determine the prevalence and incidence of bronchiectasis in Catalonia, Spain and describe the characteristics of patients with an active diagnosis of bronchiectasis in 2012. MethodsThis study used data from a population database containing information from 5.8 million people (80% of the population of Catalonia). Patients with bronchiectasis were identified using International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) codes, and information on clinical characteristics and treatment was extracted. ResultsA total of 20895 patients with bronchiectasis were identified in 2012. The prevalence of bronchiectasis was 36.2 cases per 10 000 inhabitants, with an incidence of 4.81 cases per 10 000 inhabitants. Prevalence and incidence increased with age and were highest in men over 65 years of age. Among the whole bronchiectasis population in Primary Care, 48.6% of patients had had blood tests, 11.2% had undergone spirometry, only 2.1% had a chest X-ray, and 0.9% had undergone high-resolution computed tomography or sputum culture. 56% had at least one exacerbation and 12.5% had been admitted to hospital during the year of the study. The drugs most frequently used were inhaled corticosteroids (in 37.4% of patients) and long-acting β2agonists (in 36%); half of the patients received no treatment (51.8%). ConclusionsThe prevalence and incidence of bronchiectasis increases with age. The management of bronchiectasis in primary care was not optimal, and the disease continues to represent an important clinical burden.

AB030. Prevalence and incidence of bronchiectasis in Catalonia in 2012

Background: Bronchiectasis is a pulmonary disorder defined morphologically as a permanent airway dilatation of different etiologies such as cystic fibrosis, infections or immunodeficiencies. The true incidence and prevalence of non-cystic fibrosis bronchiectasis are not well known. To determine the prevalence and incidence of bronchiectasis (BC) not due to cystic fibrosis in primary care patients in Catalonia (Spain) in 2012. To describe the clinical characteristics and treatment patterns of BQ patients and to estimate the health burden associated with BQ.

Rare presentation of bronchiectasis with multiple bronchial stones

The incidence of bronchiectasis has declined markedly in developed countries with improvement in health care, antibiotics, vaccines and control of tuberculosis (<0.6/1000 persons), but is still high in developing countries. Early complete resection of affected lung segment remains the mainstay of treatment as it causes maximum improvement in symptoms, minimum deterioration of lung function and prevents disease progression. Surgery is indicated in unsuccessful medical treatment and complications of bronchiectasis e.g. haemoptysis, lung abscess, lung masses and pneumothorax. Bronchiectasis with multiple broncholithiasis is a very rare presentation and very few cases have been reported in literature so far. This article presents here, the symptoms and signs, operative and perioperative management and literature review of a case of bronchiectasis with multiple bronchial stones.

Chirurgie de la dilatation des bronches

The incidence of bronchiectasis has declined significantly in industrialized countries and its management has also changed because of the progress of antibiotic therapy. However, for some patients, medical treatment is not sufficient to control the disease and the quality of life is affected. Surgical treatment is then a very good alternative, when a gesture of complete resection of the affected areas is feasible in terms of lung function and it allows, with a low morbidity and mortality, for very satisfactory long-term results and slows down the progression of the disease. In cases of diffuse and inhomogeneous bronchiectasis, a gesture of incomplete resection of cystic, non-perfused and suppurative areas improves symptoms and reduces recurrent infections. When the bronchiectasis is diffuse, but homogeneous, associated with severe respiratory failure, lung transplantation should be considered. Therefore, surgery remains important in the management of bronchiectasis. Its indications and the lung resection gesture to achieve should be discussed based on the symptoms, imaging examinations and the lung function of the patient.

Surgical Management of Bronchiectasis: A Collective Review of 339 Patients with Long-term Follow-up

The incidence of bronchiectasis has decreased significantly in developed countries due to successful control of childhood infections. However, the surgical treatment of this disease still plays an important role in thoracic surgical practice in underdeveloped and developing countries. The aim of this retrospective study was to present our surgical experience in patients with bronchiectasis, including our surgical treatment strategies and the results of long-term follow-up. A retrospective chart review was conducted of 339 patients who underwent surgical resection for bronchiectasis between January 1992 and December 2009. The patients' demographic features, the symptoms, etiologies and resection types, morbidity, mortality and outcomes after surgical management were analyzed. There were 301 (88.8 %) male and 38 (11.2 %) female patients; the average patient age was 22.4 years (range 15-50 years). The most common presenting symptoms were productive cough in 197 (58.1 %) patients. There were 21 (6.2 %) asymptomatic patients. Two hundred and thirty of the 339 patients (67.8 %) had had previous medical therapy before admission to our department. The most common etiology of bronchiectasis was childhood infections in 101 (29.8 %) patients. In most patients, bronchiectasis was found on the left side (n = 225, 66.4 %). Thirty-five patients underwent a second operation for bilateral disease. There were two (0.6 %) early postoperative mortalities including one myocardial infarction and one respiratory insufficiency. Complications occurred in 43 patients (12.7 %). The median follow-up was 13.6 months. Symptoms disappeared in 201 patients (71 %), and 66 patients (23.3 %) experienced an improvement, while 16 patients (5.7 %) continued to be symptomatic. Although improvements in medical treatment have resulted in a significant decrease in the number of patients with bronchiectasis, surgical management is still very important in developing countries. Surgical resection can be performed with acceptable morbidity and mortality rates. The aim should be the resection of all involved bronchiectatic sites, even in patients with bilateral disease, if the pulmonary reserve is adequate.