Stable Bronchiectasis Research Articles

Low-dose clarithromycin therapy modulates Th17 response in non-cystic fibrosis bronchiectasis patients.

Th17 cells play a crucial role in neutrophilic inflammation and tissue injury in non-cystic fibrosis (non-CF) bronchiectasis. Clarithromycin demonstrates anti-inflammatory and immunomodulatory properties but the effect of long-term clarithromycin prophylaxis on the Th17 response in non-CF bronchiectasis is still unexplored. Th17 response was studied in 22 patients with stable non-CF bronchiectasis receiving daily 500-mg clarithromycin for 12 weeks. We analysed IL-17 concentrations in exhaled breath condensate (EBC) and peripheral blood Th17 cells, whereas functional parameters and clinical data were recorded in parallel. Both, post-treatment absolute counts of CD4+IL17+ cells in peripheral blood and IL-17 levels in EBC decreased significantly (post-treatment CD4+IL17+ mean 2.418 ± 0.414 cells/μl versus pre-treatment 3.202 ± 0.507 cells/μl, p = 0.036 and post-treatment IL-17 mean levels 7.16 ± 0.47 pg/ml versus pre-treatment 9.32 ± 0.47 pg/ml, p < 0.001, respectively). Post-treatment EBC IL-17 levels decreased significantly in both patients who exhibited exacerbations and those who remained stable during the study period (mean 6.72 ± 0.37 versus 9.12 ± 0.64 pg/ml, p = 0.01 and 7.69 ± 0.9 versus 9.53 ± 0.72 pg/ml, p = 0.042, respectively), while pre-treatment and post-treatment levels did not differ between the two groups (p = 0.665 and p = 0.465, respectively). PaO(2) improved significantly (post-treatment mean 77.73 ± 2.23 mmHg versus pre-treatment 73.18 ± 2.22 mmHg, p = 0.025), while PaCO(2), post-bronchodilation FEV1, and post-bronchodilation FVC remained unaltered. Our results argue for a reduction of both systemic and local Th17 response after prophylactic, low-dose clarithromycin administration in patients with non-CF bronchiectasis, suggestive of a potential anti-inflammatory and/or immunomodulatory action.

Inhaled antibiotics for stable non-cystic fibrosis bronchiectasis: a systematic review.

We conducted a meta-analysis of randomised trials to evaluate the efficacy and safety of inhaled antibiotics in patients with stable non-cystic fibrosis (CF) bronchiectasis. We searched the Cochrane Airways Group Register of Trials from inception until March 2014. 12 trials with 1264 adult patients were included, of which five were unpublished studies. Eight trials on 590 patients contributed data to the meta-analysis. Amikacin, aztreonam, ciprofloxacin, gentamicin, colistin or tobramycin were used for 4 weeks to 12 months. Inhaled antibiotics were more effective than placebo or symptomatic treatment in reducing sputum bacterial load (five trials; weighted mean difference -2.65 log10 CFU · g(-1), 95% CI -4.38- -0.92 log10 CFU · g(-1)), eradicating the bacteria from sputum (six trials; risk ratio 4.2, 95% CI 1.66-10.64) and reducing the risk of acute exacerbations (five trials; risk ratio 0.72, 95% CI 0.55-0.94). Bronchospasm occurred in 10% of patients treated with inhaled antibiotics compared with 2.3% in the control group (seven trials; risk ratio 2.96, 95% CI 1.30-6.73), but the two groups had the same withdrawal rate due to adverse events (12.2%). Inhaled antibiotics may provide an effective suppressive antibiotic therapy with an acceptable safety profile in adult patients with stable non-CF bronchiectasis and chronic bronchial infection.

The Pilot Study of Traditional Chinese Medicine in the Treatment of Stable Bronchiectasis by N-of-1 Trials

The Pilot Study of Traditional Chinese Medicine in the Treatment of Stable Bronchiectasis by N-of-1 Trials

Lung Clearance Index Is a Repeatable and Sensitive Indicator of Radiological Changes in Bronchiectasis

In bronchiectasis there is a need for improved markers of lung function to determine disease severity and response to therapy. To assess whether the lung clearance index is a repeatable and more sensitive indicator of computed tomography (CT) scan abnormalities than spirometry in bronchiectasis. Thirty patients with stable bronchiectasis were recruited and lung clearance index, spirometry, and health-related quality of life measures were assessed on two occasions, 2 weeks apart when stable (study 1). A separate group of 60 patients with stable bronchiectasis was studied on a single visit with the same measurements and a CT scan (study 2). In study 1, the intervisit intraclass correlation coefficient for the lung clearance index was 0.94 (95% confidence interval, 0.89 to 0.97; P < 0.001). In study 2, the mean age was 62 (10) years, FEV1 76.5% predicted (18.9), lung clearance index 9.1 (2.0), and total CT score 14.1 (10.2)%. The lung clearance index was abnormal in 53 of 60 patients (88%) and FEV1 was abnormal in 37 of 60 patients (62%). FEV1 negatively correlated with the lung clearance index (r = -0.51, P < 0.0001). Across CT scores, there was a relationship with the lung clearance index, with little evidence of an effect of FEV1. There were no significant associations between the lung clearance index or FEV1 and health-related quality of life. The lung clearance index is repeatable and a more sensitive measure than FEV1 in the detection of abnormalities demonstrated on CT scan. The lung clearance index has the potential to be a useful clinical and research tool in patients with bronchiectasis.

Effect of benefiting Qi and resolving stasis therapy on lung function of stable bronchiectasis

目的 观察益气化瘀法对支气管扩张稳定期患者肺功能的疗效.方法 收集2012年2月至2013年5月上海仁济医院嘉定分院呼吸内科门诊78例患者,均符合支气管扩张稳定期的中医诊断标准,按随机数字表法分为两组各39例.对照组采用西医常规治疗并口服氨溴索30 mg/次,3次/d;治疗组在对照组用药基础上,口服补肺活血胶囊,4粒/次,3次/d.两组均60 d为1疗程.治疗结束后,分别观察两组患者治疗前后肺功能的变化.结果 两组治疗后与同组治疗前比较用力肺活量(FVC)、第1秒用力呼气容积(FEVl)、FEVl/FVC比较[治疗组治疗后分别为(2.67±0.52)L、(1.98±0.21)L、(74.57±9.92)%;治疗前分别为(2.26±0.78)L、(1.55±0.63)L、(65.17±12.20)%;对照组治疗后分别为(2.50±0.13)L、(1.78±0.58)L、(69.98±10.17)%,治疗前分别为(2.28±0.63)L、(1.57±0.25)L、(64.81±11.86)%]差异有统计学意义(P＜0.01);治疗后治疗组FEVl、FEVl/FVC的改善情况显著优于对照组(P＜0.05).治疗组治疗前后一氧化碳弥散量(DLCO)[分别为(14.65±0.41)ml/mmHg/min、(14.93±0.77)ml/mmHg/min]的改善比较,差异有统计学意义(P＜0.05).结论 益气化瘀法治疗支气管扩张稳定期可显著改善患者肺通气功能,提高患者生存质量。

Long‐term macrolides for non‐cystic fibrosis bronchiectasis: A systematic review and meta‐analysis

Long-term macrolides are increasingly being prescribed for stable bronchiectasis. This meta-analysis assessed the clinical effect of this treatment in bronchiectasis. A systematic review and meta-analysis were carried out. All randomized, controlled trials (RCT) comparing long-term macrolides with placebo and/or usual medical care, with outcome measures relating to efficacy and safety were selected. Nine RCT recruiting 530 patients were included. Compared with placebo and/or usual medical care, long-term macrolides significantly reduced the risk of the exacerbations (number of participants with exacerbations (relative risk = 0.70, 95% confidence interval (CI) 0.60-0.82, P < 0.00001); average exacerbations per participant (weighted mean difference = -1.01, 95% CI -1.35 to -0.67, P < 0.00001)), the St George's Respiratory Questionnaire total scores (weighted mean difference = -5.39 95% CI -9.89 to -0.88, P = 0.02), dyspnoea scale (weighted mean difference = -0.31 95% CI -0.42 to -0.20, P < 0.00001), 24-h sputum volume (P < 0.00001), and attenuated the decline of forced expiratory volume in 1 s (weighted mean difference 0.02 L, 95% CI 0.00-0.04, P = 0.01). Eradication of pathogens (P = 0.06), overall rate of adverse events (P = 0.61), and emergence of new pathogens (P = 0.61) were not elevated, while gastrointestinal events increased significantly with macrolides (P = 0.0001). Macrolide resistance increased, but a meta-analysis was not possible due to the diversity of parameters. Long-term use of macrolides appears to be a treatment option for stable bronchiectasis. The results of this review justify further investigation about adding this intervention to the treatment regimens of bronchiectasis.

Evaluating the Individualized Treatment of Traditional Chinese Medicine: A Pilot Study of N‐of‐1 Trials

Purpose. To compare the efficacy of individualized herbal decoction with controlled decoction for individual patients with stable bronchiectasis. Methods. We conducted N-of-1 RCTs (single-patient, double-blind, randomized, multiple crossover design) in 3 patients with stable bronchiectasis. The primary outcome was patient self-rated symptom scores on visual analogue scales. Secondary outcome was 24-hour sputum volume. A clinical efficacy criterion which combined symptoms score and medication preference was also formulated. Results. All three patients showed various degrees of improvement on their symptoms and one patient's (Case 3) 24 h sputum volume decreased from 70 mL to 30 mL. However, no significant differences were found between individualized herbal decoction and control decoction on symptoms score, or on 24-hour sputum volume. One patient (Case 2) had clear preference for the individualized herbal decoction over the standard one with the confirmation after unblinding. We therefore considered this case as clinically important. Discussion. N-of-1 trials comply with individualized philosophy of TCM clinical practice and had good compliance. It is necessary to set up clinical efficacy criteria and to consider the interference of acute exacerbation.

Effect of Low-Dose, Long-Term Roxithromycin on Airway Inflammation and Remodeling of Stable Noncystic Fibrosis Bronchiectasis

Background. Noncystic fibrosis bronchiectasis (NCFB) is characterized by airway expansion and recurrent acute exacerbations. Macrolide has been shown to exhibit anti-inflammatory effects in some chronic airway diseases. Objective. To assess the efficacy of roxithromycin on airway inflammation and remodeling in patients with NCFB under steady state. Methods. The study involved an open-label design in 52 eligible Chinese patients with NCFB, who were assigned to control (receiving no treatment) and roxithromycin (receiving 150 mg/day for 6 months) groups. At baseline and 6 months, the inflammatory markers such as interleukin- (IL-)8, neutrophil elastase (NE), matrix metalloproteinase- (MMP)9, hyaluronidase (HA), and type IV collagen in sputum were measured, along with the detection of dilated bronchus by throat computed tomography scan, and assessed the exacerbation. Results. Forty-three patients completed the study. The neutrophil in the sputum was decreased in roxithromycin group compared with control (P < 0.05). IL-8, NE, MMP-9, HA, and type IV collagen in sputum were also decreased in roxithromycin group compared with the control group (all P < 0.01). Airway thickness of dilated bronchus and exacerbation were reduced in roxithromycin group compared with the control (all P < 0.05). Conclusions. Roxithromycin can reduce airway inflammation and airway thickness of dilated bronchus in patients with NCFB.

P105 Outpatient survey of patient experience of hypertonic saline use in non-cystic fibrosis bronchiectasis

Introduction and ObjectivesHypertonic Saline (HTS) is known to accelerate tracheobronchial clearance and is felt to provide a useful adjunct to physiotherapy for airway clearance in bronchiectasis1. Previous studies have demonstrated...

Effects of long‐term azithromycin therapy on airway oxidative stress markers in non‐cystic fibrosis bronchiectasis

To explore the effect of long-term therapy with azithromycin in regards to airway oxidative stress markers in exhaled breath condensate (EBC) of adult patients with stable non-cystic fibrosis (CF) bronchiectasis. Open-label prospective study of 30 patients randomized to azithromycin 250 mg three times per week during 3 months (16 patients) or control (14 patients). Primary outcome were changes in nitric oxide, 8-isoprostane, pH, nitrites and nitrates in EBC. Secondary outcomes were changes in exacerbation rates, dyspnoea (Borg scale), sputum volume (cc), sputum colour (15-point scale), bacterial infection, health-related quality of life (St George's Respiratory Questionnaire), lung function and radiological extension. Azithromycin produced a significant decrease in sputum volume (8.9 (1.8) mL vs 2.1 (3.4) mL) and number of exacerbations (0.1 (0.6) vs 1.2 (0.9)). Dyspnoea (0.4 (0.1) vs 0.1 (0.2)) and health-related quality of life also improved after therapy. However, oxidative stress markers in EBC, systemic inflammatory markers as well as functional respiratory tests did not differ from the control group after therapy. A post-hoc analysis comparing patients infected or not with Pseudomonas aeruginosa revealed that these effects were more pronounced in infected patients. In this subgroup, treatment was followed by a significant reduction in sputum volume, number of exacerbations, dyspnoea and St George's Respiratory Questionnaire total score. Of all airway oxidative stress markers, only nitrates in EBC were reduced after therapy. Long-term azythromicin treatment has some clinical benefits in patients with non-CF stable bronchiectasis, but it does not affect airway oxidative stress markers.

Troubles anxiodépressifs et dilatation des bronches

Bronchiectasis is a chronic lung disease that may be associated with anxiety-depressive disorders affecting the quality of life of patients. Detecting these anxiety-depressive disorders may be necessary in the support and overall management of a patient with bronchiectasis. To evaluate the prevalence of anxiety and depression in patients with bronchiectasis and to investigate the possible correlation between the severity of the disease and the importance of these psychological disorders. This was a prospective study that included 53 patients with stable bronchiectasis and without other comorbidities. All the patients underwent a complete clinical examination, spirometry and chest computed tomography. All the 53 patients responded to the Hospital Anxiety and Depression Scale (HAD) questionnaire. Anxiety was present in 22.7% of patients and depression in 20.8%. Subjects who had an anxiety disorder had symptoms primarily of dyspnoea (P=0.001), a low FEV (P=0.04) and respiratory failure at a stage requiring home oxygen therapy (P=0.009). A similar comparison of patients with and without depressive disorder again found a high prevalence of dyspnea (P=0.003), a low FEV (P=0.04), and chronic respiratory failure in the depressive patients. Symptoms of depression and anxiety are common in patients with bronchiectasis and appear to be associated with dyspnoea. Early detection is necessary in the context of the overall management of these patients.

The role of the high-sensitivity C-reactive protein in patients with stable non-cystic fibrosis bronchiectasis.

Study Objectives. The aim of this study is to investigate the correlation between serum high-sensitivity C-reactive protein (hs-CRP) and other clinical tools including high-resolution computed tomography (HRCT) in patients with stable non-CF bronchiectasis. Design. A within-subject correlational study of a group of patients with stable non-CF bronchiectasis, who were recruited from our outpatient clinic, was done over a two-year period. Measurements. Sixty-nine stable non-CF bronchiectasis patients were evaluated in terms of hs-CRP, 6-minute walk test, pulmonary function tests, and HRCT. Results. Circulating hs-CRP levels were significantly correlated with HRCT scores (n = 69, r = 0.473, P < 0.001) and resting oxygenation saturation (r = −0.269, P = 0.025). HRCT severity scores significantly increased in patients with hs-CRP level of 4.26 mg/L or higher (mean ± SD 28.1 ± 13.1) compared to those with hs-CRP level less than 4.26 mg/L (31.7 ± 9.8, P = 0.004). Oxygenation saturation at rest was lower in those with hs-CRP level of 4.26 mg/L or higher (93.5 ± 4.4%) compared to those with hs-CRP level less than 4.26 mg/L (96.4 ± 1.6%, P = 0.001). Conclusion. There was a good correlation between serum hs-CRP and HRCT scores in the patients with stable non-CF bronchiectasis.

Measurement of Fractional Exhaled Nitric Oxide in Stable Bronchiectasis

BackgroundFractional exhaled nitric oxide (FeNO) can be measured easily, rapidly, and noninvasively for the assessment of airway inflammation, particularly mediated by eosinophil, such as asthma. In bronchiectasis (BE), the pathogenesis has been known as chronic airway inflammation and infection with abnormal airway dilatation; however, there are little studies to evaluate the role of FeNO in BE.MethodsFrom March 2010 to February 2012, 47 patients with BE, diagnosed by high resolution computed tomography (HRCT), performed FeNO, compared with asthma and chronic obstructive pulmonary disease (COPD). All patients carried out a complete blood count including eosinophil count, chemistry, sputum examination, and spirometry, if indicated. A retrospective analysis was performed to elucidate the clinical role of FeNO in BE patients.ResultsThe mean FeNO levels in patients with BE was 18.8±1.5 part per billion (ppb), compared to 48.0±6.4 and 31.0±4.3 in those with asthma and COPD, respectively (p<0.001). The FeNO levels tended to increase along with the disease severity scores by HRCT; however, it was statistically not significant. FeNO in BE with a co-infection of nontuberculous mycobacteria was the lowest at 17.0±3.5 ppb among the study population.ConclusionFeNO in BE was lower than other chronic inflammatory airway diseases, particularly compared with asthma. For clinical application of FeNO in BE, more large-scaled, prospective studies should be considered.

Erratum: Addition of Acknowledgements. Measurement of Fractional Exhaled Nitric Oxide in Stable Bronchiectasis

Tuberc Respir Dis 2013;74(1):7-14. http://dx.doi.org/10.4046/trd.2013.74.1.7 The acknowledgement was omitted from this article. Additional acknowledgement is as follows: Acknowledgements This study was funded by Seoul National University Bundang Hospital (No. 06-2010-004).

Impact of treatment with low dose roxithromycin on stable bronchiectasis

To investigate the impact of treatment with low dose roxithromycin on clinical symptoms and CT scores in patients with stable bronchiectasis. Fifty patients with bronchiectasis in stable condition were randomly assigned to a control group and a treatment group. Patients in the control group received ambroxol hydrochloride tablet 90 mg 3 times a day. Patients in the treatment group received roxithromycin disperse tablet 0.15 g every day and ambroxol hydrochloride tablet 90 mg 3 times a day. The course of treatment lasted for 6 months. Quality of life was assessed using St. George's respiratory questionnaire (SGRQ). The British Medical Research Council (MRC) dyspnea scale was used to assess the degree of dyspnea. The score for CT evaluation of the thorax, quality of life and SGRQ were performed for all patients before and after the treatment. After 6 months, the scores for quality of life (48 ± 13) were lower compared to that (58 ± 15) before treatment in the control group; however, the scores for bronchial wall thickening of bronchiectasis (1.8 ± 0.5) were higher than that (1.8 ± 0.4) before study. The scores for the extent of bronchiectasis (2.7 ± 1.6), the bronchial wall thickening of bronchiectasis (1.3 ± 0.4) and the global CT score (6.7 ± 2.5) were reduced after treatment as compared to those before treatment [(4.8 ± 2.3), (1.8 ± 0.5), (9.5 ± 3.3)] in the treatment group, (all P < 0.01). The degree of dyspnea (1.3 ± 0.4) and quality of life (42 ± 12) were lower than those before treatment [(1.89 ± 0.45), (56 ± 15)] in the treatment group. Furthermore, the scores for extent of bronchiectasis (2.7 ± 1.6), the scores for the bronchial wall thickening of bronchiectasis (1.3 ± 0.4) and the global CT score (6.7 ± 2.5) in the treatment group were significantly improved as compared with those [(4.8 ± 2.0), (1.8 ± 0.5), (9.7 ± 3.6)] in the control group respectively after treatment. At the same time, the degree of dyspnea (1.3 ± 0.4) in the treatment group was significantly improved as compared with that (1.7 ± 0.4) in the control group after treatment. The scores for the bronchial wall thickening of bronchiectasis were increased in patients with stable bronchiectasis. Low dose roxithromycin combined with ambroxol hydrochloride significantly improved degree of dyspnea, reduced scores for extent of bronchiectasis, scores for the bronchial wall thickening of bronchiectasis and the global CT score as compared to treatment with ambroxol hydrochloride alone in patients with bronchiectasis in stable condition.

Bronchiectasis: Time to take action and implement the British Thoracic Society quality standards

Bronchiectasis, first described by Rene Laennec in 1819, is a common long-term respiratory condition caused by permanently damaged airways. Over 1 in 1000 people in the United Kingdom now has this disease. Although there are a variety of aetiologies, there is a common end point that permanently damaged the airways with impaired mucociliary clearance and neutrophilic airways inflammation. Despite the abundance of neutrophils, over two thirds of the patients are chronically colonised with bacteria. There has been a long debate whether bronchiectasis remains a local problem in the airway or that advanced local inflammation in the airways can lead to systemic inflammation. The study by Gale and colleagues demonstrated that although patients with bronchiectasis are clinically stable (n 1⁄4 20) compared with age-matched controls (n 1⁄4 20), they had increased concentrations of interleukin-6 in peripheral blood, reduced albumin concentrations and increased arterial stiffness using aortic pulse wave velocity. Patients also had reduced exercise tolerance and reduced physical activity score, and only 20% had normal bone mineral density. This study revealed increased systemic inflammation with increased arterial stiffness, the latter thought consequent on the systemic inflammation. Wilson and colleagues also showed that the patients with bronchiectasis in a stable phase (n 1⁄4 87) have raised systemic markers of inflammation and some markers, particularly the neutrophil count, which is correlated with disease severity. Martinez-Garcia and colleagues, in a study of 76 stable adult patients with bronchiectasis, showed that the independent factors associated with an accelerated decline in lung function were due to chronic colonization with Pseudomonas aeruginosa, more frequent severe exacerbations and more systemic inflammation. Similarly, our group investigated 385 patients with stable bronchiectasis and patients with sputum bacterial loads of 10 colony forming units/ml, showing an evidence of increased concentration of the vascular endothelial adhesion markers, in particular increased serum intercellular adhesion molecule-1 (ICAM-1), which was reduced with both shortand long-term antibiotic treatments. Therefore, it is important to consider bronchiectasis as not only a localised disease but also as a systemic disease. Further studies are needed to see whether bronchiectasis impacts on vascular morbidity and mortality and whether long term interventions impact on this. It is refreshing that there has been a resurgence of interest in bronchiectasis. The British Thoracic Society (BTS) have published national guidelines in bronchiectasis and more recently have published quality standards in bronchiectasis. There are 11 quality standards focussed on the following:

Are Crackles an Appropriate Outcome Measure for Airway Clearance Therapy?

There is an urgent need to develop new outcome measures for respiratory therapy, to evaluate its effectiveness. Adventitious sounds generated from the lungs (crackles and wheezes), can now be quantified and characterized objectively with computer technology. To our knowledge, this is the first reported study designed to assess any change in lung crackles before and after a single session of airway clearance therapy. Twenty-three stable bronchiectasis patients were recruited from United Kingdom out-patient clinics and treated with a single session of airway clearance therapy, using the active cycle of breathing technique. Sound recordings were made before and after the session at 7 anatomical chest locations. Computerized lung sound analysis was used to measure crackle parameters: 2-cycle deflection width (2CD), and crackle number per breath cycle (nBC). Perceived breathlessness, lung function, and oxygen saturation data were also recorded. Crackle mean 2CD and mean nBC increased post intervention. Sixteen participants (70%) showed a statistically significant difference in mean crackle 2CD before and after the session at ≥ 1 chest location. Thirteen (57%) participants had a difference between mean crackle 2CD before and after the intervention > 1 Smallest Real Difference (SRD, mean SRD = 2.23 ms) at ≥ 1 chest location. Differences in mean crackle nBC before and after the intervention did not exceed the SRD (mean SRD = 32 crackles per breath cycle) in any participant. Perceived breathlessness was significantly reduced post intervention; no significant changes were observed in either lung function or oxygen saturation. Crackle duration (2CD) was found to change after a single session of airway clearance therapy, and shows promise as a new outcome measure for respiratory therapy interventions.

Ensayo clínico aleatorizado de técnicas de aclaramiento mucociliar en niños con bronquiectasias sin fibrosis quística

ObjectiveTo evaluate effectiveness of manual expiratory pressure and expiratory flow increase (EFI) combined with mechanical insufflation-exsufflation (MI-E) and assisted coughing (AC) versus active cycle of breathing techniques (ACBT) in stable bronchiectasis children without cystic fibrosis (CF). Material and methodsRandomized clinical trial with 2 groups of 6 children (age 8.1±1.3) who received of respiratory physiotherapy (RP) sessions twice a month. The main endpoints studied are: weight of sputum collected after each session of RP and lung function measurements at baseline and 12 months, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow between 25%-75% of FVC (FEF25-75%). We also evaluated the number of visits to emergency department, infective exacerbations and the impact of cough on quality of life with the Leicester Cough Questionnaire (LCQ), at the beginning and the end of study. ResultsThe weight of sputum and FEF25-75% increase significantly with manual expiratory pressure, EFI combined with MI-E and AC versus ACBT in our sample. There are no significant differences in FEV1 and FVC. Number of exacerbations decreased in both groups compared to the previous year (without CP treatment), and total score of the LCQ. ConclusionSlow manual expiratory pressure, EFI combined with MI-E and AC for airway permeabilization in children with non-CF bronchiectasis produce significant benefits compared to ACBT.

P246 Airway and systemic inflammation in stable and exacerbated bronchiectasis: a pilot study

IntroductionIt is not known whether systemic inflammation reflects lower airway inflammation in non-CF bronchiectasis. If confirmed, blood biomarkers may provide useful information on pulmonary disease burden in both stable and...

Does airway colonization cause systemic inflammation in bronchiectasis?

Recent evidence suggests the presence of accompanying systemic inflammation in chronic inflammatory airway diseases such as chronic obstructive pulmonary disease and asthma; however little is known regarding the presence of systemic inflammation in bronchiectasis. Although bronchiectasis was initially considered a stationary process, chronic bacterial colonization causes airway inflammation and progressive airway damage. The aim of this study was to determine the level of systemic inflammation in bronchiectasis patients and identify its relationship with colonization. White blood cell (WBC) count, erythrocyte sedimentation rate, serum C-reactive protein (CRP), plasma fibrinogen, interleukin-8, tumor necrosis factor-α and leptin levels were determined in clinically stable bronchiectasis patients (n= 50), and age- and sex-matched controls. Bronchiectasis patients were also analyzed according to colonization in sputum samples. There was no significant difference between bronchiectasis and control groups with respect to inflammatory markers but median (interquartile range-IQR) WBC count, CRP and fibrinogen levels were significantly higher in colonized patients (n= 14) when compared to non-colonized patients [8.2 (6.4-9.5) vs. 6.4 (5.8-7.7) x 103/mm3, 0.91 (0.45-1.29) vs. 0.42 (0.30-0.77) mg/dL, 433.5 (390.3-490.3) vs. 392.0 (327.0-416.0) mg/dL, respectively; p< 0.05]. There was no evidence supporting the presence of systemic inflammation in the overall bronchiectasis group when compared to controls. However, elevated WBC count, CRP and fibrinogen levels in patients with colonization suggest the presence of a systemic inflammatory response in clinically stable bronchiectasis patients with colonization.