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PubMedDate not supplied

[Clinical response to inhalation and oral antibiotics in patients with bronchiectasis].

INTRODUCTION: The aim of this technique was to achieve high concentration of the antibiotic that excedeed the minimal inhibitory concentration (MIC) of the microbial load present in the sputum. METHOD: To evaluate the bronchiectasis patients with pictures of infectious exacerbations response to the treatment with antibiotic by oral way (roxitromicin 300 mg/day for 21 days) and in cases of failure of this schema the use of antibiotic by inhalatory way (gentamicin 80 mg/2 times day for 21 days), 28 patients were evaluated a special ambulatory, some signs and respiratory symptoms according to the "Cotes modified scale" (sputum, cough, bronchospasm and dyspnea). STATISTICAL ANALYSIS: We used: Kappa concordant test and McNemar test for discordation in the evaluation of the degree of signal and respiratory symptoms, Wilcoxon test for periods without infection, Fisher test for the collaterals effects presented, G of Cochran test for the personal history analysis. RESULTS: The personal history did not influence the evolution of bronchopulmonary infeccion, the evaluated signs and symptoms had significant improvement except dyspnea that stayed the same in 80% of the cases. DISCUSSION: The group that had used the antibiotics schema by inhalatory way after oral scheme failure had a significant longer period without bronchopulmonary infection but with superior collateral effects without clinicals repercussions. CONCLUSION: The use of inhalatory antibiotic in infectious exacerbations in patients with bronchiectasis was better than the oral way.

Administration, Inhalation↗

PubMedDate not supplied

Bronchopulmonary hygiene physical therapy in bronchiectasis and chronic obstructive pulmonary disease: a systematic review.

OBJECTIVES: This study had two objectives: (1) to examine the effects of bronchopulmonary hygiene physical therapy on patients with chronic obstructive pulmonary disease and bronchiectasis; (2) to determine any differences between manual and mechanical techniques for bronchopulmonary hygiene physical therapy. DESIGN: The study design was a systematic review of the literature that used an exhaustive search for trials and review methods prescribed by the Cochrane Collaboration. INCLUSION CRITERIA: Randomized controlled trials examined patient groups, interventions, and dependent variables. PATIENTS: Patients included those with chronic obstructive pulmonary diseases (emphysema or chronic bronchitis) or bronchiectasis. INTERVENTIONS: Any of the following interventions or combinations thereof were included: manual interventions, such as postural drainage, chest percussion, vibration, chest shaking, directed coughing, or forced exhalation technique. CONTROLS: Controls of the study were as follows: no intervention; placebo; coughing; and mechanical interventions, such as mechanical vibration. RESULTS: The search identified 99 potential trials; inclusion or exclusion analysis left 7, which examined a total of 126 patients. Mean score on trial quality was 1.4 (5 = greatest). Three separate trials (N = 51) found statistically significant effects for bronchopulmonary hygiene physical therapy on sputum production and radioaerosol clearance. No trials (N = 126) found statistically significant effects on pulmonary function variables or differences between manual and mechanical techniques. CONCLUSIONS: Considering the small sizes, low quality, and mixed results from the trials, the research on bronchopulmonary hygiene physical therapy is inconclusive. There is a need for adequately sized, high-quality, randomized controlled trials with uniform patient populations to examine the effects of bronchopulmonary hygiene physical therapy.

Breathing Exercises↗

PubMed2000

Prevalence, age distribution and aetiology of bronchiectasis: a retrospective study on 144 symptomatic patients.

The incidence of bronchiectasis (BCT) has probably decreased in developed countries in recent years, but reliable statistical data on its occurrence are still lacking. The aim of the present study was to retrospectively evaluate the prevalence, age distribution and aetiology of BCT, diagnosed in a selected series of symptomatic patients of a Western country by using bronchography. The authors analysed the main known predisposing and associated conditions (PACs), and the occurrence and age distribution of BCT in 144 consecutive patients who underwent bronchological examination (fibreoptic bronchoscopy and bronchography) in the years 1987-1994 because of recurrent purulent bronchitis and/or haemoptysis. The overall prevalence of BCT was 34% (49/144); its age distribution was: 17.2% (0-10 yrs), 43.7% (11-20 yrs), 38% (21-30 yrs), 37.5% (31-40 yrs), 33.3% (41-50 yrs), 40% (51-60 yrs), and 20% (61-70 yrs). Thirty-one PACs were found in 29/144 patients of the whole study group. The prevalence of BCT was significantly higher in the subgroup of 29 patients with PACs than in the subgroup of 115 patients without PACs (75.9% versus 23.5%; p < 0000001). The aetiology of BCT was mainly unexplained, as it was only possible to detect 24 PACs in 22/49 patients with BCT (44.9%): congenital, genetic and immune disorders (eight), localized airways obstructive diseases (five), pulmonary infections (three), bronchial asthma (two), pulmonary lobar fibrosis (two), ulcerative colitis (two), dermatomiositis (one), and toxin inhalation (one). The authors conclude that bronchiectasis still occurs in a large percentage of symptomatic patients of a developed country in the post-antimicrobial era, especially in the second to sixth decades, as well as in the presence of predisposing and associated conditions; its aetiology remains unknown in more than half of cases.

Adolescent↗

PubMed2000

[A case of transient cortical blindness complicated by Henoch-Schönlein purpura with bronchiectasis].

A 19-year-old woman had been treated for bronchiectasis since she was born. In October 1995, she was diagnosed as Henoch-Schönlein purpura (HSP) and HSP nephritis with the findings as follows; palpable petechial rash of legs, abdominal pain, arthralgias, and proteinuria. The administration of oral prednisolone was started, the clinical symptoms except for proteinuria was disappeared. However, nephrotic syndrome was continued despite the therapy of intravenous methylprednisolone pulse, various immunosuppressive drugs and warfarin. In February 1998, she was admitted to our hospital because of pneumonia. Several days later, her pneumonia improved on treatment with antibiotics, but she suddenly developed transient cortical blindness and acute renal failure. A provisional diagnosis of hypertensive encephalopathy and cerebral edema related to vasculitis was made, and she was treated with nifedipine, Glycelo, and high dose immunoglobulin. After the treatment, her vision and renal function had improved. She is a rare case associated with transient cortical blindness, bronchiectasis, and HSP.

Adult↗

PubMed2000

Complementary investigations in bronchiectasis in children.

The different modalities suitable for image-guided diagnosis of bronchiectasis in children are described. Plain chest radiography is still the most important imaging method of respiratory disease in children, but when it comes to ascertaining the diagnosis of bronchiectasis, high-resolution computed tomography (CT) is currently the method of choice. Ultrafast computed tomography and multislice computed tomography have increased the value of computed tomography as a diagnostic tool by reducing the need for sedation or anaesthesia. Bronchography is as a rule no longer necessary to perform on this indication alone. If modern, high-quality computed tomography is not readily available, however, bronchography may still be necessary preoperatively.

Bronchiectasis↗

PubMedDate not supplied

[Middle lobectomy for bronchiectasis: clinical case and review of the literature].

Over the past few years bronchiectasis, among the chronic lung diseases, has been the second most important after tuberculosis in terms of frequency and mortality. Although the incidence of the disease has been decreasing in recent years, the illness is currently of great surgical interest because of an upsurge of cases among people considered to be below the bread line. The authors present the clinical case and surgical treatment of a young adult with middle lobe bronchiectasis, with a 10-year primary IgG deficiency and severe bronchopneumonia requiring hospitalisation. Medical treatment, long regarded as the treatment of choice in this condition, has reduced the short-term morbidity of patients suffering from the disease, without affecting its ultimate mortality which is still very high today. The policy in the past to reserve surgery only for the most complicated cases or for patients not responding to medical treatment can now be considered obsolete, due to the reduced surgical risks (less than 1%) and to faster patient recovery. Further surgical indications are mono- or bilaterally located forms of the disease and failure to respond to medical treatment for more than 2 years. A review of the literature enables the authors to affirm that in the absence of randomised trials on the effectiveness of surgical vs medical treatment, it seems clear that surgical therapy is the best option, being curative and safe, with a high percentage of complete remission of disease and very low operative risks and mortality. It can therefore guarantee good quality of life, radically changing the prognosis which otherwise is fatal in 1/3 of patients suffering from this orphan disease.

Adult↗

PubMedDate not supplied

Rapidly progressive bronchiectasis complicating ulcerative colitis in a child.

Patients with ulcerative colitis may have a presentation dominated by extraintestinal manifestations. These manifestations, particularly bronchiectasis, are very rarely seen in pediatric patients. A 13-year-old boy with ulcerative colitis who was diagnosed by colonic mucosa biopsy is presented. He developed unexplained productive cough after the appearance of colonic disease. He was treated and followed up at his primary care hospital with the sole diagnosis of ulcerative colitis, with little attention given to the chest symptoms. The relation of the bronchial involvement to the ulcerative colitis was not established until two years after the onset of disease. Thoracal computed tomography (CT) examination after this period showed evidence of bronchiectasis and pulmonary involvement. Despite prophylactic inhaled corticosteroid treatment, no clinical or radiographic improvement was observed and widespread bronchial destruction developed very rapidly. More effective treatment with oral steroids was probably necessary in this patient, if the early chest symptoms were related to the ulcerative colitis.

Adolescent↗

PubMed2001

[Beginning rheumatoid arthritis revealed during bronchiectasis surinfections. Value of cyclic antibiotherapy?].

Incidence of symptomatic bronchiectasis (BR) occurs in around 2% in patients with late rheumatoid arthritis (RA). Its seems that the association BR-RA could be a worsening factor for outcome of RA patients. A 58-year-old woman without dry syndrome, suffering from bronchial purulence over one year was admitted to the Department of Pneumology for hemoptysis and arthritis (knees, ankles, and wrists). Three prior episodes of inflammatory articular pain had occurred after transient bronchial purulence or pneumonitis. CT-scan showed bilateral bronchiectasis. Diagnosis of early RA was proved after the third episode of bronchial purulence related to a strain of Haemophilus influenzae. A strain of Coxiella burnetii was probably responsible for one of the three bronchial surinfections. Latex and Waaler Rose tests were transiently positive during the first episode, and became positive after the third one. At that time, RA was relevant in view of ARA criteria. Cyclic prophylactic antibiotic regimens could be proposed to patients suffering from RA-BR association, in contrast to the cases of patients with isolated BR. This approach could prevent destabilization of RA and reinforce of anti-rheumatic therapy. Activation and release of cytokines (NFk-B, TNF-alpha), and/or bacterial epitopes seems to be directly responsible for the articular destabilization.

Anti-Bacterial Agents↗

PubMed1975

Bacteriological findings in transtracheal aspirates from patients with chronic bronchitis and bronchiectasis: a preliminary report.

Thirty-six transtracheal aspirates from 34 patients with chronic bronchitis and bronchiectasis were examined bacteriologically. Bacteria were isolated from 30 aspirates, 23 of which yielded pure culture. Anaerobic bacteria were found in three aspirates, all in pure culture. This preliminary report indicates a greater complexity of the microbial flora in chronic bronchitis and bronchiectasis than hitherto appreciated.

Bacteria↗

PubMed2002

[Pulmonary Mycobacterium avium complex disease showing nodular bronchiectasis--: pathological findings in two cases].

Histopathological examinations were carried out on 2 cases of Mycobacterium avium complex (MAC) disease of nodular bronchiectasis (NB) type on radiograms. The removed lung specimens revealed histological findings of granulomatous bronchiolopneumonia, consisting of epithelioid cell granulomas with lymphocytic infiltrations without exudation in the alveolar areas surrounding the respiratory bronchiole. The central bronchiolar walls were also affected by epithelioid cell granulomas with lymphocytic infiltration, occasionally showing polypoid protrusion into the bronchiolar lumen accompanying emphysema in the peripheral alveolar area. Bronchial lesions seemed to progress from peripheral to central airway with consequent atrophy and disappearance of intramural smooth muscles, resulted in bronchioloectasis. These histological findings well correspond to radiographical 'nodular bronchiectasis'. Large histiocytic granulomas without caseous necrosis developed in some area, which are not usually found in tuberculosis lesions. Epithelioid cell granulomas were occasionally found in the hilar lymph nodes as well as in the walls of lymphatic vessel in the pulmonary interlobular tissues, indicating intrapulmonary lymphatic spread of the mycobacteria.

Bronchi↗

PubMed2002

[Effects of the zhikuofang on the inflammation and cytostatics of the airway model of bronchiectasis].

OBJECTIVE: To explore the effects of Zhikuofang, a TCM prescription, and Ofloxacin on the inflammation and cytostatics of the airway model of bronchiectasis. METHOD: The airway model of bronchiectasis (AMB) was set up and infused with Ps. Aeruginosa. A comparison between the effects of Zhikuofang and Of loxacin on the AMB was made. RESULT: Zhikuofang is better than Ofloxacin in following aspects: lowering the density of inflammation cells in blood, decreasing the volume of tracheal secretion and inhibiting the cytostatics (IL-8 and TNF-alpha) of the trachea tissue, but Ofloxacin is more effective in diminishing the amount of bacteria in trachea flushing liquor. There was no marked difference between them in their histopathy effects on the trachea. CONCLUSION: Zhikuofang probably plays antiphlogistic and bacteriostatic effects by inhibiting the IL-8 and TNF-alpha, resisting secretion, decreasing the inflammation cells and resisting inflammation of trachea.

Animals↗

PubMedDate not supplied

Airway obstruction in bronchiectasis and its reversibility--a study of 38 patients.

Thirty-eight patients (20 males and 18 females) with bronchiectasis were studied for the evidence of airway obstruction and its reversibility in response to subcutaneous terbutaline. There was an improvement in VC (8.56%), FEV1 (6.36%), PEFR (15%) and PEF 25-75% (18%) respectively. The difference being statistically significant in VC and highly significant in FEV1, PEFR and FEF25-75 as compared to initial values and in 6 patients the improvement in FEV1 was more than 15%. The improvement in airway obstruction was not related to the character of expectoration. It is suggested that all the patients of bronchiectasis should be assessed for the reversibility of airway obstruction and those showing a reversible pattern be treated accordingly.

Adult↗

PubMed2004

[Indications for the surgical treatment in bronchiectasis and postoperative results].

During Jan. 1990 and Dec. 2002 a total of 14 patients with bronchiectasis were operated on. They were 5 female and 9 male with mean age of 35.7 years. In two of them (14.3%) the disease was with bilateral localization. Patients were typically presented with cough and purulent sputum production 12(85.7%), recurrent pulmonary infections 8(57.1%), halitosis 6(42.9%) and hemoptysis 4(28.6%). The mean duration of clinical manifestations was 8.4 years. The indications for surgery were failure of medical treatment in 10(71.4%) patients, hemoptysis in 2(14.3%) and lung abscesus, as a complication in 2(14.3%) patients. The operative methods included 9(64.3%) lobectomies, 1(7.1%) pleuropneumonectomy, 1(7.1%) pneumonectomy, 1(7.1%) bilobectomy with broncho-esophageal fistula resection, 1(7.1%) middle lobectomy with polysegmental resection S7-10 and 1(7.1%) polysegmental resection S7-10. No 30-day postoperative death was faced. Major complications, followed by rethoracotomy, were found in 2(14.3%) of the cases. The postoperative results were excellent in 8(57.1%) of the patient, very good in 5(35.75) of them and in only 1 patient there was no clinical improvement. In conclusion, surgery for bronchiectasis is followed by acceptable postoperative complications and better long-term result after radical operation.

Adolescent↗

PubMed1991

[Bronchiectasis: a method of obtaining bronchoalveolar lavage fluid and studying its cytological characteristics].

The bronchoalveolar fluid (BAF) cytology of 63 patients with bronchiectasis has been studied. BAF from 8 subjects without pulmonary pathology served as control. BAF samples were obtained after preliminary cleaning of the bronchial tree from the purulent contents. BAF cytosis was found significantly increased in bronchiectasis as compared to the control being observed even at minimal inflammatory activity in the lungs and due to elevated neutrophil count. Alveolar macrophage numbers reduced only in advanced inflammation. Lymphocyte count remained unchanged. BAF cytologic evidence objectively reflects the degree of the bronchoalveolar inflammation.

Adult↗

PubMed1990

Abnormal mucociliary action in asthma and bronchiectasis.

Nasal mucociliary clearance (NMCC) time was measured in four groups of patients: asthmatics with allergic rhinitis, asthmatics without rhinitis, bronchiectasis and normal subjects. The saccharin method was used for the study. The NMCC time was prolonged significantly in the asthmatic groups and group with bronchiectasis when compared with control subjects (P less than 0.001). It is likely that the impaired mucociliary clearance is due to a combination of mucus abnormality and ciliary malfunction.

Adult↗

PubMed1990

Double-blind randomized study of prolonged higher-dose oral amoxycillin in purulent bronchiectasis.

Thirty-eight patients with bronchiectasis and daily expectoration of purulent sputum despite conventional antibiotic courses were randomly allocated to receive a sachet of amoxycillin (3 g) or matched placebo twice daily for 32 weeks in a double-blind study. Nine patients (four amoxycillin, five placebo) were withdrawn from the study treatment; the response of the two patients (both on amoxycillin) withdrawn within the first six weeks was not assessed. The pretreatment characteristics of the two groups were similar. Independent assessment of overall response based on patients' diary cards showed that a higher proportion improved in the amoxycillin group (11 of 17) than in the placebo group (four of 19; p = 0.02). Patients in the amoxycillin group spent significantly less time confined to bed and away from work during treatment. The frequency of exacerbations during the study treatment phase was similar in the two groups but they were less severe than before study treatment in the amoxycillin group. There was a greater reduction in purulent sputum volume between exacerbations during the study treatment in the amoxycillin group to 20 per cent of pretreatment volume than in the placebo group (88 per cent of pretreatment volume, p = 0.008), although the concentrations of Haemophilus spp. in sputum between exacerbations was similar in the two groups. Adverse effects experienced were minor except in one patient (amoxycillin) withdrawn after developing a rash and in six patients (three amoxycillin, three placebo) who had diarrhoea lasting more than one week necessitating withdrawal of two patients (one amoxycillin, one placebo) from study treatment. Sputum and stool cultures collected regularly during the study showed no important changes in the bacterial flora in either group. Prolonged higher-dose antibiotic therapy in these patients with severe purulent bronchiectasis significantly reduced the host (patient) inflammatory response to colonizing microorganisms and reduced morbidity.

Adult↗

PubMed1990

[The tumorlet carcinoid in bronchiectasis-changed lungs. An example of a multifocal, endocrine tumor].

Tumorlets of the lungs are multifocal hyperplasias of endocrine cells which may develop via nodular hyperplasia into peripheral, occasionally also metastatic, carcinoids. They are observed with a particular frequency in bronchiectasis. Resected material obtained from patients with bronchiectasis (4 women, 3 men, mean age 43.5 years, range 19-66 years) were submitted to conventional histological studies employing HE, PAS and van Gieson staining, and also to an immunohistological analysis. Conventional staining sufficed to identify endocrine cell proliferations in the scarred lung tissue in 3 preparations. An assignment to bronchioles and alveoli with conventional histology was, in view of the extensive scarring of the lung parenchyma, very difficult, but was accomplished with the aid of immunohistological investigation. As a multifocal tumour, the tumourlet suggests itself as a model, employing immunohistochemistry, for studying the formal genesis of neuroendocrine tumours of the lung, since it shows the earliest intra-epithelial neoplastic transformations through in situ tumour to carcinoid.

Adult↗

PubMedDate not supplied

[Changes in etiologic factors, anatomic distribution and age in children with bronchiectasis].

Changing aetiology, anatomic distribution and age of 62 children with bronchiectasis undergoing lobectomy between 1979 and 1987, were analysed. Postpneumonic bronchiectases were found in about 50% of cases during several years of observed 9-years' period. There was significant increase of bronchiectasis due to the documented congenital malformations of the lungs according to the exact diagnosis of intrapulmonary congenital lesions (congenital cystic disease of the lungs, bronchial and vascular abnormalities). Bronchiectases have been diagnosed and surgically treated in very young children lately; mean age at the time of surgery decreased from 7.1 years in 1979. to 5.2 years in 1987.

Age Factors↗