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Loss Of Small, Distal Pulmonary Arteries Associated With Bronchiectasis Progression - Healio
September 02, 2022
2 min read
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The loss of small, distal pulmonary arteries was associated with progression of CT-derived bronchiectasis, especially among smokers with COPD, according to results published in Respiratory Medicine Journal.
"Smokers with bronchiectasis present a loss of small, distal pulmonary vessels, and children with cystic fibrosis bronchiectasis and adults who underwent surgery due to bronchiectasis manifest a loss of small pulmonary arteries and capillary beds," Wojciech R. Dolliver, MD, research assistant in the division of pulmonary and critical care medicine at Brigham and Women's Hospital, and colleagues wrote. "Therefore, this study aimed to test the hypothesis that intra-parenchymal pulmonary arterial pruning is associated with bronchiectasis progression, using techniques applied on noncontract CT that allow to objectively assess in vivo vascular trees."
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Researchers evaluated bronchiectasis on CT at baseline and 5 years later among 386 participants (mean age, 64 years; 41% women) with 10 or more pack-years smoking history with (n = 185) and without (n = 201) COPD. Researchers visually scored bronchiectasis, with higher scores indicating more severe disease. They also measured vascular pruning with use of the ratio of blood vessel volume in arteries less than 5 mm2in cross-section to total arterial blood vessel volume (BV5a:BVTa) on baseline CTs; lower values indicated more pruning.
Participants with more arterial pruning were more likely to be non-Hispanic Black women compared with those with less arterial pruning (36% vs. 18%; P = .001). These participants also had lower FEV1 (1.73 L vs. 2.24 L; P < .001), 6-minute walk distance (1,268 ft vs. 1,447 ft; P < .001) and resting oxygen saturation (96% vs. 97%; P = .0008) as well as higher baseline 10 mm inner perimeter airway (2.43 mm vs. 1.89 mm; P < .001) compared with participants with less arterial pruning, the researchers wrote.
Overall, 34.5% of participants met the definition of CT-derived bronchiectasis progression, with a mean 5-year change of an increase of 5.7 points. Researchers reported an increase in pulmonary segments with bronchiectasis as the main contributor to score changes, followed by the extent of airway wall thickness severity and airway dilation severity.
In addition, the baseline BV5a:BVTa ratio was associated with 5-year progressing CT-derived bronchiectasis per 5% lower BV5a:BVTa (OR = 1.28; 95% CI, 1.07-1.53; P = .007). Among those with COPD, the corresponding OR was 1.45, according to the researchers.
"These results extend this knowledge by revealing that disappearance of small pulmonary arteries is associated with structural bronchiectasis progression, and they are in line with studies demonstrating that pulmonary vascular pruning is associated with other chronic airway disease, COPD and asthma," the researchers wrote.
Sources/DisclosuresCollapse Disclosures: Dolliver reports no relevant financial disclosures. Please see the study for all other authors' relevant financial disclosures.Add topic to email alerts
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Bronchiectasis Plus Chronic Respiratory Infection Raises Exacerbation Risk - Healio
October 01, 2024
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Having a chronic respiratory infection in addition to bronchiectasis heightened the risk for an exacerbation and hospitalization within 2 years of diagnosis, according to results published in BMC Pulmonary Medicine.
"We found a high prevalence of infections and severe outcomes in a nationally distributed population of persons with bronchiectasis, who are likely more representative of all persons with bronchiectasis compared with those enrolled in specialized registries at tertiary care centers," Samantha G. Dean, BA, fourth-year biostatistics PhD student at Yale University's School of Medicine, and colleagues wrote.
Data were derived from Dean SG, et al. BMC Pulm Med. 2024;doi:10.1186/s12890-024-02973-3.
Through the large, geographically diverse Cerner HealthFacts Electronic Health Record database, Dean and colleagues evaluated 7,749 patients (65% aged 65 years or older; 65% women) with incident bronchiectasis to determine the type and frequency of pulmonary infections experienced by this population, as well as how these infections impact exacerbation and hospitalization rates.
In addition to bronchiectasis, 50% of the total cohort had COPD. Some patients with bronchiectasis also suffered with asthma (35%) or lung cancer (7%) at the same time, researchers noted.
After analyzing the organisms in pulmonary samples from 56% of the total cohort, researchers found Pseudomonas aeruginosa in 937 (12%) patients, of whom 219 (23%) had chronic colonization.
Researchers observed three additional common organisms in the samples, all of which appeared less frequently than P. Aeruginosa: Staphylococcus aureus (n = 502; 6%), Mycobacterium avium complex (MAC; n = 336; 4%) and Aspergillus species (n = 288; 4%).
A chronic MAC infection appeared in 101 (30%) patients with a minimum of one isolate of this pathogen. Smaller proportions of patients had chronic Aspergillus species infection (17%; n = 50) or chronic S. Aureus colonization (15%; n = 74).
Other organisms found included Haemophilus influenzae, Stenotrophomonas maltophilia, Streptococcus pneumoniae, Klebsiella pneumoniae and Mycobacterium abscessus.
In terms of exacerbation and hospitalization rates, researchers had data from 2 years after the bronchiectasis diagnosis for 5,795 patients.
During this timeframe, hospitalization frequently occurred (60%), whereas fewer patients (32%) experienced an exacerbation.
Researchers observed a significantly greater proportion of hospitalized patients in the 2-year period among those with bronchiectasis plus chronic P. Aeruginosa vs. MAC (87% vs. 64%: P < .0029).
For those with chronic P. Aeruginosa, the median total hospitalization duration was 32.6 days, whereas patients with chronic MAC and patients with no chronic infection had a shorter duration (10.9 days and 11.7 days, respectively).
Further, more patients with bronchiectasis plus chronic P. Aeruginosa vs. MAC suffered an exacerbation (64% vs. 38%; P < .0064).
At the 2-year mark, the risk for exacerbations went up by 70% if patients with bronchiectasis also had a chronic infection with any of outlined organisms vs. No chronic infection. Researchers found a similar outcome when evaluating the risk for hospitalization at 2 years, which was heightened by 50% with a chronic infection.
"These findings [speak] to the need for continued monitoring of lung infections among all persons with bronchiectasis," Dean and colleagues wrote.
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Key Areas Of Research And Emerging Therapies In Bronchiectasis Treatment - AJMC
Dr Metersky provides his closing thoughts, highlighting key points of emphasis surrounding bronchiectasis care and the future of its treatment landscape.
This is a video synopsis/summary of an Insights involving Mark Metersky, MD, FCCP, on emerging bronchiectasis research and key takeaways.
Many new experimental bronchiectasis therapies are under investigation with increased pharmaceutical industry interest. One medication class is dipeptidyl-peptidase (DPP-1) inhibitors which block neutrophil serine protease activation (like neutrophil elastase) without impairing other neutrophil functions. Neutrophil elastase directly causes bronchiectasis inflammation and tissue damage. A DPP-1 inhibitor phase 2 trial demonstrated reduced exacerbations. Multiple similar agents are under study.
Research into bronchiectasis endotypes (underlying characteristics) also shows promise for precision therapy approaches. About 20% of bronchiectasis patients have eosinophil-predominant inflammation. Some case reports suggest possible benefits from asthma biologic medications in this subgroup. Also, the historical practice of avoiding inhaled corticosteroids due to infection risks like nontuberculous mycobacteria is being reevaluated given the potential advantages of treating eosinophilic inflammation.
Another emerging endotype is primary ciliary dyskinesia (PCD) among adults with bronchiectasis, found to be around 10% rather than the previous estimate of 1% to 2%. Biotechnology investigations target whether improving ciliary function in PCD bronchiectasis could improve outcomes. Additionally, significant percentages of noncystic fibrosis bronchiectasis patients have single mutant cystic fibrosis transmembrane conductance regulator (CFTR) genes. Early CFTR modulator research is underway for such heterozygotes.
In summary, key points are that bronchiectasis remains underdiagnosed with an average of 5- to 10-year delays from symptom onset, often initially misattributed to asthma or chronic obstructive pulmonary disease. Clinicians should maintain a low threshold for CT diagnostic imaging given bronchiectasis treatment benefits. Though incurable, evidence-based supportive treatments significantly improve symptoms and quality of life for many patients. Exciting near-future targeted therapies seem probable given expanding pharmaceutical interest and research.
Video synopsis is AI-generated and reviewed by AJMC® editorial staff.
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