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Bronchoscopic airway clearance therapy for acute exacerbations of bronchiectasis

BACKGROUND: Persistent cough and large amounts of purulent sputum affects many bronchiectasis patients. No studies have evaluated the efficacy and safety of bronchoscopic airway clearance therapy and bronchoalveolar lavage (B-ACT) for non-cystic fibrosis bronchiectasis patients with acute exacerbati...

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Autores principales: Liu, Yang, Lu, Hai-Wen, Gu, Shu-Yi, Wang, Wen-Wen, Ge, Juan, Jie, Zhi-Jun, Jia, Jin-Guang, Gao, Zhi-Ting, Li, Jun, Shi, Jing-Yun, Liang, Shuo, Cheng, Ke-Bing, Bai, Jiu-Wu, Qu, Jie-Ming, Xu, Jin-Fu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8452777/
https://www.ncbi.nlm.nih.gov/pubmed/34537448
http://dx.doi.org/10.1016/j.ebiom.2021.103587
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author Liu, Yang
Lu, Hai-Wen
Gu, Shu-Yi
Wang, Wen-Wen
Ge, Juan
Jie, Zhi-Jun
Jia, Jin-Guang
Gao, Zhi-Ting
Li, Jun
Shi, Jing-Yun
Liang, Shuo
Cheng, Ke-Bing
Bai, Jiu-Wu
Qu, Jie-Ming
Xu, Jin-Fu
author_facet Liu, Yang
Lu, Hai-Wen
Gu, Shu-Yi
Wang, Wen-Wen
Ge, Juan
Jie, Zhi-Jun
Jia, Jin-Guang
Gao, Zhi-Ting
Li, Jun
Shi, Jing-Yun
Liang, Shuo
Cheng, Ke-Bing
Bai, Jiu-Wu
Qu, Jie-Ming
Xu, Jin-Fu
author_sort Liu, Yang
collection PubMed
description BACKGROUND: Persistent cough and large amounts of purulent sputum affects many bronchiectasis patients. No studies have evaluated the efficacy and safety of bronchoscopic airway clearance therapy and bronchoalveolar lavage (B-ACT) for non-cystic fibrosis bronchiectasis patients with acute exacerbation. METHODS: A randomised controlled trial was conducted to explore the efficacy and safety of B-ACT among 189 bronchiectasis inpatients from February 1, 2018 to February 28, 2019. The primary outcome was the time to first acute exacerbation. Secondary outcomes included changes of health-related scores, length of hospital stay, hospitalization expenses and incidences of adverse events. FINDINGS: B-ACT therapy significantly prolonged the median days to first acute exacerbation when compared with control group (198 vs 168 days, HR 0·555 (0·322-0·958), p=0·012; effect size(r)= 0·94). Further analysis showed that B-ACT therapy was more beneficial for these patients with severe disease and greater symptoms. COPD Assessment Test (CAT) scores improved significantly on the third day (5·45 vs 4·85, 0·60 (0·09-1·11), p=0·023), and Leicester Cough Questionnaire (LCQ) scores improved obviously on the third and seventh days (1·53 vs 1·23, 0·30 (0·05-0·55), p=0·044; 1·66 vs 1·32, 0·34 (0·08-0·60), p=0·022; respectively) after B-ACT therapy. Adverse events associated with B-ACT were mostly transient and mild. Differences of the lengths of hospital stay and hospitalization expenses in both group was not significant. INTERPRETATION: B-ACT therapy significantly prolonged the time to first acute exacerbation after discharge, highlighting the importance of B-ACT therapy focused on symptom improvements in preventing exacerbation. FUNDING: National Natural Science Foundation of China. TRIAL REGISTRY: ClinicalTrials.gov; No.:NCT03643302; URL: www.clinicaltrials.gov.
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spelling pubmed-84527772021-09-27 Bronchoscopic airway clearance therapy for acute exacerbations of bronchiectasis Liu, Yang Lu, Hai-Wen Gu, Shu-Yi Wang, Wen-Wen Ge, Juan Jie, Zhi-Jun Jia, Jin-Guang Gao, Zhi-Ting Li, Jun Shi, Jing-Yun Liang, Shuo Cheng, Ke-Bing Bai, Jiu-Wu Qu, Jie-Ming Xu, Jin-Fu EBioMedicine Research Paper BACKGROUND: Persistent cough and large amounts of purulent sputum affects many bronchiectasis patients. No studies have evaluated the efficacy and safety of bronchoscopic airway clearance therapy and bronchoalveolar lavage (B-ACT) for non-cystic fibrosis bronchiectasis patients with acute exacerbation. METHODS: A randomised controlled trial was conducted to explore the efficacy and safety of B-ACT among 189 bronchiectasis inpatients from February 1, 2018 to February 28, 2019. The primary outcome was the time to first acute exacerbation. Secondary outcomes included changes of health-related scores, length of hospital stay, hospitalization expenses and incidences of adverse events. FINDINGS: B-ACT therapy significantly prolonged the median days to first acute exacerbation when compared with control group (198 vs 168 days, HR 0·555 (0·322-0·958), p=0·012; effect size(r)= 0·94). Further analysis showed that B-ACT therapy was more beneficial for these patients with severe disease and greater symptoms. COPD Assessment Test (CAT) scores improved significantly on the third day (5·45 vs 4·85, 0·60 (0·09-1·11), p=0·023), and Leicester Cough Questionnaire (LCQ) scores improved obviously on the third and seventh days (1·53 vs 1·23, 0·30 (0·05-0·55), p=0·044; 1·66 vs 1·32, 0·34 (0·08-0·60), p=0·022; respectively) after B-ACT therapy. Adverse events associated with B-ACT were mostly transient and mild. Differences of the lengths of hospital stay and hospitalization expenses in both group was not significant. INTERPRETATION: B-ACT therapy significantly prolonged the time to first acute exacerbation after discharge, highlighting the importance of B-ACT therapy focused on symptom improvements in preventing exacerbation. FUNDING: National Natural Science Foundation of China. TRIAL REGISTRY: ClinicalTrials.gov; No.:NCT03643302; URL: www.clinicaltrials.gov. Elsevier 2021-09-16 /pmc/articles/PMC8452777/ /pubmed/34537448 http://dx.doi.org/10.1016/j.ebiom.2021.103587 Text en © 2021 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Research Paper
Liu, Yang
Lu, Hai-Wen
Gu, Shu-Yi
Wang, Wen-Wen
Ge, Juan
Jie, Zhi-Jun
Jia, Jin-Guang
Gao, Zhi-Ting
Li, Jun
Shi, Jing-Yun
Liang, Shuo
Cheng, Ke-Bing
Bai, Jiu-Wu
Qu, Jie-Ming
Xu, Jin-Fu
Bronchoscopic airway clearance therapy for acute exacerbations of bronchiectasis
title Bronchoscopic airway clearance therapy for acute exacerbations of bronchiectasis
title_full Bronchoscopic airway clearance therapy for acute exacerbations of bronchiectasis
title_fullStr Bronchoscopic airway clearance therapy for acute exacerbations of bronchiectasis
title_full_unstemmed Bronchoscopic airway clearance therapy for acute exacerbations of bronchiectasis
title_short Bronchoscopic airway clearance therapy for acute exacerbations of bronchiectasis
title_sort bronchoscopic airway clearance therapy for acute exacerbations of bronchiectasis
topic Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8452777/
https://www.ncbi.nlm.nih.gov/pubmed/34537448
http://dx.doi.org/10.1016/j.ebiom.2021.103587
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