Data di Pubblicazione:
2020
Citazione:
The Relationship Between Symptoms, Exacerbations and Treatment Response in Bronchiectasis / Y. Gao, H. Abo Leyah, S. Finch, M. Lonergan, S. Aliberti, A. De Soyza, T.C. Fardon, G. Tino, J.D. Chalmers. - In: AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE. - ISSN 1073-449X. - (2020). [Epub ahead of print] [10.1164/rccm.201910-1972OC]
Abstract:
RATIONALE:
Bronchiectasis guidelines regard treatment to prevent exacerbation and treatment of daily symptoms as separate objectives.
OBJECTIVE:
We hypothesized that patients with greater symptoms would be at higher risk of exacerbations and therefore a treatment aimed at reducing daily symptoms would also reduce exacerbations in highly symptomatic patients.
METHODS:
An observational cohort of 333 patients from the East of Scotland(2012-2016). Symptoms were either modelled as a continuous variable or patients were classified as high, moderate and low symptom burden(>70, 40-70 and <40 using the SGRQ symptom score). We hypothesised that exacerbation would be reduced in highly symptomatic patients. This was tested in a post-hoc analysis of a randomized trial of inhaled mannitol (N=461 patients) Measurement and Main Results: In the observational cohort daily symptoms were a significant predictor of future exacerbations (rate ratio [RR] 1.10, 95% confidence interval[CI] 1.03-1.17, P=0.005). Patients with high symptom scores had higher exacerbation rates (RR 1.74, 95% CI 1.12-2.72,P=0.01) over 12 months follow-up compared to those with lower symptoms. Inhaled mannitol treatment improved the time to first exacerbation (hazard ratio [HR] 0.56; 95% CI 0.40-0.77; P<0.001) and the proportion of patients remaining exacerbation free for 12 months treatment was higher in the mannitol group (32.7% vs. 14.6%; RR 2.84, 95% CI 1.40-5.76; P=0.003) only in highly symptomatic patients. In contrast no benefit was evident in patients with lower symptom burden.
CONCLUSIONS:
Highly symptomatic patients are at increased risk of exacerbations, and exacerbation benefit with inhaled mannitol was only evident in patients with high symptom burden.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Cough; Exacerbations; Macrolides; Mucoactive; bronchiectasis
Elenco autori:
Y. Gao, H. Abo Leyah, S. Finch, M. Lonergan, S. Aliberti, A. De Soyza, T.C. Fardon, G. Tino, J.D. Chalmers
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