Toru Kadowaki1, Shuichi Yano2, Kiryo Wakabayashi3, Kanako Kobayashi4, Shigenori Ishikawa5, Masahiro Kimura6, Toshikazu Ikeda7. 1. Department of Pulmonary Medicine, National Hospital Organization Matsue Medical Center, 8-31, 5 cho-me, Agenogi, Matsue, Shimane 690-8556, Japan. Electronic address: toru.kadowaki@mmedc.jp. 2. Department of Pulmonary Medicine, National Hospital Organization Matsue Medical Center, 8-31, 5 cho-me, Agenogi, Matsue, Shimane 690-8556, Japan. Electronic address: shuichi.yano@mmedc.jp. 3. Department of Pulmonary Medicine, National Hospital Organization Matsue Medical Center, 8-31, 5 cho-me, Agenogi, Matsue, Shimane 690-8556, Japan. Electronic address: kiryo731@aol.com. 4. Department of Pulmonary Medicine, National Hospital Organization Matsue Medical Center, 8-31, 5 cho-me, Agenogi, Matsue, Shimane 690-8556, Japan. Electronic address: kanako.kobayashi@mmedc.jp. 5. Department of Pulmonary Medicine, National Hospital Organization Matsue Medical Center, 8-31, 5 cho-me, Agenogi, Matsue, Shimane 690-8556, Japan. Electronic address: wsmt31399@leto.eonet.ne.jp. 6. Department of Pulmonary Medicine, National Hospital Organization Matsue Medical Center, 8-31, 5 cho-me, Agenogi, Matsue, Shimane 690-8556, Japan. Electronic address: masahiro.kimura@mmedc.jp. 7. Department of Pulmonary Medicine, National Hospital Organization Matsue Medical Center, 8-31, 5 cho-me, Agenogi, Matsue, Shimane 690-8556, Japan. Electronic address: toshikazu.ikeda@mmedc.jp.
Abstract
BACKGROUND: Bronchiectasis (BE), a syndrome that presents with persistent or recurrent bronchial sepsis related to irreversibly damaged and dilated bronchi, has not been well-characterized in Asians. This study aims to review the etiology, causal pathogens, imaging patterns, and treatment of BE and to define the prognostic factors for acute exacerbation in a Japanese population. METHODS: We performed a retrospective cohort study of 147 patients (104 women; median age, 73 years; range, 30-95 years) with BE at our institution using high-resolution computed tomography to identify imaging patterns and the area of pulmonary involvement. RESULTS: Common BE etiologies were idiopathic (N=50 [34%]), sinobronchial syndrome (N=37 [25%]), non-tuberculous mycobacteriosis (NTM; N=26 [18%]), and previous respiratory infection (N=21[14%]). Pseudomonas aeruginosa was the most common causal pathogen (24%). Common imaging patterns were cylindrical (66%) and mixed including cylindrical pattern (47%). The median number of involved lobes was 2; 49% of the patients had ≥ 3 involved lobes, and 49% had middle lobe and left lingula dominant BE. Patients with predominantly lower lobe BE comprised 4% of the NTM group and 48% of the non-NTM group (P<0.001). In multivariate analysis, cystic BE was a predictor for frequent exacerbations in non-NTM patients (OR=7.947; P=0.004) which led to increased hospital admissions (OR=4.691; P=0.004). CONCLUSIONS: Idiopathic and sinobronchial syndrome were common causes of BE. Etiology did not contribute to imaging pattern or predictors of exacerbations. Cystic BE was a predictor for frequent exacerbations in the non-NTM BE patients.
BACKGROUND:Bronchiectasis (BE), a syndrome that presents with persistent or recurrent bronchial sepsis related to irreversibly damaged and dilated bronchi, has not been well-characterized in Asians. This study aims to review the etiology, causal pathogens, imaging patterns, and treatment of BE and to define the prognostic factors for acute exacerbation in a Japanese population. METHODS: We performed a retrospective cohort study of 147 patients (104 women; median age, 73 years; range, 30-95 years) with BE at our institution using high-resolution computed tomography to identify imaging patterns and the area of pulmonary involvement. RESULTS: Common BE etiologies were idiopathic (N=50 [34%]), sinobronchial syndrome (N=37 [25%]), non-tuberculous mycobacteriosis (NTM; N=26 [18%]), and previous respiratory infection (N=21[14%]). Pseudomonas aeruginosa was the most common causal pathogen (24%). Common imaging patterns were cylindrical (66%) and mixed including cylindrical pattern (47%). The median number of involved lobes was 2; 49% of the patients had ≥ 3 involved lobes, and 49% had middle lobe and left lingula dominant BE. Patients with predominantly lower lobe BE comprised 4% of the NTM group and 48% of the non-NTM group (P<0.001). In multivariate analysis, cystic BE was a predictor for frequent exacerbations in non-NTMpatients (OR=7.947; P=0.004) which led to increased hospital admissions (OR=4.691; P=0.004). CONCLUSIONS:Idiopathic and sinobronchial syndrome were common causes of BE. Etiology did not contribute to imaging pattern or predictors of exacerbations. Cystic BE was a predictor for frequent exacerbations in the non-NTM BE patients.
Authors: Ravishankar Chandrasekaran; Micheál Mac Aogáin; James D Chalmers; Stuart J Elborn; Sanjay H Chotirmall Journal: BMC Pulm Med Date: 2018-05-22 Impact factor: 3.317
Authors: Martina Contarini; Amelia Shoemark; Jessica Rademacher; Simon Finch; Andrea Gramegna; Michele Gaffuri; Luca Roncoroni; Manuela Seia; Felix C Ringshausen; Tobias Welte; Francesco Blasi; Stefano Aliberti; James D Chalmers Journal: Multidiscip Respir Med Date: 2018-08-09