David De la Rosa Carrillo1, Miguel Ángel Martínez-García2, Esther Barreiro3, Eva Tabernero Huguet4, Roser Costa Sola5, Marta María García-Clemente6, Nuria Celorrio Jiménez7, Laura Rodríguez Pons8, Carmen Calero Acuña9, Juan Luís Rodríguez Hermosa10, Rafael Golpe11, Raquel Dacal Quintas12, Silvia Sánchez-Cuéllar13, Irene Torres Arroyo14, Marina Blanco Aparicio15, Virginia Almadana Pacheco16, Marc Miravitlles17. 1. Pneumology Service, Hospital de la Santa Creu i Sant Pau, C. Sant Quintí 89, 08041, Barcelona, Spain. Electronic address: david.rosa23@gmail.com. 2. Pneumology Service, Hospital Universitario y Politécnico La Fe, Av. de Fernando Abril Martorell 106, 46026, Valencia, Spain. 3. Pulmonology Department, Hospital del MAR-IMIM, CEXS (UPF), CIBERES, Passeig Marítim de la Barceloneta 25-29, 08003, Barcelona, Spain. 4. Pneumology Service, Hospital de Cruces, Cruces Plaza, s/n, 48903, Barakaldo, Bizkaia, Spain. 5. Pneumology Service, Hospital Mutua de Terrassa, Plaça del Doctor Robert 5, 08221, Terrassa, Barcelona, Spain. 6. Pneumology Service, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011, Oviedo, Spain. 7. Pneumology Service, Hospital de Viladecans, Av. de Gavà 38, 08840, Viladecans, Barcelona, Spain. 8. Pneumology Service, Hospital Universitario Germans Trias i Pujol, Carretera de Canyet, s/n, 08916, Badalona, Barcelona, Spain. 9. Pneumology Service, Hospital Universitario Virgen del Rocio, Av. Manuel Siurot, s/n, 41013, Sevilla, Spain. 10. Pneumology Service, Hospital Clínico San Carlos, School of Medicine, Universidad Complutense de Madrid, Calle del Profesor Martín Lagos, s/n, 28040, Madrid, Spain. 11. Pneumology Service, Hospital Universitario Lucus Augusti, Rúa Dr. Ulises Romero 1, 27003, Lugo, Spain. 12. Pneumology Service, Complexo Hospitalario Universitario de Ourense, Calle Ramon Puga Noguerol 54, 32005, Ourense, Spain. 13. Pneumology Service, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este 80, 28031, Madrid, Spain. 14. Pneumology Service, Hospital Fundación Alcorcón, Calle Budapest 1, 28922, Alcorcón, Madrid, Spain. 15. Pneumology Service, Complexo Hospitalario Universitario A Coruña, Xubias de Arriba 84, 15006, A Coruña, Spain. 16. Pneumology Service, Hospital Universitario Virgen de la Macarena, Calle Dr. Fedriani 3, 41009, Sevilla, Spain. 17. Pneumology Service, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorios (CIBERES), Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain.
Abstract
BACKGROUND: We aimed to describe the effectiveness and safety of inhaled antibiotics in chronic obstructive pulmonary disease (COPD) patients, as well as the patient profile in which they are usually prescribed and the patient groups that can most benefit from this treatment. METHODS: Multicentre retrospective observational cohort study in COPD patients who had received ≥1 dose of inhaled antibiotics in the last 5 years. Clinical data from the two years prior to and subsequent to the start of the treatment were compared. PRIMARY OUTCOME: COPD exacerbations. SECONDARY OUTCOMES: side effects, symptomatology (sputum purulence, dyspnoea), microbiological profile and pathogen eradication. RESULTS: Of 693 COPD patients analyzed (aged 74.1; 86.3% men; mean FEV1=43.7%), 71.7% had bronchiectasis and 46.6% presented chronic bronchial infection (CBI) by Pseudomonas aeruginosa (PA). After 1 year of treatment with inhaled antibiotics, there was a significant decrease in the number of exacerbations (-33.3%; P<.001), hospital admissions (-33.3%; P<.001) and hospitalization days (-26.2%; P=.003). We found no difference in effectiveness between patients with or without associated bronchiectasis. Positive patient outcomes were more pronounced in PA-eradicated patients. We found a significant reduction in daily expectoration (-33.1%; P=.024), mucopurulent/purulent sputum (-53.9%; P<.001), isolation of any potentially pathogenic microorganisms (PPM) (-16.7%; P<.001), CBI by any PPM (-37.4%; P<.001) and CBI by PA (-49.8%; P<.001). CBI by any PPM and ≥three previous exacerbations were associated with a better treatment response. 25.4% of patients presented non-severe side-effects, the most frequent of these being bronchospasm (10.5%), dyspnoea (8.8%) and cough (1.7%). CONCLUSIONS: In COPD patients with multiple exacerbations and/or CBI by any PPM (especially PA), inhaled antibiotics appear to be an effective and safe treatment, regardless of the presence of bronchiectasis.
BACKGROUND: We aimed to describe the effectiveness and safety of inhaled antibiotics in chronic obstructive pulmonary disease (COPD) patients, as well as the patient profile in which they are usually prescribed and the patient groups that can most benefit from this treatment. METHODS: Multicentre retrospective observational cohort study in COPD patients who had received ≥1 dose of inhaled antibiotics in the last 5 years. Clinical data from the two years prior to and subsequent to the start of the treatment were compared. PRIMARY OUTCOME: COPD exacerbations. SECONDARY OUTCOMES: side effects, symptomatology (sputum purulence, dyspnoea), microbiological profile and pathogen eradication. RESULTS: Of 693 COPD patients analyzed (aged 74.1; 86.3% men; mean FEV1=43.7%), 71.7% had bronchiectasis and 46.6% presented chronic bronchial infection (CBI) by Pseudomonas aeruginosa (PA). After 1 year of treatment with inhaled antibiotics, there was a significant decrease in the number of exacerbations (-33.3%; P<.001), hospital admissions (-33.3%; P<.001) and hospitalization days (-26.2%; P=.003). We found no difference in effectiveness between patients with or without associated bronchiectasis. Positive patient outcomes were more pronounced in PA-eradicated patients. We found a significant reduction in daily expectoration (-33.1%; P=.024), mucopurulent/purulent sputum (-53.9%; P<.001), isolation of any potentially pathogenic microorganisms (PPM) (-16.7%; P<.001), CBI by any PPM (-37.4%; P<.001) and CBI by PA (-49.8%; P<.001). CBI by any PPM and ≥three previous exacerbations were associated with a better treatment response. 25.4% of patients presented non-severe side-effects, the most frequent of these being bronchospasm (10.5%), dyspnoea (8.8%) and cough (1.7%). CONCLUSIONS: In COPD patients with multiple exacerbations and/or CBI by any PPM (especially PA), inhaled antibiotics appear to be an effective and safe treatment, regardless of the presence of bronchiectasis.