Management of non-cystic fibrosis bronchiectasis

2021 ◽  
pp. 1-9
Author(s):  
Philip Webb ◽  
Jenny King ◽  
Caroline Baxter ◽  
Robert W Lord
Keyword(s):  
Antibiotic Therapy ◽  
Management Approach ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Respiratory Condition ◽  
General Management ◽  
Prompt Treatment ◽  
Infection And Inflammation ◽  
Underlying Causes ◽  
Bronchial Dilatation

Bronchiectasis is a common respiratory condition, characterised by abnormal bronchial dilatation, that often leads to recurrent airway infection and inflammation. It is an increasingly recognised respiratory condition, both as a primary lung disease but also co-existing with other respiratory diseases, such as chronic obstructive pulmonary disease and asthma. Diagnosis can have important treatment implications. There are shared systematic approaches to treatment, such as sputum clearance techniques, prompt treatment of exacerbations and, in certain circumstances, regular antibiotic therapy. It is vital to target antibiotic therapy appropriately, and knowledge of the patient's airway microbiology can assist with this. Certain infective and colonising organisms, such as Pseudomonas aeruginosa, cause worse patient outcomes and so need prompt treatment with appropriate antibiotics. In addition to this general management approach, there are many different underlying causes of bronchiectasis that should be identified wherever possible, to support more targeted therapy and prevent disease progression. This article provides a guide to the key principles of diagnosing and managing bronchiectasis, and outlines situations where more specialist respiratory support is required.

Appendicitis in Diabetics: Predictors of Complications and Their Incidence

2016 ◽  
Vol 82 (8) ◽  
pp. 753-758 ◽  
Author(s):  
Lindsay Bach ◽  
Andrew Donovan ◽  
Whitney Loggins ◽  
Stephanie Thompson ◽  
Bryan Richmond
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Univariate Analysis ◽  
Multivariate Regression Analysis ◽  
General Surgeon ◽  
Management Approach ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Cell Counts ◽  
Chi Squared

Appendicitis is the most common surgical emergency encountered by the general surgeon. Literature has demonstrated that diabetics may manifest atypical signs of infection, often clouding the diagnostic picture. We conducted a 3-year retrospective analysis of adults with appendicitis to determine differences in presentation, diagnosis, treatment, and outcomes for diabetic versus nondiabetic patients. Demographics, symptoms, imaging, procedure(s), complications, and length of stay (LOS) were obtained via chart review. Factors were compared between patients with and without diabetes using chi-squared test, t test, or Mann-Whitney U test (significance at P ≤ 0.05). Multivariate regression analysis identified variables predicting longer LOS or perforation at diagnosis. Overall, 339 patients met inclusion criteria [303 were nondiabetic (ND), 36 were diabetic (D)]. On univariate analysis, diabetics were more likely to have other comorbid illnesses: obesity ( P < 0.001), chronic kidney disease ( P = 0.003), hypertension ( P < 0.001), coronary artery disease ( P < 0.001), peripheral vascular disease (PVD, P = 0.31), and chronic obstructive pulmonary disease ( P = 0.002). Diabetics presented with lower white blood cell counts (mean 14.2 ND, 11.9 D, P = 0.02), and were more likely to present with perforation (18.5% ND, 38.9% D, P = 0.008). LOS was longer in diabetics (1.0 day for ND, 3.0 day for D, P < 0.001). Complications were more frequent in diabetics (19.4% D vs 8.6% ND), which trended toward but failed to reach significance ( P = 0.066). On multivariate analysis, however, old age was the only characteristic associated with perforation [odds ratio: 1.05 (1.02–1.06), P < 0.001], whereas diabetes, chronic obstructive pulmonary disease, and older age predicted longer LOS ( P ≤ 0.001). Diabetics present a more complicated clinical picture having significantly more comorbidities and a trend toward postoperative complications necessitating a higher index of suspicion to detection complications. Further study is needed to evaluate the optimal diagnostic and management approach in this challenging population.

scholarly journals Failed Early Intervention of Pyomyositis in an Immunocompetent Individual

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Ranna Al-Dossari ◽  
Sana Zekri
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Early Intervention ◽  
Antibiotic Therapy ◽  
Pulmonary Disease ◽  
Striated Muscle ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Immunocompetent Individual ◽  
History Of ◽  
Patient Presentation

Pyomyositis is a purulent infection of striated muscle tissue that usually leads to an abscess, commonly due to S. aureus. Pyomyositis is typically found in tropic regions, but it is increasingly being recognized in temperate climates, especially in immunocompromised individuals. Patient presentation ranges from afebrile with mildly elevated WBC to frank sepsis. In many reported cases, patients may develop multiple abscesses at different sites. We report a case of a 54-year-old male with a history of chronic obstructive pulmonary disease (COPD) presenting with right pectoral infection. This case demonstrates the possibility that antibiotic therapy in early presentations may not effectively prevent abscess formation, contrary to treatment suggestions found in the literature.

scholarly journals ROSE: Radiology, Obstruction, Symptoms and Exposure, a Delphi consensus definition of the association of COPD and Bronchiectasis by the EMBARC Airways Working Group

2021 ◽  
pp. 00399-2021
Author(s):  
Letizia Traversi ◽  
Marc Miravitlles ◽  
Miguel Angel Martinez-Garcia ◽  
Michal Shteinberg ◽  
Apostolos Bossios ◽  
...  
Keyword(s):  
Chronic Obstructive ◽  
Delphi Consensus ◽  
Consensus Definition ◽  
Obstructive Pulmonary Disease ◽  
European Consensus ◽  
Toxic Agents ◽  
And Gender ◽  
Definition Of ◽  
Bronchial Dilatation ◽  
Worse Prognosis

IntroductionThe coexistence of chronic obstructive pulmonary disease (COPD) and bronchiectasis (BE) seems to be common and associated with a worse prognosis than for either disease individually. However, no definition of this association exists to guide researchers and clinicians.MethodsWe conducted a Delphi survey involving expert pulmonologists and radiologists from Europe, Turkey and Israel in order to define the “COPD-BE association”.A panel of 16 experts from EMBARC selected 35 statements for the survey after reviewing scientific literature. Invited participants, selected on the basis of expertise, geographical and gender distribution, were asked to express agreement on the statements. Consensus was defined as a score of ≥6 points (scale 0 to 9) in ≥70% of answers across two scoring rounds.ResultsA-hundred-and-two (72.3%) out of 141 invited experts participated the first round. Their response rate in the second round was 81%. The final consensus definition of “COPD-BE association” was: “The coexistence of (1) specific radiological findings (abnormal bronchial dilatation, airways visible within 1 cm of pleura and/or lack of tapering sign in ≥1 pulmonary segment and in >1 lobe) with (2) an obstructive pattern on spirometry (FEV1/FVC<0.7), (3) at least two characteristic symptoms (cough, expectoration, dyspnoea, fatigue, frequent infections) and (4) current or past exposure to smoke (≥10 pack-years) or other toxic agents (biomass, etc.)”. These criteria form the acronym “ROSE” (Radiology, Obstruction, Symptoms, Exposure).ConclusionsThe Delphi process formulated a European consensus definition of “COPD-BE association”. We hope this definition will have broad applicability across clinical practice and research in the future.

scholarly journals Serum Procalcitonin Guided Antibiotic Therapy in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

2015 ◽  
Vol 3 (2) ◽  
pp. 67-70
Author(s):  
Rawshan Arra Khanam ◽  
Md Ashraful Haque ◽  
Mohammad Omar Faruq
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Antibiotic Therapy ◽  
Pulmonary Disease ◽  
Hospital Admissions ◽  
Respiratory Infections ◽  
Chronic Obstructive ◽  
Acute Phase Reactants ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Exacerbation Of Copd

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable, but progressive disease. Hospital admissions of patients with COPD are frequently due to acute exacerbations of COPD (AECOPD). AECOPD are very common, affecting about 20% of COPD patients. The bacterial infection plays an important role in the exacerbation of COPD patients. In addition, recent studies using molecular diagnostics indicate that a substantial proportion of AECOPD are associated with viral infection. Accurate methods to differentiate viral and bacterial respiratory infections to allow targeted antibiotic therapy would be beneficial. Acute phase reactants are capable of demonstrating the inflammation; however, they cannot be employed to make a difference between bacterial and nonbacterial causes of the inflammation. Recently, measurement of procalcitonin (PCT) levels appears to be useful in order to minimize this problem.Bangladesh Crit Care J September 2015; 3 (2): 67-70

scholarly journals New Pharmacological Tools to Target Leukocyte Trafficking in Lung Disease

2021 ◽  
Vol 12 ◽  
Author(s):  
Kylie B. R. Belchamber ◽  
Michael J. Hughes ◽  
Daniella A. Spittle ◽  
Eloise M. Walker ◽  
Elizabeth Sapey
Keyword(s):  
Lung Disease ◽  
Immune Cells ◽  
Lung Diseases ◽  
Immune Cell ◽  
Current Evidence ◽  
Chronic Obstructive ◽  
Cellular Functions ◽  
Obstructive Pulmonary Disease ◽  
Microbial Invasion ◽  
Infection And Inflammation

Infection and inflammation of the lung results in the recruitment of non-resident immune cells, including neutrophils, eosinophils and monocytes. This swift response should ensure clearance of the threat and resolution of stimuli which drive inflammation. However, once the threat is subdued this influx of immune cells should be followed by clearance of recruited cells through apoptosis and subsequent efferocytosis, expectoration or retrograde migration back into the circulation. This cycle of cell recruitment, containment of threat and then clearance of immune cells and repair is held in exquisite balance to limit host damage. Advanced age is often associated with detrimental changes to the balance described above. Cellular functions are altered including a reduced ability to traffic accurately towards inflammation, a reduced ability to clear pathogens and sustained inflammation. These changes, seen with age, are heightened in lung disease, and most chronic and acute lung diseases are associated with an exaggerated influx of immune cells, such as neutrophils, to the airways as well as considerable inflammation. Indeed, across many lung diseases, pathogenesis and progression has been associated with the sustained presence of trafficking cells, with examples including chronic diseases such as Chronic Obstructive Pulmonary Disease and Idiopathic Pulmonary Fibrosis and acute infections such as Pneumonia and Pneumonitis. In these instances, there is evidence that dysfunctional and sustained recruitment of cells to the airways not only increases host damage but impairs the hosts ability to effectively respond to microbial invasion. Targeting leukocyte migration in these instances, to normalise cellular responses, has therapeutic promise. In this review we discuss the current evidence to support the trafficking cell as an immunotherapeutic target in lung disease, and which potential mechanisms or pathways have shown promise in early drug trials, with a focus on the neutrophil, as the quintessential trafficking immune cell.

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