scholarly journals Effectiveness of chest physiotherapy and pulmonary rehabilitation in patients with non-cystic fibrosis bronchiectasis: a narrative review

2020 ◽  
Vol 90 (1) ◽  
Author(s):  
Sara Annoni ◽  
Angela Bellofiore ◽  
Elena Repossini ◽  
Marta Lazzeri ◽  
Antonello Nicolini ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cystic Fibrosis ◽  
Pulmonary Rehabilitation ◽  
Hypertonic Solution ◽  
Exacerbation Rate ◽  
Airway Clearance ◽  
Fatigue Exercise ◽  
Sputum Volume

Respiratory physiotherapy and rehabilitation are important therapeutic options in non-cystic fibrosis bronchiectasis (NCFB). The aims of this review of clinical trials were to evaluate the safety and the effects on physiologic and clinical outcomes of airway clearance techniques (ACTs) and rehabilitation in NCFB patients, in comparison to usual care. The search was performed on March 2018 by using PubMed and PeDro databases. 33 studies were selected. The use of ACTs for NCFB were effective in increasing sputum volume although no benefit in quality of life (QoL) or pulmonary exacerbations were observed. There were no differences in effectiveness between the several techniques used. Humidification and saline inhalation were able to aid airway clearance. Hypertonic solution (HS) was more effective than isotonic solutions (IS) in improving expectoration and sputum viscosity. Pulmonary rehabilitation (PR) was found to be associated with short term benefits in exercise capacity, dyspnea and fatigue. Exercise training seems to improve quality of life and lower exacerbation rate, but long-term data are not available. Further studies are necessary to identify the most feasible long-term outcomes such as QoL and exacerbation rate.

scholarly journals Long-Term Adherence and Maintenance of Benefits in Pulmonary Rehabilitation

2020 ◽  
Author(s):  
Hulya Sahin
Keyword(s):  
Quality Of Life ◽  
Pulmonary Rehabilitation ◽  
Lung Diseases ◽  
Functional Dependence ◽  
Daily Life Activities ◽  
Chronic Lung Diseases ◽  
Maintenance Program ◽  
Decrease Decrease

Pulmonary rehabilitation (PR) is a comprehensive intervention in chronic lung diseases, including personalized special therapies, exercise training, education and behavioral changes to improve the physical and psychological status of the patients, and aims to promote behavior that helps improve health status in the long term. A personalized PR program administered by a multidisciplinary team is recently considered a standard and complementary treatment method in chronic lung diseases. After the PR program, dyspnea of COPD patients decreases and their exercise capacities increase. Their daily life activities and physical activities increase. Their functional dependence decreases and quality of life increases. It presents a perfect opportunity to provide self-management and independence for the patients and improve their quality of life. Studies have shown that, unless there is a structured maintenance program, after an average of 6–12 months following PR programs, the gains that are realized start to decrease. Decrease of gains due to causes like a decrease in compliance to exercises, disease progress, attacks and co-morbidities. Causes such as decreased compliance to exercise, progression of the disease, attacks and comorbidities play a role in reducing gains. Especially in advanced age and in the presence of severe disease, the gain in exercise tolerance is lost more rapidly. The methods used and the results obtained to ensure the continuation of the gains differ.

scholarly journals Management of chronic Pseudomonas aeruginosa infection with inhaled levofloxacin in people with cystic fibrosis

2021 ◽  
Author(s):  
J Stuart Elborn ◽  
Patrick A Flume ◽  
Donald R Van Devanter ◽  
Claudio Procaccianti
Keyword(s):  
Quality Of Life ◽  
Cystic Fibrosis ◽  
Pseudomonas Aeruginosa ◽  
Lung Function ◽  
Standard Care ◽  
Bacterial Infections ◽  
Pulmonary Infections ◽  
Pseudomonas Aeruginosa Infection

People with cystic fibrosis (CF) are highly susceptible to bacterial infections of the airways. By adulthood, chronic Pseudomonas aeruginosa ( Pa) is the most prevalent infective organism and is difficult to eradicate owing to its adaptation to the CF lung microenvironment. Long-term suppressive treatment with inhaled antimicrobials is the standard care for reducing exacerbation frequency, improving quality of life and increasing measures of lung function. Levofloxacin (a fluoroquinolone antimicrobial) has been approved as an inhaled solution in Europe and Canada, for the treatment of adults with CF with chronic P. aeruginosa pulmonary infections. Here, we review the clinical principles relating to the use of inhaled antimicrobials and inhaled levofloxacin for the management of P. aeruginosa infections in patients with CF.

Long-Term Antibiotics in Bronchiectasis

2021 ◽  
Vol 42 (04) ◽  
pp. 606-615
Author(s):  
Guillermo Suarez-Cuartin ◽  
Marta Hernandez-Argudo ◽  
Lidia Perea ◽  
Oriol Sibila
Keyword(s):  
Quality Of Life ◽  
Bacterial Resistance ◽  
Bacterial Load ◽  
Significant Proportion ◽  
Exacerbation Rate ◽  
Inhaled Antibiotics ◽  
Post Hoc ◽  
The Impact

AbstractA significant proportion of bronchiectasis patients are chronically infected by potentially pathogenic microorganisms which may lead to frequent exacerbations and worse clinical outcomes. Current bronchiectasis guidelines recommend long-term inhaled antibiotics and/or oral macrolides as a part of patient management. In recent years, an increasing amount of evidence assessing the impact of these treatments on patient outcomes has been collected. Inhaled antibiotics have demonstrated significant improvements in sputum bacterial load, but their impact on patient quality of life, lung function, and exacerbation rate has not been consistent across trials. In this regard, recent post hoc analyses of inhaled antibiotics trials in bronchiectasis patients have shown that sputum bacterial load may be a key biomarker to predict treatment response in these patients. Oral macrolides, on the other hand, have proven to reduce exacerbation frequency and improve quality of life, but potential drug-related adverse effects and the increase in bacterial resistance are relevant. This review aims to summarize current important evidence for long-term antibiotic treatment in bronchiectasis patients.

The Long-term Benefits of Outpatient Pulmonary Rehabilitation on Exercise Endurance and Quality of Life

CHEST Journal ◽  
1993 ◽  
Vol 103 (1) ◽  
pp. 42-45 ◽  
Author(s):  
Frederick Vale ◽  
Jane Z. Reardon ◽  
Richard L. ZuWallack
Keyword(s):  
Quality Of Life ◽  
Pulmonary Rehabilitation ◽  
Exercise Endurance

The Effects of Short-term and Long-term Pulmonary Rehabilitation on Functional Capacity, Perceived Dyspnea, and Quality of Life

CHEST Journal ◽  
2005 ◽  
Vol 128 (2) ◽  
pp. 673-683 ◽  
Author(s):  
David Verrill ◽  
Cole Barton ◽  
Will Beasley ◽  
W Michael Lippard
Keyword(s):  
Quality Of Life ◽  
Functional Capacity ◽  
Pulmonary Rehabilitation ◽  
Short Term

scholarly journals Prevention of exacerbations in patients with stable non-cystic fibrosis bronchiectasis: a systematic review and meta-analysis of pharmacological and non-pharmacological therapies

2018 ◽  
Vol 23 (3) ◽  
pp. 96-103 ◽  
Author(s):  
Abd Moain Abu Dabrh ◽  
Adam T Hill ◽  
Claudia C Dobler ◽  
Noor Asi ◽  
Wigdan H Farah ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Cystic Fibrosis ◽  
Meta Analysis ◽  
Moderate Quality ◽  
Number Of Patients ◽  
Inhaled Antibiotics ◽  
Quality Evidence

BackgroundSeveral pharmacological and non-pharmacological therapies are used to treat stable bronchiectasis of non-cystic fibrosis (CF) aetiology.ObjectiveWe conducted a systematic review and meta-analysis to assess the evidence of the effectiveness of pharmacological and non-pharmacological treatment options in patients with stable non-CF bronchiectasis with a focus on reducing exacerbations.Study selectionMultiple databases were searched through September 2017. Outcomes included the number of patients with exacerbation events, mean number of exacerbations, hospitalisations, mortality, quality of life measures, and safety and adverse effects. Meta-analysis was conducted using the random effects model.Findings30 randomised controlled trials enrolled subjects with non-CF bronchiectasis using different interventions. Moderate-quality evidence supported the effect of long-term antibiotics (≥3 months) on lowering the number of patients experiencing exacerbation events (relative risk 0.77 (95% CI 0.68 to 0.89)), reducing number of exacerbations (incidence rate ratio 0.62 (95% CI 0.49 to 0.78)), improving forced expiratory volume (litre) in the first second (FEV1) (weighted mean difference (WMD); 0.02 (95% CI 0.00 to 0.04)), decreasing sputum purulence scores (numerical scale of 1-8) (WMD −0.90 (95% CI −1.58 to −0.22)) and improving quality of life scores assessed by the St George’s Respiratory Questionnaire (WMD −6.07 (95% CI −10.7 to −1.43)). Bronchospasm increased with inhaled antibiotics while diarrhoea increased particularly with oral macrolide therapy.ConclusionsModerate-quality evidence supports long-term antibiotic therapy for preventing exacerbations in stable non-CF bronchiectasis. However, data about the optimum agent, mode of therapy and length of treatment are limited. There is paucity of high-quality evidence to support the management of stable non-CF bronchiectasis including prevention of exacerbations.

scholarly journals Measuring airway clearance outcomes in bronchiectasis: a review

2020 ◽  
Vol 29 (156) ◽  
pp. 190161
Author(s):  
Lisa J. Franks ◽  
James R. Walsh ◽  
Kathleen Hall ◽  
Norman R. Morris
Keyword(s):  
Quality Of Life ◽  
Lung Function ◽  
Outcome Measures ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Airway Clearance ◽  
Patient Reported ◽  
Related Quality ◽  
Sputum Volume

While airway clearance techniques (ACTs) are recommended for individuals with bronchiectasis, many trials have demonstrated inconsistent benefits or failed to reach their primary outcome. This review determined the most common clinical and patient-reported outcome measures used to evaluate the efficacy of ACTs in bronchiectasis. A literature search of five databases using relevant keywords and filtering for studies published in English, up until the end of August 2019, was completed. Studies included randomised controlled trials, using crossover or any other trial design, and abstracts. Studies were included where the control was placebo, no intervention, standard care, usual care or an active comparator. Adults with bronchiectasis not related to cystic fibrosis were included. Extracted data comprised study authors, design, duration, intervention, outcome measures and results. The search identified 27 published studies and one abstract. The most common clinical outcome measures were sputum volume (n=23), lung function (n=17) and pulse oximetry (n=9). The most common patient-reported outcomes were health-related quality of life (measured with St George's Respiratory Questionnaire, n=4), cough-related quality of life (measured with Leicester Cough Questionnaire, n=4) and dyspnoea (measured with Borg/modified Borg scale, n=8). Sputum volume, lung function, dyspnoea and health- and cough-related quality of life appear to be the most common clinical and patient-reported measures of airway clearance treatment efficacy.

scholarly journals Non Cystic Fibrosis Bronchiectasis-new clinical approach, management of treatment and pulmonary rehabilitation

2019 ◽  
Vol 10 (10.2) ◽  
pp. 103-113
Author(s):  
Anca Maierean ◽  
Teodora Gabriela Alexescu ◽  
Lorena Ciumarnean ◽  
Nicoleta Motoc ◽  
Ana Chis ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cystic Fibrosis ◽  
Chronic Obstructive ◽  
Clinical Approach ◽  
Obstructive Pulmonary Disease ◽  
Postural Drainage ◽  
Related Quality ◽  
Specific Medication ◽  
Sputum Volume

Abstract Non-Cystic Fibrosis Bronchiectasis (NCFB) are characterised by abnormal, permanently damaged and dilated bronchi due to the innapropiate clearence of various microorganisms and recurrent chronic infections.The diagnosis is suggested by the clinical presentation and is confirmed by multiple investigations. There are some comorbidities associated with bronhciectasis, such as chronic obstructive pulmonary disease (COPD), cardiovascular disorders, gastro-esophageal reflux disease (GERD), psychological illnesses, pulmonary hypertension, obstructive apnea syndrome(OSA). The condition has a substantial socioeconomic impact because it requests a multidisciplinary management and periods of exacerbations are common. The aims of the management of bronchiectasis are to reduce symptoms (such as sputum volume and purulence, cough and dyspnea), reduce the frequency and severity of exacerbations, preserve lung function and improve health-related quality of life. The multidisciplinary approach of bronchiectasis patients require along with the medical treatment, a specific plan of nonphamarcological strategies, including balneological intervention. There are a lot of techniques improving the airway clearence, such as: active cycle of breathing techniques (which include breathing control, thoracic expansion exercises, forced expiratory technique), oscilatting possitive expiratory pressure, autogenic drainage, gravity-assisted-positioning, modified postural drainage. Together with specific medication, these techniques can diminuate symptoms and improve the quality of life. Key words: NCFB, airway clearence, physiotherapy,

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