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Bronchiectasis (Non-Cystic Fibrosis)


Polverino E, Goeminne P, McDonnel M, et al. European respiratory society guidelines for the management of adult bronchiectasis. Eur Respir J. 2017;50(3):1700629. These guidelines describe appropriate investigation and treatment strategies by posing nine key clinical questions and conducting systematic reviews to answer the questions.

PMID: 28889110

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O’Donnell AE, Barker AF, Ilowite JS, et al. Treatment of idiopathic bronchiectasis with aerosolized recombinant human DNase I. Chest 1998;113:1329-1334. A large multinational trial of patients with idiopathic bronchiectasis found increased exacerbation frequency and a more brisk decrease in FEV1. While noteworthy for its specific findings, this study is widely cited as a reason cystic fibrosis treatment strategies cannot be universally applied to all types of bronchiectasis.

PMID: 9596315

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Scheinberg P, Shore E. A pilot study of the safety and efficacy of tobramycin solution for inhalation in patients with severe bronchiectasis. Chest. 2005;127:1420-6. This open label study in 41 patients found significant improvements in pulmonary symptom score and SGRQ. Notably, 9 patients withdrew from the study due to adverse effects likely due to the treatment, primarily cough, wheezing, and dyspnea.

PMID: 15821224

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Haworth CS, Foweraker JE, Wilkinson P, et al. Inhaled colistin in patients with bronchiectasis and chronic Pseudomonas aeruginosa infection. Am J Respir Crit Care Med 2014; 189: 975-982. A prospective, randomized, placebo-controlled study comparing colimycin or 0.45% saline nebs twice daily for up to 6 months in 144 patients with non-CF bronchiectasis and chronic P. aeruginosa colonization. Although the primary outcome of time to exacerbation was not significantly different between groups (165 vs 111 days), a subgroup of adherent patients did have significant benefit (168 vs 103 days). Additionally, there were no safety concerns.

PMID: 24625200

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The following two trials examined chronic macrolide antibiotic treatment in patients with stable non-cystic fibrosis bronchiectasis. They both found decreased pulmonary exacerbation rate but both also were associated with increased macrolide resistance.

Serisier DJ, Martin ML, McGuckin MA, et al. Effect of long-term, low-dose erythromycin on pulmonary exacerbations among patients with non-cystic fibrosis bronchiectasis: the BLESS randomized controlled trial. JAMA. 2013;309(12):1260-7

PMID: 23532242

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Altenburg J, de Graaff CS, Stienstra Y, et al. Effect of azithromycin maintenance treatment on infectious exacerbations among patients with non-cystic fibrosis bronchiectasis: the BAT randomized controlled trial. JAMA. 2013;309:1251-9.

PMID: 23532241

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