RESUMEN
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.
RESUMEN
BACKGROUND AND OBJECTIVE: We intended to perform a descriptive-evolutive study of a series of patients diagnosed with Reactive Airways Dysfunction Syndrome. PATIENTS AND METHOD: Retrospective study of 18 patients diagnosed with Reactive Airways Dysfunction Syndrome. Clinical data, functional respiratory study, and allergic and laboratory tests were collected. The clinical, functional and occupational evolution one year after diagnosis was evaluated. RESULTS: Twelve men and 4 women aged 27 to 66 years were evaluated. More frequent activities were metallurgy and cleaning, and the related agents were derived from chlorine and sulphur. Time from the beginning of exposure to development of symptoms was 1 hour in 10 (55%) patients and less than 24 hours in all cases. All patients reported to have dyspnea (100%), 12 (67%) wheezing, 8 (44%) nose and throat symptoms, 8 (44%) general symptoms such as headache and vomits, and 4 (22%) ocular manifestations. Although all patients received medical assistance after exposure, a correct diagnosis was made some months or years later (average time 3.6 years). At that time there was an airway obstruction in 6 of 18 (33%) patients. With regard to the clinical evolution, there was an improvement in 8 of 18 (44%) patients, while the rest remained stable. In the functional follow up, 8 of 17 (47%) showed no changes, 6 of 17 (35%) improved and 3 of 17 (18%) worsened. Among the patients who inhaled in the workplace, 7 of 14 (50%) continued working in the same job, 5 of 14 (36%) were off sick and 2 of 14 (14%) changed their role in the same company. CONCLUSIONS: Reactive Airways Dysfunction Syndrome is not frequently suspected and thus its diagnosis and treatment can be delayed for months or years.
