Addition of hyaluronic acid improves tolerance to 7% hypertonic saline solution in bronchiectasis patients.

BACKGROUND: The excessive retention of sputum in the airways, leading to pulmonary infections, is a common consequence of bronchiectasis. Although inhalation of 7% hypertonic saline (HS) has proven an effective method to help remove the mucus, many patients are intolerant of this treatment. The addition of 0.1% hyaluronic acid to HS (HS+HA) could increase tolerance to HS in these patients. The main objective of this study was to evaluate the tolerability of HS+HA in bronchiectasis patients who are intolerant to HS. METHODS: This prospective, observational, open-label study analysed the outcomes of two groups of bronchiectasis patients previously scheduled to start HS therapy. Patients were assessed for tolerance to HS by a questionnaire, spirometry and clinical evaluation. Patients who were intolerant were evaluated for tolerance to HS+HA approximately one week later. All patients were evaluated for their tolerance to HS or HS+HA 4 weeks after the start of their treatment. Patients were also assessed with quality-of-life and adherence questionnaires, and all adverse events were registered. RESULTS: A total of 137 bronchiectasis patients were enrolled in the study (age = 63.0 ± 14.7 years; 63.5% women). Of these, 92 patients (67.1%) were tolerant and 45 patients (32.9%) were intolerant to HS. Of the 45 patients intolerant to HS, 31 patients (68.9%) were tolerant and 14 patients (31.1%) intolerant to HS+HA. Of these 31 tolerant patients, 26 (83.9%) could complete the 4-week treatment with HS+HA. CONCLUSIONS: Two-thirds of bronchiectasis patients that presented intolerance to inhaled HS alone are tolerant to inhaled HS+HA, suggesting that HA improves tolerance to HS therapy.

Antibiotic resistance and population structure of cystic fibrosis Pseudomonas aeruginosa isolates from a Spanish multi-centre study.

The first Spanish multi-centre study on the microbiology of cystic fibrosis (CF) was conducted from 2013 to 2014. The study involved 24 CF units from 17 hospitals, and recruited 341 patients. The aim of this study was to characterise Pseudomonas aeruginosa isolates, 79 of which were recovered from 75 (22%) patients. The study determined the population structure, antibiotic susceptibility profile and genetic background of the strains. Fifty-five percent of the isolates were multi-drug-resistant, and 16% were extensively-drug-resistant. Defective mutS and mutL genes were observed in mutator isolates (15.2%). Considerable genetic diversity was observed by pulsed-field gel electrophoresis (70 patterns) and multi-locus sequence typing (72 sequence types). International epidemic clones were not detected. Fifty-one new and 14 previously described array tube (AT) genotypes were detected by AT technology. This study found a genetically unrelated and highly diverse CF P. aeruginosa population in Spain, not represented by the epidemic clones widely distributed across Europe, with multiple combinations of virulence factors and high antimicrobial resistance rates (except for colistin).

[Inhaled antibiotic therapy in other respiratory diseases]. / Antibioterapia inhalada en otras enfermedades respiratorias.

Aerosolized antimicrobial agents have been used in clinical practice since the 1950s. The main advantage and aim of using this route of administration is delivery of the drug to the site of infection in the lung. Achieving this aim may produce high concentrations in the site of infection or colonization and reduce systemic toxicity to a minimum. The most convincing data to support the use of aerosolized antimicrobials comes from their use as maintenance treatment in patients with cystic fibrosis. In addition to this indication, the use of aerosolized antimicrobials has also been studied in the treatment or prevention of a series of other diseases, including noncystic fibrosis bronchiectasis, ventilator-associated pneumonia, prophylaxis against fungal lung infections, mycobacterial lung infections and, more recently, in chronic obstructive pulmonary disease. Although the theoretical bases underlying aerosol antibiotic administration seem convincing, there is insufficient evidence to support its routine use. Due to the gaps in knowledge that persist in the routine use of aerosolized antibiotics, caution should be exercised in situations without clearly established indications for this modality, such as the treatment of patients with cystic fibrosis, bronchiectasis or Pneumocystis pneumonia.