Video game-based exercise in children and adolescents with non-cystic fibrosis bronchiectasis: A randomized comparative study of aerobic and breathing exercises.

BACKGROUND: Video game-based systems have been proposed to improve effectiveness and compliance with exercise training in children and adolescents with noncystic fibrosis bronchiectasis (NCFB). This study aimed to investigate the effects of aerobic and breathing video game-based exercises (VGE) on pulmonary function, respiratory and peripheral muscle strength, functional capacity, and balance in children and adolescents with NCFB. METHOD: Thirty-nine children and adolescents aged between 8 and 18 years with NCFB were randomly allocated into three groups as "home-based chest physiotherapy group" (CP), "aerobic VGE given in addition to home-based chest physiotherapy group" (CP + aerobic VGE), and "breathing VGE given in addition to home-based chest physiotherapy group" (CP + breathing VGE). All three groups performed chest physiotherapy program twice a day for 7 days per week for 8 weeks. Pulmonary function, respiratory and peripheral muscle strength, functional capacity, and balance were assessed at baseline and after 8 weeks of training. RESULTS: The improvement in maximum expiratory pressure and balance scores were significantly higher in both CP + aerobic and CP + breathing VGE groups. The significant improvement in maximum inspiratory pressure was greater in the CP + breathing VGE group. The changes in peripheral muscle strength and functional capacity were significantly higher in the CP + aerobic VGE group. CONCLUSIONS: The present study showed that aerobic VGE provides additional benefits in improving peripheral muscle strength and functional capacity, while breathing VGE provides further increase in improving respiratory muscle strength. In addition, both aerobic and breathing VGE were effective in improving balance, but they were not superior to each other.

Medical nutritional therapy in infected bronchiectasis with impending respiratory failure: A case report.

OBJECTIVE: Bronchiectasis is a chronic infective and inflammatory respiratory disease that causes significant morbidity and mortality. Repeated respiratory infections may lead to infected bronchiectasis (IB) and acute exacerbations which often require hospital admission, increase risk of malnutrition and impact quality of life and eventually leads to death. Nutritional therapy is needed to modulate inflammation and enhance immunity to reduce severity of exacerbation, overcome malnutrition, as well as to decrease morbidity and mortality. METHODS: A 59-year-old female patient, diagnosed with IB. The patient had low oral intake due to productive cough and anorexia since 2 weeks before admission. Moreover, she had gradual shortness of breath that caused an impending respiratory failure during hospitalization, supported by continuous positive airway pressure (CPAP). Nutritional assessment was made based on Subjective Global Assessment (SGA) score C. Abnormal laboratory findings seen were increased in neutrophil-to-lymphocyte ratio (NLR) 9.3, moderate depletion of immune system with total lymphocyte count (TLC) 808.4/µl, hypoalbuminemia (3.2g/dl) and increased in liver enzymes: aspartate aminotransferase (AST) 206U/l, Alanine aminotransferase (ALT) 224U/l. Nutritional therapy was given gradually with target calorie 1400-1900kcal, protein 0.8-1.5g/kg IBW/day, carbohydrates 45-50%, and fat 33.3-43% through oral and parenteral nutrition. The patient was given supplementations such as vitamins (A, B complex, C, D), zinc, curcumin and snakehead fish extract high albumin content. RESULT: After 14 days of treatment, significant clinical and metabolic improvement in NLR, TLC, plasma albumin, liver enzymes (AST/ALT), blood gas analysis, and functional capacity (handgrip strength) were found. CONCLUSION: An adequate nutritional therapy with macro and micro-nutrients in IB patient can improve clinical outcome, nutritional status and quality of life.

The Effect of a High-Intensity PrO2Fit Inspiratory Muscle Training Intervention on Physiological and Psychological Health in Adults with Bronchiectasis: A Mixed-Methods Study.

Bronchiectasis is characterised by airflow obstruction and hyperinflation resulting in respiratory muscle weakness, and decreased exercise capacity. Inspiratory muscle training (IMT) is potentially an alternative treatment strategy to enhance respiratory muscle strength and endurance. Therefore, the aim was to investigate the effects of IMT on those with bronchiectasis. Eighteen participants (10 bronchiectasis) took part in an eight-week, three times a week IMT programme at 80% sustained maximal inspiratory pressure (SMIP). Lung function, respiratory muscle strength and endurance, exercise capacity, physical activity and self-determination theory measures were taken. Participants also took part in a semi-structured interview to assess their perceptions and experience of an IMT intervention. After eight weeks of IMT, bronchiectasis and healthy participants exhibited significant increases in MIP (27% vs. 32%, respectively), SMIP (16% vs. 17%, respectively) and inspiratory duration (36% vs. 30%, respectively). Healthy participants exhibited further improvements in peak expiratory flow and maximal oxygen consumption. Bronchiectasis participants reported high levels of perceived competence and motivation, reporting higher adherence and improved physical ability. Eight weeks of IMT increased inspiratory muscle strength and endurance in those with bronchiectasis. IMT also had a positive effect on perceived competency and autonomy, with bronchiectasis participants reporting improved physical ability and motivation, and high adherence.

Airway clearance, mucoactive therapies and pulmonary rehabilitation in bronchiectasis.

This paper aims to provide physiological rationale for airway clearance, mucoactive therapy and pulmonary rehabilitation (PR) (or exercise interventions) in bronchiectasis. There is increasing emphasis on the role of airway clearance techniques (ACT) in the management of bronchiectasis. No single ACT has currently shown superior effect over another. Given the large range of different techniques available, consideration of the physiological effects underpinning a technique including expiratory flow, ventilation and oscillation, is essential to effectively personalize ACT. Key clinical trials of mucoactives in bronchiectasis are underway and will provide clarity on the role of these agents in the management of patients with bronchiectasis. Prescription of mucoactive therapies should be done in conjunction with ACT and therefore the mechanism of action of mucoactive drugs and their timing with ACT should be taken into consideration. PR and/or exercise training are recommended in all current bronchiectasis guidelines. There is a clear physiological rationale that muscle weakness and physical inactivity may play a role in disease progression as well as impacting health-related quality of life, frequency of pulmonary exacerbations and ability to mobilize sputum. However, there are residual unanswered questions surrounding the delivery and accessibility to PR. This review summarizes the physiological principles and supporting evidence for airway clearance, mucoactive medication and PR, which are key components in the management of bronchiectasis.

Paediatric and adult bronchiectasis: Monitoring, cross-infection, role of multidisciplinary teams and self-management plans.

Bronchiectasis is a chronic lung disease associated with structurally abnormal bronchi, clinically manifested by a persistent wet/productive cough, airway infections and recurrent exacerbations. Early identification and treatment of acute exacerbations is an integral part of monitoring and annual review, in both adults and children, to minimize further damage due to infection and inflammation. Common modalities used to monitor disease progression include clinical signs and symptoms, frequency of exacerbations and/or number of hospital admissions, lung function (forced expiratory volume in 1 s (FEV1 )% predicted), imaging (radiological severity of disease) and sputum microbiology (chronic infection with Pseudomonas aeruginosa). There is good evidence that these monitoring tools can be used to accurately assess severity of disease and predict prognosis in terms of mortality and future hospitalization. Other tools that are currently used in research settings such as health-related quality of life (QoL) questionnaires, magnetic resonance imaging and lung clearance index can be burdensome and require additional expertise or resource, which limits their use in clinical practice. Studies have demonstrated that cross-infection, especially with P. aeruginosa between patients with bronchiectasis is possible but infrequent. This should not limit participation of patients in group activities such as pulmonary rehabilitation, and simple infection control measures should be carried out to limit the risk of cross-transmission. A multidisciplinary approach to care which includes respiratory physicians, chest physiotherapists, nurse specialists and other allied health professionals are vital in providing holistic care. Patient education and personalized self-management plans are also important despite limited evidence it improves QoL or frequency of exacerbations.

The overlap between bronchiectasis and chronic airway diseases: state of the art and future directions.

Bronchiectasis is a clinical and radiological diagnosis associated with cough, sputum production and recurrent respiratory infections. The clinical presentation inevitably overlaps with other respiratory disorders such as asthma and chronic obstructive pulmonary disease (COPD). In addition, 4-72% of patients with severe COPD are found to have radiological bronchiectasis on computed tomography, with similar frequencies (20-30%) now being reported in cohorts with severe or uncontrolled asthma. Co-diagnosis of bronchiectasis with another airway disease is associated with increased lung inflammation, frequent exacerbations, worse lung function and higher mortality. In addition, many patients with all three disorders have chronic rhinosinusitis and upper airway disease, resulting in a complex "mixed airway" phenotype.The management of asthma, bronchiectasis, COPD and upper airway diseases has traditionally been outlined in separate guidelines for each individual disorder. Recognition that the majority of patients have one or more overlapping pathologies requires that we re-evaluate how we treat airway disease. The concept of treatable traits promotes a holistic, pathophysiology-based approach to treatment rather than a syndromic approach and may be more appropriate for patients with overlapping features.Here, we review the current clinical definition, diagnosis, management and future directions for the overlap between bronchiectasis and other airway diseases.

Kartagener's syndrome: a case report.

BACKGROUND: Kartagener's syndrome is a subset of primary ciliary dyskinesia, an autosomal recessive inherited disorder characterized by the clinical triad of chronic sinusitis, bronchiectasis, and situs inversus. Abnormal ciliary structure or function leading to impaired ciliary motility is the main pathophysiologic problem in Kartagener's syndrome. CASE PRESENTATION: A 24-year-old man from Gondar town, North-West Ethiopia, presented to University of Gondar Hospital with recurrent episodes of nasal congestion with itching and paranasal discomfort, and productive cough for more than a decade. Clinical and imaging findings revealed chronic sinusitis, bronchiectasis, dextrocardia, and situs inversus. He was treated with orally administered antibiotics, mucolytic, and chest physiotherapy. He was symptomatically better with the above therapy, and started on a long-term low-dose prophylactic antibiotic. CONCLUSIONS: Patients with Kartagener's syndrome exist in Ethiopia as cases of chronic recurrent sinopulmonary infections. As there is no easy, reliable non-invasive diagnostic test for Kartagener's syndrome and the correct diagnosis is often delayed by years, it may cause chronic respiratory problems with reduced quality of life. Genetic counseling and fertility issues should be addressed once Kartagener's syndrome is diagnosed.

Ensayo clínico aleatorizado de técnicas de aclaramiento mucociliar en niños con bronquiectasias sin fibrosis quística / Randomized clinical trial of mucociliary clearance techniques in non-cystic fibrosis bronchiectasis in children

Objetivo Evaluar la eficacia de las presiones manuales espiratorias lentas y aumentos de flujo espiratorio (AFE) combinadas con insuflación-exuflación mecánica (I-EM) y tos asistida (TA), frente al ciclo activo de técnicas respiratorias (CATR) en bronquiectasia infantil estable sin fibrosis quística (FQ).Material y métodos Ensayo clínico aleatorizado en 2 grupos de 6 niños (edad 8,1±1,3) que reciben 2 sesiones de fisioterapia respiratoria (FR) al mes. Las principales variables de estudio son: peso de esputo recogido tras sesión de FR y medición de la función pulmonar al inicio del estudio y a los 12 meses; capacidad vital forzada (CVF), volumen espiratorio máximo en 1 s (VEMS o FEV1) y el flujo espiratorio forzado entre el 25%-75% de la CVF (FEF25-75%). Asimismo, evaluamos el número de ingresos y exacerbaciones infecciosas y el impacto de la tos en la calidad de vida con el Leicester Cough Questionnaire (LCQ), al inicio y al final del estudio. Resultados El peso del esputo y el FEF25-75%, aumenta significativamente con las presiones manuales espiratorias lentas, AFE combinados con I-E M y TA, frente al CATR, en nuestra muestra. No hay diferencias significativas en cuanto a FEV1 y CVF. El número de exacerbaciones disminuyó en ambos grupos con respecto al año anterior (sin tratamiento de FR), y la puntuación total del LCQ. Conclusión Las presiones manuales espiratorias lentas, AFE combinados con I-E M y TA, para la permeabilización de la vía aérea en niños con bronquiectasias sin FQ, producen beneficios significativos en comparación al CATR (AU)

Objective To evaluate effectiveness of manual expiratory pressure and expiratory flow increase (EFI) combined with mechanical insufflation-exsufflation (MI-E) and assisted coughing (AC) versus active cycle of breathing techniques (ACBT) in stable bronchiectasis children without cystic fibrosis (CF).Material and methods Randomized clinical trial with 2 groups of 6 children (age 8.1±1.3) who received of respiratory physiotherapy (RP) sessions twice a month. The main endpoints studied are: weight of sputum collected after each session of RP and lung function measurements at baseline and 12 months, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow between 25%-75% of FVC (FEF25-75%). We also evaluated the number of visits to emergency department, infective exacerbations and the impact of cough on quality of life with the Leicester Cough Questionnaire (LCQ), at the beginning and the end of study. Results The weight of sputum and FEF25-75% increase significantly with manual expiratory pressure, EFI combined with MI-E and AC versus ACBT in our sample. There are no significant differences in FEV1 and FVC. Number of exacerbations decreased in both groups compared to the previous year (without CP treatment), and total score of the LCQ. Conclusion Slow manual expiratory pressure, EFI combined with MI-E and AC for airway permeabilization in children with non-CF bronchiectasis produce significant benefits compared to ACBT (AU)

Força muscular respiratória e pico de fluxo expiratório de pacientes com bronquiectasia submetidos à reabilitação respiratória / Respiratory muscle strength and peak expiratory flow in patients with bronchiectasis underwent pulmonary rehabilitation / La fuerza muscular respiratoria y el flujo espiratorio máximo en pacientes con bronquiectasias en rehabilitación respiratoria

Este estudio tuvo como objetivo evaluar la fuerza muscular respiratoria y el flujo espiratorio máximo en pacientes con bronquiectasias en rehabilitación respiratoria. Método. Clínico, experimental, en el que, una vez verificados los criterios de inclusión y exclusión, la muestra se dividió aleatoriamente en: grupo experimental (GE, n = 13, edad = 60 ± 14,86 años) - que fueron tratados con rehabilitación respiratoria dos veces por semana, con una duración de 40 minutos por sesión, por 12 semanas y el grupo de control (GC, n = 13, edad = 58 ± 13,90 años) - los pacientes tratados con clínica conservadora de seguimiento permanecieron sin tratamiento durante el período de estudio, porque eran parte de una lista de espera para el servicio. Las variables dependientes del estudio fueron la fuerza muscular respiratoria (MIP - Presión de MIP-espiratorio - MEP) y el flujo espiratorio máximo (FEM), medida por el manómetro y el pico de flujo ®, respectivamente. El nivel de significación se fijó en p <0,05. Resultados. En la comparación dentro de los grupos, hubo un aumento significativo sólo en las variables de GE, a saber: MIP (cmH2O Δ = 18,08, p <0,001); MEP (cmH2O Δ = 12,31, p <0,001) y el FEM (Δ = 26,77 l / min, p = 0,016). En la comparación entre los grupos, hubo incremento satisfactorio en el post-test, el GE frente al GC en el MIP y la MEP (p = 0,005). Conclusiones. Por lo tanto, parece que la terapia física propuesta influencia en el aumento de la fuerza muscular respiratoria y del flujo espiratorio máximo en pacientes con bronquiectasia(AU)

Objetivo. Este estudio tuvo como objetivo evaluar la fuerza muscular respiratoria y el flujo espiratorio máximo en pacientes con bronquiectasias en rehabilitación respiratoria. Método. Clínico, experimental, en el que, una vez verificados los criterios de inclusión y exclusión, la muestra se dividió aleatoriamente en: grupo experimental (GE, n = 13, edad = 60 ± 14,86 años) - que fueron tratados con rehabilitación respiratoria dos veces por semana, con una duración de 40 minutos por sesión, por 12 semanas y el grupo de control (GC, n = 13, edad = 58 ± 13,90 años) - los pacientes tratados con clínica conservadora de seguimiento permanecieron sin tratamiento durante el período de estudio, porque eran parte de una lista de espera para el servicio. Las variables dependientes del estudio fueron la fuerza muscular respiratoria (MIP - Presión de MIP-espiratorio - MEP) y el flujo espiratorio máximo (FEM), medida por el manómetro y el pico de flujo®, respectivamente. El nivel de significación se fijó en p <0,05. Resultados. En la comparación dentro de los grupos, hubo un aumento significativo sólo en las variables de GE, a saber: MIP (cmH2O Δ = 18,08, p <0,001); MEP (cmH2O Δ = 12,31, p <0,001) y el FEM (Δ = 26,77 l / min, p = 0,016). En la comparación entre los grupos, hubo incremento satisfactorio en el post-test, el GE frente al GC en el MIP y la MEP (p = 0,005). Conclusiones. Por lo tanto, parece que la terapia física propuesta influencia en el aumento de la fuerza muscular respiratoria y del flujo espiratorio máximo en pacientes con bronquiectasia

Objective. This research aimed to evaluate the respiratory muscle strength and peak expiratory flow in patients with bronchiectasis undergoing respiratory rehabilitation. Method. Clinical trial where, after scrutiny of inclusion and exclusion criteria, the sample was divided randomly into experimental group (EG, n = 13, age = 60 ± 14.86 years) - who underwent treatment with respiratory rehabilitation twice week, lasting 40 minutes per session, at 12 weeks and control group (CG, n = 13, age = 58 ± 13.90 years) - patients with conservative clinical follow-up without therapy during the period of research because they were part of a waiting list for care. The dependent variables of the study were respiratory muscle strength (maximal inspiratory pressure - MIP- expiratory pressure - MEP) and peak expiratory flow (PEF), measured by the manometer and the peak flow®, respectively. The level of significance was set at p < 0.05. Results. In within groups comparison, there was a significant increase only in the EG variables, namely: MIP (Δ = 18.08 cm H2O, p < 0.001) and MEP (cmH2O Δ = 12.31, p < 0.001) and PEF (Δ = 26.77 l / min, p = 0.016). In the between groups comparison, increased satisfactory post-test, GE, compared to GC in MIP and MEP (p = 0.005). Conclusion. it appears that physical therapy influences the proposed increase in respiratory muscle strength and peak expiratory flow in patients with bronchiectasis(AU)

Are crackles an appropriate outcome measure for airway clearance therapy?

BACKGROUND: There is an urgent need to develop new outcome measures for respiratory therapy, to evaluate its effectiveness. Adventitious sounds generated from the lungs (crackles and wheezes), can now be quantified and characterized objectively with computer technology. To our knowledge, this is the first reported study designed to assess any change in lung crackles before and after a single session of airway clearance therapy. METHODS: Twenty-three stable bronchiectasis patients were recruited from United Kingdom out-patient clinics and treated with a single session of airway clearance therapy, using the active cycle of breathing technique. Sound recordings were made before and after the session at 7 anatomical chest locations. Computerized lung sound analysis was used to measure crackle parameters: 2-cycle deflection width (2CD), and crackle number per breath cycle (nBC). Perceived breathlessness, lung function, and oxygen saturation data were also recorded. RESULTS: Crackle mean 2CD and mean nBC increased post intervention. Sixteen participants (70%) showed a statistically significant difference in mean crackle 2CD before and after the session at ≥ 1 chest location. Thirteen (57%) participants had a difference between mean crackle 2CD before and after the intervention > 1 Smallest Real Difference (SRD, mean SRD = 2.23 ms) at ≥ 1 chest location. Differences in mean crackle nBC before and after the intervention did not exceed the SRD (mean SRD = 32 crackles per breath cycle) in any participant. Perceived breathlessness was significantly reduced post intervention; no significant changes were observed in either lung function or oxygen saturation. CONCLUSIONS: Crackle duration (2CD) was found to change after a single session of airway clearance therapy, and shows promise as a new outcome measure for respiratory therapy interventions.

Update on treatment of childhood bronchiectasis unrelated to cystic-fibrosis.

There are multiple aetiologies for childhood bronchiectasis unrelated to cystic fibrosis. Some of these aetiologies, such as those predisposing to recurrent lung infections, e.g. immunodeficiencies, require treatment of the underlying condition and disease-specific pulmonary pathogens within the airway. Regardless of aetiology, the treatments for bronchiectasis include antibiotics, airway clearance regimens, immunizations to prevent infections, and in some cases asthma therapies. The grade of evidence for specific treatments is low with few randomized controlled trials in children. Extrapolations of care provided to adults with bronchiectasis and patients with cystic fibrosis may not always be justified. Comprehensive care programs for children with bronchiectasis have demonstrated clinically relevant improvements over 2-7 year periods. Multi-center research is needed to rigorously evaluate current treatment practices for children with this disorder.

A comparison of the Acapella and a threshold inspiratory muscle trainer for sputum clearance in bronchiectasis-A pilot study.

BACKGROUND: Inspiratory muscle training is used to specifically strengthen the respiratory muscles. Controversy exists regarding the use of inspiratory muscle training as a method of facilitating airways clearance. Acapella is already known to be effective in airway clearance. OBJECTIVE: The objective of the study was to compare the effects of the Acapella and a threshold inspiratory muscle trainer as a method of airway clearance in subjects with bronchiectasis and to determine patient preference between the two techniques. METHODS: Thirty patients (10 males, 20 females) mean age of 50.67+/-6.37 (mean+/-SD) with a history of expectoration of more than 30 ml sputum per day were recruited. The sequence of therapy was allocated by block randomization. Assessment and familiarization session was performed on day 1. Treatments employing the Acapella and inspiratory muscle trainer were done on days 2 and 3. Treatment order and allocation was determined by block randomization. Sputum volume was measured during and 2 hours after the treatment and patient treatment preference was recorded. RESULTS: A statistically significant difference was found in the sputum volume expectorated after treatment with the Acapella (7.16+/-1.12 ml) compared with the threshold inspiratory muscle trainer (6.46+/-1.08 ml). Patients preferred Acapella in terms of usefulness of clearing secretions. CONCLUSION: The present study demonstrated increased sputum clearance following the use of the Acapella when compared to the threshold inspiratory muscle trainer. In addition, the Acapella was preferred by patients who judged that it was more useful in clearing secretions.

Singing for children and adults with bronchiectasis.

BACKGROUND: Bronchiectasis is a common respiratory disease, especially in developing countries. Its cause varies from chronic infection to rare immune deficiencies. Bronchiectasis can be present with other respiratory diseases, such as chronic obstructive pulmonary disease (COPD). People with bronchiectasis may suffer from chronic cough, fatigue, shortness of breath, chest pain and coughing up blood. Their lung function may decline with time. These can also have a negative impact on their quality of life. Thus, a holistic management is needed to provide treatment and support. Therapies which include breathing manoeuvres, such as singing, may have health benefits for respiratory function and psychological well being. OBJECTIVES: To evaluate the effects of a singing intervention as a therapy on the quality of life, morbidity, respiratory muscle strength and pulmonary function of children and adults with bronchiectasis. SEARCH STRATEGY: We searched the Cochrane Airways Group (CAG) trials register, the Cochrane Central Register of Controlled Trials, major allied complementary databases, and clinical trials registers. Professional organisations and individuals were also contacted. CAG performed searches in February, and additional searches were carried out in June 2009. SELECTION CRITERIA: Randomised controlled trials in which singing (as an intervention) is compared with either a sham intervention or no singing in patients with bronchiectasis. DATA COLLECTION AND ANALYSIS: Two authors independently reviewed the titles, abstracts and citations to assess potential relevance for full review. No eligible trials were identified and thus no data were available for analysis. MAIN RESULTS: No meta-analysis could be performed. AUTHORS' CONCLUSIONS: In the absence of data, we cannot draw any conclusion to support or refute the adoption of singing as an intervention for people with bronchiectasis. Given the simplicity of the potentially beneficial intervention, future randomised controlled trials are required to evaluate singing therapy for people with bronchiectasis.

[Diagnosis and treatment of bronchiectasis. Spanish Society of Pneumology and Thoracic Surgery]. / Diagnóstico y tratamiento de las bronquiectasias. SEPAR.

Bronchiectasis is the end result of several different diseases that share principles of management. The clinical course usually involves chronic bronchial infection and inflammation, which are associated with progression. The cause of bronchiectasis should always be investigated, particularly when it can be treated. We recommend evaluating etiology, symptoms, bronchial colonization and infection, respiratory function, inflammation, structural damage, nutritional status, and quality of life in order to assess severity and to monitor clinical course. Care should be supervised by specialized units, at least in cases of chronic bronchial infection, recurrent exacerbations, or when there is a cause that is likely to respond to treatment. Improving symptoms and halting progression are the goals of management, which is based on treatment of the underlying cause and of acute or chronic infections and on the drainage of secretions. Complications that arise must also be treated. Antibiotic prescription is guided by how well infection is being controlled, and this is indicated by the color of sputum and a reduction in the number of exacerbations. We recommend inhaled antibiotics in cases of chronic bronchial infection that does not respond to oral antibiotics, when these cause side effects, or when the cause is Pseudomonas species or other bacteria resistant to oral antibiotics. Inhaled administration is also advisable to treat initial colonization by Pseudomonas species.

Tratamiento de las bronquiectasias no fibrosis quística en fase estable / Treatment of non-cystc fibrosis bronchiectases in stable phase

Las bronquiectasias no son una entidad nosológica homogénea ya que pueden ser la expresión de varias etiologías y, muy posiblemente, de varios mecanismos patogénicos que se constituyen en un círculo vicioso de alteración del aclaramiento mucociliar, inflamación e infección bacteriana crónica. Las diferentes opciones terapéuticas disponibles pretenden controlar estos aspectos y los objetivos finales son el control de los síntomas, la reducción de la morbilidad y la prevención de la progresión. En la actualidad la evidencia clínica que soporta el tratamiento de esta patología es escasa pero la valoración multidisciplinar de la misma puede hacer cambiar su historia natural (AU)

The bronchiectases are not a homogeneous defined entity since they can be the expression of several aetiologies and, very possibly, of several pathogenic mechanisms that are constituted in a vicious circle of alteration of the mucociliary clearance, inflammation and chronic bacterial infection. The different therapeutic options available try to control these aspects and the final objectives are the control of the symptoms, the prevention of progression and the reduction of morbidity. At present the clinical evidence that supports the treatment of this pathology is scarce, but its multidisciplinary evaluation can change its natural history (AU)

Exercise training and inspiratory muscle training in patients with bronchiectasis.

BACKGROUND: Bronchiectasis is a chronic suppurative lung disease often characterised by airflow obstruction and hyperinflation, and leading to decreased exercise tolerance and reduced health status. The role of pulmonary rehabilitation (PR) and inspiratory muscle training (IMT) has not been investigated in this group of patients. METHODS: Thirty two patients with idiopathic bronchiectasis were randomly allocated to one of three groups: PR plus sham IMT (PR-SHAM), PR plus targeted IMT (PR-IMT), or control. All patients (except the control group) underwent an 8 week training programme of either PR or PR plus targeted IMT. Exercise training during PR was performed three times weekly at 80% of the peak heart rate. IMT was performed at home for 15 minutes twice daily over the 8 week period. RESULTS: PR-SHAM and PR-IMT resulted in significant increases in the incremental shuttle walking test of 96.7 metres (95% confidence interval (CI) 59.6 to 133.7) and 124.5 metres (95% CI 63.2 to 185.9), respectively, and in endurance exercise capacity of 174.9% (95% CI 34.7 to 426.1) and 205.7% (95% CI 31.6 to 310.6). There were no statistically significant differences in the improvements in exercise between the two groups. Significant improvements in inspiratory muscle strength were also observed both in the PR-IMT group (21.4 cm H2O increase, 95% CI 9.3 to 33.4; p = 0.008) and the PR-SHAM group (12.0 cm H2O increase, 95% CI 1.1 to 22.9; p = 0.04), the magnitude of which were also similar (p = 0.220). Improvements in exercise capacity were maintained in the PR-IMT group 3 months after training, but not in the PR-SHAM group. CONCLUSION: PR is effective in improving exercise tolerance in bronchiectasis but there is no additional advantage of simultaneous IMT. IMT may, however, be important in the longevity of the training effects.

Tratamiento médico de las bronquiectasias: evidencia científica / Medical treatment of bronchiectasis: scientific evidence

Las bronquiectasias son el resultado final de toda una serie de procesos etiológicos diferentes. Aunque pueden definirse como dilataciones anormales y permanentes de los bronquios, la magnitud de la dilatación, la extensión en el árbol bronquial y la etiología producen enormes diferenciasen el resultado clínico y funcional y, por lo tanto, en el tratamiento de los enfermos. Se revisa la evidencia científica de cada uno de los tratamientos médicos que se utilizan en esta enfermedad. Problemas en el diseño de los ensayos clínicos pueden haber ocasionado diferencias de criterio en el análisis y recopilación de los trabajos analizados y en consecuencia, incidir y distorsionar las conclusiones de los revisores con respecto a la eficacia de las diferentes modalidades terapéuticas, en especial en el apartado de la fisioterapia respiratoria

Bronchiectases are the final result of an entire series of different etiological conditions. Although they may be defined as abnormal and permanent dilatations of the bronchi, the magnitude of the dilations, extension in the bronchial tree and etiology give rise to enormous differences in the clinical and functional results and thus in the management of the patients. The scientific evidence of each one of the medical treatments used in this disease is reviewed. Problems in the design of the clinical trials may have caused differences of criterion in the analysis and compiling of the studies analyzed and consequently affect and distort the conclusions of the reviewers regarding the efficacy of the different therapeutic modal modalities, especially in the section of respiratory physiotherapy

Evaluation of nebulised hypertonic saline (7%) as an adjunct to physiotherapy in patients with stable bronchiectasis.

Sputum clearance is of prime importance in the management of patients with bronchiectasis. While nebulised normal isotonic saline (0.9%) (IS) has been anecdotally used to treat patients with tenacious sputum, the use of hypertonic saline (7%) (HS) could have potential muco-protective and clearance properties. 24 patients with bronchiectasis were randomised to receive four single treatment schedules in random order: (1) active cycle breathing technique (ACBT) alone, (2) nebulised terbutaline then ACBT, (3) nebulised terbutaline, nebulised IS then ACBT and (4) nebulised terbutaline, nebulised HS then ACBT. Sputum weights were significantly higher after HS than IS (P = 0.002). Ease of expectoration also differed overall (P < 0.0001) and was significantly lower with HS than with IS (P = 0.0005). Sputum viscosity differed between treatment phases, with a significant linear trend to reduced sputum viscosity with HS (P = 0.0002). These changes were associated with small but statistically significant differences in FEV1 (P = 0.043) and FVC (P = 0.011) between treatment phases. Nebulised hypertonic saline can be used safely and effectively as an adjunct to physiotherapy in selected patients. A long-term prospective trial is now indicated to determine its effectiveness on long-term infection rate, quality of life and lung function.

[Typing of bronchiectasis according to syndrome differentiation].

OBJECTIVE: To study the general law of typing of bronchiectasis according to syndrome differentiation. METHODS: We collected the symptoms, conditions of tongue and pulse in patients of bronchiectasis, using frequencies procedure, discriminant analysis and K-means cluster analysis in SPSS statistical software as research medium. RESULTS: Five hundred and sixty three patients with bronchiectasis were studied. It suggested that accumulation of phlegm-heat in the lungs (45.65%), liver fire attacking the lungs (24.51%), asthenia of pulmonosplenic qi (22.38%), asthenia of both qi and yin (7.46%) were the main types. CONCLUSION: Clinical epidemiology provided scientific basis for further studying of the typing of bronchiectasis according to syndrome differentiation. Building up differentiation of syndromes through differentiation and analysis of main symptoms can be used in clinical diagnosis.