Effectiveness and Safety of Inhaled Antibiotics in Patients With Chronic Obstructive Pulmonary Disease. A Multicentre Observational Study.

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.

Effectiveness and Safety of Inhaled Antibiotics in Patients With Chronic Obstructive Pulmonary Disease. A Multicentre Observational Study / Eficacia y seguridad de los antibióticos inhalados en pacientes con enfermedad pulmonar obstructiva crónica. Estudio observacional multicéntrico

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.

Antecedentes Nuestro objetivo fue describir la efectividad y seguridad de los antibióticos inhalados en enfermedad pulmonar obstructiva crónica (EPOC), así como el perfil de pacientes en los que se prescriben habitualmente y los grupos de pacientes que más pueden beneficiarse de este tratamiento. Métodos Estudio de cohorte observacional retrospectivo multicéntrico en pacientes con EPOC que habían recibido ≥1 dosis de antibióticos inhalados en los últimos 5 años. Se compararon los datos clínicos de los 2 años anteriores y posteriores al inicio del tratamiento. Criterio primario: exacerbaciones de EPOC. Criterios secundarios: efectos secundarios, sintomatología (purulencia del esputo, disnea), perfil microbiológico y erradicación de patógenos. Resultados De los 693 pacientes con EPOC analizados (74,1 años; 86,3% hombres; FEV1 medio=43,7%) el 71,7% presentaba bronquiectasias y el 46,6% presentaba infección bronquial crónica (IBC) por Pseudomonas aeruginosa (PA). Después de un año de tratamiento con antibióticos inhalados se produjo una disminución significativa en el número de exacerbaciones (−33,3%; p<0,001), ingresos hospitalarios (−33,3%; p<0,001) y días de hospitalización (−26,2%; p=0,003). No encontramos diferencias en la efectividad entre los pacientes con o sin bronquiectasias asociadas. Los resultados positivos fueron más pronunciados en los pacientes que erradicaron la PA. Encontramos una reducción significativa de la expectoración diaria (−33,1%; p=0,024), el esputo mucopurulento/purulento (−53,9%; p<0,001), el aislamiento de cualquier microorganismo potencialmente patógeno (MPP) (−16,7%; p<0,001), IBC por cualquier MPP (−37,4%; p<0,001) e ICB por PA (−49,8%; p<0,001). La IBC por cualquier MPP y más de 3 exacerbaciones previas se asociaron con una mejor respuesta al tratamiento. El 25,4% de los pacientes presentó efectos secundarios no graves, siendo los más frecuentes el broncoespasmo (10,5%), la disnea (8,8%) y la tos (1,7%). Conclusiones En los pacientes con EPOC con múltiples exacerbaciones o IBC por cualquier MPP (especialmente PA), los antibióticos inhalados parecen ser un tratamiento eficaz y seguro, independientemente de la presencia de bronquiectasias.

[Reactive Airways Dysfunction Syndrome. A study of 18 cases]. / Síndrome de disfunción reactiva de las vías respiratorias. Estudio de 18 casos.

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.

Síndrome de disfunción reactiva de las vías respiratorias. Estudio de 18 casos / Reactive airways dysfunction syndrome. A study of 18 cases

Fundamento y objetivo: Estudio descriptivo y evolutivo de una serie de pacientes diagnosticados de síndrome de disfunción reactiva de las vías respiratorias. Pacientes y método: Estudio retrospectivo de 18 pacientes diagnosticados de síndrome de disfunción reactiva de las vías respiratorias. Se recogieron los datos de la historia clínica, el estudio funcional respiratorio, las pruebas de alergia y las analíticas. Se valoró la evolución clínica, funcional y laboral al año del diagnóstico. Resultados: El estudio incluía 12 varones y 6 mujeres con una edad comprendida entre los 27 y los 66 años. Las actividades implicadas con mayor frecuencia fueron la metalurgia y la limpieza. Los agentes que en más ocasiones estuvieron involucrados fueron sustancias o agentes químicos derivados del cloro y del azufre. El tiempo medio desde la exposición a la aparición de los síntomas fue, en todos, antes de 1 h en 10 pacientes (55%) y antes de las 24 h. Todos los pacientes relataron que habían presentado disnea, 12 (67%) refirieron sibilancias, 8 (44%) síntomas del área otorrinolaringológica, 8 (44%) síntomas sistémicos como, por ejemplo, cefalea y vómitos, y 4 (22%) síntomas oculares. Aunque todos los pacientes habían recibido asistencia médica tras la inhalación, el diagnóstico correcto se retrasó durante meses o años (tiempo medio: 3,6 años). En aquel momento 6 de 18 pacientes (33%) mostraron obstrucción bronquial en las pruebas de función respiratoria. En la evolución clínica presentaron mejoría 8 de 18 pacientes (44%), mientras que el resto quedó sin cambios. En el control funcional 8 de 17 (47%) quedaron estacionados, 6 de 17 (35%) mejoraron y 3 de 17 (18%) empeoraron. De los 14 pacientes en que la inhalación se produjo en el lugar de trabajo, 7 (50%) continuaban trabajando en la misma ocupación, 5 (36%) estaban de baja y 2 (14%) habían cambiado de lugar dentro de la misma empresa. Conclusiones: El síndrome de disfunción reactiva de las vías aéreas a menudo no se sospecha, lo que puede producir un retraso de meses o años en el diagnóstico y en el tratamiento adecuado. Incluso entonces, éste debería considerarse, ya que en más de una tercera parte de nuestros pacientes se demostró una mejoría clínica y funcional

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