Bronchoscopic airway clearance therapy for acute exacerbations of bronchiectasis,EBioMedicine

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Bronchoscopic airway clearance therapy for acute exacerbations of bronchiectasis
EBioMedicine ( IF 9.7 ) Pub Date : 2021-09-16 , DOI: 10.1016/j.ebiom.2021.103587
Yang Liu ₁ , Hai-Wen Lu ₁ , Shu-Yi Gu ₁ , Wen-Wen Wang ₁ , Juan Ge ₂ , Zhi-Jun Jie ₃ , Jin-Guang Jia ₄ , Zhi-Ting Gao ₅ , Jun Li ₆ , Jing-Yun Shi ₇ , Shuo Liang ₁ , Ke-Bing Cheng ₁ , Jiu-Wu Bai ₁ , Jie-Ming Qu ₈ , Jin-Fu Xu ₁

Affiliation

Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai 200092, China.
Department of Respiratory Medicine, The Sixth People's Hospital of Nantong, Shanghai University, Jiangsu 226001, China.
Department of Respiratory and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China.
Department of Respiratory and Critical Care Medicine, People's Hospital of Zhengzhou, Henan University of Chinese Medicine, Henan 450014, China.
Department of Respiratory and Critical Care Medicine, People's Hospital of Putuo District, School of Medicine, Tongji University, Shanghai 200092, China.
Center of Clinical Research, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200092, China.
Department of Radiology Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200092, China.
Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.

Background

Persistent cough and large amounts of purulent sputum affects many bronchiectasis patients. No studies have evaluated the efficacy and safety of bronchoscopic airway clearance therapy and bronchoalveolar lavage (B-ACT) for non-cystic fibrosis bronchiectasis patients with acute exacerbation.

Methods

A randomised controlled trial was conducted to explore the efficacy and safety of B-ACT among 189 bronchiectasis inpatients from February 1, 2018 to February 28, 2019. The primary outcome was the time to first acute exacerbation. Secondary outcomes included changes of health-related scores, length of hospital stay, hospitalization expenses and incidences of adverse events.

Findings

B-ACT therapy significantly prolonged the median days to first acute exacerbation when compared with control group (198 vs 168 days, HR 0·555 (0·322-0·958), p=0·012; effect size(r)= 0·94). Further analysis showed that B-ACT therapy was more beneficial for these patients with severe disease and greater symptoms. COPD Assessment Test (CAT) scores improved significantly on the third day (5·45 vs 4·85, 0·60 (0·09-1·11), p=0·023), and Leicester Cough Questionnaire (LCQ) scores improved obviously on the third and seventh days (1·53 vs 1·23, 0·30 (0·05-0·55), p=0·044; 1·66 vs 1·32, 0·34 (0·08-0·60), p=0·022; respectively) after B-ACT therapy. Adverse events associated with B-ACT were mostly transient and mild. Differences of the lengths of hospital stay and hospitalization expenses in both group was not significant.

Interpretation

B-ACT therapy significantly prolonged the time to first acute exacerbation after discharge, highlighting the importance of B-ACT therapy focused on symptom improvements in preventing exacerbation.

Funding

National Natural Science Foundation of China.

Trial registry

ClinicalTrials.gov; No.:NCT03643302; URL: www.clinicaltrials.gov.

中文翻译：

支气管扩张急性加重期支气管镜气道清除治疗

背景

持续咳嗽和大量脓痰影响许多支气管扩张症患者。没有研究评估支气管镜气道清除疗法和支气管肺泡灌洗 (B-ACT) 对非囊性纤维化支气管扩张急性加重患者的疗效和安全性。

方法

在 2018 年 2 月 1 日至 2019 年 2 月 28 日期间，对 189 名支气管扩张症住院患者进行了一项随机对照试验，以探讨 B-ACT 的疗效和安全性。主要结果是首次急性发作的时间。次要结局包括健康相关评分、住院时间、住院费用和不良事件发生率的变化。

发现

与对照组相比，B-ACT 治疗显着延长了首次急性发作的中位天数（198 天 vs 168 天，HR 0·555 (0·322-0·958)，p=0·012；效应量 (r)= 0·94)。进一步分析表明，B-ACT 疗法对这些病情严重、症状更严重的患者更有益。第三天 COPD 评估测试 (CAT) 分数显着提高（5·45 vs 4·85、0·60 (0·09-1·11), p=0·023）和莱斯特咳嗽问卷 (LCQ) 分数第三天和第七天明显好转（1·53 vs 1·23、0·30（0·05-0·55），p=0·044；1·66 vs 1·32、0·34（0· 08-0·60), p=0·022;分别) 在 B-ACT 治疗后。与 B-ACT 相关的不良事件大多是短暂的和轻微的。两组住院时间和住院费用差异不显着。