Materiały źródłowe

• #1 Predicting outcomes in bronchiectasis | Pulmonology

  https://www.journalpulmonology.org/en-predicting-outcomes-in-bronchiectasis-articulo-S2531043718300734

  Bronchiectasis is a common chronic respiratory disorder characterized by irreversible bronchial dilatation leading to daily productive cough and recurrent respiratory infections. This is a simplistic description of a multidimensional disease with heterogeneous clinical course and significant co-morbidity. According to expert opinion, along with vast evidence in other chronic diseases [e.g. chronic obstructive pulmonary disease (COPD) and asthma], accurate severity assessment is essential to guide decision-making treatment and disease management. […] Historically evaluated based on computed tomography (CT) features, bronchiectasis severity assessment has been increasingly recognized as an integration of many clinical, functional, radiological and microbiological factors. In the last few years, two multidimensional scoring systems, the Bronchiectasis Severity Index (BSI) and FACED have been developed to integrate those fundamental factors predicting prognosis of patients with bronchiectasis.

• #1 Prognosis For Patients Diagnosed With Bronchiectasis

  https://www.ajmc.com/view/prognosis-for-patients-diagnosed-with-bronchiectasis

  Trajectory of patient outcomes for those diagnosed with bronchiectasis is explored by Dr Metersky. […] The prognosis varies based on severity, especially if treated aggressively early on. With treatment, most patients can have a normal life expectancy, though slow symptom progression often occurs. At initial evaluation, patients are counseled that bronchiectasis will likely persist lifelong as an annoyance rather than severely limiting. Evidence supports improved quality of life with specialty center care, though high-quality generalist care can replicate good outcomes. […] The bronchiectasis severity index stratifies prognosis based on multiple factors like age, comorbidities, lung function, and chronic bacterial airway infection. Most patients have nonsevere disease without dramatically shortened survival. Death directly related to bronchiectasis is unusual. […] Worse outcomes are predicted by chronic Pseudomonas airway infection and frequent exacerbations of 3 or more per year despite aggressive therapy. These patients tend to remain frequent exacerbators.

• #2 Predicting outcomes in bronchiectasis | Pulmonology

  https://www.journalpulmonology.org/en-predicting-outcomes-in-bronchiectasis-articulo-S2531043718300734

  Since their development, some studies have tried to compare and contrast the evaluation of disease severity and the prognostic value of these two scoring systems. The key conclusion of the work by Costa et al., in our opinion, is that BSI and FACED may contain similar variables, but are clearly measuring very different things because there is limited correlation between them. […] The data so far suggests that, as shown by Costa and colleagues, the two scores measure different things. FACED was designed to predict mortality a job it does very well. Most patients with bronchiectasis are at low risk of 5-year mortality because unlike idiopathic pulmonary fibrosis or lung cancer, bronchiectasis is not a rapidly fatal disease. […] Therefore the greatest strength of the BSI is that it places a large degree of weight on the history of exacerbations. It is much more effective at predicting patients at high risk of future exacerbations, worse quality of life and patients with more severe symptoms compared to FACED.

• #2 Predicting outcomes in bronchiectasis | Pulmonology

  https://www.journalpulmonology.org/en-predicting-outcomes-in-bronchiectasis-articulo-S2531043718300734

  In summary, comparing BSI and FACED has clearly established that they measure two different things. BSI is a severity assessment tool, while FACED accurately predicts risk of death. Clinicians should use the appropriate tool for the appropriate context, depending on what they wish to predict and why. […] It is now more important than ever to increase awareness of adverse prognostic features in bronchiectasis to increase the overall quality of treatment and reduce the devastating burden of the disease.

• #3 Predicting outcomes in bronchiectasis | Pulmonology

  https://www.journalpulmonology.org/en-predicting-outcomes-in-bronchiectasis-articulo-resumen-S2531043718300734

  Since their development, some studies have tried to compare and contrast the evaluation of disease severity and the prognostic value of these two scoring systems. The key conclusion of the work by Costa et al., in our opinion, is that BSI and FACED may contain similar variables, but are clearly measuring very different things because there is limited correlation between them. […] Previous studies have shown similar results. The largest study in this field that included 1612 patients from seven European cohorts participating in the European Bronchiectasis registry project showed that BSI scored most patients as moderate or severe, while mild disease predominated according to FACED. […] The data so far suggests that, as shown by Costa and colleagues, the two scores measure different things. FACED was designed to predict mortality a job it does very well. Most patients with bronchiectasis are at low risk of 5-year mortality because unlike idiopathic pulmonary fibrosis or lung cancer, bronchiectasis is not a rapidly fatal disease.

• #3 Predicting outcomes in bronchiectasis | Pulmonology

  https://www.journalpulmonology.org/en-predicting-outcomes-in-bronchiectasis-articulo-resumen-S2531043718300734

  Exacerbations are the key clinical end-points in bronchiectasis clinical trials and are a major driver of morbidity and mortality. We argue it is not possible to talk about severity of bronchiectasis without talking about exacerbations. Therefore the greatest strength of the BSI is that it places a large degree of weight on the history of exacerbations. […] In summary, comparing BSI and FACED has clearly established that they measure two different things. BSI is a severity assessment tool, while FACED accurately predicts risk of death. Clinicians should use the appropriate tool for the appropriate context, depending on what they wish to predict and why. It is now more important than ever to increase awareness of adverse prognostic features in bronchiectasis to increase the overall quality of treatment and reduce the devastating burden of the disease.

• #4

  https://advances.umw.edu.pl/en/article/2021/30/12/1315/

  Bronchiectasis is a progressive chronic disease associated with an increased risk of mortality. […] The mortality rate during the observation period was 16%. […] The median number of comorbidities was significantly higher in the group of non-survivors (5 (IQR 35.75)) compared with survivors (3 (IQR 14); p = 0.0100). […] The burden of comorbidities was associated with an increased hazard of death: having 4 or more comorbidities was associated with an increased risk of death compared to patients with 2 or 3 coexisting illnesses (hazard ratio (HR) = 1.35 (95% confidence interval (95% CI) [0.41, 4.41]); p = 0.0494). […] The BACI was a significant predictor of death in patients with severe bronchiectasis. […] The comorbidity burden has an impact on mortality in patients with bronchiectasis. […] The Bronchiectasis Aetiology Comorbidity Index (BACI) is a useful tool for the clinical assessment of patients with severe bronchiectasis.

• #5 Prognosis – Bronchiectasis

  https://bronchiectasis.com.au/bronchiectasis/living-with-bronchiectasis/prognosis

  To improve prognosis, it is important that patients are educated in the disease process and have an understanding of the preventative measures. […] Most people with bronchiectasis have a good outlook. A regular airway clearance routine and an early response to exacerbations with antibiotics is generally a pathway to maintaining good health. […] The outlook where bronchiectasis is secondary to another condition may have a worse prognosis. […] Factors associated with poorer prognosis include: tobacco smoking, gram negative organisms (Escherichia coli and Pseudomonas aeruginosa), aspergillus in sputum, poor FEV1 and FVC, compromised immunity.

• #6 Prognostic factors of pulmonary exacerbations severity in pediatric bronchiectasis: a retrospective cohort study | Egyptian Pediatric Association Gazette | Full Text

  https://epag.springeropen.com/articles/10.1186/s43054-023-00180-z

  Based on the results of the current study, we demonstrated the best indices for identifying pulmonary exacerbation severity. BSI more than 11, ICU admissions more than once, frequent exacerbations more than 3 times per year, and cough severity index were the strongest predictors of pulmonary exacerbation severity in pediatric bronchiectasis. […] Our results have also revealed that severe exacerbations were associated with increased exacerbation frequency, higher rates of hospital admissions, ICU admissions, and use of intravenous antibiotics in the last year. […] According to our results, BSI more than 11, ICU admissions more than once, frequent exacerbations, and cough severity index were the best factors which may help to predict more frequent and severe pulmonary exacerbations and to identify high-risk bronchiectasis patients who need more extensive close follow-up, extra care, intensive management, and preventive strategies hoping to improve prognosis, reducing the disease severity and the healthcare costs among pediatric bronchiectasis patients.

• #7 Prediction of Clinical Bronchiectasis from Asymptomatic Radiological Bronchiectasis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC12003985/

  Under persistent inflammation, asymptomatic radiological bronchiectasis (ARB) may develop into clinical bronchiectasis (CB). […] Whether the ARB could progress to CB and the risk factors to speed up the process are poorly understood. […] In 2022, 60 out of 296 ARB patients progressed to CB. Age, FEV1% predicted, COPD, heart failure (HF), degree of bronchiectasis, number of lobes with bronchiectasis and number of lung segments with mucus plugs were risk factors. […] ARB may progress to CB under the risk factors, including age, FEV1% predicted, COPD, HF and CT images including degree of bronchiectasis, number of lobes with bronchiectasis and number of lung segments with mucus plugs), based on which the nomogram model is a convenient and efficient tool for follow-up management and preventing CB in patients with ARB.

• #7 Prediction of Clinical Bronchiectasis from Asymptomatic Radiological Bronchiectasis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC12003985/

  This study demonstrated that asymptomatic radiological bronchiectasis may progress to clinical bronchiectasis after 4 years of follow-up. […] Our study is the first to demonstrate that the asymptomatic radiological bronchiectasis could develop into clinical bronchiectasis under the influence of risk factors including advanced age, low FEV1, comorbid COPD and/or HF, the degree of bronchiectasis, the number of lobes with bronchiectasis as well as the number of lobes with mucus plugs. […] The model constructed from the above risk factors can help clinicians address the controversial issues of when and in which patients therapeutic intervention should be initiated.

• #8 Outcome and prognostic factors after lung transplantation for bronchiectasis other than cystic fibrosis | BMC Pulmonary Medicine | Full Text

  https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-021-01634-z

  Bronchiectasis (n=13), compared to non-bronchiectasis (n=111), was not associated with mortality in the overall study cohort (HR 1.62, 95% CI 0.634.19), yet age was a risk factor to death (HR 1.03, 95% CI 1.011.08). […] Risk factors for the development of CLAD were also analyzed, showing the recipient age at the LTX (HR 1.04, 95% CI 1.011.08) and chronic sinusitis (HR 2.56, 95% CI 1.105.99) becoming predictors of CLAD onset but bronchiectasis was not associated with its development (HR 1.88, 95% CI 0.655.40). […] Our study demonstrated that LTX recipients with bronchiectasis other than CF experienced high rate of pre- and post-transplant Pseudomonas colonization with statistical significance. […] Nevertheless, long-term survival in the bronchiectasis group was as great as the non-bronchiectasis group or other disease categories, and bronchiectasis was not an independent risk for CLAD development. […] In conclusion, the long-term outcome in LTX recipients with the underlying disease of bronchiectasis other than CF, a representative of the suppurative lung disease in Japan, was comparable to those without bronchiectasis.

• #8 Outcome and prognostic factors after lung transplantation for bronchiectasis other than cystic fibrosis | BMC Pulmonary Medicine | Full Text

  https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-021-01634-z

  LTX recipients with bronchiectasis experienced a high rate of pre- and post-transplant Pseudomonas colonization compared to other diseases with statistical significance (p0.001 and p0.001, respectively). […] Nevertheless, long-term survival in bronchiectasis was as great as non-bronchiectasis (Log-rank p=0.522), and the bronchiectasis was not a trigger for death (HR 1.62, 95% CI 0.634.19). […] On the other hand, the chance of CLAD onset in bronchiectasis was comparable to non-bronchiectasis (Log-rank p=0.221), and bronchiectasis was not a predictor of the development of CLAD (HR 1.88, 95% CI 0.655.40). […] Despite high prevalence of pre- and post-transplant Pseudomonas colonization, the outcome in LTX recipients with bronchiectasis other than CF was comparable to those without bronchiectasis.

• #9 The existence of bronchiectasis predicts worse prognosis in patients with COPD | Scientific Reports

  https://www.nature.com/articles/srep10961

  Bronchiectasis is prevalent in patients with COPD. […] The presence of bronchiectasis (HR, 1.77; 95% CI, 1.023.08; P=0.043) was associated with an increase in all-cause mortality in patients with COPD. […] Bronchiectasis was an independent risk factor for all-cause mortality in patients with COPD. […] The risk of all-cause mortality in patients with COPD with bronchiectasis was higher than in patients with COPD without bronchiectasis (unadjusted HR, 1.68; 95% CI, 1.06-2.64; P=0.026). […] In the fully adjusted model, the risk remained significantly higher in patients with COPD with bronchiectasis than in patients with COPD without bronchiectasis (fully adjusted HR, 1.77; 95% CI, 1.02-3.08; P=0.043). […] The patients age, the isolation of PPM in sputum and the presence of bronchiectasis were independent risk factors of all-cause mortality in the survival analysis of patients with COPD. […] When bronchiectasis is detected in older patients who have been diagnosed with COPD and whose sputum culture contains PPM, their prognosis is poorer than that of other patients.

• #10

  https://discovery.ucl.ac.uk/10054265/

  On univariate analysis, CPI was the most powerful functional predictor of mortality (p 0.0001). […] Visual traction bronchiectasis (p 0.0001), PA diameter (p 0.0001) and honeycombing presence (p = 0.0001) and CALIPER PVV (p = 0.0003) were the strongest CT outcome predictors. […] On multivariate analysis of baseline indices, traction bronchiectasis (p = 0.003), PA diameter (p = 0.003) and CPI (p = 0.0001) independently predicted mortality. […] In uILD patients, CPI, traction bronchiectasis severity and PA diameter independently predicted outcome at baseline. […] Increasing fibrosis extent measured by CALIPER was the most powerful index of outcome regardless of baseline disease severity and strongly predicted outcome in patients with marginal FVC declines.

• #11 Unclassifiable-interstitial lung disease: Outcome prediction using CT and functional indices

  https://spiral.imperial.ac.uk/entities/publication/d0de8ce5-3d12-45fc-8c1b-4590dc8b0f19

  Unclassifiable-interstitial lung disease: Outcome prediction using CT and functional indices […] On univariate analysis, CPI was the most powerful functional predictor of mortality (p 0.0001). Visual traction bronchiectasis (p 0.0001), PA diameter (p 0.0001) and honeycombing presence (p = 0.0001) and CALIPER PVV (p = 0.0003) were the strongest CT outcome predictors. […] On multivariate analysis of baseline indices, traction bronchiectasis (p = 0.003), PA diameter (p = 0.003) and CPI (p = 0.0001) independently predicted mortality. […] In uILD patients, CPI, traction bronchiectasis severity and PA diameter independently predicted outcome at baseline. Increasing fibrosis extent measured by CALIPER was the most powerful index of outcome regardless of baseline disease severity and strongly predicted outcome in patients with marginal FVC declines.

• #12 Bronchiectasis Flares Can Be Better Predicted by New Scoring Tool, Study Shows

  https://bronchiectasisnewstoday.com/2017/02/14/new-tool-predicting-bronchiectasis-exacerbations-alllows-targeted-preventive-measures/

  “E-FACED score significantly increases the FACED capacity to predict future yearly exacerbations while maintaining the score’s simplicity and prognostic capacity for death,” the researchers concluded. […] Since exacerbations are potentially preventable and also drive disease progression, the new tool may help identify patients most in need of interventions and prevent their condition from worsening.

• #13 Prognostic Value of Concomitant Bronchiectasis in Newly Diagnosed Diffuse Panbronchiolitis Patients on a Maintenance Therapy with Macrolides

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6431487/

  Factors determining the prognosis of diffuse panbronchiolitis (DPB) remain unclear at present. The objective of this study was to identify the prognostic value of concomitant bronchiectasis in the macrolide treatment efficacy and exacerbation risk in DPB patients. […] Furthermore, bronchiectasis was associated with a lower rate of responsiveness to macrolides and increased exacerbation frequency during follow-up. […] The coexistence of bronchiectasis predicted a poor outcome of maintenance macrolide therapy and an increased exacerbation risk in DPB subjects, possibly through its impacts on nutritional status, pulmonary function, and P. aeruginosa infections. […] Our results demonstrated a poorer outcome of macrolide treatment, as well as a shorter period to episode relapse and increased exacerbation frequency since study enrollment in newly diagnosed DPB patients with bronchiectasis compared with their bronchiectasis-free counterparts.

• #13 Prognostic Value of Concomitant Bronchiectasis in Newly Diagnosed Diffuse Panbronchiolitis Patients on a Maintenance Therapy with Macrolides

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6431487/

  According to the multiple Cox regression analysis, comorbid bronchiectasis (in combination with a couple of other clinically significant confounding variables including BMI, FEV1, and positive P. aeruginosa culture) was a strong independent factor of macrolide treatment. […] It could thus be speculated that bronchiectasis exerts a detrimental influence on DPB disease control and prognosis, at least through pathways involving nutritional condition, pulmonary function, and lower airway tract infections. […] The KaplanMeier survival and log-rank test results showed a significant difference in the time to exacerbation after the beginning of macrolide therapy between patients with and without bronchiectasis (P 0.001), with the estimated value of 20.0 (95% confidence interval (CI): 17.622.4) months and 29.0 (95% CI: 21.736.3) months, respectively.

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