pulmicort and Bronchiectasis

Bronchiectasis is a major contributor to chronic respiratory morbidity and mortality worldwide. Wheeze and other asthma-like symptoms and bronchial hyperreactivity may occur in people with bronchiectasis. Physicians often use asthma treatments in patients with bronchiectasis.. To assess the effects of inhaled long-acting beta2-agonists (LABA) combined with inhaled corticosteroids (ICS) in children and adults with bronchiectasis during (1) acute exacerbations and (2) stable state.. The Cochrane Airways Group searched the the Cochrane Airways Group Specialised Register of Trials, which includes records identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and other databases. The Cochrane Airways Group performed the latest searches in October 2013.. All randomised controlled trials (RCTs) of combined ICS and LABA compared with a control (placebo, no treatment, ICS as monotherapy) in children and adults with bronchiectasis not related to cystic fibrosis (CF).. Two review authors extracted data independently using standard methodological procedures as expected by The Cochrane Collaboration.. We found no RCTs comparing ICS and LABA combination with either placebo or usual care. We included one RCT that compared combined ICS and LABA with high-dose ICS in 40 adults with non-CF bronchiectasis without co-existent asthma. All participants received three months of high-dose budesonide dipropionate treatment (1600 micrograms). After three months, participants were randomly assigned to receive either high-dose budesonide dipropionate (1600 micrograms per day) or a combination of budesonide with formoterol (640 micrograms of budesonide and 18 micrograms of formoterol) for three months. The study was not blinded. We assessed it to be an RCT with overall high risk of bias. Data analysed in this review showed that those who received combined ICS-LABA (in stable state) had a significantly better transition dyspnoea index (mean difference (MD) 1.29, 95% confidence interval (CI) 0.40 to 2.18) and cough-free days (MD 12.30, 95% CI 2.38 to 22.2) compared with those receiving ICS after three months of treatment. No significant difference was noted between groups in quality of life (MD -4.57, 95% CI -12.38 to 3.24), number of hospitalisations (odds ratio (OR) 0.26, 95% CI 0.02 to 2.79) or lung function (forced expiratory volume in one second (FEV1) and forced vital capacity (FVC)). Investigators reported 37 adverse events in the ICS group versus 12 events in the ICS-LABA group but did not mention the number of individuals experiencing adverse events. Hence differences between groups were not included in the analyses. We assessed the overall evidence to be low quality.. In adults with bronchiectasis without co-existent asthma, during stable state, a small single trial with a high risk of bias suggests that combined ICS-LABA may improve dyspnoea and increase cough-free days in comparison with high-dose ICS. No data are provided for or against, the use of combined ICS-LABA in adults with bronchiectasis during an acute exacerbation, or in children with bronchiectasis in a stable or acute state. The absence of high quality evidence means that decisions to use or discontinue combined ICS-LABA in people with bronchiectasis may need to take account of the presence or absence of co-existing airway hyper-responsiveness and consideration of adverse events associated with combined ICS-LABA.

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Adrenergic beta-2 Receptor Agonists; Adult; Bronchiectasis; Budesonide; Child; Disease Progression; Drug Therapy, Combination; Ethanolamines; Formoterol Fumarate; Humans; Randomized Controlled Trials as Topic

The aim of this study is to evaluate the efficacy and safety of medium-dose formoterol-budesonide combined inhaled treatment in a single inhaler compared with high-dose budesonide treatment in patients with non-cystic fibrosis (non-CF) bronchiectasis.. This is a 12-month randomized, double-blind, parallel-groups clinical trial, to run in 40 patients with non-CF bronchiectasis diagnosed by high-resolution CT scan of the chest, receiving formoterol-budesonide combined treatment (18/640 μg daily) or budesonide treatment (1,600 μg daily). Variables concerning clinical condition, health-related quality of life (HRQL), lung function, β(2)-adrenergic agonist use, potentially pathogenic microorganism (PPM) isolates, and medication side effects were analyzed by intention-to-treat analysis.. The study group receiving a formoterol-budesonide combined treatment showed a significant improvement, both clinically and statistically, of symptoms (dyspnea, number of coughs, and rescue β(2)-adrenergic agonist-free days). Furthermore, we observed an HRQL improvement, with no changes in functional parameters or in PPM isolates, together with an important reduction in overall side effects, especially for those related to inhaled steroids, compared with the high-dose budesonide treatment group.. Inhaled medium-dose formoterol-budesonide combined treatment in a single inhaler is more effective and safe compared with high-dose budesonide treatment in patients with non-CF bronchiectasis.. ClinicalTrials.gov; No.: NCT00728715; URL: www.clinicaltrials.gov.

Topics: Administration, Inhalation; Adolescent; Adrenergic beta-Agonists; Adult; Aged; Aged, 80 and over; Bronchiectasis; Bronchodilator Agents; Budesonide; Chi-Square Distribution; Double-Blind Method; Drug Combinations; Ethanolamines; Female; Formoterol Fumarate; Humans; Male; Middle Aged; Quality of Life; Respiratory Function Tests; Tomography, X-Ray Computed; Treatment Outcome

The therapeutic benefit of inhaled corticoids in bronchiectasis not due to cystic fibrosis is still not well documented. The aim of the present study was to assess the efficacy and safety of inhaled corticoids in this disease.. This study was conducted at a tertiary university hospital in the city of Barcelona, Catalonia, (Spain).. A prospective, double-blind, parallel, placebo-masked study was conducted. Seventy-seven patients (40 women; mean age: 68 years) were randomly assigned to receive either 400 mcg budesonide twice daily or placebo and were regularly reviewed for six months.. Differences in forced vital capacity and forced expiratory volume in the first second between the beginning and end of the study were not significantly lower in the budesonide group than in the placebo group, either in absolute values [-17.4 (386.9) versus -21.4 (375.5)] or in percentages [-1.9(9.5) versus -2.8 (11.6)]. Microbiological criteria applied to evaluate changes between the beginning and end of the study showed no worsening in the budesonide group compared with the control group, whereas a non-significant improvement was obtained in 8.1 % of cases in the budesonide group compared to 3 % in the placebo group. Although significance was only achieved for sputum eosinophils (p = 0.021), a consistent tendency towards improvement was also observed in secondary end-points (symptoms, number and duration of exacerbations, quality of life, sputum cytology and interleukin-8) in the budesonide group.. Although further studies are required, inhaled corticoid treatment may be efficacious and safe in bronchiectasis not due to cystic fibrosis.

Topics: Administration, Inhalation; Aged; Bronchiectasis; Budesonide; Double-Blind Method; Female; Forced Expiratory Volume; Glucocorticoids; Humans; Interleukin-8; Male; Quality of Life; Sputum; Vital Capacity

Topics: Bronchiectasis; Bronchodilator Agents; Budesonide; Eosinophils; Fluticasone; Humans

Chronic respiratory disease and inhaled corticosteroid (ICS) therapy for chronic obstructive pulmonary disease (COPD) increase the risk of pneumonia. Few data are available on the association of these risk factors with non-tuberculous mycobacterial (NTM) pulmonary disease.. This study examined chronic respiratory diseases and ICS use as risk factors in a population-based case-control study encompassing all adults in Denmark with microbiologically confirmed NTM pulmonary disease between 1997 and 2008. The study included 10 matched population controls per case. Conditional logistic regression was used to compute adjusted ORs for NTM pulmonary disease with regard to chronic respiratory disease history.. Overall, chronic respiratory disease was associated with a 16.5-fold (95% CI 12.2 to 22.2) increased risk of NTM pulmonary disease. The adjusted OR for NTM disease was 15.7 (95% CI 11.4 to 21.5) for COPD, 7.8 (95% CI 5.2 to 11.6) for asthma, 9.8 (95% CI 2.03 to 52.8) for pneumoconiosis, 187.5 (95% CI 24.8 to 1417.4) for bronchiectasis, and 178.3 (95% CI 55.4 to 574.3) for tuberculosis history. ORs were 29.1 (95% CI 13.3 to 63.8) for patients with COPD on current ICS therapy and 7.6 (95% CI 3.4 to 16.8) for patients with COPD who had never received ICS therapy. Among patients with COPD, ORs increased according to ICS dose, from 28.1 for low-dose intake to 47.5 for high-dose intake (more than 800 μg/day). The OR was higher for fluticasone than for budesonide.. Chronic respiratory disease, particularly COPD treated with ICS therapy, is a strong risk factor for NTM pulmonary disease.

Topics: Administration, Inhalation; Aged; Androstadienes; Anti-Inflammatory Agents; Asthma; Bronchiectasis; Budesonide; Case-Control Studies; Chronic Disease; Confidence Intervals; Denmark; Female; Fluticasone; Humans; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Odds Ratio; Pneumoconiosis; Pulmonary Disease, Chronic Obstructive; Respiratory Tract Diseases; Risk Factors; Tuberculosis, Pulmonary

Topics: Bronchiectasis; Bronchodilator Agents; Budesonide; Ethanolamines; Female; Humans; Male

Topics: Adult; Anti-Asthmatic Agents; Anti-Inflammatory Agents; Bronchiectasis; Bronchodilator Agents; Budesonide; Cromolyn Sodium; Ethanolamines; Follow-Up Studies; Formoterol Fumarate; Humans; Lung; Male; Mycoplasma Infections; Prednisolone; Respiratory Function Tests; Tomography, X-Ray Computed; Treatment Outcome; Whooping Cough; Young Adult

A 78-year-old man was referred to our hospital complaining of chronic productive cough. Physical examination revealed yellowish, thin nails and pretibial edema. A chest computed tomograph showed bilateral bronchiectasis. A sinus radiograph showed the findings of chronic sinusitis. From these findings, yellow nail syndrome was diagnosed. Long-term low-dose macrolide therapy with 400 mg/day clarithromycin was started and his symptoms began to gradually improve. However, complete resolution of his symptoms was not achieved and fiberoptic bronchoscopy was performed. Transbronchial biopsy specimen obtained from the right second carina showed bronchial asthma-like findings such as eosinophilic infiltration, thickening of the basement membrane, mucosal edema and goblet cell hyperplasia. Airflow reversibility was not detected. Thus a diagnosis of coexistence of yellow nail syndrome and eosinohilic bronchial disease was established. Further improvement of his symptoms was achieved by additional therapy with 800 microg/day budesonide and 100 microg/day salmeterol. To the best of our knowledge, this is the first report of a case of yellow nail syndrome associated with eosinophilic bronchial disease successfully treated with long-term low-dose macrolides and inhaled corticosteroids.

Topics: Aged; Anti-Bacterial Agents; Anti-Inflammatory Agents; Bronchial Diseases; Bronchiectasis; Budesonide; Clarithromycin; Drug Therapy, Combination; Eosinophilia; Humans; Lymphedema; Male; Nail Diseases; Sinusitis; Syndrome

To determine the concentration of exhaled H(2)O(2) in patients with bronchiectasis, and to study the relationship between levels of exhaled H(2)O(2), extent of disease, symptoms score, spirometry, and cellular composition obtained from induced sputum; furthermore, to account for possible confounding effects of inhaled corticosteroids (ICS) usage, long-term oral antibiotic treatment, and chronic colonization with Pseudomonas aeruginosa.. Cross-sectional study.. Thirty patients with steady-state bronchiectasis.. Mean (95% confidence interval [CI]) exhaled H(2)O(2) levels were significantly elevated in patients with bronchiectasis compared to normal subjects: 1.1 (0.87 to 1.29) microM vs 0.3 (0.19 to 0.36) microM, respectively (p < 0.0001). Patients treated with ICS had similar values as steroid-naïve patients. The group of patients with P aeruginosa colonization showed a significantly increased concentration of H(2)O(2) compared to the group without P aeruginosa colonization. Patients receiving long-term oral antibiotic treatment had significantly higher values of H(2)O(2) compared to those not receiving antibiotics. There was a significant positive correlation between H(2)O(2) and either the percentage of neutrophils in induced sputum or the extent of the disease as defined by high-resolution CT. A significant negative correlation was found between H(2)O(2) and FEV(1) percent predicted. Finally, there was a significant positive correlation between H(2)O(2) and the symptoms score.. Patients with bronchiectasis in stable condition showed increased levels of exhaled H(2)O(2). The above-mentioned levels were not decreased either by ICS or long-term oral antibiotic treatment, but were significantly affected by chronic colonization with P aeruginosa. H(2)O(2) levels could be an indirect index of neutrophilic inflammation, impairment of lung function, and extension and severity of the disease.

Topics: Administration, Inhalation; Administration, Oral; Adrenal Cortex Hormones; Adult; Androstadienes; Anti-Bacterial Agents; Breath Tests; Bronchiectasis; Budesonide; Confidence Intervals; Female; Fluticasone; Forced Expiratory Volume; Humans; Hydrogen Peroxide; Leukocyte Count; Long-Term Care; Male; Middle Aged; Pneumonia, Bacterial; Pseudomonas aeruginosa; Pseudomonas Infections; Risk Factors; Spirometry; Sputum; Vital Capacity

Bronchiectasis is defined as pathological and permanent dilatation of the bronchial tree. Affected patients suffer from chronic sputum production and usually slowly progressive airway destruction as a result of continued airway infection and inflammation. Regression of bilateral bronchiectasis has never been reported in the English literature. We report the case of a 60-year-old woman with longstanding progressive idiopathic bilateral bronchiectasis whose respiratory symptoms, including sputum, rapidly disappeared after commencement of inhaled budesonide. Repeat computed tomography assessment 40 months after commencement of inhaled steroid therapy, showed partial regression of bronchial dilation and resolution of small airways sepsis. In the absence of other possible explanations for the partial resolution of the bronchiectasis, the present case suggests a possible benefit of inhaled steroid therapy in bronchiectasis.

Topics: Administration, Inhalation; Anti-Inflammatory Agents; Bronchiectasis; Budesonide; Female; Humans; Middle Aged; Remission Induction; Tomography, X-Ray Computed

Bronchiectasis is characterized by chronic inflammation in one or more bronchi, but the extent of inflammation is difficult to monitor. The concentration of nitric oxide (NO) in exhaled air is increased in asthmatic patients, possibly as a result of the chronic inflammatory process. We have measured exhaled NO in patients with documented bronchiectasis and investigated whether the concentration of exhaled NO is related to the extent of disease as defined by computed tomography (CT) and lung function. In 20 patients with bronchiectasis who were not taking inhaled steroids, the peak concentration of NO in exhaled air, measured by a modified chemiluminescence analyzer, was significantly elevated (285 +/- 49.0 ppb) as compared with values for 79 normal subjects (89 +/- 2.7 ppb, p < 0.01) and 19 patients with bronchiectasis treated with inhaled steroids (88 +/- 13.4 ppb, p < 0.01). Thin-section CT was used to quantify the extent of bronchiectasis in the 19 patients. There was a significant correlation between the CT score and FEV1 (r = 0.73, p < 0.01). In patients not treated with inhaled steroids there was a significant relationship between CT score and peak exhaled NO (r = 0.81, n = 12, p < 0.02), but this was not the case for patients treated with regular inhaled steroids (n = 7). We conclude that untreated bronchiectasis is associated with an increase in exhaled NO, and that this is correlated with disease severity, whereas patients treated with inhaled steroids have levels of exhaled NO within the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adrenergic beta-Agonists; Aerosols; Beclomethasone; Breath Tests; Bronchiectasis; Bronchodilator Agents; Budesonide; Case-Control Studies; Female; Humans; Luminescent Measurements; Lung; Male; Middle Aged; Nitric Oxide; Pregnenediones; Spirometry; Tomography, X-Ray Computed