Bronchoscopic airway clearance therapy for acute exacerbations of bronchiectasis

Abstract

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.

Keywords: Acute exacerbation; B-ACT; Bronchiectasis; Efficacy.

Conflict of interest statement

Declaration of Competing Interest All authors declare that they have no competing interests.

Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.

Figures

Fig. 1

Flow diagram and timeline of the study design The detailed procedure of the study is shown in panel a); The timeline of the study is shown in panel b).

Fig. 2

Subgroups analysis of the target populations who benefit more from the B-ACT therapy according to comparison of the time to first acute exacerbation after discharge Differences of the time to first acute exacerbation after discharge for total population, patients with BSI scores ≥8, the number of acute exacerbations in the past year ≥2, SGRQ scores ≥15, CAT scores ≥11, or LCQ scores

Fig. 3

The improvement of CAT and LCQ scores were more significant in the B-ACT group at different time points after treatment The overall trends of the change of CAT and LCQ scores at different time points in two groups were shown in panel a) and b). The change of CAT score, LCQ score, CAT-sputum score and CAT-cough score were shown in panel c), d), e) and f). *: p

Fig. 4

B-ACT therapy was more suitable for improving CAT scores in patients with long disease course Differences of the changes of CAT-cough score at different time points after B-ACT therapy in different subgroup related to sex and age were shown in panel a) and b); Comparisons of the change of CAT-score and CAT-sputum score at different time points after B-ACT therapy between patients with disease duration less than 10 years and those with more than 10 years were shown in panel c) and d). *: p

Fig. 5

The massive purulent sputum retention in patients’ airway was reduced significantly after B-ACT therapy Large amounts of purulent sputum retained in patient's airway before the B-ACT therapy are shown in panel a), and the disappeared sputum in the same place after the treatment are shown in panel b). Panel c) showed obvious inflammatory exudative lesions on both sides before the B-ACT therapy, and improvement of inflammatory exudation in the same CT scanning plane for the same patient three months later after B-ACT therapy were shown in panel d); Red shading on the CT scans represent the focal area of the lung in a patient with bronchiectasis.