Bronchoscopic airway clearance therapy for acute exacerbations of bronchiectasis
Yang Liu, Hai-Wen Lu, Shu-Yi Gu, Wen-Wen Wang, Juan Ge, Zhi-Jun Jie, Jin-Guang Jia, Zhi-Ting Gao, Jun Li, Jing-Yun Shi, Shuo Liang, Ke-Bing Cheng, Jiu-Wu Bai, Jie-Ming Qu, Jin-Fu Xu, Yang Liu, Hai-Wen Lu, Shu-Yi Gu, Wen-Wen Wang, Juan Ge, Zhi-Jun Jie, Jin-Guang Jia, Zhi-Ting Gao, Jun Li, Jing-Yun Shi, Shuo Liang, Ke-Bing Cheng, Jiu-Wu Bai, Jie-Ming Qu, Jin-Fu Xu
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](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8452777/bin/gr1.jpg)
![Fig. 2](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8452777/bin/gr2.jpg)
Fig. 3
The improvement of CAT and…
Fig. 3
The improvement of CAT and LCQ scores were more significant in the B-ACT…
Fig. 4
B-ACT therapy was more suitable…
Fig. 4
B-ACT therapy was more suitable for improving CAT scores in patients with long…
Fig. 5
The massive purulent sputum retention…
Fig. 5
The massive purulent sputum retention in patients’ airway was reduced significantly after B-ACT…
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- Randomized Controlled Trial
- Acute Disease / therapy*
- Adult
- Aged
- Bronchi / physiopathology*
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- Bronchoalveolar Lavage / methods*
- Cough / therapy
- Female
- Hospitalization
- Humans
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- ClinicalTrials.gov/NCT03643302
- Full Text Sources
- Medical
- Miscellaneous
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![Fig. 3](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8452777/bin/gr3.jpg)
Fig. 4
B-ACT therapy was more suitable…
Fig. 4
B-ACT therapy was more suitable for improving CAT scores in patients with long…
Fig. 5
The massive purulent sputum retention…
Fig. 5
The massive purulent sputum retention in patients’ airway was reduced significantly after B-ACT…
- Airway clearance techniques for bronchiectasis.Lee AL, Burge AT, Holland AE. Lee AL, et al. Cochrane Database Syst Rev. 2015 Nov 23;2015(11):CD008351. doi: 10.1002/14651858.CD008351.pub3. Cochrane Database Syst Rev. 2015. PMID: 26591003 Free PMC article. Review.
- Positive expiratory pressure therapy versus other airway clearance techniques for bronchiectasis.Lee AL, Burge AT, Holland AE. Lee AL, et al. Cochrane Database Syst Rev. 2017 Sep 27;9(9):CD011699. doi: 10.1002/14651858.CD011699.pub2. Cochrane Database Syst Rev. 2017. PMID: 28952156 Free PMC article. Review.
- Airway clearance techniques for bronchiectasis.Lee AL, Burge A, Holland AE. Lee AL, et al. Cochrane Database Syst Rev. 2013 May 31;(5):CD008351. doi: 10.1002/14651858.CD008351.pub2. Cochrane Database Syst Rev. 2013. PMID: 23728674 Updated. Review.
- Exercise training for bronchiectasis.Lee AL, Gordon CS, Osadnik CR. Lee AL, et al. Cochrane Database Syst Rev. 2021 Apr 6;4(4):CD013110. doi: 10.1002/14651858.CD013110.pub2. Cochrane Database Syst Rev. 2021. PMID: 33822364 Free PMC article.
- The short and long term effects of exercise training in non-cystic fibrosis bronchiectasis--a randomised controlled trial.Lee AL, Hill CJ, Cecins N, Jenkins S, McDonald CF, Burge AT, Rautela L, Stirling RG, Thompson PJ, Holland AE. Lee AL, et al. Respir Res. 2014 Apr 15;15(1):44. doi: 10.1186/1465-9921-15-44. Respir Res. 2014. PMID: 24731015 Free PMC article. Clinical Trial.
- Research advances and clinical management of bronchiectasis: Chinese perspective.Xu JF, Gao YH, Song YL, Qu JM, Guan WJ. Xu JF, et al. ERJ Open Res. 2022 Apr 11;8(2):00017-2022. doi: 10.1183/23120541.00017-2022. eCollection 2022 Apr. ERJ Open Res. 2022. PMID: 35415184 Free PMC article. Review.
-
- Tino G. Bronchiectasis: Phenotyping an Orphan Disease. Am J Respir Crit Care Med. 2018;197(11):1371–1373. - PubMed
-
- Boyton RJ, Altmann DM. Bronchiectasis: current concepts in pathogenesis, immunology, and microbiology. Ann Rev Pathol. 2016;11:523–554. - PubMed
-
- Ringshausen FC, Rademacher J, Pink I. Increasing bronchiectasis prevalence in Germany, 2009-2017: a population-based cohort study. Eur Respir J. 2019;54(6) - PubMed
-
- Choi H, Yang B, Nam H. Population-based prevalence of bronchiectasis and associated comorbidities in South Korea. Eur Respir J. 2019;54(2) - PubMed
-
- Snell N, Gibson J, Jarrold I, Quint JK. Epidemiology of bronchiectasis in the UK: Findings from the British lung foundation's 'Respiratory health of the nation' project. Respir Med. 2019;158:21–23. - PubMed
- Randomized Controlled Trial
- Acute Disease / therapy*
- Adult
- Aged
- Bronchi / physiopathology*
- Bronchiectasis / therapy*
- Bronchoalveolar Lavage / methods*
- Cough / therapy
- Female
- Hospitalization
- Humans
- Male
- Middle Aged
- ClinicalTrials.gov/NCT03643302
- Full Text Sources
- Medical
- Miscellaneous
![Fig. 4](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8452777/bin/gr4.jpg)
Fig. 5
The massive purulent sputum retention…
Fig. 5
The massive purulent sputum retention in patients’ airway was reduced significantly after B-ACT…
![Fig. 5](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8452777/bin/gr5.jpg)
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