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Assessing response to treatment of exacerbations of bronchiectasis in adults

Dept of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.

CORRESPONDENCE: M. P. Murray, Dept of Respiratory Medicine, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK. Fax: 44 1312421870. E-mail: maevemurray{at}hotmail.com

Keywords: Exacerbations, noncystic fibrosis bronchiectasis, treatment

Received: August 8, 2008
Accepted September 23, 2008

The present study aimed to assess the effect of intravenous antibiotic therapy on clinical and laboratory end-points in exacerbations of noncystic fibrosis bronchiectasis and to determine whether the outcomes were influenced by the pathogenic organism isolated.

A prospective cohort study was conducted from November 2006 to March 2008 of exacerbations requiring intravenous antibiotics. End-points included 24-h sputum volume, forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), incremental shuttle walk test, qualitative sputum microbiology, white cell count, erythrocyte sedimentation rate, C-reactive protein (CRP) and St George's Respiratory Questionnaire (SGRQ). Exacerbations due to Pseudomonas aeruginosa were compared with exacerbations due to other potential pathogenic organisms.

In total, 32 exacerbations were studied. Following 14 days of intravenous antibiotics, all outcomes significantly improved independent of a pathogenic organism, except FEV₁ and FVC. The most responsive markers were: 24-h sputum volume (reduced in all patients and 80% had 50% reduction); sputum bacterial clearance (78.1%); CRP (75% reduction in 62.5%) and SGRQ (4 unit improvement in 89.7%). CRP, 24-h sputum volume and SGRQ improved independent of microbial clearance.

In the current study, 24-h sputum volume, microbial clearance, C-reactive protein and St George’s Respiratory Questionnaire were the most useful parameters to assess response to treatment of exacerbations of bronchiectasis. Outcomes were similar independent of the pathogenic organism with the exception of forced expiratory volume in one second and forced vital capacity.