RT Journal Article
SR Electronic
T1 Inhaled Aztreonam improves symptoms of cough and sputum production in patients with bronchiectasis: a post-hoc analysis of the AIR-BX studies
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 2000608
DO 10.1183/13993003.00608-2020
A1 Megan L. Crichton
A1 Mike Lonergan
A1 Alan F. Barker
A1 Oriol Sibila
A1 Pieter Goeminne
A1 Amelia Shoemark
A1 James D. Chalmers
YR 2020
UL http://erj.ersjournals.com/content/early/2020/04/01/13993003.00608-2020.abstract
AB Introduction Inhaled antibiotics may improve symptom scores but it is not known which specific symptoms improve with therapy. Item-level analysis of questionnaire data may allow us to identify which specific symptoms respond best to treatment.Methods Post-hoc analysis of the AIR-BX1 and 2 trials of inhaled aztreonam versus placebo in bronchiectasis. Individual items from the quality of life bronchiectasis respiratory symptom scale (QOL-B) were extracted, as representing severity of 9 distinct symptoms. Generalised linear models were used to evaluate changes in symptoms with treatment versus placebo from baseline to end of first on treatment cycle and mixed models used to evaluate changes across the full 16 week trial.Results Aztreonam improved cough (difference 0.22; 95%CI 0.08–0.37, p=0.002), sputum production (0.30; 95%CI 0.15–0.44, p<0.0001) and sputum colour (0.29; 95%CI 0.15–0.43 p<0.0001) versus placebo equating to a 20% improvement in cough and 25% improvement in sputum production and colour respectively. Similar results were observed for cough, sputum production and sputum purulence across the trial duration (all p<0.05). Patients with higher sputum production and sputum colour scores had a greater response on the overall QOL-B (difference 4.82; 95%CI 1.12–8.53, p=0.011) for sputum production and 5.02; 95%CI 1.19–8.86, p=0.01 for sputum colour. In contrast, treating patients who had lower levels of bronchitic symptoms resulted in shorter time to next exacerbations (HR 1.83; 95%CI 1.02–3.28, p=0.042).Conclusion Baseline bronchitic symptoms predict response to inhaled aztreonam in bronchiectasis. More sensitive tools to measure bronchitic symptoms may be useful to enrich for inhaled antibiotic responders and to evaluate patient response to treatment.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Crichton has nothing to disclose.Conflict of interest: Dr. Lonergan has nothing to disclose.Conflict of interest: Dr. Barker has nothing to disclose.Conflict of interest: Dr. Sibila has nothing to disclose.Conflict of interest: Dr. Goeminne has nothing to disclose.Conflict of interest: Dr. Shoemark has nothing to disclose.Conflict of interest: Dr. Chalmers reports grants from Gilead, during the conduct of the study; grants and personal fees from Astrazeneca, grants and personal fees from Glaxosmithkline, personal fees from Chiesi, grants from Gilead, grants and personal fees from Grifols, grants and personal fees from Insmed, grants and personal fees from Boehringer Ingelheim, outside the submitted work.