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Relationship between Symptoms, Exacerbations, and Treatment Response in Bronchiectasis
Yong-Hua Gao1,2, Hani Abo Leyah2, Simon Finch2
1Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
American Journal of Respiratory and Critical Care Medicine
|February 26, 2020
Summary
Patients with more severe symptoms of bronchiectasis face a higher risk of exacerbations. Treatments targeting daily symptoms, like inhaled mannitol, effectively reduced exacerbations, but only in highly symptomatic individuals.
Area of Science:
- Pulmonary Medicine
- Respiratory Diseases
- Clinical Research
Background:
- Bronchiectasis guidelines often separate exacerbation prevention from daily symptom management.
- A clinical hypothesis suggests that reducing daily symptoms may also decrease exacerbations, particularly in patients with a high symptom burden.
Purpose of the Study:
- To investigate the relationship between daily symptom severity and exacerbation risk in bronchiectasis patients.
- To determine if treatments aimed at symptom reduction offer a benefit in preventing exacerbations, specifically in highly symptomatic individuals.
Main Methods:
- An observational cohort of 333 bronchiectasis patients was analyzed.
- Symptom burden was assessed using the St. George's Respiratory Questionnaire score.
- A post-hoc analysis of a randomized trial involving inhaled dry powder mannitol (461 patients) was conducted to test the hypothesis.
Main Results:
- Daily symptoms significantly predicted future exacerbations in the observational cohort.
- Higher symptom scores correlated with increased exacerbation rates over 12 months.
- Inhaled mannitol improved time to first exacerbation and increased exacerbation-free patients, but this benefit was confined to highly symptomatic individuals.
Conclusions:
- Highly symptomatic bronchiectasis patients exhibit a greater risk of exacerbations.
- The exacerbation-reducing benefits of inhaled mannitol were observed exclusively in patients with a high symptom burden, not in those with lower symptom severity.
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