Exacerbations in noncystic fibrosis bronchiectasis: Clinical features and investigations

Kapur, Nitin, Masters, Ian Brent and Chang, Anne B. (2009) Exacerbations in noncystic fibrosis bronchiectasis: Clinical features and investigations. Respiratory Medicine, 103 11: 1681-1687. doi:10.1016/j.rmed.2009.05.007


Author Kapur, Nitin
Masters, Ian Brent
Chang, Anne B.
Title Exacerbations in noncystic fibrosis bronchiectasis: Clinical features and investigations
Journal name Respiratory Medicine   Check publisher's open access policy
ISSN 0954-6111
1532-3064
Publication date 2009-11
Sub-type Article (original research)
DOI 10.1016/j.rmed.2009.05.007
Volume 103
Issue 11
Start page 1681
End page 1687
Total pages 7
Place of publication Oxford, United Kingdom
Publisher Elsevier
Language eng
Formatted abstract
Summary: Children with bronchiectasis have recurrent acute pulmonary exacerbations and many of these exacerbations require hospital admission when oral therapies fail. However there is no standardized definition and little published data is available about the features of an exacerbation. Our aim was to determine the clinical and investigational features of exacerbations in bronchiectasis, the proportion that fail to resolve on oral antibiotics and the factors associated with it.
Methods: A retrospective cohort study of 115 respiratory exacerbations from 30 children with noncystic fibrosis bronchiectasis diagnosed on HRCT chest. Clinical features, investigations and treatment related to the exacerbations were extracted and analysed.
Results: Increase in frequency of cough (88%) and a change in its character (67%) were the most common symptoms associated with an exacerbation. Fever (28%), increase in sputum volume (42%) and purulence (35%) were also common features. Chest pain, dyspnea, hemoptysis and tachypnea were rare. 56% had a worsening in their chest auscultatory findings during an exacerbation. Spirometry was not significantly different between stable and exacerbation state. 35% of exacerbations failed to respond to oral antibiotic therapy and required hospital admission. Prophylactic antibiotic therapy was the only significant predictor of failure of oral therapy with adjusted odds ratio of 6.77 (95% CI 2.06–19.90; p = 0.003).
Conclusions: Important clinical features of non-CF exacerbation in bronchiectasis were changes in cough frequency or character, and worsening chest signs; which resolved on therapies. However there is a high failure rate of oral antibiotic therapy and use of prophylactic antibiotic therapy increases this risk.
Keyword Bronchiectasis
Exacerbation
Clinical features
Investigations
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: ERA 2012 Admin Only
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