Updated therapies in bronchiectasis

• Main Authors: Gabriela C. OBILIŞTEANU, Alexandru MATEI, Loredana MANOLESCU, Viviana DRAGODAN, Ruxandra ULMEANU, Florin D. MIHĂLŢAN
• Format: Article
• Language: English
• Published: Amaltea Medical Publishing House 2017-06-01
• Series: Romanian Journal of Medical Practice
• Subjects: bronchiectasis; therapies; antibiotics; mucolytics; bronchodilators
• Online Access: https://rjmp.com.ro/articles/2017.2/RJMP_2017_2_Art-06.pdf
• ISSN: 1842-8258; 2069-6108

Objective. The aim of this study is to evaluate the constantly updated and integrated treatment strategies for the improvement and the cure of bronchiectasis, with a beneficial effect on the quality of life of patients diagnosed with this disease. Material and method. The retrospective study (december 17th 2014 – june 2nd 2015), was conducted on 89 patients hospitalised in the Pneumophtysiology Institute "Marius Nasta" in Bucharest, with the confirmed clinical diagnosis of non cystic fibrosis bronchiectasis. From the clinical observation charts of the patients included in the study, we evaluated the treatment strategies applied for each patient in correlation with the confirmed clinical diagnosis. The therapies applied included antimicrobial, mucolytic, bronchodilator, corticosteroid, immunotherapy treatment, pulmonary rehabilitation, treatment of associated disease (ORL and gastro-oesophageal reflux), hygiene diet and antidepressant treatment. Results. The microbial etiology identified in the sputum (17,97%) consisted of Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, Klebsiella pneumoniae, Haemophilus parainfluenzae, Streptococcus pyogenes and Candida albicans, 82,03% of the cases presented non-specific (normal) flora. The associated therapy of antibiotic treatment (cephalosporin + fluoroquinolone) + mucolytic agent (erdosteine) + corticosteroid & β adrenergic agonist + anticolinergic agent + nonsteroid anti-inflammatory + anti-influenza vaccination + immunotherapy was the most efficient and the most used first-intention therapeutic association (35/39,32%). All the patients were discharged with improved bronchiectatic status. Discussions. The present study, with multiple date regarding the treatment of the acute disease, revealed the importance and the benefit of the multitype therapy, continuously updated, for the treatment of bronchiectasis of various degrees of severity. In time, the treatment can have serious side effects for the patient and the community in regard to antibiotic resistance; the severity and the complications' risk offers an useful background for taking clinical decisions that patients require long term treatment courses, such as macrolides, airway adjuvants, inhalatory antibiotics and other measures. Conclusions. Future studies should refer to a greater number of patients with varying degrees of severity of this disease, with more specific etiological information and with a longer duration, to clarify the actual benefits of new promising therapies and to offer new perspectives on the medical approach of bronchiectasis.