ObjectiveTo describe the clinical characteristics of pulmonary nocardiosis associated with bronchiectasis and to evaluate the methods of diagnosis and treatment.MethodsClinical data of two patients with pulmonary nocardiosis and bronchiectasis were analyzed and the literature on the subject were reviewed.ResultsTwo female patients with bronchiectasis were respectively 55 and 62 years old, both of them presented with fever, cough, expectoration, and leukocytosis. Case 1 also complicated with respiratory failure and leukemoid reaction. Chest CT showed bilateral pulmonary multi-patchy consolidations with cavities in case 1 and unilateral pulmonary local consolidation without cavities in case 2. Sputum smears on modified Ziehl-Neelsen staining of both patients showed typical Nocardia hyphe. Sputum culture of case 1 showed Nocardia otitidiscaviarum, which was sensitive to sulfamethoxazole/trimethoprim (SMZ/TMP), amikacin and moxifloxacin while resistant to ceftriaxone, imipenem and meropenem. Sputum culture of case 2 was negative. Case 1 was treated with SMZ/TMP + moxifloxacin + amikacin for 6 months, and case 2 treated with SMZ/TMP for 3 months. Both patients were clinically cured. Six case reports including 7 patients were searched, including 4 Chinese reports and 2 English reports. Most of them were reported individually. ConclusionsBronchiectasis is a risk factor for pulmonary nocardiosis, and the treatment of nocardiosis should accord with drug susceptibilities and severities of diseases. The prognoses of patients with pulmonary nocardiosis and bronchiectasis are relatively good.
Objective To explore the causal relationship between the Collagen VI (COL6) family proteins COL6A1, A2, and A3 and bronchiectasis using the Mendelian randomization (MR) method.MethodsThe primary analysis was conducted using MR combined with summary-data-based Mendelian randomization (SMR) analysis. COL6 family proteins were used as exposure data, and bronchiectasis was used as outcome data. Cis-protein quantitative trait locus (cis-pQTL) data were extracted for analysis, and the results were meta-analyzed. Subsequently, COL6A3-cis-pQTL data from the UK Biobank plasma proteome study were used for further validation. Colocalization analysis was also performed to further explore the association between COL6 proteins and bronchiectasis.Results MR and SMR results revealed a negative causal relationship between COL6A3 and bronchiectasis (p-MRmeta = 0.005, OR = 0.30; p-SMRmeta = 0.004, OR = 0.26). The validation phase also confirmed the negative causal relationship between COL6A3 and bronchiectasis (p-MRmeta = 0.000007, OR = 0.27; p-SMRmeta = 0.0003, OR = 0.29). Colocalization analysis supported the presence of a shared causal variant (rs972974) between COL6A3 and bronchiectasis (PP.H4 = 0.967/0.876).Conclusion There is an inverse causal relationship between COL6A3 and bronchiectasis. Low expression of COL6A3 increases the risk of developing bronchiectasis, making COL6A3 a potential biomarker and therapeutic target for drug development in bronchiectasis.
ObjectiveTo explore the safety and feasibility of the application of video-assisted thoracic surgery (VATS) anatomic segmentectomy in single-stage bilateral thoracic surgery for the treatment of bilateral localized bronchiectasis.MethodsFrom June 2014 to June 2018, 19 patients with bilateral localized bronchiectasis underwent single-stage bilateral thoracic surgery with VATS anatomic segmentectomy, including 11 males and 8 females aged 38.0±12.5 years. The clinical efficacy of the surgery was evaluated.ResultsAll surgeries were successfully completed, of which 17 were bilateral VATS, 2 were unilateral VATS with the other lateral converted to thoracotomy. The average number of bilateral resected segments was 4-8 (5.9±1.2). Mean operation time was 330.0±40.0 min and mean blood loss was 150.0±60.0 mL. Mean ventilator-assisted breathing time was 6.0±1.8 h, mean duration of chest-tube placement was 4.0±1.0 d and mean hospital stay time was 14.0±1.5 d. Three patients suffered pulmonary infection and 1 patient received tracheotomy. No perioperative death occurred. Arterial oxygen pressures on postoperative day (POD) 1 (F=340.18, P<0.05) and POD 3 (F=131.26, P<0.05) were significantly lower than that before operation, arterial carbon dioxide pressures on POD 1 (F=46.62, P<0.05) and POD 3 (F=48.21, P<0.05) were significantly higher than that before operation, and pulse oximeter saturation on POD 1 was significantly lower than that before operation (F=210.82, P<0.05). The patients were followed up for one to five years without recurrence.ConclusionApplication of VATS anatomic segmentectomy in single-stage bilateral thoracic surgery for the treatment of bilateral localized bronchiectasis is safe and feasible with strictly selected patients. Postoperative airway management is very important. The surgery is worthy of wide clinical practice.
Objective To evaluate the efficacy of long-term inhaled salmeterol / fluticasone combined with low-dose oral erythromycin in patients with bronchiectasis. Methods Sixty-two patients with bronchiectasis after exacerbation and maintained stable were randomly divided into three groups. Group A was treated with low-dose oral erythromycin, group B inhaled salmeterol/fluticasone, and group C inhaled salmeterol/fluticasone plus low-dose oral erythromycin. The study duration lasted for 6 months. The clinical symptoms, dyspnea scale, exacerbation frequency, and pulmonary function parameters were measured and compared. Results Fifty-four patients completed the whole study and 8 cases withdrew. The results showed that 6 months of low-dose erythromycin therapy can improve the clinical symptoms, whille exacerbation frequency was also decreased. Inhaled salmeterol/fluticasone improved lung function, however, had no effect on cough, expectoration and exacerbation frequency. Inhaled salmeterol/fluticasone combined with erythromycin was more significantly effective in improving lung functions as well as symptoms. Conclusions Long-terminhaled salmeterol/fluticasone combined with low-dose oral erythromycin can improve the clinical symptoms and lung function, decrease the frequency of exacerbation in patients with bronchiectasis. It may be as an alternative to the maintenance treatment of bronchiectasis.
ObjectiveTo explore the risk factors for death in patients with bronchiectasis. MethodsTwo hundred and eighty-three patients diagnosed with bronchiectasis at Daxing Hospital of Capital Medical University from January 2011 to December 2013 were collected and followed up to October 2015 after discharge. Patients' age, gender, body mass index (BMI), smoking history, dyspnea score, image data, sputum culture, blood gas analysis and the results of spirometry were collected. The risk factors for death were analyzed with COX regression analysis. ResultsAmong 283 cases, 52 patients died. The 1-, 2-, 3-and 4-year cumulative survival rates were 97%, 86%, 71%, 45%, respectively. COX regression analysis showed that age≥70 years (RR=2.222, 95%CI 1.145-4.314), BMI < 18.5 kg/m2 (RR=2.328, 95%CI 1.205-4.497), bronchiectasis involving≥3 lobes in chest high-resolution computed tomography (RR=0.382, 95%CI 0.188-0.774) and FEV1% pred < 70% (RR=1.032, 95%CI 0.923-1.180) were the independent risk factors for death of patients with bronchiectasis (all P < 0.05). ConclusionsThere are multiple risk factors contribute to death of patients with bronchiectasis. Early identification of risk factors shall improve the prognosis of patients with bronchiectasis.
Objective To explore the effect of leukotriene receptor antagonist montelukast on physicochemical property of sputum and airway mucus hypersecretion in patients with acute exacerbation of bronchiectasis. Methods Eighty-four inpatients with acute exacerbation of bronchiectasis were randomly divided into a control group and an experiment group, with 42 cases in each group. The control group received conventional therapy and the experiment group took orally montelukast 10 mg before sleep every day based on conventional therapy for two weeks. At admission and 15 days after admission, the amount in 24 hours, dry/wet weight ratio and viscosity of sputum were observed while the levels of neutrophil elastase (NE) and mucin MUC5ac in sputum were determined by ELISA. The pulmonary ventilation function, airway resistance and blood gas analysis were also measured. Results The sputum amount in 24 hours, dry/wet weight ratio and viscosity of sputum, NE and MUC5ac of sputum, pulmonary ventilation function, blood gas analysis and airway resistance were declined or improved remarkably after treatment compared with before treatment in two groups (P<0.05). Meanwhile, the sputum amount in 24 hours [(5.62±1.83) g vs. (7.53±2.32) g], NE [(3.85±0.97) μg/ml vs. (4.54±1.03) μg/ml], MUC5ac [(0.65±0.21) μg/ml vs. (0.82± 0.29) μg/ml] and the airway resistance [(119.16±11.76)% vs. (128.37±12.08)%] were declined remarkably in the experiment group compare with the control group after treatment (all P<0.05). The viscosity of sputum between the two groups after treatment showed no significant difference. Conclusion In patients with acute exacerbation of bronchiectasis, montelukast can reduce amount of sputum and airway resistance, reduce expression of mucin MUC5ac through down-regulation of NE, thus inhibit airway mucus hypersecretion.