Miguel Angel Martı´nez-Garcı´a, MD; Juan-Jose Soler-Catalun˜ a, MD; Factors Associated With Lung Function Decline in Adult Patients With Stable Non-Cystic Fibrosis Bronchiectasis* Miguel Angel Martı´nez-Garcı´a, MD; Juan-Jose Soler-Catalun˜ a, MD; Miguel Perpin˜ a´-Tordera, MD; Pilar Roma´n-Sa´nchez, MD; and Joan Soriano, MD Chest 2007;132;1565-1572

Background Bronchiectasis : chronic airway disease dysfunction of mucociliary clearance Bronchiectasis : chronic airway disease : abnormal destruction and dilation of the large airways, bronchi, and bronchioles  Impaired lung function

Backgroud To date, it is largely unknown which factors modify this loss and whether any management strategy slows this pulmonary decline. The objective of our study was to explore modifiable and nonmodifiable factors associated with lung function decline in a clinical cohort of patients with stable non-cystic fibrosis (CF) bronchiectasis.

Materials And Methods Study Population 1) Diagnosis : affecting more than one lung lobe, or with cystic bronchiectasis, unrelated to CF and in a clinically stable phase (ie, subjects had been free from acute exacerbation for at least 4 weeks prior to the start of the study). 2) Exclusion criteria - current smokers; patients with a smoking history of 10 pack- years - patients at occupational risk for COPD - patients with asthma - patients with other cardiopulmonary conditions

Materials And Methods Diagnosis of Bronchiectasis - HRCT - Cause posttuberculous postinfectious other

Materials And Methods Study Measurements & Follow-up - Baseline data were collected on clinical history, symptoms,disease extension, treatment, sputum volume, microbiological aspects, laboratory findings,and exacerbations. - All patients were invited to attend the clinic every 6 months for 24 monthsto conduct full spirometry and microbiological analysis of sputum, and to report the numberof exacerbations.

Results 112-->76 participants (48.7% men; mean age, 69.9 years; age range, 39 to 83 years) Cause - Postinfectious bronchiectasis : 32.9% - Posttuberculous bronchiectasis: 19.7% - Unknown etiology :42.1%

Result

Result During the 2-year study :2 (death) & 2( f/u loss) The mean annual rate of exacerbations was 2.4 and the mean annual rate of severe exacerbations was 1.5 patients with chronic colonization due to PA : -6 were treated with inhaled colistin -7 were treated with oral quinolones (ciprofloxacin or levofloxacin), - two were treated with intermittent courses of IV ceftazidime. - only one patient had PA eradicated for 6 months. No changes in bronchodilator or corticosteroid treatment except during exacerbations.

Results mean annual decline in FEV1 was 52.7 mL, corresponding to 2.35%

Chronicallu colonized by PA Result bronchiectasis Chronicallu colonized by PA

Result There were no significant differences in FEV1 decline between patientswhether the bronchiectasis was postinfectious (n 25; mean, 54.6 mL per year; SE, 27.4 mL per year), posttuberculous (n 15; mean, 50.8 mL per year; SE, 26.1 mL per year), or idiopathic

Result patients with bronchiectasis >1.5 severe exacerbations per year

Discussion Our study, using a well-characterized cohort with stable, non-CF bronchiectasis - chronic sputum colonization with PA - more frequent severe exacerbations - more systemic inflammation None of the long -term treatment strategies evaluated

Discussion Limitations - the number of patients is limited, and a single hospital, --> generalizability of the studyresults. - the follow-up period of 2 years is relatively short for precisely determining the meanannual decrease in FEV1.

Conculsion A decline in lung function (FEV1) that was estimated to be 50 mLper year in a well-characterized group of adult patients with non-CF bronchiectasis in stable phase and were followed up for 2 years Chronic colonization by PA, severe exacerbations, and systemic inflammation are associated with disease progression in non-CF bronchiectasis