Update on non-cystic fibrosis bronchiectasis.
ABSTRACT There is growing awareness in both adult and paediatric respiratory clinics regarding the importance of non-cystic fibrosis bronchiectasis. There has been debate regarding the requirement for investigations to establish an underlying cause of bronchiectasis. Furthermore, there has been growing interest in establishing the role of bacteria in disease progression.
Post-infection is no longer the most common cause of bronchiectasis in developed countries in children or adults and the importance of identifying immunodeficiency has been underlined. Nontuberculous mycobacteria are recognized as both causing and complicating non-cystic fibrosis bronchiectasis. It has been suggested that infection with Pseudomonas aeruginosa may confer a worse prognosis compared with other pathogens but recent publications produce conflicting views. There is increasing recognition that patients with non-cystic fibrosis bronchiectasis do not necessarily respond to cystic fibrosis treatment regimens in the same way as patients with cystic fibrosis regimens.
Non-cystic fibrosis bronchiectasis can be approached in a systematic fashion to establish the underlying cause and develop treatment strategies.
SourceAvailable from: Simone Scarlata[Show abstract] [Hide abstract]
ABSTRACT: The treatment of older and oldest old patients with COPD poses several problems and should be tailored to specific outcomes, such as physical functioning. Indeed, impaired homeostatic mechanisms, deteriorated physiological systems, and limited functional reserve mainly contribute to this complex scenario. Therefore, we reviewed the main difficulties in managing therapy for these patients and possible remedies. Inhaled long acting beta-agonists (LABA) and anticholinergics (LAMA) are the mainstay of therapy in stable COPD, but it should be considered that pharmacological response and safety profile may vary significantly in older patients with multimorbidity. Their association with inhaled corticosteroids is recommended only for patients with severe or very severe airflow limitation or with frequent exacerbations despite bronchodilator treatment. In hypoxemic patients, long-term oxygen therapy (LTOT) may improve not only general comfort and exercise tolerance, but also cognitive functions and sleep. Non-pharmacological interventions, including education, physical exercise, nutritional support, pulmonary rehabilitation and telemonitoring can importantly contribute to improve outcomes. Older patients with COPD should be systematically evaluated for the presence of risk factors for non-adherence, and the inhaler device should be chosen very carefully. Comorbidities, such as cardiovascular diseases, chronic kidney disease, osteoporosis, obesity, cognitive, visual and auditory impairment, may significantly affect treatment choices and should be scrutinized. Palliative care is of paramount importance in end-stage COPD. Finally, treatment of COPD exacerbations has been also reviewed. Therapeutic decisions should be founded on a careful assessment of cognitive and functional status, comorbidity, polypharmacy, and age-related changes in pharmacokinetics and pharmacodynamics in order to minimize adverse drug events, drug-drug or drug-disease interactions, and non-adherence to treatment.
Frontiers in Pediatrics 01/2015; 3:9. DOI:10.3389/fped.2015.00009
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ABSTRACT: Halotherapy is a treatment modality suggested for patients with chronic pulmonary diseases. In this technique, inhalation of crystal salt stones extracted from mines improves patients' pulmonary function tests and symptoms by facilitating the secretion or expulsion of phlegm and mucus and reducing the risk of bacterial infections. Bronchiectasis is chronic disease of the airways characterized by irreversible dilation of airways. It has a progressive course and despite the available treatments, many of these patients eventually enter the advanced phase of disease. The aim of this study was to evaluate the effect of halotherapy on pulmonary function tests and quality of life of non-CF bronchiectatic patients.Tanaffos 03/2013; 12(2):22-7.This article is viewable in ResearchGate's enriched formatRG Format enables you to read in context with side-by-side figures, citations, and feedback from experts in your field.