Science topic

Bronchiectasis - Science topic

Persistent abnormal dilatation of the bronchi.
Questions related to Bronchiectasis
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Many published studies showed the role of Neutrophil Elastaste (NE) in sputum to bronchiectastic patients. NE in sputum or BAL could present neutrophil inflammation on airways of bronchiectastic patients but why we do not use the count of neutrophil in sputum or BAL to prognosis for those patients?
Thanks for your help.
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The topic you propose would make a really valuable publication. I'm not aware of the differences in prognosis of bronchiectasis patients, but in that case, it's important to show that neutrophil counts or a threshold correlate with disease activity and prognosis. Sometimes the diagnosis of bronchiectasis or its cause could be sufficient to estimate the prognosis, that is, neutrophil count in sputum might be unnecessary. But it would be a valuable investigation and to carry out the corresponding sensitivity vs 1-specificity plots (ROC curves).
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can we use steroids in cases of bronchiectasis with tuberculosis or that may cause bad prognosis ?
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The short response is: NOT indicated
The long response is: It can be an alternative to other anti-inflammatory treatments in exacerbator patients in the case of non-response to this treatment (for example: macrolides), always at the lowest dose possible.
The exceptions: 1. The presence of concomitant asthma. In this case inhaled steroids are needed. 2. Use of systemic steroids (like COPD) in severe exacerbations (usually required hospitalization).
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inhaled topramycin in non-cystic bronchiectasis
Do you apply this treatment ?
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Her are 1 article that may help you decide about treatment:
Also the ATS have guidelines for the treatment of non-CF bronchiectasis. I believe they haven't been updated since 2015 but they may help.
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Do ground gross will left a bronchiectasis after the patient of COVID19 recover ?
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Ground glass appearance followed by traction bronchiectasis can occur as a complication of severe COVID-19 pneumonia.
Pulmonary fibrosis and bronchiectasis is one of the feared complication of severe-COVID-19 pneumonia in survivors and these patients may need extended follow up.
Further reading:
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in what level of FEV1/FVC we must begin thr inhaled treatment ?
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Inhaled treatment in patients with bronchiectasis.
These articles would give you the answers to your question:
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It is recommended to use inhaled topramycin in non cystic bronchiectasis but is it recommended in non cystic even without isolation of P.aurginosa
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Aerosolised antibiotics in the treatment of non-cystic bronchiectasis
Different aerosolised antibiotics including Tobramycin alone or inaddition to ciprofloxacin have been useful and effective in the treatment of non-cystic bronchiectasis (1-4).
Please have a look at these useful links:
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I am trying a lot to find about how many bronchiectasis patient suffer from neutrophil based inflammation, I know that approximately all the bronchiectasis patients suffer from neutrophil based inflammation but I am not getting any reference that can be give me solid evidence about exact proportion. Please answer with reference.
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Hi  Ravi
Look  abstract ,   links  and PDF attached
 
Respiration. 2000;67(1):52-9.
Neutrophil inflammation and activation in bronchiectasis: comparison with pneumonia and idiopathic pulmonary fibrosis.
Schaaf B1, Wieghorst A, Aries SP, Dalhoff K, Braun J.
Author information
 
Abstract
BACKGROUND:
Pulmonary inflammation in bronchiectasis, pneumonia and idiopathic pulmonary fibrosis (IPF) is dominated by neutrophils. Pathophysiologic differences are seen in the degree of airway and tissue destruction. Neutrophil activation and neutrophil proteolytic activity might differ between bronchiectasis, pneumonia and IPF.
OBJECTIVE:
The aim of this study was to determine whether levels of inflammatory and protective markers in bronchoalveolar lavage (BAL) differed among cases of bronchiectasis, pneumonia and IPF.
METHODS:
We studied 11 bronchiectasis patients (group 1), 30 pneumonia patients (group 2), 15 IPF patients (group 3) and 12 healthy volunteers (group 4). In the bronchoalveolar lavage fluid, concentrations of alpha(1)-proteinase inhibitor, myeloperoxidase (MPO) and elastase-alpha(1)PI complex were determined using immunoluminometric assays. Elastase inhibition capacity (EIC) and elastase activity were determined using a colorimetric assay.
RESULTS:
No EIC, but free elastase activity, was found in 82% of group 1, 20% of group 2, 20% of group 3 and 0% of group 4. Median MPO concentration was highest in group 1: 7,951 ng/ml (16th-84th percentile [16-84%]: 256-36,342) vs. 692 ng/ml (106-2,279; group 2), 332 ng/ml (98-1,657; group 3), and 0.12 ng/ml (0.08-0.26; group 4). Bronchiectasis patients with bronchial Pseudomonas infection showed higher amounts of neutrophils (p < 0.01) and higher elastase activity (p < 0.05) than patients with sterile lavage.
CONCLUSION:
Bronchiectasis patients show a severe imbalance between neutrophil activity and protective molecules leading to possible lung destruction. Chronic Pseudomonas infection might trigger neutrophil activation. Future research and treatment strategies should focus on increased bacterial clearance and inhibition of neutrophil toxicity.
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Neutrophil Inflammation and Activation in Bronchiectasis: Comparison ...
Neutrophil Inflammation and Activation in Bronchiectasis: Comparison with ... Pulmonary inflammation in bronchiectasis, pneumonia and idiopathic .... Note: This list is based on the publications in our database and might not be exhaustive.
Neutrophil Inflammation and Activation in Bronchiectasis - Karger
by B Schaaf - ‎2000 - ‎Cited by 36 - ‎Related articles
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Sep 1, 2014 - Conduct of a biomarker study in bronchiectasis patients: Correlation of neutrophil elastase activity and inflammatory load .... First results from 15 patients and 5 healthy controls indicate that, based on sputum HNE activity, BE ...
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We work in a pediatric facility where IHCs are very important and naturally fixation is critical.  We NEVER rush our tissues and the best quality is of utmost importance.  But our PA has developed lung issues from the formalin we believe and though we have ventilated as much as possible and all the badge testing comes back with minimal exposure results his symptoms persist.  Any opinions on formalin substitutes? 
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Thank you all for your answers, I think I will be forced to continue with the formalin since it is the industry standard for so many other types of testing.  Perhaps one day we will be able to move away from the toxic substances in our laboratory.
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In research articles and reviews which was conducted with chronic pulmonary diseases such as COPD and cystic fibrosis, for assessing physical activity researchers generally used Actigraph GT3X, DynaPort Minimod and SenseWear accelerometers. By using accelerometers more information will be concluded other than using pedometers. Is there any other validated and low cost method to assess physical activity?
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field tests can assess exercise capacity which is really different from physical activity.
physical activity can be assessed with actimeters,  pedometers or questionnaire but the most objective tool is probably actimeter.
 pedometers are low cost but but they don't always detect low walk speed
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From the abstract, lobar analysis on extent (on a six-point scale) of emphysema, the presence of bronchiectasis, airway wall thickening, and tracheal abnormalities on volumetric CT images was done by thoracic radiologists. So the extent of the abnormality at each lobar level will range from 0 to 6, right? Next, the extent of emphysema, airway wall thickening, and luminal area were quantified at the lobar level by using commercial software. Does this mean the sum of the extent of 0-6 at each level is used to quantify the extent of the feature/abnormalities at the lobar level? If not, what is the variable used to combine the extent (0-6) that has been analyzed by the radiologist for quantification at lobar level. Also, what is the commercial software used to get the value, and do you use the term score to refer to the extent of the features,i.e emphysema, airway wall thickening and etc.?
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No, the amount of emphysema is based on the attenuation of the xray beam as it passes through the lung. If the collimation gives slices more than 1 mm thick, then the number in Hounsfield units should be more than -950 HU, the standard amount for today's high resolution scans. If you are using, say, scans of 2.5 to 5 mm in thickness, for example, a cutoff of -910 to -920 HU would be better. As you can see, it is a little arbitrary! I think the commercial software, such as Vida, is set up for -950 HU.
Airway dimensions, thickness and lumen size, are tricky, since they depend on the size of the airway normally. The right way to do it, and the most tedious, is to make several observations and plot them in the form of percent of the airway wall area or the square root of the airway wall area (but not mixed up!) against the length of the internal perimeter of the airway where it was measured, making sure that the plotted values are spread out a bit. Of course, you calculate these measurements from your actual measurement of the diameter of the airway itself and its lumen. An arbitrary value of this perimeter (iP=10 mm) is what is usually reported, so it must lie on the plot as well. And that is the number that explains airway wall thickness. I have no idea what commercial software does here, since my experience is with a home-grown program. I am not familiar with the 0-6 method of grading, though it is as good as any.
A new idea is that of air trapping, as opposed to emphysema alone. Certainly emphysema causes air trapping, but many cases with significant airway problems have no emphysema, How this is to be measured is still under debate and study. For example, does an increase in small airway wall thickness account for air trapping? It usually requires an expiratory CT scan and careful observation of the lungs for irregular air trapping, or a mosaic pattern. Quantification is much debated.