Epidemiología de la infección pulmonar por Pseudomonas aeruginosa en la Fibrosis Quística

361 p.La Fibrosis Quística (FQ) es la enfermedad hereditaria que más frecuentemente amenaza la vida en las personas de raza blanca. La insuficiencia pulmonar progresiva es la principal causa de su morbilidad y mortalidad. El epitelio de la vía aérea de estos pacientes es susceptible a la colonización microbiana, aislándose como patógeno respiratorio más frecuente Pseudomonas aeruginosa; su presencia conlleva un peor pronóstico.Los estudios presentados en esta tesis investigaron la prevalencia global de la infección crónica por P. aeruginosa en nuestra cohorte de pacientes con FQ, y dentro de éstas la de las cepas multirresistentes a los antibióticos antipseudomónicos.Nuestros resultados evidenciaron que los factores asociados al desarrollo de una infección crónica por P. aeruginosa fueron: el ser homocigoto para la mutación F508del, el aumento del nivel de precipitinas séricas frente a P. aeruginosa y la coinfección por el hongo filamentoso Aspergillus fumigatus. Además, los pacientes infectados por cepas de P. aeruginosa multirresistentes presentaban un peor curso clínico, con un aumento en el número de exacerbaciones infecciosas y de ingresos hospitalarios

Addition of hyaluronic acid improves tlerance to 7% hypertonic saline solution in bronchiectasis patients.

Background: The excessive retention of sputum in the airways, leading to pulmonary infections, is a common consequence of bronchiectasis. Although inhalation of 7% hypertonic saline (HS) has proven an effective method to help remove the mucus, many patients are intolerant of this treatment. The addition of 0.1% hyaluronic acid to HS (HS+HA) could increase tolerance to HS in these patients. The main objective of this study was to evaluate the tolerability of HS+HA in bronchiectasis patients who are intolerant to HS. Methods: This prospective, observational, open-label study analysed the outcomes of two groups of bronchiectasis patients previously scheduled to start HS therapy. Patients were assessed for tolerance to HS by a questionnaire, spirometry and clinical evaluation. Patients who were intolerant were evaluated for tolerance to HS+HA approximately one week later. All patients were evaluated for their tolerance to HS or HS+HA 4 weeks after the start of their treatment. Patients were also assessed with quality-of-life and adherence questionnaires, and all adverse events were registered. Results: A total of 137 bronchiectasis patients were enrolled in the study (age = 63.0 ± 14.7 years; 63.5% women). Of these, 92 patients (67.1%) were tolerant and 45 patients (32.9%) were intolerant to HS. Of the 45 patients intolerant to HS, 31 patients (68.9%) were tolerant and 14 patients (31.1%) intolerant to HS+HA. Of these 31 tolerant patients, 26 (83.9%) could complete the 4-week treatment with HS+HA. Conclusions: Two-thirds of bronchiectasis patients that presented intolerance to inhaled HS alone are tolerant to inhaled HS+HA, suggesting that HA improves tolerance to HS therapy

Epidemiología de la infección pulmonar por Pseudomonas aeruginosa en la Fibrosis Quística

361 p.La Fibrosis Quística (FQ) es la enfermedad hereditaria que más frecuentemente amenaza la vida en las personas de raza blanca. La insuficiencia pulmonar progresiva es la principal causa de su morbilidad y mortalidad. El epitelio de la vía aérea de estos pacientes es susceptible a la colonización microbiana, aislándose como patógeno respiratorio más frecuente Pseudomonas aeruginosa; su presencia conlleva un peor pronóstico.Los estudios presentados en esta tesis investigaron la prevalencia global de la infección crónica por P. aeruginosa en nuestra cohorte de pacientes con FQ, y dentro de éstas la de las cepas multirresistentes a los antibióticos antipseudomónicos.Nuestros resultados evidenciaron que los factores asociados al desarrollo de una infección crónica por P. aeruginosa fueron: el ser homocigoto para la mutación F508del, el aumento del nivel de precipitinas séricas frente a P. aeruginosa y la coinfección por el hongo filamentoso Aspergillus fumigatus. Además, los pacientes infectados por cepas de P. aeruginosa multirresistentes presentaban un peor curso clínico, con un aumento en el número de exacerbaciones infecciosas y de ingresos hospitalarios

Addition of hyaluronic acid improves tolerance to 7% hypertonic saline solution in bronchiectasis patients

Background: The excessive retention of sputum in the airways, leading to pulmonary infections, is a common consequence of bronchiectasis. Although inhalation of 7% hypertonic saline (HS) has proven an effective method to help remove the mucus, many patients are intolerant of this treatment. The addition of 0.1% hyaluronic acid to HS (HS+HA) could increase tolerance to HS in these patients. The main objective of this study was to evaluate the tolerability of HS+HA in bronchiectasis patients who are intolerant to HS. Methods: This prospective, observational, open-label study analysed the outcomes of two groups of bronchiectasis patients previously scheduled to start HS therapy. Patients were assessed for tolerance to HS by a questionnaire, spirometry and clinical evaluation. Patients who were intolerant were evaluated for tolerance to HS+HA approximately one week later. All patients were evaluated for their tolerance to HS or HS+HA 4 weeks after the start of their treatment. Patients were also assessed with quality-of-life and adherence questionnaires, and all adverse events were registered. Results: A total of 137 bronchiectasis patients were enrolled in the study (age = 63.0 ± 14.7 years; 63.5% women). Of these, 92 patients (67.1%) were tolerant and 45 patients (32.9%) were intolerant to HS. Of the 45 patients intolerant to HS, 31 patients (68.9%) were tolerant and 14 patients (31.1%) intolerant to HS+HA. Of these 31 tolerant patients, 26 (83.9%) could complete the 4-week treatment with HS+HA. Conclusions: Two-thirds of bronchiectasis patients that presented intolerance to inhaled HS alone are tolerant to inhaled HS+HA, suggesting that HA improves tolerance to HS therapy

Factores de riesgo y mortalidad de los derrames pleurales que precisan de una toracocentesis diagnóstica

Resumen: Introducción: El derrame pleural (DP) maligno se asocia a un mal pronóstico, pero la mortalidad de los pacientes con derrames no malignos no ha sido suficientemente estudiada. Nuestro objetivo fue describir la evolución clínica y explorar los factores asociados con la mortalidad por todas las causas a 1, 5 y 10 años de los pacientes que desarrollan un DP. Métodos: Estudio observacional retrospectivo de los pacientes intervenidos mediante toracocentesis diagnóstica durante el decenio 2008-2017 en un servicio de neumología. Se evaluaron variables demográficas, bioquímicas, anatomopatológicas y evolutivas. La etiología de los derrames se determinó mediante criterios estandarizados. Resultados: Se estudió a 358 pacientes con líquido pleural analizado; el 69,2% de los cuales eran varones con una edad media de 68,9 años (DE 15,1). Predominaron los derrames malignos (29,4%), paraneumónicos (19,8%) y secundarios a insuficiencia cardiaca (18,9%). Los pacientes con derrame maligno y por insuficiencia cardiaca tuvieron tasas de mortalidad a un año del 60,0% y 30,8%, respectivamente y del 85% y 64,7% a 5 años. El sexo masculino (hazard ratio [HR] 1,46; IC 95%: 1,03-2,07), la citología positiva para malignidad (HR 1,66; IC 95%: 1,03-2,68) y la recidiva del derrame (HR 1,61; IC 95%: 1,17-2,21) se asociaron a un peor pronóstico y a mortalidad a 5 años. Conclusiones: Los pacientes intervenidos mediante toracentesis por derrame tienen una alta mortalidad a corto y largo plazo. En nuestros pacientes hospitalizados con DP, los factores asociados con mayor mortalidad a 1 y 5 años fueron la edad, el sexo masculino, la recidiva del DP y la coexistencia de neoplasia maligna. Abstract: Introduction: Occurrence of malignant pleural effusion (PE) is known to be associated with a poor prognosis, but the mortality of patients with non-malignant effusions has not been sufficiently studied. Our objective was to describe the clinical course and explore risk factors associated with all-cause mortality at 1, 5 and 10 years in patients who develop a PE. Methods: Retrospective observational study of patients undergoing diagnostic thoracentesis during the decade 2008-2017 in a pulmonology service. Demographic, biochemical, pathological and evolutionary variables were evaluated. The etiology of the effusions was determined using standardized criteria. Results: Pleural fluid samples from 358 patients with a mean age of 68.9 years (SD 15.1 years), 69.2% males, were analyzed. Malignant (29.4%), parapneumonic (19.8%) and secondary to heart failure (18.9%) effusions predominated. Patients with malignant and heart failure related PE had 1-year mortality rates of 60.0% and 30.8%, respectively, and 85% and 64.7% at 5 years. Male gender (hazard ratio [HR] 1.46; 95% CI: 1.03-2.07), positive cytology for malignancy (HR 1.66; 95% CI: 1.03-2.68) and effusion recurrence (HR 1.61; 95% CI: 1.17-2.21) were associated with a worse prognosis and 5-year mortality. Conclusions: Patients undergoing thoracentesis for effusion have a high short and long-term mortality. In our series of hospitalized patients with PE, the factors associated with higher mortality at 1 and 5 years were age, male sex, recurrence of PE, and coexistence of malignancy

Impact of COVID-19 infection on lung function and nutritional status amongst individuals with cystic fibrosis: A global cohort study

International audienceBackground: Factors associated with severe COVID-19 infection have been identified; however, the impact of infection on longer-term outcomes is unclear. The objective of this study was to examine the impact of COVID-19 infection on the trajectory of lung function and nutritional status in people with cystic fibrosis (pwCF).Methods: This is a retrospective global cohort study of pwCF who had confirmed COVID-19 infection diagnosed between January 1, 2020 and December 31, 2021. Forced expiratory volume in one second percent predicted (ppFEV 1 ) and body mass index (BMI) twelve months prior to and following a diagnosis of COVID-19 were recorded. Change in mean ppFEV 1 and BMI were compared using a t-test. A linear mixed-effects model was used to estimate change over time and to compare the rate of change before and after infection.Results: A total of 6,500 cases of COVID-19 in pwCF from 33 countries were included for analysis. The mean difference in ppFEV 1 pre-and post-infection was 1.4 %, (95 % CI 1.1, 1.7). In those not on modulators, the difference in rate of change pre-and post-infection was 1.34 %, (95 % CI -0.88, 3.56) per year (p = 0.24) and -0.74 % (-1.89, 0.41) per year (p = 0.21) for those on elexacaftor/tezacaftor/ivacaftor. No clinically significant change was noted in BMI or BMI percentile before and after COVID-19 infection.Conclusions: No clinically meaningful impact on lung function and BMI trajectory in the year following infection with COVID-19 was identified. This work highlights the ability of the global CF community to unify and address critical issues facing pwCF