Assessing response to treatment of exacerbations of bronchiectasis in adults

¹ Dept of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK

^* To whom correspondence should be addressed. E-mail: maevemurray{at}hotmail.com.

	Abstract

This study aimed to assess the effect of intravenous antibiotic therapy on clinical and laboratory endpoints in exacerbations of non-cystic fibrosis bronchiectasis and to determine whether the outcomes were influenced by the pathogenic organism isolated.

A prospective cohort study was conducted (Nov06-Mar08) of exacerbations requiring intravenous antibiotics. Endpoints included 24-hour sputum volume, FEV₁, FVC, incremental shuttle walk test, qualitative sputum microbiology, white cell count, erythrocyte sedimentation rate, C-reactive protein (CRP) and St George's Respiratory Questionnaire (SGRQ). Exacerbations due to Pseudomonas aeruginosa were compared with exacerbations due to other potential pathogenic organisms.

32 exacerbations were studied. Following 14 days' antibiotics, all outcomes significantly improved (P<0.0001) independent of pathogenic organism, except FEV₁ and FVC. The most responsive markers were: 24 hour sputum volume (reduced in all patients and 80% had 50% reduction); sputum bacterial clearance (78.1%); CRP (75% reduction in 62.5%) and SGRQ (4 unit improvement in 89.7%). 24 hr sputum volume, CRP and SGRQ improved independent of microbial clearance.

In this study, 24-hour sputum volume, microbial clearance, CRP and SGRQ were the most useful parameters to assess response to treatment of exacerbations of bronchiectasis. Outcomes were similar independent of the pathogenic organism with the exception of FEV₁ and FVC.