New York University School of Medicine, New York, NY.
Research, the COPD Foundation, Miami, FL; College of Public Health, University of Kentucky, Lexington, KY.
Chest. 2020 Oct;158(4):1376-1384. doi: 10.1016/j.chest.2020.06.050. Epub 2020 Jul 3.
In patients with bronchiectasis, airway clearance techniques (ACTs) are important management strategies.
What are the differences in patients with bronchiectasis and a productive cough who used ACTs and those who did not? What was the assessment of bronchiectasis exacerbation frequency and change in pulmonary function at 1-year follow up?
Adult patients with bronchiectasis and a productive cough in the United States Bronchiectasis and NTM Research Registry were included in the analyses. ACTs included the use of instrumental devices and manual techniques. Stratified analyses of demographic and clinical characteristics were performed by use of ACTs at baseline and follow up. The association between ACT use and clinical outcomes was assessed with the use of unadjusted and adjusted multinomial logistic regression models.
Of the overall study population (n = 905), 59% used ACTs at baseline. A greater proportion of patients who used ACTs at baseline and follow up continuously had Pseudomonas aeruginosa (47% vs 36%; P = .021) and experienced an exacerbation (81% vs 59%; P < .0001) or hospitalization for pulmonary illness (32% vs 22%; P = .001) in the prior two years, compared with those patients who did not use ACTs. Fifty-eight percent of patients who used ACTs at baseline did not use ACTs at 1-year follow up. There was no significant change in pulmonary function for those who used ACTs at follow up, compared with baseline. Patients who used ACTs at baseline and follow up had greater odds for experiencing exacerbations at follow up compared with those patients who did not use ACTs.
In patients with bronchiectasis and a productive cough, ACTs are used more often if the patients have experienced a prior exacerbation, hospitalization for pulmonary illness, or had P aeruginosa. There is a significant reduction in the use of ACTs at 1-year follow up. The odds of the development of a bronchiectasis exacerbation are higher in those patients who use ACTs continuously, which suggests more frequent use in an ill bronchiectasis population.
在患有支气管扩张症的患者中，气道清除技术（ACT）是重要的管理策略。
使用 ACT 和未使用 ACT 的支气管扩张症伴咳痰患者有何不同？在 1 年随访时，支气管扩张症加重频率和肺功能变化的评估结果如何？
在美国支气管扩张症和非结核分枝杆菌研究注册中心纳入患有支气管扩张症和有痰的成年患者进行分析。ACT 包括使用仪器设备和手动技术。根据基线和随访时使用 ACT 的情况，对人口统计学和临床特征进行分层分析。使用未调整和调整后的多项逻辑回归模型评估 ACT 使用与临床结局之间的关联。
在整个研究人群（n=905）中，59%的患者在基线时使用 ACT。与未使用 ACT 的患者相比，在基线和连续随访时使用 ACT 的患者，更多的患者有铜绿假单胞菌（47%比 36%；P=0.021），且在过去两年内经历过加重（81%比 59%；P<0.0001）或因肺部疾病住院（32%比 22%；P=0.001）。在基线时使用 ACT 的 58%的患者在 1 年随访时未使用 ACT。与基线相比，在随访时使用 ACT 的患者的肺功能没有显著变化。与未使用 ACT 的患者相比，在基线和随访时使用 ACT 的患者在随访时发生加重的可能性更大。
在患有支气管扩张症和有痰的患者中，如果患者先前经历过加重、因肺部疾病住院或有铜绿假单胞菌，他们更常使用 ACT。在 1 年随访时，ACT 的使用显著减少。在持续使用 ACT 的患者中，支气管扩张症加重的几率更高，这表明在患有支气管扩张症的患者中，ACT 的使用更为频繁。
