Hospital Admissions for Exacerbations of Non-Cystic Fibrosis Bronchiectasis: 2 Years’ Experience

Abstract

PURPOSE: The exacerbations of non-cystic fibrosis bronchiectasis induce a clinical worsening of the symptoms and frequently require long course of antibiotics. Our goal was to evaluate the clinical features of the patients with hospital admission for exacerbations of non-cystic fibrosis bronchiectasis. METHOD(S): Retrospective analysis of the clinical data of patients admitted with this diagnosis, in a 2 years' period (2011- 2012). RESULT(S): 36 hospital admissions were included, which corresponded to 24 patients (average age - 71 years). In 89% of the admissions the patient had already a history of bronchiectasis and 58% of these had past positive cultures, mainly for Pseudomonas (43%) and Hemophilus Influenzae (19%). 42% of the patients referred two or more exacerbations in the last year. None had previously been treated with inhaled antibiotics. The most common etiology for bronchiectasis was past respiratory infections (50%), by Mycobacterium Tuberculosis (MT) in 25% of cases, and asthma (33%). Increased sputum production, dyspnea and fever were the main clinical manifestations. Sputum culture was positive in 33% of cases, with a higher frequency for Pseudomonas (33%). All patients were treated with antibiotics, empirical or according to antibiotic sensitivity tests, with an average of 13 days. In chest-CT, most bronchiectasis were cylindrical (47,2%) and in 22% for cases they were localized. 36% demonstrated findings of fluid-filling, 28% signs of emphysema and 14% consolidations. Lung functional tests showed an obstructive pattern in most patients, with a FEV1 < 35% in 22% of cases. CONCLUSION(S): We highlight the high prevalence of asthma and pulmonary tuberculosis in this group of patients, and the past infections as the main etiologic factor for bronchiectasis, as described in the literature. It is also worth noting the high frequency of patients with positive sputum cultures for Pseudomonas, and the number of exacerbations, with two or more in the last year in 42% of patients.