Faculty Bibliography

BACKGROUND:In patients with bronchiectasis, airway clearance techniques (ACTs) are important management strategies. RESEARCH QUESTION/OBJECTIVE:The primary objective was to describe differences in patients with bronchiectasis and productive cough who utilized ACTs and those who did not. Secondary objectives included assessment of bronchiectasis exacerbation frequency and change in pulmonary function at one-year follow-up. STUDY DESIGN/METHODS:and methods:Adult patients with bronchiectasis and 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. Association between ACT use and clinical outcomes was assessed using unadjusted and adjusted multinomial logistic regression models. RESULTS:Of the overall study population (n=905), 59% utilized ACTs at baseline. A greater proportion of patients using ACTs at baseline and follow-up continuously had Pseudomonas aeruginosa (47% vs. 36%, p=0.021) and experienced an exacerbation (81% vs. 59%, p<0.0001) or hospitalization for pulmonary illness (32% vs. 22%, p=0.001) in the prior two years, compared to those not using ACTs. Fifty-eight percent of patients who utilized ACTs at baseline did not use ACTs at one-year follow-up. There was no significant change in pulmonary function for those that used ACTs at follow-up, compared to baseline. Patients using ACTs at baseline and follow-up had greater odds for experiencing exacerbations at follow-up compared to those not using ACTs.

Background: Aspiration is associated with non-tuberculous mycobacterial (NTM) pulmonary disease and airway dysbiosis is associated with increased inflammation. We examined whether NTM disease was associated with a distinct airway microbiota and immune profile.Methods: 297 oral wash and induced sputum samples were collected from 106 participants with respiratory symptoms and imaging abnormalities compatible with NTM. Lower airway samples were obtained in 20 participants undergoing bronchoscopy. 16S rRNA gene and a nested mycobacteriome sequencing approaches characterised microbiota composition. Inflammatory profiles of lower airway samples were also examined.Results: The prevalence of NTM+ cultures was 58%. Few changes were noted in microbiota characteristic or composition in oral wash and sputum samples among groups. Among NTM+ samples, 27% of the lower airway samples were enriched with Mycobacterium A mycobacteriome approach identified Mycobacterium in a greater percentage of samples, including some non-pathogenic strains. In NTM+ lower airway samples, taxa identified as oral commensals were associated with increased inflammatory biomarkers.Conclusions: The 16S rRNA gene sequencing approach is not sensitive in identifying NTM among airway samples which are culture positive. However, associations between lower airway inflammation and microbiota signatures suggest a potential role for these microbes in the inflammatory process in NTM disease.

Antibiotic therapy against non-tuberculous mycobacteria (NTM) is prolonged and can be associated with toxicity. We sought to evaluate whether chest physical therapy (PT) was associated with clinical improvement in patients with NTM not receiving anti-mycobacterial pharmacotherapy. A retrospective review of 77 subjects that were followed from June 2006 to September 2014 was performed. Baseline time point was defined as the first positive sputum culture for NTM; symptoms, pulmonary function, and radiology reports were studied. Subjects were followed for up to 24 months and results analyzed at specified time points. Half of the subjects received chest PT at baseline. Cough improved at 12 (p = 0.001) and 24 months (p = 0.003) in the overall cohort when compared with baseline, despite lack of NTM antibiotic treatment. Cough decreased at 6 (p = 0.01), 9 (p = 0.02), 12 (p = 0.02) and 24 months (p = 0.002) in subjects that received chest PT. Sputum production also improved at 24 months in the overall cohort (p = 0.01). There was an increase in the percent change of total lung capacity in subjects that received chest PT (p = 0.005). Select patients with NTM may have clinical improvement with chest PT, without being subjected to prolonged antibiotic therapy. Future studies are warranted to prospectively evaluate outcomes in the setting of non-pharmacologic treatment and aid with the decision of antibiotic initiation.