Faculty Bibliography

BACKGROUND AND OBJECTIVE/UNASSIGNED:Treatable traits in bronchiectasis have been classified as pulmonary, etiological, extra-pulmonary and behavioral or lifestyle factors. A range of non-pharmacological interventions may be applied to address these traits, with selected therapies applicable to multiple traits. The aim of this narrative review was to synthesize the evidence for non-pharmacological therapies through the lens of treatable traits for adults with bronchiectasis and highlight the clinical effects of these treatments. METHODS/UNASSIGNED:Electronic searches of PubMed and Medline using specific keywords were conducted. Articles underwent screening for relevance, with potential sources from review articles, systematic and scoping reviews, case series, prospective and retrospective studies, clinical practice guidelines and statements, and editorials in peer-reviewed journals. The data included were limited to English publications from 1980 to 2024. KEY CONTENT AND FINDINGS/UNASSIGNED:Of those traits which fall under the pulmonary and etiology categories, treatment options include airway clearance therapy, adjuncts to airway clearance such as mucoactive agents, smoking cessation programs, non-invasive ventilation and oxygen therapy, including high flow nasal therapy. Extra-pulmonary traits that are amenable to non-pharmacological approaches included psychological symptoms, nutritional concerns, gastroesophageal reflux disease, rhinosinusitis and cardiovascular disease. Treatment options span from cognitive behavioral therapy and counselling, nutritional advice and supplements, lifestyle adjustments and nasal-sinus irrigation. Key behavioral or lifestyle traits are low treatment adherence, smoking and lack of exercise. These are addressed via education and self-management programs, smoking cessation, pulmonary rehabilitation and other forms of exercise or physical activity. CONCLUSIONS/UNASSIGNED:A variety of non-pharmacological therapies may be applied to address treatable traits in those with bronchiectasis and adopting an integrated approach is important to optimize patient outcomes. Further studies could guide the implementation of non-pharmacological interventions for newly identified treatable traits in this population.

BACKGROUND:Nebulized Hypertonic saline (HS) and positive expiratory pressure device (PEP) are often used in patients with bronchiectasis. We sought to describe the clinical characteristics in patients using HS and PEP, utilizing a large national database registry. METHODS:Data from the US Bronchiectasis and NTM Research Registry were used in this study. Patients with a diagnosis of bronchiectasis were included. Eligible patients were assigned to one of four mutually exclusive groups: HS only, PEP only, HS & PEP, or no airway clearance or mucoactive agent. Descriptive statistics were computed for the overall study population and stratified by the four groups. One-way ANOVA and chi-square tests were used to test the difference in the means in continuous variables and the association between categorical variables (respectively) across the four groups. RESULTS:A total of 2195 patients were included. Of those with bronchiectasis and a productive cough, a greater number of patients utilized HS only vs PEP only (17.5 % vs 9.1 %, p < 0.001). Similar association was found in those with Pseudomonas aeruginosa (22.3 % HS only vs 6.5 % PEP only, p < 0.001). There was a higher number of patients who used HS and PEP therapy in combination vs PEP therapy alone (25.0 % vs 9.1 %, p = 0.002), in those with a productive cough. CONCLUSIONS:In patients with bronchiectasis and a productive cough or Pseudomonas aeruginosa, HS is used more often than PEP alone. There is a need for further analysis to compare these two modalities and explore the factors influencing their utilization.

BACKGROUND:High frequency chest wall oscillation (HFCWO) is a form of airway clearance therapy that has been available since the mid-1990s and is routinely used by patients suffering from retained pulmonary secretions. Patients with cystic fibrosis (CF), neuromuscular disease (NMD), and other disorders, including bronchiectasis (BE) and COPD (without BE), are commonly prescribed this therapy. Limited evidence exists describing HFCWO use in the BE population, its impact on long-term management of disease, and the specific patient populations most likely to benefit from this therapy. This study sought to characterize the clinical characteristics of patients with BE who have documented use of HFCWO at baseline and 1-year follow-up. METHODS:An analysis from a large national database registry of patients with BE was performed. Demographic and clinical characteristics of all patients receiving HFCWO therapy at baseline are reported. Patients were stratified into two groups based on continued or discontinued use of HFCWO therapy at 1-year follow-up. RESULTS:Over half (54.8 %) of patients who reported using HFCWO therapy had a Modified Bronchiectasis Severity Index (m-BSI) classified as severe, and the majority (81.4 %) experienced an exacerbation in the prior two years. Of patients with 1-year follow-up data, 73 % reported continued use of HFCWO. Compared to patients who discontinued therapy, these patients were more severe at baseline and at follow-up suggesting that patients with more severe disease are more likely to continue HFCWO therapy. CONCLUSIONS:Patients who have more severe disease and continue to experience exacerbations and hospitalizations are more likely to continue HFCWO therapy. CLINICAL TRIAL REGISTRATION/BACKGROUND:NA.