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Vol. 58. Issue 1.
Pages 11-21 (January 2022)
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Vol. 58. Issue 1.
Pages 11-21 (January 2022)
Original Article
Effectiveness and Safety of Inhaled Antibiotics in Patients With Chronic Obstructive Pulmonary Disease. A Multicentre Observational Study
Eficacia y seguridad de los antibióticos inhalados en pacientes con enfermedad pulmonar obstructiva crónica. Estudio observacional multicéntrico
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David De la Rosa Carrilloa,
Corresponding author
david.rosa23@gmail.com

Corresponding author.
, Miguel Ángel Martínez-Garcíab, Esther Barreiroc, Eva Tabernero Huguetd, Roser Costa Solae, Marta María García-Clementef, Nuria Celorrio Jiménezg, Laura Rodríguez Ponsh, Carmen Calero Acuñai, Juan Luís Rodríguez Hermosaj, Rafael Golpek, Raquel Dacal Quintasl, Silvia Sánchez-Cuéllarm, Irene Torres Arroyon, Marina Blanco Aparicioo, Virginia Almadana Pachecop, Marc Miravitllesq, Study group on the effectiveness of inhaled antibiotic treatment in COPD 1
a Pneumology Service, Hospital de la Santa Creu i Sant Pau, C. Sant Quintí 89, 08041, Barcelona, Spain
b Pneumology Service, Hospital Universitario y Politécnico La Fe, Av. de Fernando Abril Martorell 106, 46026, Valencia, Spain
c Pulmonology Department, Hospital del MAR-IMIM, CEXS (UPF), CIBERES, Passeig Marítim de la Barceloneta 25-29, 08003, Barcelona, Spain
d Pneumology Service, Hospital de Cruces, Cruces Plaza, s/n, 48903, Barakaldo, Bizkaia, Spain
e Pneumology Service, Hospital Mutua de Terrassa, Plaça del Doctor Robert 5, 08221, Terrassa, Barcelona, Spain
f Pneumology Service, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011, Oviedo, Spain
g Pneumology Service, Hospital de Viladecans, Av. de Gavà 38, 08840, Viladecans, Barcelona, Spain
h Pneumology Service, Hospital Universitario Germans Trias i Pujol, Carretera de Canyet, s/n, 08916, Badalona, Barcelona, Spain
i Pneumology Service, Hospital Universitario Virgen del Rocio, Av. Manuel Siurot, s/n, 41013, Sevilla, Spain
j Pneumology Service, Hospital Clínico San Carlos, School of Medicine, Universidad Complutense de Madrid, Calle del Profesor Martín Lagos, s/n, 28040, Madrid, Spain
k Pneumology Service, Hospital Universitario Lucus Augusti, Rúa Dr. Ulises Romero 1, 27003, Lugo, Spain
l Pneumology Service, Complexo Hospitalario Universitario de Ourense, Calle Ramon Puga Noguerol 54, 32005, Ourense, Spain
m Pneumology Service, Hospital Universitario Infanta Leonor, Av. Gran Vía del Este 80, 28031, Madrid, Spain
n Pneumology Service, Hospital Fundación Alcorcón, Calle Budapest 1, 28922, Alcorcón, Madrid, Spain
o Pneumology Service, Complexo Hospitalario Universitario A Coruña, Xubias de Arriba 84, 15006, A Coruña, Spain
p Pneumology Service, Hospital Universitario Virgen de la Macarena, Calle Dr. Fedriani 3, 41009, Sevilla, Spain
q Pneumology Service, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorios (CIBERES), Passeig de la Vall d’Hebron 119, 08035, Barcelona, Spain
Study group on the effectiveness of inhaled antibiotic treatment in COPD
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Tables (4)
Table 1. Baseline Sociodemographic and Clinical Characteristics of the Study Population (Non-stratified and Stratified Data by Absence or Presence of Bronchiectasis According to Thoracic HRCT). Significant Results are Indicated in Bold (P<.05).
Table 2. Comparative Analysis of COPD Exacerbations (Primary Outcome) Before and After Inhaled Antibiotics in Non-stratified and Stratified Patient Data According to Absence or Presence of Bronchiectasis. Significant Results Are Indicated in Bold (P<.05).
Table 3. Factor Independently Associated With Statistically Significant Changes in the Number of Exacerbations.
Table 4. Effectiveness of Inhaled Antibiotics on COPD Symptoms, Respiratory Function and Microbiological Profile (Secondary Outcomes). Data Comprising One Year Before and One Year After Treatment Onset Are shown. Significant Results Are Indicated in Bold (P<.05). N=443.
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Abstract
Background

We aimed to describe the effectiveness and safety of inhaled antibiotics in chronic obstructive pulmonary disease (COPD) patients, as well as the patient profile in which they are usually prescribed and the patient groups that can most benefit from this treatment.

Methods

Multicentre retrospective observational cohort study in COPD patients who had received ≥1 dose of inhaled antibiotics in the last 5 years. Clinical data from the two years prior to and subsequent to the start of the treatment were compared. Primary outcome: COPD exacerbations. Secondary outcomes: side effects, symptomatology (sputum purulence, dyspnoea), microbiological profile and pathogen eradication.

Results

Of 693 COPD patients analyzed (aged 74.1; 86.3% men; mean FEV1=43.7%), 71.7% had bronchiectasis and 46.6% presented chronic bronchial infection (CBI) by Pseudomonas aeruginosa (PA). After 1 year of treatment with inhaled antibiotics, there was a significant decrease in the number of exacerbations (−33.3%; P<.001), hospital admissions (−33.3%; P<.001) and hospitalization days (−26.2%; P=.003). We found no difference in effectiveness between patients with or without associated bronchiectasis. Positive patient outcomes were more pronounced in PA-eradicated patients. We found a significant reduction in daily expectoration (−33.1%; P=.024), mucopurulent/purulent sputum (−53.9%; P<.001), isolation of any potentially pathogenic microorganisms (PPM) (−16.7%; P<.001), CBI by any PPM (−37.4%; P<.001) and CBI by PA (−49.8%; P<.001). CBI by any PPM and ≥three previous exacerbations were associated with a better treatment response. 25.4% of patients presented non-severe side-effects, the most frequent of these being bronchospasm (10.5%), dyspnoea (8.8%) and cough (1.7%).

Conclusions

In COPD patients with multiple exacerbations and/or CBI by any PPM (especially PA), inhaled antibiotics appear to be an effective and safe treatment, regardless of the presence of bronchiectasis.

Keywords:
Chronic obstructive pulmonary disease
Chronic bronchial infection
Inhaled antibiotics
Pseudomonas aeruginosa
Bronchiectasis
Exacerbations
Resumen
Antecedentes

Nuestro objetivo fue describir la efectividad y seguridad de los antibióticos inhalados en enfermedad pulmonar obstructiva crónica (EPOC), así como el perfil de pacientes en los que se prescriben habitualmente y los grupos de pacientes que más pueden beneficiarse de este tratamiento.

Métodos

Estudio de cohorte observacional retrospectivo multicéntrico en pacientes con EPOC que habían recibido ≥1 dosis de antibióticos inhalados en los últimos 5 años. Se compararon los datos clínicos de los 2 años anteriores y posteriores al inicio del tratamiento. Criterio primario: exacerbaciones de EPOC. Criterios secundarios: efectos secundarios, sintomatología (purulencia del esputo, disnea), perfil microbiológico y erradicación de patógenos.

Resultados

De los 693 pacientes con EPOC analizados (74,1 años; 86,3% hombres; FEV1 medio=43,7%) el 71,7% presentaba bronquiectasias y el 46,6% presentaba infección bronquial crónica (IBC) por Pseudomonas aeruginosa (PA). Después de un año de tratamiento con antibióticos inhalados se produjo una disminución significativa en el número de exacerbaciones (−33,3%; p<0,001), ingresos hospitalarios (−33,3%; p<0,001) y días de hospitalización (−26,2%; p=0,003). No encontramos diferencias en la efectividad entre los pacientes con o sin bronquiectasias asociadas. Los resultados positivos fueron más pronunciados en los pacientes que erradicaron la PA. Encontramos una reducción significativa de la expectoración diaria (−33,1%; p=0,024), el esputo mucopurulento/purulento (−53,9%; p<0,001), el aislamiento de cualquier microorganismo potencialmente patógeno (MPP) (−16,7%; p<0,001), IBC por cualquier MPP (−37,4%; p<0,001) e ICB por PA (−49,8%; p<0,001). La IBC por cualquier MPP y más de 3 exacerbaciones previas se asociaron con una mejor respuesta al tratamiento. El 25,4% de los pacientes presentó efectos secundarios no graves, siendo los más frecuentes el broncoespasmo (10,5%), la disnea (8,8%) y la tos (1,7%).

Conclusiones

En los pacientes con EPOC con múltiples exacerbaciones o IBC por cualquier MPP (especialmente PA), los antibióticos inhalados parecen ser un tratamiento eficaz y seguro, independientemente de la presencia de bronquiectasias.

Palabras clave:
Enfermedad pulmonar obstructiva crónica
Infección bronquial crónica
Antibióticos inhalados
Pseudomonas aeruginosa
Bronquiectasia
Exacerbaciones

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