The edition · Pulmonology
One in 14 patients with bronchiectasis had primary ciliary dyskinesia, and nasal nitric oxide found most of them
Screening bronchiectasis clinics for PCD, sputum eosinophils and hospital use in asthma versus COPD, chest wall oscillation for secretion retention on non-invasive support, and home interval training for post-infectious bronchiolitis obliterans.
The edition in brief
A Shanghai cross-sectional study of 373 adolescents and adults with bronchiectasis found 7.4% had confirmed or highly likely primary ciliary dyskinesia; nasal nitric oxide at a cut-off of 77 nL/min had 85% sensitivity and 97% specificity, and PCD was strongly linked to rhinosinusitis (OR 25) and Pseudomonas (OR 8.5). An Ontario cohort of 4,821 patients found sputum eosinophils above 3% were associated with nearly twice the rate of asthma-specific emergency visits in asthma, but not with health service use in COPD, where high neutrophils were linked to more hospitalisation. An 88-patient Italian trial found high-frequency chest wall oscillation in acute respiratory failure with hypersecretion did not significantly reduce therapeutic bronchoscopy after adjustment, though exploratory outcomes favoured it. A Spanish trial in 51 young people with post-infectious bronchiolitis obliterans found 16 weeks of remotely supervised home interval training raised peak oxygen uptake by 3.4 mL/kg/min. The pearl covers a structured aetiology work-up in new bronchiectasis.
Sputum eosinophilia predicted emergency visits in asthma but not health service use in COPD
Where induced sputum is available, use eosinophil counts to identify asthma patients at risk of attacks; do not assume the same signal carries over to COPD.
Chest wall oscillation did not significantly reduce bronchoscopy for secretions on non-invasive support
High-frequency chest wall oscillation can be considered for secretion clearance in respiratory failure, but evidence that it reduces bronchoscopy is not yet established.
Home interval training raised peak oxygen uptake in young people with post-infectious bronchiolitis obliterans
Consider supervised exercise programmes, including remote ones, for children and adolescents with post-infectious bronchiolitis obliterans.
Work up the cause of every new bronchiectasis diagnosis
In new bronchiectasis, check for treatable causes before labelling it idiopathic.
Nasal nitric oxide with clinical features identified primary ciliary dyskinesia in 7% of bronchiectasis patients
Consider nasal nitric oxide screening for primary ciliary dyskinesia in bronchiectasis, especially with early onset, rhinosinusitis, Pseudomonas or situs inversus.
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