According to a recent study published in the journal Respiratory Research, exacerbations of non-CF bronchiectasis are inflammatory incidents, with deteriorated symptoms, lung function and health status, and require a prolonged recovery. Useful tools for exacerbations detection and monitoring may include symptom diary cards, PEFR and CAT scores.
Non-cystic fibrosis (CF) bronchiectasis is a chronic lung disease that causes lung damage and dilated airways leading to recurrent episodes of bronchial sepsis, also called exacerbation. Prevalence estimates indicate 52.3 cases of the disease per 100,000, and mortality seems to be increasing by 3% per year. Exacerbations in the non-cystic fibrosis form of the disease are responsible for significant morbidity and accelerate the progression of the disease, with recent studies being focused on approaches to avert them. There is a gap in the evidence on the changes in lung function and symptomatology during exacerbation development and recovery, making it necessary to have access to this data to develop disease monitoring tools or surrogate trial endpoints.
To tackle this question, in their study titled “Lung function, symptoms and inflammation during exacerbations of non-cystic fibrosis bronchiectasis: a prospective observational cohort study” John Hurst and colleagues from the University College London conducted an observational prospective study in 32 patients with a clinical diagnosis of bronchiectasis identified from general respiratory outpatient clinics. Patients were enrolled between August 2010 and August 2012 and the median follow-up duration was 491 days. At baseline, 51 exacerbations occurred in 22 of these patients during the study period. Patients were asked to monitor their morning postmedication peak expiratory flow rate (PEFR) each day. They also recorded the presence or worsening of up to 15 symptoms and any changes in their treatment on daily diary cards.
The results revealed that exacerbation symptoms commenced at median of 4 days before treatment started and the median exacerbation duration was of 16 days. A total of 16% had not recovered by 35 days. At exacerbation, mean PEFR dropped by 10.6% and mean Assessment Test (CAT) score increased by 6.3 units, median symptom count by 4, and mean CRP by 9.0mg/L. Exacerbations where PEFR fell by ≥10% were longer with more symptoms at onset.
This study provided comprehensive information of the symptomatic and lung function changes during the development and recovery from exacerbations, and the relationships between lung function, exacerbation length, systemic inflammation and health status during exacerbations. According to the researchers, PEFR and symptom diary cards provide simple measures to detect and monitor exacerbations.