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    PREVALENCE OF BRONCHIECTASIS IN COPD PATIENTS
    (2023-01)
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    Mickovski, Ivana
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    Neshovska, Radmila
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    Buklioska, Adriana
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    Trajkova, Vesna
    Introduction - There is increasing recognition that radiological bronchiectasis is present in many patients with COPD. Computed tomography scan images have been used to identify different radiological COPD phenotypes based on the presence and severity of emphysema, bronchial wall thickening, and bronchiectasis. Bronchiectasis is defined as an abnormal dilation of the bronchi, usually as a result of chronic airway inflammation and/or infection. The prevalence of bronchiectasis in patients with COPD is high, especially in advanced stages, estimated prevalence varies from 4% to 50%. Methods - COPD patients underwent chest CT as part of their clinical assessment. Patients were included if COPD was diagnosed based on spirometry and clinical assessment and excluded if there was clinical bronchiectasis. Scoring was by a simplified system based on Smith (Thorax, 1996) and returned a score of 0 (no bronchiectasis), 1 (0–50% of bronchi involved), or 2 (50–100% of bronchi involved) for each lobe, with a total score of 12 including the lingula; emphysema, interstitial lung disease (ILD), or other pathology was noted. A total of 220 COPD patients (77.2% ex- or current smokers, 79.5% male) were consecutively enrolled. Results - Bronchiectasis was present in 54.5% of patients (score ≥2/12) and there was significant inter-observer correlation in the scoring (r=0.63, p<0.0001). Scores were highest in the lower lobes and lowest in the middle lobes (1.66 vs 0.86, p<0.000). Patients with widespread bronchiectasis (score ≥6/12) had a trend towards reduced bronchodilator reversibility (4% vs 9%, p=0.08) than those with limited bronchiectasis. Emphysema was present in 77.2% and ILD in 11.36%. The overall prevalence of emphysema was not different between patients with and without previous pulmonary tuberculosis (PTB) n=30 (13.63%), but in those with previous PTB, a higher number of subjects with middle (p=0.002) and lower (p=0.017) lobe emphysema, higher severity score (p=0.029), higher prevalence of panlobular emphysema (p=0.015), and more extensive centrilobular emphysema (p=0.036) were observed. Conclusions - In this study, we found a higher prevalence of bronchiectasis than previously reported which may reflect the heterogeneity of COPD patients in a general respiratory clinic. Radiological features of bronchial wall thickening and mild bronchiectasis were commonly seen and when widespread this may result in reduced bronchodilator reversibility; however, the presence of radiological bronchiectasis was not related to disease severity. COPD patients with previous PTB had unique features of bronchiectasis and emphysema on HRCT, which were associated with significant dyspnea and higher frequency of severe exacerbations.
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    Efficacy and Safety of Levofloxacin in Outpatient Treatment of Exacerbations of COPD and Bronchiectasis
    (European Journal of Respiratory Medicine, 2022-01)
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    Petrova, Tatjana
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    Atanasovska, Aneta
    Introduction: Majority of the exacerbations of chronic obstructive pulmonary disease (COPD) and bronchiectasis could be treated on outpatient basis. Aim of the study: To assess efficacy and safety of levofloxacin as empirical treatment of exacerbations of COPD and bronchiectasis in outpatient setting. Methods: We performed an observational, non-randomized, open-label study including 74 patients with exacerbation of COPD and 34 patients with exacerbation of bronchiectasis of bacterial origin which met criteria for outpatient treatment. The patients were treated with oral levofloxacin 500 mg once daily for 10 days (COPD exacerbations) and 14 days (exacerbations of bronchiectasis). Efficacy of the treatment was assessed by a number of patients with clinical remission of exacerbation, while the safety was assessed by a number of patients with side effects during the treatment. Results: Clinical remission of exacerbation, i.e. complete resolution of clinical symptoms and signs or their return to their baseline severity, was achieved in 87.8% of patients with COPD, as well as in 82.3% of patients with bronchiectasis. In addition, the mean time to clinical remission of exacerbation in patients with COPD and bronchiectasis was 6.2 and 9.6 days, respectively. Incidence of side effects during the treatment with levofloxacin was 9.4% in patients with COPD and 11.7% in patients with bronchiectasis. Registered side effects were mild and self-limited and did not require premature discontinuation of the treatment with levofloxacin. Conclusion: Our findings confirmed high efficacy and good tolerability of levofloxacin in empirical treatment of exacerbations of COPD and bronchiectasis in outpatient setting.
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    CEFPODOXIME IN THE OUTPATIENT TREATMENT OF LOWER RESPIRATORY TRACT INFECTIONS
    (Faculty of Medicine, Skopje, 2021-05-15)
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    Petrova, Tatjana
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    Introduction. According to the recent data, lower respiratory tract infections (LRTIs), i.e. a broad terminology including acute bronchitis (AB), influenza, community-acquired pneumonia (CAP), acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and acute exacerbation of bronchiectasis (AEBX), represent the fourth most common cause of death at global level. Aim of the study. To assess efficacy and safety of cefpodoxime in the empirical treatment of LRTIs of bacterial origin in an outpatient setting. Methods. We performed an observational, non-randomized, open-label study (a real life-study) including 126 patients with LRTI of bacterial origin, 59 patients with AECOPD, 32 patients with CAP and 35 patients with AEBX, who met criteria for treatment in an outpatient setting. All study subjects were treated with cefpodoxime 200 mg twice daily, and had intermediate visits at 3, 5, and 7 days (patients with AECB) and at 3, 5, 7, and 10 days (patients with CAP and AEBX) at which their symptoms as well as eventual side effects were evaluated. The treatment was considered to be successful if complete resolution of symptoms or their return to the baseline severity was achieved. Results. Percentage of clinical success, i.e., complete resolution of clinical symptoms and signs or their return to the baseline severity, varied from 77.9% in patients with AECOPD, 81.3% in patients with CAP to 77.1% in patients with AEBX. Mean time to clinical remission varied from 6.5  0.3 days in patients with AECOPD, 7.8  0.5 days in patients with CAP to 10.7  1.2 days in patients with AEBX. Incidence of side effects during the treatment varied from 10.2% in patients with AECOPD, 12.5% to 8.6% in patients with AEBX. Registered side effects were mild and self-limited and did not require premature discontinuation of the treatment. Conclusion. Our findings supported the use of cefpodoxime in the treatment of bacterial LRTI due to its high efficacy and good tolerability.
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    Assessment of the Non-Cystic Fibrosis Bronchiectasis Severity: The FACED Score vs the Bronchiectasis Severity Index
    (Bentham Science Publishers Ltd., 2015)
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    Introduction: Non-cystic fibrosis bronchiectasis (NCFB) is a multidimensional disease, and no single isolated parameter is proved to have sufficient power for any overall determination of its severity and prognosis. Objective: To compare the results of the assessment of the NCFB severity with respect to its prognosis in the same patients by two different validated scores, i.e. the FACED score and the Bronchiectasis Severity Index (BSI). Methods: An observational study including 37 patients with NCFB (16 males and 21 female aged 46 to 76 years) was performed. All patients underwent evaluation of the variables incorporated in the FACED score (FEV1 % predicted, age, chronic colonization by Pseudomaonas aeruginosa, radiological extent of the disease, and dyspnea) and in the BSI (age, body mass index, FEV1 % predicted, hospitalization and exacerbations in previous year, dyspnea, chronic colonization by Pseudomaonas aeruginosa and other microrganisms, and radiological extent of the disease). Results: According to the value of the derived overall FACED score we found 17 patients (45.9%) with mild bronchiectasis, 14 patients (37.8%) with moderate bronchiectasis and 6 patients (16.2%) with severe bronchiectasis. The mean derived FACED score was 3.4 ± 1.3. In addition, according to the value of the derived overall BSI score, the frequency of patients with low, intermediate and high BSI score was 16 patients (43,2%), 14 patients (37.8%) and 7 patients (18.9%), respectively. The mean derived BSI score was 6.4 ± 2.5. Conclusion: We found similar results by the assessment of the NCFB severity in regard to its prognosis by both the FACED score and the BSI. Further studies determining how these scores may impact clinical practice are needed.
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    Effects of Pleuran (β-glucan from Pleurotus ostreatus) Supplementation on Incidence and Duration of Bronchiectasis Exacerbations
    (Scientific Foundation SPIROSKI, Skopje, Republic of Macedonia, 2020-09-15)
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    Petrova, Tatjana
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    BACKGROUND: Patients with non-cystic fibrosis bronchiectasis (BE) have frequent exacerbations that are causes of significant morbidity and sometimes mortality, and which it is desirable to prevent. AIM: We aimed to assess the effects of pleuran on the incidence and duration of exacerbations in patients with BE. METHODS: A prospective, observational, open-label, and active-controlled study was realized as a comparison of the frequency and duration of exacerbations between a group of patients with BE (30 patients, 14 males and 16 females, aged 44–72 years) who received a combination supplement containing pleuran 100 mg, Vitamin C 60 mg and zinc 5 mg over a 3-month period and a group of patients with BE (31 patients, 15 males and 16 females, aged 45–74 years) treated over a 3-month period with a combination supplement containing Vitamin C 60 mg and zinc 5 mg. RESULTS: Over the study period, altogether 46 exacerbations were documented (19 in the patients receiving pleuran and 27 in the patients who did not receive pleuran), nine of which required hospital treatment (four in the patients receiving pleuran [21.5%] and five in the patients who did not receive pleuran [18.6%]). The mean number of exacerbations over the study period was significantly lower in the patients receiving pleuran (0.6 ± 0.4) as compared to the mean number in the patients who did not receive pleuran (0.8 ± 0.3) (p = 0.0297). The mean duration of exacerbations, expressed in days, needed for cure or clinical improvement in the patients receiving pleuran (11.2 ± 1.7 days) was significantly shorter than that of exacerbations in the patients who did not receive pleuran (12.4 ± 1.3 days) (p = 0.0029). We found significantly lower incidence and significantly shorter duration of exacerbations in the patients with BE who received pleuran as compared to their incidence and duration in the patients with BE who did not receive pleuran. CONCLUSION: Our findings indicated a need for further investigations in this domain to define the possible role of pleuran in the prevention of BE exacerbations.
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    Effects of a Long-Term Use of Carbocysteine on Frequency and Duration of Exacerbations in Patients with Bronchiectasis
    (ID Design Press/Scientific Foundation SPIROSKI, 2019-12-15)
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    Petrova, Tatjana
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    The failure of mucus clearance in bronchiectasis can be improved by chest physiotherapy or/and mucoactive agents.
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    Exacerbations in COPD Patients with Bronchiectasis
    (MDPI AG, 2017-04-11)
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    Atanasovska, Aneta
    There is evidence that coexisting bronchiectasis (BE) in patients with chronic obstructive pulmonary disease (COPD) aggravates the course of the disease. In this study, we aimed to evaluate the frequency and severity of bacterial exacerbations in COPD patients with BE. The frequency and duration of bacterial exacerbations treated in a 12-month period, as well as the duration of the exacerbation-free interval, were evaluated in 54 patients with COPD (Group D) who were diagnosed and assessed according to official recommendations. In 27 patients, BE was diagnosed by high-resolution computed tomography (HRCT), whereas an equal number of COPD patients who were confirmed negative for BE by HRCT, served as controls. We found a significantly higher mean number of exacerbations in a 12-month period in COPD patients with BE (2.9 ± 0.5), as compared to their mean number in controls (2.5 ± 0.3) (p = 0.0008). The mean duration of exacerbation, i.e. the mean number of days elapsed before complete resolution of the symptoms or their return to the baseline severity, was significantly longer in COPD patients with BE as compared to their mean duration in controls (6.9 ± 1.8 vs. 5.7 ± 1.4; p = 0.0085). In addition, the mean exacerbation-free interval expressed in days, in patients with COPD with BE, was significantly shorter than in COPD patients in whom BE were excluded (56.4 ± 17.1 vs. 67.2 ± 14.3; p = 0.0149). Overall, our findings indicate that coexisting BE in COPD patients may lead to more frequent exacerbations with a longer duration.