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Abstract Background The study assessed the association between COVID-19 and new-onset obstructive airway diseases, including asthma, chronic obstructive pulmonary disease, and bronchiectasis among vaccinated individuals recovering from COVID-19 during the Omicron wave. Methods This multicenter retrospective cohort study comprised 549,606 individuals from the U.S. Collaborative Network of TriNetX database, from January 8, 2022, to January 17, 2024. The hazard of new-onset obstructive airway diseases between COVID-19 and no-COVID-19 groups were compared following propensity score matching using the Kaplan–Meier method and Cox proportional hazards model. Results After propensity score matching, each group contained 274,803 participants. Patients with COVID-19 exhibited a higher risk of developing new-onset asthma than that of individuals without COVID-19 (adjusted hazard ratio (aHR), 1.27; 95% CI, 1.22–1.33; p

Abstract Introduction Celiac disease is a disease triggered by a protein called gluten. Celiac disease has intestinal and extraintestinal manifestations. Bronchiectasis is a permanent dilation of the bronchi that causes symptoms, such as cough producing a large amount of sputum, recurrent respiratory infections, and breathlessness. In addition, bronchiectasis can present in 60% of cases with chronic rhinosinusitis. Case presentation A 40-year-old Arab woman presented with a worsening old cough with an increased amount of sputum; the patient was diagnosed with Celiac disease 7 months prior. Investigations started with laboratory tests followed by a computed tomography scan for the head and chest, bronchoscopy, bronchoalveolar lavage, and spirometry; the final diagnosis was bronchiectasis with chronic rhinosinusitis. She was advised to commit to the gluten-free diet, in addition to the medications prescribed for her bronchiectasis and chronic rhinosinusitis. Conclusion Celiac disease and bronchiectasis might share an immunologic disturbance that caused both entities, so Celiac disease should be kept in mind as an etiology for pulmonary diseases.

Abstract Background The pathogenesis of noncystic fibrosis bronchiectasis in adults is complex, and the relevant molecular mechanisms remain unclear. In this study, we constructed a panoramic map of bronchiectasis mRNA, explored the potential molecular mechanisms, and identified potential therapeutic targets, thus providing a new clinical perspective for the preventive management of bronchiectasis and its acute exacerbation. Methods The mRNA profiles of peripheral blood and bronchiectasis tissues were obtained through transcriptome sequencing and public databases, and bioinformatics methods were used to screen for differentially expressed genes (DEGs). The DEGs were then subjected to biological function and pathway analyses. Some DEGs were validated using a real-time quantitative polymerase chain reaction (RT-qPCR) in peripheral blood. Spearman’s correlation analysis was used to analyse the correlation between DEGs and clinical indicators. Results Based on transcriptome sequencing and public databases, the mRNA profile of bronchiectasis was determined. DEGs were obtained from the peripheral blood sequencing dataset (985 DEGs), tissue sequencing dataset (2919 DEGs), and GSE97258 dataset (1083 DEGs). Bioinformatics analysis showed that upregulated DEGs had enriched neutrophil-related pathways, and downregulated DEGs had enriched ribosome-related pathways. RT-qPCR testing confirmed the upregulated expression of VCAN, SESTD1, SLC12A1, CD177, IFI44L, SIGLEC1, and RSAD2 in bronchiectasis. These genes were related to many clinical parameters, such as neutrophils, C-reactive protein, and procalcitonin (P

Abstract Background Swyer–James–MacLeod syndrome (SJMS) is a rare lung condition characterized by a unilateral lung hyperlucency and reduction in the pulmonary vasculature, with or without the presence of bronchiectasis. In the 1950s, Swyer, James, and Macleod simultaneously characterized the syndrome for the first time. It is typically diagnosed in childhood. Adult-onset cases are extremely rare, with little literature available on its clinical presentation and diagnostic challenges. Swyer–James–MacLeod syndrome can mimic other lung disorders, resulting in misdiagnosis and improper treatment. Case presentation A 49- year-old woman from Debre Berhan, Ethiopia, presented to the emergency department of Hakim Gizaw Teaching Hospital with symptoms and radiographic findings mimicking acute pulmonary embolism. On the basis of the clinical presentation and radiographic findings, the patient was first treated as a probable case of pulmonary embolism. Anticoagulant therapy and oxygen support were initiated. Nevertheless, additional testing using a chest computed tomography angiography revealed left lung hyperlucency, decreased vascularity, bronchiectasis, and a negative result for pulmonary embolism. As a result, Swyer–James–MacLeod syndrome was diagnosed. Conclusion The symptoms of Swyer–James–MacLeod syndrome can be mistaken for pulmonary embolism, which could lead to ineffective treatment and needless expenses. In individuals presenting with symptoms suggestive of pulmonary embolism, this case emphasizes the significance of considering Swyer–James–MacLeod syndrome as a differential diagnosis, especially in the absence of established risk factors for pulmonary embolism.

Kartagener’s Syndrome, alternatively known as Primary Ciliary Dyskinesia (PCD) is a rare and intricate inherited disorder that impacts the structure and function of cilia, leading to compromised mucociliary clearance. The defining features of this condition consist of chronic sinusitis, situs inversus totalis, and bronchiectasis, forming a characteristic triad. Kartagener’s Syndrome presents numerous challenges in its diagnosis and management, and its clinical implications have significant ramifications for affected individuals. This review aims to comprehensively review and analyse the clinical impact of this syndrome, focusing on the diagnosis, treatment, and management modalities. The ciliary dysfunction in Kartagener’s Syndrome disrupts the mucus clearance and pathogens from the respiratory tract, resulting in chronic infections, progressive lung damage, and respiratory failure in severe cases. Through a narrative review of literature, reviews, and case studies, the authors have explored clinicians’ diagnostic challenges and the advances in genetic testing methods that aid in early and accurate diagnosis. The authors have discussed the multidisciplinary approach to manage Kartagener’s Syndrome, which involves respiratory therapies, antibiotics, and surgical interventions to improve the patient’s quality of life and prevent complications. The review paper also includes in-depth case studies of individuals with Kartagener’s Syndrome, highlighting the variability in clinical presentations and treatment outcomes. These case studies provide valuable insights into the diverse manifestations of this syndrome, further enhancing the existing understanding of the disease and its management. Ultimately, this review is directed to raise awareness among healthcare professionals about Kartagener’s Syndrome, its clinical implications, and its diagnostic and treatment challenges. By shedding light on this rare and intricate genetic disorder, the authors here promote early recognition and proactive management, leading to improved outcomes and better quality of life for individuals with Kartagener’s Syndrome.

Background: Rheumatoid arthritis (RA) is a chronic inflammatory arthritis with various extra-articular manifestations, pulmonary being the most involved. Aims and Objectives: This study aims to identify the radiological patterns in the lungs among patients with RA. Materials and Methods: A total of 39 patients with RA were chosen randomly. They were examined and imaged by chest X-ray and high-resolution computed tomography (HRCT) thorax, and findings were analyzed. Results: The mean age of patients was 53.9 and had a female preponderance of 74.4%. Among the 39 patients studied, 30 had no respiratory symptoms. The most common HRCT thorax findings were bronchiectasis and ground-glass opacities. Conclusion: Radiological pulmonary manifestations of RA identified in HRCT imaging are wide and occur in the majority of clinically asymptomatic patients.

Key Clinical Message Mounier‐Kuhn syndrome, characterized by tracheal dilatation due to the loss of elastic fibers and smooth muscle cells, is a rare condition, often leading to recurrent respiratory infections from impaired mucociliary clearance.

Abstract Background Bronchiectasis is a chronic airway disease characterized by permanent and irreversible abnormal dilatation of bronchi. Several studies have reported the development of bronchiectasis after renal transplantation (RT), but no prospective study specifically assessed bronchiectasis in this population. This study aimed to compare features of patients with bronchiectasis associated with RT to those with idiopathic bronchiectasis. Methods Nineteen patients with bronchiectasis associated with RT (RT-B group) and 23 patients with idiopathic bronchiectasis (IB group) were prospectively included in this monocentric cross-sectional study. All patients underwent clinical, functional, laboratory, and CT scan assessments. Sputum was collected from 25 patients (n = 11 with RT-B and n = 14 with IB) and airway microbiota was analyzed using an extended microbiological culture. Results Dyspnea (≥ 2 on mMRC scale), number of exacerbations, pulmonary function tests, total bronchiectasis score, severity and prognosis scores (FACED and E-FACED), and quality of life scores (SGRQ and MOS SF-36) were similar in the RT-B and IB groups. By contrast, chronic cough was less frequent in the RT-B group than in the IB group (68% vs. 96%, p = 0.03). The prevalence and diversity of the airway microbiota in sputum were similar in the two groups. Conclusion Clinical, functional, thoracic CT scan, and microbiological characteristics of bronchiectasis are overall similar in patients with IB and RT-B. These results highlight that in RT patients, chronic respiratory symptoms and/or airway infections should lead to consider the diagnosis of bronchiectasis. Further studies are required to better characterize the pathophysiology of RT-B including airway microbiota, its incidence, and impact on therapeutic management.

Introduction: Tuberculosis is a worldwide public health problem associated with high morbidity and mortality. Tuberculosis can manifest in active and latent forms. Improving the diagnosis, treatment, and screening of tuberculosis is crucial for effective tuberculosis control. Chest X-ray and Computed Tomography chest play a vital role in diagnosing and screening for tuberculosis. Aim: To analyse the spectrum of radiological findings in pulmonary tuberculosis. Materials and Methods: The present retrospective descriptive study was conducted at a teritary care hospital in the Department of Radiodiagnosis, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India. The data of 160 patients diagnosed with pulmonary tuberculosis between January 2019 and December 2020 were accessed and analysed. The recorded variables included forms of pulmonary tuberculosis, age/gender distribution, co-morbidities, Acid-fast Bacillus (AFB) smear status, and radiological findings and distribution. Descriptive statistics are presented in frequency and percentage. Results: Among the 160 cases of pulmonary tuberculosis, 30 (18.75%) cases were active primary tuberculosis, 105 (65.63%) cases were active post-primary tuberculosis, and 25 (15.62%) cases were inactive tuberculosis. Among the 30 cases of active primary tuberculosis, 14 (46.67%) cases had consolidation with air bronchogram, and 6 (20%) cases had consolidation without air bronchogram. Among the 105 cases of active post-primary tuberculosis, 65 (61.9%) cases had consolidation, 50 (47.62%) cases had cavities, and 56 (81.9%) cases had centrilobular nodules with a tree-in-bud appearance. Among the 25 cases of inactive tuberculosis, 18 (72%) cases had fibrosis with bronchiectasis, while 4 (16%) cases had fibrosis without bronchiectasis, and 3 (12%) cases had calcified granulomas. Conclusion: The study conclusively demonstrates the diverse radiological manifestations of pulmonary tuberculosis in different patient demographics. It highlights a higher incidence of active post-primary tuberculosis, especially in patients above 45 years, with varying radiological findings such as consolidation, cavitation, and fibrosis.

Background: Bronchiectasis is a chronic disorder of the lung caused due to permanent structural changes in the bronchial tree which consequently leads to high morbidity. Many clinical factors lead to severe morbidity in patients and affect the respiratory quality of life. Aim: The present study aimed to determine the various clinical and radiological factors affecting the respiratory quality of life of patients with bronchiectasis. Materials and Methods: We recruited forty diagnosed patients with bronchiectasis and collected their social, clinical, and radiological data, and correlated various obtained parameters with their respiratory quality of life, based on the St. George Respiratory Questionnaire scoring. Observation: We observed low body mass index, higher bronchial obstruction, and worse structural damage to the lungs correlated with worse respiratory quality of life in the patients. Conclusion: Parameters worsening the quality of life can be considered prognostic factors for the disease. Treating clinicians can design protocols for patient management and the institutional pulmonary rehabilitation program based on these prognostic factors.

Post-tuberculosis lung disease (PTLD) is emerging as a significant area of global interest. As the number of patients surviving tuberculosis (TB) increases, the subsequent long-term repercussions have drawn increased attention due to their profound clinical and socioeconomic impacts. A primary obstacle to its comprehensive study has been its marked heterogeneity. The disease presents a spectrum of clinical manifestations which encompass tracheobronchial stenosis, bronchiectasis, granulomas with fibrosis, cavitation with associated aspergillosis, chronic pleural diseases, and small airway diseases—all persistent consequences of PTLD. The spectrum of symptoms a patient may experience varies based on the severity of the initial infection and the efficacy of the treatment received. As a result, the long-term management of PTLD necessitates a detailed and specific approach, addressing each manifestation individually—a tailored strategy. In the immediate aftermath (0–12 months after anti-TB chemotherapy), there should be an emphasis on monitoring for relapse, tracheobronchial stenosis, and smoking cessation. Subsequent management should focus on addressing hemoptysis, managing infection including aspergillosis, and TB-associated chronic obstructive pulmonary disease or restrictive lung function. There remains a vast expanse of knowledge to be discovered in PTLD. This review emphasizes the pressing need for comprehensive, consolidated guidelines for management of patients with PTLD.

Introduction: Blue rubber bleb nevus syndrome is a rare disorder of venous malformations, with around 200 cases reported. We present a case of Mycobacterium xenopi infection in a patient with blue rubber bleb nevus syndrome. Case Description: A 40-year-old female with blue rubber bleb nevus syndrome, asthma, and bronchiectasis came to the pulmonology clinic with shortness of breath and a cough. She was recently admitted for a bronchiectasis exacerbation but continued to have a worsening productive cough and fevers. The most recent CT scan of the chest showed interval stable right upper lobe fibrocavitary disease, demonstrating gradual progression over two years. She had occasional positive cultures for Mycobacterium Avium Complex and M. xenopi one year previously, assumed to be a colonizer and not treated. Most recent hospital cultures were negative for bacteria and an acid-fast bacilli smear. She was sent to the emergency department for bronchiectasis exacerbation and returned to the clinic six weeks later with two sputum cultures growing M. xenopi. It was decided to treat M. xenopi as this was likely the cause of her cavitary lung lesion and frequent infections. Azithromycin, rifampin, and sulfamethoxazole/trimethoprim were initiated. Intravenous amikacin was added later on. She finally had a right partial lung resection done after one year at an outside hospital. She was on and off antibiotics for M. xenopi for approximately three years with negative repeat cultures for non-tuberculous mycobacteria. Conclusion: Due to the high mortality of M. xenopi infections (which can be as high as 69%), treatment of at least twelve months is recommended. To our knowledge, this is the first reported case of M. xenopi in a patient with blue rubber bleb nevus syndrome.

Situs inversus, chronic sinusitis, and bronchiectasis together make up the trinity that characterize the uncommon autosomal recessive genetic ciliary condition known as Kartagener's syndrome. The fundamental issue is the improper movement of cilia, which causes infertility, frequent chest infections, and ear, nose, and throat complaints. A fertile male with Kartagener's disease is a unique case of this rare entity, which we are reporting here. The significance of having a high index of suspicion in such patients cannot be stressed to arrive at an early diagnosis and, whenever possible, provide alternatives for fast treatment and avoid needless symptom evaluation.

Background Allergic bronchopulmonary aspergillosis (ABPA) is a lung disease caused by aspergillus sensitization, which is often misdiagnosed or missed diagnosis due to low prevalence, few case reports, and controversial diagnostic criteria, leading to inappropriate treatment and exacerbation of the disease. Previous studies have shown that ABPA is one of the etiologies of bronchiectasis, but its prevalence and clinical characteristics still remain to be studied. Objective To analyze the prevalence and clinical characteristics of ABPA in patients with bronchiectasis. Methods Outpatients or inpatients diagnosed with bronchiectasis and received examinations for peripheral blood eosinophilcount, serum total IgE and aspergillus-specific IgE at Peking University Third Hospital from January 2012 to September 2021 were retrospectively selected. The data including gender, age, smoking history, asthma/wheezing symptoma, laboratory indicators (peripheral blood eosinophil count, serum total IgE, aspergillus-specific IgE and IgG), chest CT (types of bronchiectasis, number oflobes involved), and pulmonary function indexes〔the first forced expiratory volume as a percentage of the predicted value (FEV1%pred), ratio of the first forced expiratory volume and forced vital capacity in percentage (FEV1/FVC) 〕was collected. The Smith score and the Bhalla score was used to evaluate the extent and the severity of bronchiectasis lesions, respectively. The included patients were divided into the ABPA group (n=10) and non-ABPA group (n=149) according to the combination of ABPA and analyzed for the cases with total serum IgE>60 U/mL, total serum IgE>500 U/mL, total serum IgE>1 000 U/mL, aspergillus-specific IgE>0.35 U/mL, and peripheral blood eosinophil count >0.5×109/L. Results In 159 patients with bronchiectasis, 10 cases met the diagnostic criteria of ABPA (6.29%, 10/159) with elevated aspergillus-specific IgE level (>0.35 U/mL), including 9 cases with aspergillus-specific IgE>1 000 U/mL and 1 case with aspergillus-specific IgE0.5×109/L, radiological bronchiectasis, positive serum aspergillus-specific IgG), of whom 7 cases had episodic wheezingsymptom and 9 cases with absolute peripheral blood eosinophil count>0.5×109/L. Aspergillus-specific IgG was detected in 5 of the 10 cases with ABPA, 4 of whom were positive. Chest CT findings showed central bronchiectasis and peripheral bronchiectasis in 6 and 4 of the 10 cases with ABPA, and cystic bronchiectasis were shown in all 10 cases. Compared with the non-ABPA group, the ABPA group showed a higher number of lung lobesinvolved, Smith score and Bhalla score (P

The primary defect in Kartagener's syndrome is at the ciliary level and so the normal ciliary activity is compromised causing impaired respiratory tract clearance, infertility and defective organ(s) orientation and left-right laterality predisposition during organogenesis. The authors came across the case of a 20-year-old female that was later diagnosed with Kartagener's syndrome. This case may be of particular interest to general physicians and pulmonologists.

Influenza is an important respiratory viral pathogen in adults, with secondary bacterial pneumonia being a common complication. While pneumococcal vaccines can prevent pneumococcal pneumonia and invasive pneumococcal disease, whether they can also prevent the severe in-hospital outcomes among patients hospitalized for influenza has not been examined. A territory-wide retrospective study was conducted in Hong Kong, which included all adult patients having chronic airway diseases (asthma, bronchiectasis, and chronic obstructive pulmonary disease) hospitalized for influenza and who had received seasonal influenza vaccine. The occurrence of secondary bacterial pneumonia, mortality, and other severe in-hospital outcomes were compared among subjects with or without pneumococcal vaccination. There was a total of 3066 eligible patients who were hospitalized for influenza in public hospitals in Hong Kong from 1 January 2016 to 30 June 2023. Completed pneumococcal vaccination with PSV23/PCV13 conferred protection against secondary bacterial pneumonia, all-cause mortality, and respiratory cause of mortality with adjusted odds ratios of 0.74 (95% CI = 0.57–0.95, p = 0.019), 0.12 (95% CI = 0.03–0.53, p = 0.005), and 0.04 (95% CI = 0.00–0.527, p = 0.0038), respectively.

Purpose: Although the international guidelines for managing bronchiectasis are centred on preventing the exacerbation of bronchiectasis, the medical causes of admissions to hospital among patients with bronchiectasis have not been fully investigated. Methods: This study targeted patients with bronchiectasis who were admitted to hospitals between April 2018 and March 2020 using the national inpatient database in Japan. The causes of hospitalisation and types of antibiotics used for hospitalised patients were recorded. Results: In total, 21,300 hospitalisations of 16,723 patients with bronchiectasis were analysed. The most common cause was respiratory diseases in 15,145 (71.1%) admissions, including bacterial pneumonia and the exacerbation of bronchiectasis in 6238 (41.2%) and 3151 (20.8%), respectively. Antipseudomonal antibiotics were used in approximately 60% of patients with bacterial pneumonia who were administered antibiotic treatments and in approximately 50% of patients with the exacerbation of bronchiectasis. Conclusions: Bacterial pneumonia was the most frequent cause of hospitalisation, followed by the exacerbation of bronchiectasis, among patients with bronchiectasis. Physicians need to focus on the prevention of bacterial pneumonia in addition to the exacerbation of bronchiectasis in patients with bronchiectasis.

Authors present a case involving a 47-year-old male farmer who sought medical attention at the Outpatient Department (OPD) due to a persistent cough and progressive dyspnoea over the past year. Additionally, he reported experiencing intermittent low-grade fever for the last 10 days, managed with 500 mg of paracetamol prescribed by a local doctor. The patient had a history of being diagnosed with drug-sensitive, sputum-positive pulmonary tuberculosis four years ago and had undergone treatment with HRZE (Isoniazid-300 mg, Rifampicin-450 mg, Pyrazinamide-1500 mg, Ethambutol-1200 mg) for a duration of six months.

Abstract Background Although bronchiectasis has been recognised as a feature of some patients with Alpha1-Antitrypsin deficiency the prevalence and characteristics are not widely known. We wished to determine the prevalence of bronchiectasis and patient characteristics. The first cohort of patients recruited to the EARCO (European Alpha1 Research Collaboration) International Registry data base by the end of 2021 was analysed for radiological evidence of both emphysema and bronchiectasis as well as baseline demographic features. Results Of the first 505 patients with the PiZZ genotype entered into the data base 418 (82.8%) had a reported CT scan. There were 77 (18.4%) with a normal scan and 38 (9.1%) with bronchiectasis alone. These 2 groups were predominantly female never smokers and had lung function in the normal range. The remaining 303 (72.5%) ZZ patients all had emphysema on the scan and 113 (27%) had additional evidence of bronchiectasis. Conclusions The data indicates the bronchiectasis alone is a feature of 9.1% of patients with the PiZZ genotype of Alpha1-antitrypsin deficiency but although emphysema is the dominant lung pathology bronchiectasis is also present in 27% of emphysema cases and may require a different treatment strategy.

Objective: To determine the association of diabetes and hypertension with the severity of disease by evaluation through HighResolution Computed Tomography, keeping a Chest CT severity score of 19.5 or greater as a reference for severe disease. Study Design: Cross-sectional study. Place and Duration of Study: Department of Diagnostic Radiology Combined Military Hospital, Okara, Pakistan from Apr 2020 to Mar 2021. Methodology: A total of 60 patients, both male and female, aged 50 years and above, having SARS -C0V-2 infection confirmed through polymerase chain reaction presenting with the severe disease diabetes, hypertension or both as comorbid were selected. Patients' clinical information was taken from medical records from our data collection centre after informed consent from attendants. Results: Forty-five (75%) out of 60 patients presenting clinically with severe COVID–19 pneumonia having diabetes mellitus, hypertension, or both as co-morbids had Chest CT severity score of 19.5 or greater. 15(25%) patients had Chest CT severity scores of less than 19.5. All the patients had bilateral multi-lobe involvement. 54(90%) patients demonstrated typical imaging features, and 14(23.3%) demonstrated atypical ones. Conclusions: Patients aged 50 years and above having diabetes, hypertension or both as comorbid presenting clinically with severe disease developed severe critical COVID-19 pneumonia with Chest CT – severity score of 19.5 or greater having typical imaging features on High-resolution computed tomography.

AbstractBackground The association between pulmonary involvement and microscopic polyangiitis (MPA) has been increasingly recognized in recent years. Whether interstitial lung disease (ILD) and bronchiectasis (BE) are disease manifestations of MPA, preexisting comorbidities or important complications remains unclear. The purpose of this study was to determine the clinical characteristics and prognosis of MPA with pulmonary involvement to further guide clinical management.Methods The data for 97 patients with a definitive diagnosis of MPA were retrospectively reviewed. The MPA diagnosis was based on the 2012 revised Chapel Hill Consensus Conference (CHCC) criteria. The baseline clinical information and laboratory parameters were collected and analysed at each patient’s initial diagnosis.Results Forty-seven out of the 97 (48.5%) patients who were diagnosed with MPA presented with pulmonary involvement, including 37 patients with ILD, 12 patients with BE and two patients with diffuse alveolar haemorrhage (DAH). ILD and BE antedated MPA in 56.76% and 75.00% of the patients, respectively. Compared with that in the MPA-BE group, the serum LDH level (222.86 ± 68.19 vs. 171.58 ± 31.43, p = .016) in the MPA-ILD group was significantly higher. In the multivariate Cox analysis, elevated serum creatinine (HR 4.08, confidence interval (CI) 1.38–12.05, p = .011) was an independent risk factor for shorter survival in MPA patients with pulmonary involvement, and treatment with glucocorticoid pulse cyclophosphamide therapy (HR 0.095, 95% CI 0.019–0.47, p = .004) was independently associated with prolonged survival. Among the patients in the MPA-ILD group, acute exacerbations of ILD (HR 4.55 CI 1.16–17.86, p = .029) and elevated serum creatinine (HR 4.95, CI 1.39–17.54, p = .014) were independently associated with a poor prognosis, and treatment with glucocorticoids (HR 0.057, 95% CI 0.012–0.28, p

Non-cystic fibrosis (non-CF) bronchiectasis has emerged as a significant respiratory disease in developing countries. Given the variation in causes and clinical characteristics across different regions, it is necessary to conduct studies in regions with limited data such as low-middle income countries (LMIC). The aim of the study was to investigate the underlying causes, clinical presentation, etiology, lung function and imaging in patients with bronchiectasis who sought treatment at a tertiary care hospital in a LMIC. We conducted retrospective observational study at the Aga Khan University, Pakistan. Adult patients diagnosed with non-CF bronchiectasis on high-resolution computed tomography scan between 2000 and 2020 were included. We evaluated the etiology, clinical characteristics, microbiology, radiology and spirometric pattern of these patients. A total of 340 patients were included with 56.5% being female and 44.7% aged over 60 years. Among them, 157 (46.2%) had experienced symptoms for 1-5 years. The most common spirometric pattern observed was obstructive impairment (58.1%). Previous tuberculosis (TB) (52.94%) was the most common etiology followed by allergic bronchopulmonary aspergillosis (7.64%). Bilateral lung involvement on HRCT scan was found in 63.2% of patients. Pseudomonas aeruginosa was the most frequently identified organism (38.75%) among 240 patients with available specimens. Patients with P. aeruginosa infections had a significantly higher number of exacerbations (p=0.016). There was a significant difference (p

Bronchiectasis is a common comorbidity in chronic obstructive pulmonary disease (COPD). There are limited data regarding the incidence of bronchiectasis in COPD. The purpose of the study was to use a nationwide database to evaluate the incidence of bronchiectasis in COPD in Taiwan. We used a cohort of 2,000,000 individuals followed from 2005 to 2018. Patients with COPD diagnosed between January 1, 2011, and December 31, 2017, were selected, and those with bronchiectasis before COPD were excluded. In total, 134,366 patients with COPD were enrolled, and propensity score matching was used to ensure homogeneity of baseline characteristics between the COPD and non-COPD groups. The incidence rate of bronchiectasis was higher in the COPD group than in the non-COPD group (87.83 vs 69.80 per 10,000 person-years). The adjusted hazard ratio (1.9; 95% confidence interval 1.75–2.05; P < 0.001) of bronchiectasis indicated that the risk of bronchiectasis was 1.9 times higher for patients with COPD than for patients without COPD. In the COPD group, the age-stratified incidence rates of bronchiectasis increased with age (55.01, 80.92, 101.52, and 105.23 for 40–49, 50–59, 60–69, and over 70 years, respectively). The incidence of bronchiectasis was higher in patients with COPD than in the general population, the risk of bronchiectasis increased with age in COPD, and post-tuberculosis status was an important risk factor for bronchiectasis.

Increased bronchiectasis (BE) prevalence has imposed heavy economic burden on patients and their families, greatly affecting the quality of life of patients. With increased use of patient reported outcome (PRO) in bronchiectasis treatment assessment, researchers not only focus on statistical pre-and post-treatment differences (P

Bronchiectasis is a chronic inflammatory disease of the airway in which one or more proximal bronchi （diameter greater than 2 mm） are irreversibly dilated caused by a variety of causes. Bronchiectasis is mainly caused by infection, and infection can induce bronchiectasis instead, which exert mutual effect. Bacteria have been proven as the major pathogens of infection by multiple studies. Aspergillus colonization is relatively rare in patients with bronchiectasis, whereas the pathogenesis remains elusive. Nevertheless, the incidence of pulmonary aspergillosis has been on the rise in recent years, especially in bronchiectasis patients complicated with infection. In addition, vitamin D level in bronchiectasis patients has been confirmed to be negatively correlated with the severity. However, relevant studies have seldom been reported. In this article, the relationship of bronchiectasis and pulmonary aspergillosis, their diagnosis and treatment were investigated, aiming to provide theoretical evidence for relevant research.

Background/Aims Patients with bronchiectasis often present with respiratory symptoms caused by chronic rhinosinusitis (CRS). However, studies on the prevalence of CRS and its relationship with bronchiectasis are limited. Methods The baseline characteristics of patients with bronchiectasis recruited from the Korean Multicenter Bronchiectasis Audit and Research Collaboration were analyzed. CRS diagnosis was determined by a physician, on the basis of medical records, upper airway symptoms, and/or radiologic abnormalities. Questionnaires for quality of life, fatigue, and depression were administered when patients were stable for a minimum of 4 weeks after the bronchiectasis exacerbation. Results The prevalence of CRS was 7.1% (66/931). Patients with CRS were significantly younger than those without CRS (60.5 ± 10.7 years vs. 64.6 ± 9.3 years, p = 0.001). Idiopathic bronchiectasis was more common in patients with CRS compared to those without CRS (53.0% vs. 36.0%, p = 0.006). Lung function, inflammatory markers, exacerbations, bronchiectasis severity, and scores for quality of life, fatigue, and depression did not differ between the two groups. In a logistic regression analysis, CRS was associated with age of bronchiectasis diagnosis (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.94 to 0.99; p = 0.003) and idiopathic bronchiectasis (OR, 1.95; 95% CI, 1.12 to 3.34; p = 0.018). Conclusions The prevalence of CRS was relatively low. CRS was not associated with the severity or clinical outcomes of bronchiectasis. Early diagnosis and idiopathic etiology were associated with CRS. Our findings reflect the low recognition of CRS in the clinical practice of bronchiectasis and highlight the need for awareness of CRS by adopting objective diagnostic criteria.

Key Clinical Message We reported a case of a 7‐year‐old boy with pulmonary alveolar microlithiasis (PAM) and detected two novel compound heterozygous mutations of solute carrier family 34 member 2 (SLC34A2), EXON:2–6 duplication and c.1218 (EXON:11) C > A (p. Phe406Leu). His symptoms were nonspecific. Chest computed tomography (CCT) showed bronchiectasis, a mosaic feature, and extensive calcifications in both lungs. In addition, bronchoscopy showed bronchitis obliterans which has rarely been reported as a complication in the literature. This case aimed to explore the mechanism of PAM and emphasize the role of gene analysis in diagnosing rare pediatric diseases. Finally, we undertook a review of the current literature containing SLC34A2 gene mutations to update the gene mutation spectrum of PAM.

Abstract: People with bronchiectasis reduce their physical activity (PA) due to muscle weakness, dyspnea, fatigue, reduced exercise capacity and frequent cough with expectoration. Patient-reported and objective physical assessment methods have been used to evaluate PA in people with bronchiectasis. In the literature, significant differences in the PA measured using patient-reported outcome measures when compared with the objective methods. Given the availability of many PA assessment tools, it is tedious for the clinician or researcher to choose an outcome measure for clinical practice or research. The evidence on validity and reliability in bronchiectasis are unclear. Objectives: To identify the PA assessment tools, describe and evaluate the literature on psychometric properties of instruments measuring and analyzing PA. Methods: The search will be conducted in PubMed/Medline, Cochrane Central Register of Controlled Studies, Scopus and EMBASE databases. The keywords, index terms and synonyms of the following words will be used: bronchiectasis, physical activity, and outcome measures. Published studies of adult with clinical and/ or radiologically diagnosed bronchiectasis, aged >18 years, any gender and studies that assessed PA and/or if there are reports on measurement properties of PA will be included in the review. Studies using qualitative research methods, narrative reviews, letters to editors and editorials will be excluded. The quality of the study will be assessed and data will be extracted. Any disagreement will be resolved in the presence of an author not involved in the screening or selecting studies. Discussion: By assessing the quality of studies on measurement properties, this review will help researchers choose the outcome measure to evaluate the effects of interventions on PA. This review will identify the suite of outcome measures of PA for people with bronchiectasis that can be used for research and clinical purpose.

Abstract Objective To compare the morphological features of bronchiectasis between patients with different underlying diseases, we performed quantitative analysis of high-resolution computed tomography (HRCT) images of 14 patients with non-tuberculous mycobacteriosis (NTM) and 13 with idiopathic pulmonary fibrosis (IPF). A 3D image of the bronchial structure was made from HRCT data. Bronchiectasis was defined as abnormal dilatation of the bronchi with the diameter greater than that of the accompanying pulmonary artery. We measured the inner and outer diameters, wall area as %total airway cross sectional area (WA%), and wall thickness to airway diameter ratio (T/D) of the 4-8th generations of bronchi. Results In patients with IPF, the inner and outer diameters linearly decreased toward the distal bronchi. In contrast, the inner and outer diameters of NTM fluctuated. The coefficient of variation of the outer diameters of the 6-7th generations of bronchi was larger in the NTM patients than in those with IPF, whereas no significant difference was observed in the coefficient of variation of the inner diameters between the groups. In IPF patients, WA% and T/D varied between the generation of bronchi, but the coefficient of variation of WA% and T/D was relatively small in those with NTM.

Background and Objective: Hemoptysis is defined as the expectoration of blood from the lower respiratory tract. Bronchiolitis, bronchogenic carcinoma, and bronchiectasis are the most common causes of hemoptysis in developed countries, while infections caused by Mycobacterium tuberculosis are the most common cause in endemic countries. This study was conducted to determine the frequency of causes of hemoptysis and some related factors. Methods: This descriptive-analytical study was done on 68 patients (37 men and 31 women, average age 56.85±17.27 years) who were referred to the Shahid Sayyad Shirazi Hospital in Gorgan, north of Iran during 2014-16 with the complaint of hemoptysis. Demographic information, cause of hemoptysis and history of illness or drug abuse were extracted from the patients’ records. Results: Based on the results, 42.6%, 45.6%, and 17.6% of the patients had a history of smoking, drug abuse, and diabetes, respectively. The most frequent causes of hemoptysis were bronchiectasis (25%), pneumonia (20.6%), tuberculosis, and lung cancer (16.4%). Gender was determined as an independent risk factor for hemoptysis (P

Congenital pulmonary airway malformation (CPAM) is a rare developmental lung malformation. Nowadays, most CPAMs are diagnosed prenatally, allowing optimal prenatal and immediate postnatal care. Rarely, however, CPAM may go undetected in asymptomatic or paucisymptomatic patients, until a complication, most commonly of infectious nature, uncovers the underlying lesion. In this case report, a young teenage boy with a history of recurrent pneumonia presented with clinical worsening following a respiratory infection and subsequent adequate antibiotic intake. Chest radiograph revealed a left heterogeneous hypotransparency, and chest computed tomography scan disclosed exuberant cystic bronchiectasis occupying almost the entire left lower lobe. Further investigation excluded primary immunodeficiency, cystic fibrosis, and mechanical obstruction of the airway. Following the acute infectious phase, the patient underwent a programmed thoracoscopic resection of the lower lobe, that was uneventful. Macroscopic and histological examination confirmed a congenital cystic adenomatoid malformation Stocker type 1. On long-term follow-up, the patient remained asymptomatic, with normal respiratory function tests. Recurrent pneumonia and chronic productive cough should be actively sought in routine visits, and should prompt further investigation, including imaging targeting adequate characterization of the lung parenchyma. Despite the overall good surgical prognosis, whatever the age, early intervention, especially in asymptomatic patients at birth, may decrease surgical morbidity and other late complications related to severe and recurrent infections or even malignancy.

Objective To investigate the relationship between vitamin D deficiency and chronic sinusitis in patients with bronchiectasis. Methods A total of 119 patients with bronchiectasis were selected. Upon admission, serum 25-hydroxyvitamin D （25（OH）D）, serum total IgE and the proportion of eosinophil were detected, and sinus CT scan （Lund-Mackay score） was performed. According to whether the serum 25（OH）D level was less than 20 ng/mL, all patients were divided into the vitamin D deficiency group （< 20 ng/mL） and normal group （≥20 ng/mL）. The incidence of chronic sinusitis in patients with bronchiectasis was statistically compared between two groups. Lund-Mackay score in bronchiectasis patients complicated with sinusitis was compared between two groups. Moreover, the correlation between serum 25（OH）D level and Lund-Mackay score in bronchiectasis patients complicated with sinusitis was analyzed. Results Among 119 patients with bronchiectasis, 69 cases developed vitamin D deficiency and 50 had normal vitamin D levels; 71 of them were complicated with sinusitis, accounting for 59.7%, and 48 patients had no sinus abnormality. Compared with the normal group, the incidence of chronic sinusitis were significantly higher in the vitamin D deficiency group （both P < 0.05）. Among 71 bronchiectasis patients complicated with chronic sinusitis, Lund-Mackay score in the vitamin D deficiency group was considerably higher than that in the normal group （P < 0.05）. In bronchiectasis patients complicated with chronic sinusitis, serum 25（OH）D level was negatively correlated with Lund-Mackay score （P < 0.05）. Conclusion In bronchiectasis patients, vitamin D deficiency is correlated with the incidence and progression of chronic sinusitis.

Abstract Background Pulmonary arteriovenous malformations are mostly caused by congenitally abnormal shunts between pulmonary arteries and pulmonary veins. Case presentation A 74-year-old Japanese woman with a history of bronchiectasis was admitted to our hospital because of dyspnea on exertion. Pulmonary angiography and reconstructed three-dimensional contrast-enhanced computed tomography images showed shunts between pulmonary arteries and pulmonary veins, indicating a diagnosis of pulmonary arteriovenous malformations. Coil embolization of the shunts was successful. Conclusions Our findings imply that bronchiectasis can cause pulmonary arteriovenous malformations, and thus patients who present with hypoxemia with bronchiectasis should be carefully evaluated.

Kartagener’s syndrome is a subset of primary ciliary dyskinesia, an autosomal recessive inherited disease, and is characterized by the triad of chronic sinusitis, bronchiectasis, and situs inversus. This paper reports the case of a 27-year-old female presenting with dyspnea on medium exertion, accompanied by chronic cough, non-productive or with clear expectoration. She had recurrent pneumonia until 15 years of age and underwent a lobectomy in the lower lobe of the left lung, probably due to bronchiectasis. Chest computed tomography showed situs inversus totalis, signs of previous surgical manipulation, and mild bronchial thickening. Computed tomography of the paranasal sinuses showed signs of chronic sinusitis due to a probable ciliary kinesis disorder. These finding suggest the diagnosis of Kartagener’s syndrome. The prognosis reveals a slow rate of decline in lung function. However, repeated or chronic infections can negatively influence the quality of life of these patients.

Abstract Bronchial dilatation is a potentially serious and irreversible clinical and radiological entity. It is an often underdiagnosed condition, particularly in developing countries. This clinical image presents bronchial dilatations of casual discovery associated with radiographic images suggestive of progressive pulmonary tuberculosis. Thoracic imaging remains crucial in the diagnosis of bronchopulmonary diseases.

Background/Aims Although international guidelines for bronchiectasis management have been published in Western countries, there is a lack of data about their application in Asian populations including patients with different phenotypes. We aimed to investigate the current status of bronchiectasis management in Asian populations. Methods A nationwide questionnaire survey was performed of Asian respiratory specialists from South Korea, Japan, Taiwan, Singapore, Vietnam, and Sri Lanka. Participants were invited by e-mail to answer a questionnaire comprising 25 questions based on international guidelines for the management of bronchiectasis. Results A total of 221 physicians participated in the survey. About half of them were Korean (50.2%), with the next most common nationalities being Japanese (23.1%), Taiwanese (13.6%), and Singaporean (7.7%). Only 18 (8.1%) responders had local guidelines for bronchiectasis. While 85 (38.5%) responders checked sputum acid-fast bacillus smear/culture about 1 to 3 times per year, only a small proportion of responders routinely performed a serum immunoglobulin test (36/221, 16.3%) or evaluated for allergic bronchopulmonary aspergillosis (41/221, 18.6%). Less than half (43.4%) of responders performed eradication treatment in patients with drug-sensitive Pseudomonas aeruginosa infection, mainly due to the limited availability of inhaled antibiotics (34.8%). In addition, 58.6% of responders considered physiotherapy such as airway clearance and pulmonary rehabilitation. Conclusions Discrepancies might exist between guideline recommendations and practice for bronchiectasis management in Asian populations, partly due to the limited availability of treatment in each country. The development of local guidelines that consider the phenotypes and situation will help to standardize and improve the management of bronchiectasis.

Abstract We report the first case of Mycobacterium iranicum pulmonary disease in an elderly patient with extensive usual interstitial pneumonia and traction bronchiectasis. He was treated with oral doxycycline, ciprofloxacin, and sulfamethoxazole/trimethoprim daily for 9 months. This was associated with eradication of the microorganism in the sputum and steady weight gain.

Abstract Similar to bronchiectasis, Turner syndrome is possible to have more pathological manifestations or etiologies than what has already been documented. Slower recovery process is expected when treating a patient with several comorbidities like Turner syndrome. Turner syndrome patients are vulnerable and should be extensively monitored to lower late presentation rates.

A 67-year-old man with a history of IgM deficiency and pulmonary fibrosis and bronchiectasis was admitted for management of worsening symptoms. Investigations revealed exudative pleural effusion with rapidly progressive bronchiectasis. Although a potential trigger of bronchiectasis and pulmonary fibrosis was not identified despite extensive work-up by several physicians in the past, a bedside observation of yellow dystrophic nails on all extremities revealed the diagnosis. This case report helps to remind clinicians of a rare medical disorder of still uncertain aetiology and no available cure. This case is consistent with a few previous case reports that suggest a potential association with selective immunoglobulin deficiency.

Common variable immunodeficiency (CVID) is a primary immune deficit (PID) mainly characterized by hypogammaglobulinemia. In addition to increased susceptibility to infections and several immune-mediated manifestations, patients with CVID frequently develop bronchiectasis because of recurrent respiratory infections. This occurrence could be more likely if the diagnosis of CVID is delayed, as it often happens in less resourced clinical settings. A 15-year-old female patient was admitted to a tertiary hospital in Kazakhstan for consultation regarding a previous and established diagnosis of bronchiectasis. The clinical history was characterized by recurrent respiratory infections for several years, in addition to the development of a mixed restrictive-obstructive respiratory syndrome. Therefore, she underwent chest computerized tomography, which confirmed the presence of multiple and bilateral bronchiectasis. The clinical discussion on this patient highlighted that serum immunoglobulins were never measured previously and, thus, their assessment was strongly recommended. Based on that, a diagnosis of CVID was finally achieved, and the patient started the appropriate immunoglobulin replacement therapy. To our knowledge, this report is the first English-language publication on CVID and bronchiectasis from Central Asia. Bronchiectasis is currently an important medical problem in developing countries and populations with low socioeconomic status, where the diagnosis of the underlying cystic fibrosis and non-cystic fibrosis comorbidities can be delayed and more difficult than in countries with more accessible health care systems and facilities. This case report emphasized this important clinical issue in Central Asia and should raise the medical attention and awareness of this health problem, in order to improve the diagnostic timing and rate.

Purpose: We aimed to analyze the cases that we monitored for long term after applying surgical resection. Materials and Methods: Admitted to our clinic between 2005 and 2019, the files of 108 patients (38 male, 70 female, mean age of 23.03 years (18-63)), who visited our clinic, were diagnosed with bronchiectasis and operated on, were retrospectively analyzed. For the monitoring of the patients after surgery, chest radiography, PFT, CBC and CRP follow-up results, and their preoperative complaints (coughing, expectoration, recurrent pulmonary infections) were examined and recorded. While assessing the patients’ status after the surgery, they were categorized as disappearance of the preoperative complaints, decrease in the complaints, and no change in the complaints. Results: 115 surgical operations were carried out on 108 patients. The most frequently encountered complications after surgery were atelectasis and prolonged air leak. Mostly lobectomy was applied as surgery. Postoperative morbidity was seen in 44 patients (41%). Mortality was seen in 5 patients (5%). Complete recovery was observed in 87 patients (81%), while the complaints of 15 patients (14%) were on an acceptable level, and they needed to use antibiotics. The disease relapsed in another lobe in 6 patients (5%). The mean time of monitoring among our patients was 3.71 years (8 months - 12 years). Conclusion: Infections fall into a vicious circle in bronchiectasis patients who are not appropriately treated. The risk factors that require surgery determine morbidity. This cycle may be ended by the surgical resection of the affected tissues.

Bronchiectasis (BE) is a long-term, chronic lung condition featured by widened and scarred airways. These can alter the physiological mucociliary clearance, making it difficult to clear mucus and microorganisms, leading to frequent exacerbations. High flow nasal therapy (HFNT) is a noninvasive respiratory support that delivers heated and humidified gas eventually enriched with oxygen, through a nasal cannula. Humidification is crucial for adequate airways mucociliary clearance, improving ciliary function and consequently reducing airways inflammation and recurrent infections. HFNT has been mostly used in patients with acute hypoxemic respiratory failure and in selected patients with chronic respiratory failure due to COPD. Still, evidence about its use in acute and long-term home setting in patients with clinically relevant BE are lacking. We report a case of severe widespread BE, already on top medical therapy and pulmonary rehabilitation, still suffering from difficult mucus expectoration and recurrent exacerbations, who has been additionally treated with HFNT, both in hospital and domiciliary, reporting significant improvements on relevant clinical and patient-centered outcomes. Thus, HFNT may confer additional benefits as an add-on treatment of patients with severe BE and respiratory failure.

Esophageal lung is a type of Group-II communicating bronchopulmonary foregut malformations (CBPFM) usually diagnosed beyond neonatal period during investigation for recurrent respiratory symptoms and persistent radiographic features suggesting pneumonia or bronchiectasis. In our case, we noticed bronchiectasis and disproportionately severe volume loss in an infant with associated multisystem anomalies in the absence of “significant” lower respiratory tract symptoms. A detailed evaluation with repeat imaging confirmed a Group-II CBPFM, a congenital pathology instead of an infective cause. Pneumonectomy is a more prudent option instead of undertaking major airway reconstruction for the dysplastic “dysfunctional” tissue. Amongst the various associated anomalies reported till now, the associated rib and renal anomalies noted by us have not been described earlier to the best of our knowledge.

Marfan’s syndrome is an autosomal dominant genetic disorder related to a mutation in fibrillin gene type 1 involving mainly the cardiovascular, ocular, skeletal, and pulmonary systems. A 22-year-old female patient presented with cough, blood-stained sputum, and fever for 4 months. The patient was tall and on skeletal examination, high arched palate, arm-span longer than height, positive finger thumb sign, arachnodactyly, asymmetrical chest, and skin striae were present. Family history of Marfan’s syndrome was present. Echocardiography showed large ventricular septal defect with aortic override and severe pulmonary stenosis. CECT thorax showed bronchiectasis changes. Marfan’s syndrome with cardiovascular abnormalities usually has aortic dilatation, aortic regurgitation, aortic aneurysm, mitral valve prolapse, mitral regurgitation, etc. In this case, the patient has Marfan’s syndrome with tetralogy of Fallot (TPF) and bronchiectasis. The association of TOF with Marfan’s syndrome is one of the rarest findings.

Nontuberculous mycobacteria infection is increasing in incidence and can lead to chronic, debilitating pulmonary disease. We investigated the accuracy of diagnosis code–based nontuberculous mycobacteria lung disease claims among Medicare beneficiaries in the United States. We observed that these claims have moderate validity, but given their low sensitivity, incidence might be underestimated.

Abstract Background Both cystic fibrosis (CF) and non-cystic fibrosis bronchiectasis are characterized by permanent bronchial dilation, impaired mucociliary clearance, and development of chronic colonization and infection. Although the major airway microbiota in both CF and non-CF bronchiectasis may be similar, there are some differences in clinical and microbiologic features. There may also be differences in antibiotic susceptibility patterns between the CF and non-CF populations. Therefore, analysis and comparison of the microbiota and antibiotic susceptibility pattern in CF bronchiectasis versus non-CF bronchiectasis would help to improve the management of both conditions. Methods Two authors will independently search the electronic databases PubMed, EMBASE, the Cochrane Library, and LIVIVO, for studies reporting bacterial colonization of the respiratory tract in adults and children diagnosed with bronchiectasis in either CF or non-CF. We will include studies examining any respiratory tract specimen, using conventional bacterial culture or other specialized techniques such as molecular methods. We will also examine the antimicrobial susceptibility patterns in people with CF bronchiectasis versus non-CF bronchiectasis. The authors will independently assess the risk of bias in each included study using the Newcastle Ottawa Scale (NOS). We will present the data with descriptive statistics and provide pooled estimates of outcomes, wherever it is feasible to perform meta-analysis. Heterogeneity in studies will be explored by visual inspection of forest plots as well as using the Higgins and Thompson I 2 method. We will contact the corresponding authors of studies where data is/are missing and try to obtain the missing data. We will undertake sensitivity analysis to explore the impact of study quality and subgroup analysis based on pre-set criteria. We will prepare a summary of findings’ table and assess the confidence in the evidence using the GRADE methodology. Discussion To date, there are no locally applicable evidence-based guidelines for antimicrobial treatment of non-CF bronchiectasis patients. In general, treatment is based on extrapolation of evidence in people with CF bronchiectasis. An insight into the microbiota and antimicrobial susceptibility patterns in the two conditions would facilitate appropriate rather than empiric antimicrobial therapy and hopefully reduce the burden of antimicrobial resistance created by rampant usage of antibiotics. Systematic review registration The protocol has been registered in PROSPERO on July 26, 2020 (PROSPERO registration number: CRD42020193859 ).

AbstractObjectives The impact of Pseudomonas aeruginosa on the prognosis of bronchiectasis remains controversial. This study aimed to explore the prognostic value of P. aeruginosa in adult patients with bronchiectasis in central-southern China.Patients and methods This prospective cohort study enrolled 1,234 patients with bronchiectasis between 2013 and 2019. The independent impact of P. aeruginosa on all-cause mortality, annual exacerbations, and hospitalizations was assessed.Results P. aeruginosa was isolated from 244 patients (19.8%). A total of 188 patients died over a follow-up period of 16 (1–36) months. Patients with P. aeruginosa had a longer disease course, poorer lung function, more lung lobe involvement, and more severe Bronchiectasis Severity Index (BSI) stage than those without P. aeruginosa. The independent impact of P. aeruginosa was observed on frequent hospitalizations but not on mortality and frequent exacerbations. Moderate- or high-risk comorbidities increased the risk of mortality (hazard ratio [HR]: 1.93, 95% confidence interval [CI]: 1.26–2.95), and this effect was magnified by the presence of P. aeruginosa (HR: 2.11, 95% CI: 1.28–3.48).Conclusions P. aeruginosa infection acts as a marker of disease severity as well as predictor of frequent hospitalizations. P. aeruginosa had no independent effect on all-cause mortality. P. aeruginosa combined with moderate- or high-risk comorbidities posed an increased risk of mortality. The management of comorbidities may be a critical target during the treatment of P. aeruginosa infection in bronchiectasis.KEY MESSAGE:P. aeruginosa increased the risk of frequent hospitalizations; however, it had no independent impact on all-cause mortality.P. aeruginosa combined with moderate- or high-risk comorbidities posed an increased risk of mortality.The management of comorbidities may be a critical target during the treatment of P. aeruginosa infection in bronchiectasis.

Abstract Mediastinal shift and chest wall retraction limit the indication of a double lung transplant in patients with complete destruction of lung parenchyma. We report outcomes as well as preoperative and operative management in two patients with significant lung volume reduction and mediastinal shift due to bronchiectasis of the right lung.