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Pseudomonas aeruginosa (PA) in patients with bronchiectasis (BE) is associated with a poor outcome and quality of life, and its presence is considered a marker of disease severity. This opportunistic pathogen is known for its ability to produce biofilms on biotic or abiotic surfaces and to survive environmental stress exerted by antimicrobials, inflammation, and nutrient or oxygen depletion. The presence of PA biofilms has been linked to chronic respiratory infection in cystic fibrosis but not in BE. There is considerable inconsistency in the reported infection/eradication rates of PA and chronic PA. In addition, inadequate antimicrobial treatment may potentiate the progression from intermittent to chronic infection and also the emergence of antibiotic resistance. A better comprehension of the pathophysiology of PA infections and its implications for BE is urgently needed. This can drive improvements in diagnostic accuracy, can move us toward a new consensus definition of chronic infection, can better define the follow-up of patients at risk of PA, and can achieve more successful eradication rates. In addition, the new technological advances regarding molecular diagnostics, -omics, and biomarkers require us to reconsider our traditional concepts.

Background Non-cystic fibrosis bronchiectasis (BE) is a chronic structural lung condition that facilitates chronic colonization by different microorganisms and courses with recurrent respiratory infections and frequent exacerbations. One of the main pathogens involved in BE is Pseudomonas aeruginosa. Objectives To determine the molecular mechanisms of resistance and the molecular epidemiology of P. aeruginosa strains isolated from patients with BE. Methods A total of 43 strains of P. aeruginosa were isolated from the sputum of BE patients. Susceptibility to the following antimicrobials was analysed: ciprofloxacin, meropenem, imipenem, amikacin, tobramycin, aztreonam, piperacillin/tazobactam, ceftazidime, ceftazidime/avibactam, ceftolozane/tazobactam, cefepime and colistin. The resistance mechanisms present in each strain were assessed by PCR, sequencing and quantitative RT–PCR. Molecular epidemiology was determined by MLST. Phylogenetic analysis was carried out using the eBURST algorithm. Results High levels of resistance to ciprofloxacin (44.19%) were found. Mutations in the gyrA, gyrB, parC and parE genes were detected in ciprofloxacin-resistant P. aeruginosa strains. The number of mutated QRDR genes was related to increased MIC. Different β-lactamases were detected: blaOXA50, blaGES-2, blaIMI-2 and blaGIM-1. The aac(3)-Ia, aac(3)-Ic, aac(6″)-Ib and ant(2″)-Ia genes were associated with aminoglycoside-resistant strains. The gene expression analysis showed overproduction of the MexAB-OprM efflux system (46.5%) over the other efflux system. The most frequently detected clones were ST619, ST676, ST532 and ST109. Conclusions Resistance to first-line antimicrobials recommended in BE guidelines could threaten the treatment of BE and the eradication of P. aeruginosa, contributing to chronic infection.

Resumen: La pandemia causada por la enfermedad de la COVID-19 ha supuesto un gran reto para los profesionales del sistema sociosanitario, intensificándose con el manejo y atención de las manifestaciones clínicas que potencialmente pueden presentarse de manera persistente en las personas que han superado la enfermedad. Para ello, la fisioterapia respiratoria se presenta como piedra angular dentro del modelo de abordaje interdisciplinar que requiere esta población. Dado que la implementación de esta opción terapéutica continúa siendo limitada en España, es imprescindible realizar una evaluación integral y exhaustiva de la persona que nos permita establecer criterios de selección a fin de optimizar el uso de los recursos humanos y materiales existentes. Para ello, se propone un algoritmo de decisión terapéutica basado en pruebas de evaluación validadas y objetivas de las posibles manifestaciones clínicas del paciente. La aplicación de este algoritmo, en cualquier nivel asistencial (atención especializada y atención primaria/comunitaria) junto con la atención centrada en la persona, el impulso del uso de los espacios comunitarios verdes y azules de las ciudades y un adecuado uso de las tecnologías de la comunicación y la información, nos permitirá optimizar el modelo de atención de fisioterapia respiratoria en el contexto actual, marcado por la COVID-19. Abstract: The outbreak of COVID-19 has posed a great challenge for the healthcare system which has been later aggravated by the need of managing clinical manifestations and potential sequelae in COVID-19 survivors. In this context, respiratory Physiotherapy emerges as a cornerstone in the interdisciplinary management warranted in this population. Given that the implementation and resources available for the interdisciplinary therapeutic interventions in Spain is scarce, it is essential to perform a comprehensive, exhaustive and personalised assessment. This will allow us to establish more accurate selection criteria in order to optimise the use of existing human and material resources. To this end, we propose here a decision-making algorithm for clinical practice to assess the clinical manifestations in people recovered from COVID-19 based on well-established, validated tests and assessment tools. This algorithm can be used at any clinical practice environment (primary care/community or hospital-based), combined with a patient-centered model and the use of community and e-Health resources and its application to improve the Physiotherapy care of these patients in the COVID-19 era.

Introduction and aim Pseudomonas aeruginosa could acquire a mucoid phenotype due to mutations in mucA (mucoid Pseudomonas aeruginosa - mPA) that is a hallmark of poor prognosis in patients with bronchiectasis. Despite the higher prevalence of Pseudomonas aeruginosa in bronchiectasis, how mPA and non-mucoid Pseudomonas aeruginosa (non-mPA) phenotypes could affect viscoelastic properties of sputum is unknown. Our aim was to determine the relationship between Pseudomonas aeruginosa phenotypes isolation, the viscoelastic properties of sputum and the clinical outcomes in patients with bronchiectasis. Methods A cross-sectional study was conducted of sputum samples obtained by spontaneous expectoration and sent for microbiology and rheology analysis. Elasticity and viscosity were measured at two oscillatory frequencies (1 and 100 rad/s). Socio-demographic and clinical data were recorded. Results We analyzed 17 patients with mPA, 14 with non-mPA and 17 with no organism reported (NOR). Compared with the NOR group, the mPA group showed higher elasticity (median 10.30 vs. 5.70, p = 0.023), viscosity (2.40 vs. 1.50, p = 0.039), and stiffness (10.70 vs. 6.00, p = 0.024). Values in the mPA group tended to be higher compared with non-mPA. Clinically, the mPA group showed greater hospitalizations during the previous year and greater affected lobes than the non-mPA and NOR groups. Conclusions The mPA phenotype is associated with increased elasticity, viscosity and stiffness of bronchiectatic sputum. Viscoelastic properties could be used as a marker of poor mucociliary clearance in mPA, with potentially important clinical implications.

Background: Low physical activity and high sedentary behaviour in patients with bronchiectasis are associated with hospitalisation over one year. However, the factors associated with longitudinal changes in physical activity and sedentary behaviour have not been explored. We aimed to identify clinical and sociodemographic characteristics related to a change in physical activity and sedentary behaviour in patients with bronchiectasis after one year. Methods: This was a prospective observational study during which physical activity measurements were recorded using a SenseWear Armband for one week at baseline and at one year. At each assessment point, patients were classified as active or inactive (measured as steps per day) and as sedentary or not sedentary (measured as sedentary time). Results: 53 patients with bronchiectasis were analysed, and after one year, 18 (34%) had worse activity and sedentary levels. Specifically, 10 patients became inactive and sedentary. Multivariable analysis showed that the number of exacerbations during the follow-up period was the only outcome independently associated with change to higher inactivity and sedentary behaviour (odds ratio (OR), 2.19, 95% CI, 1.12 to 4.28). Conclusions: The number of exacerbations in patients with bronchiectasis was associated with changes in physical activity and sedentary behaviour. Exacerbation prevention may appear as a key factor in relation to physical activity and sedentary behaviour in patients with bronchiectasis.

Background Population-based and retrospective studies have shown that risk for cardiovascular events such as arrythmias, ischemic episodes or heart failure, increase during and after bronchiectasis exacerbations. Research Question What are the risk factors for cardiovascular events (CVE) during and after bronchiectasis exacerbations and its impact on mortality? Study Design and Methods This was a post-hoc retrospective analysis of a prospective observational study of 250 patients with bronchiectasis at two tertiary care hospitals. Only the first exacerbation was considered for each patient, collecting demographic, comorbidity, and severity data. The main outcomes were the appearance of CVE and mortality. Risk factors for CVE were analyzed using a semi-competing risks model. Results During a median follow-up of 35 months, 74 (29.6%) patients had a CVE and 93 (37.2%) died. Semi-competing risks analysis indicated that age, arterial hypertension, chronic obstructive pulmonary disease, and potentially the severe exacerbations significantly increased the risk for developing CVE. Compared to patients without CVE, those with CVE had higher mortality. Interpretation. Demographic factors and comorbidities are risk factors for the development of CVE after an acute exacerbation of bronchiectasis. The appearance of CVE worsens long-term prognosis.

Los sistemas de hardware son cada vez más complejos y difíciles de validar, a la vez que la validación para asegurar su correcto funcionamiento resulta muy costosa, entre el 50 y 70% del costo de los proyectos es dedicado para validación; y las fallas que se escapen pueden resultar también muy costosas. Es por esta razón que se deben buscar áreas de oportunidad para mejorar el proceso, resulte más eficiente y menos costoso. En este trabajo se busca automatizar la generación de casos de prueba a partir del análisis de los requerimientos funcionales con el propósito de reducir el tiempo de generación de estos casos de prueba y así reducir los costos. Para este fin se utiliza una plataforma que analiza los requerimientos y luego genera los casos de prueba con la información obtenida del análisis. Esta plataforma está conformada por dos módulos: un analizador de requerimientos y un generador de casos de prueba. El módulo analizador está siendo reusado del sistema TCG_UML (Espejel Salazar, 2019), este módulo requiere de una gramática para habilitar el análisis. Esta gramática fue desarrollada para habilitar el análisis sintáctico y semántico de los requerimientos. El módulo generador de casos de prueba se implementó para que trabajara en conjunto con el módulo analizador, este recibe el árbol sintáctico que el analizador genera y a partir de ahí construye los casos de prueba necesarios para garantizar que los requerimientos son correctamente validados. Al automatizar la generación de casos de prueba se logró llegar al resultado esperado, se redujo el tiempo de generación de los casos de prueba y los costos de validación en un 8%. Hardware systems are getting more complex and harder to validate, and at the same time, validation to guarantee its correct functionality is very expensive, it is between 50% and 70% the total cost of the project. Also, the not found bugs could be very expensive. This is the reason to try to find opportunities to enhance the validation process and make it more efficient and less expensive. In this project the objective is to automate the test cases generation activity from functional requirements analysis to reduce the time and cost. For this purpose, it is used a platform that analyses the requirements and then it generates the tests cases with the information produced from the analysis. This platform is comprised of two modules: the requirements analyzer and a test cases generator. The analyzer module is taken from TCG_UML (Espejel Salazar, 2019), this module requires a grammar to enable the analysis. This grammar was developed to enable the syntactic and semantic analysis. The test cases generator module was developed to work in conjunction with the analyzer module, it receives the syntactic tree that the analyzer module generates, and it generates the test cases from it to guarantee that the requirements are correctly validated. Test cases automation achieved the expected result, the time needed for tests cases generation and the cost was reduced by 8%.

Introduction: Population-based and retrospective studies suggest an increased cardiovascular risk in bronchiectasis, although there is a lack of prospective studies. Aims and Objectives: The aim of this study was to prospectively characterize the frequency and type of new cardiovascular events (CVE), and to identify clinical risk factors for CVE in patients with bronchiectasis after an exacerbation diagnosis. Methods: Observational, prospective study of patients with bronchiectasis enrolled in two tertiary-care hospitals. Only the first exacerbation per patient after enrollment was considered. Variables including demographics, comorbidities, microbiology, and severity were recorded and evaluated. CVE incidence was evaluated as main outcome. Multiple imputations with Bayesian models were performed for the statistical analysis. Results: We included 250 exacerbations. The median follow-up was 35 (22-64) months. A total of 74 (29.6%) patients had a CVE and 93 (37.2%) died during the study period. Through a Bayesian approach, the analysis showed that some characteristics were likely to be associated with an increased risk of CVE, with the following probability: age 99.9%, previous vascular disease 99%, arterial hypertension 98%, renal disease 89%, chronic obstructive pulmonary disease 99%, and diabetes mellitus 83.6%. Severe exacerbations were also likely to be associated with an increased probability risk of CVE of 91.6%. Conclusions: Severity of exacerbations and host comorbid conditions are useful for CVE risk evaluation after bronchiectasis exacerbations.

Introduction: Non-cystic fibrosis bronchiectasis (NCFB) is considered a chronic heterogenic pulmonary disease, characterized by the permanent and abnormal enlargement and thickening of bronchial walls, impaired mucociliary clearance, and suppuration. Inhaled antibiotics have been used for a long time in patients with cystic fibrosis but are seldom used in those with NCFB and few randomized clinical trials are available in this population.Areas covered: This review summarizes current clinical evidence of efficacy, adverse events, and future directions of inhaled antibiotics in NCFB.Expert commentary: Inhaled antibiotics are theoretically a promising therapeutic option for patients with NCFB, owing to the achieved high pulmonary concentrations and the irrelevant systemic adverse effects. In the era of multidrug resistance, we call for comprehensive clinical trials in this field to corroborate the merits of inhaled antibiotics in NCFB patients.

BACKGROUND: Despite the widespread use of sputum weight to assess the effect of airway clearance interventions, its psychometric properties have not been evaluated. The purpose of this ad hoc analysis was to determine the test-retest reliability of 24-h sputum weight in clinically stable individuals with bronchiectasis. This study also aimed to estimate the minimum important difference of 24-h sputum weight after an airway clearance session in subjects with bronchiectasis. METHODS: Sixty subjects were included in the 24-h test-retest cohort, 42 of whom were part of the airway clearance cohort. For the 24-h test-retest cohort, spontaneously expectorated sputum was collected over 24 h on 2 different days without any airway clearance interventions. For the airway clearance cohort, sputum expectoration was also collected during 3 airway clearance sessions and over the 24 h following these interventions. Intraclass correlation coefficient (ICC3,1) and Bland-Altman analysis were used to assess reliability. The minimum important difference was calculated using distribution-based and anchor-based methods, with cough impact as assessed with the Leicester Cough Questionnaire and the global rating of change as anchors. RESULTS: The reliability was acceptable (ICC3,1 = 0.75) for sputum weight over 24 h without any intervention. The agreement level was wide, particularly for high levels of sputum expectoration. The minimum important difference of the sputum collected in the 24 h after the intervention from baseline was −6.4 g (about −17%), determined using distribution-based methods. There was no correlation between sputum weight and the anchors, thus the anchor-based methodology could not be used. CONCLUSIONS: Multiple measurements should be considered to increase the agreement when sputum weight is used as an outcome measure for short periods in people with bronchiectasis. A reduction of 6.4 g (or 17% from baseline) in sputum collected during the 24 h after the airway clearance intervention may be considered the minimum important difference in people with bronchiectasis. (ClinicalTrials.gov registration NCT02392663; NCT01854788; NCT02614300.)

Background In adult patients with bronchiectasis (BE) the identification of the underlying aetiology may be difficult. In a new patient with BE the performance of a panel of tests is recommended, even though this practice may be expensive and the level of evidence supporting is low. We aimed to identify a panel of variables able to predict the aetiological diagnosis of BE. Methods Our prospective study derived from our real-life experience on the management of adult stable BE outpatients. We recorded variables concerning clinical, radiological, microbiological and laboratory features. We identified five groups of aetiological diagnosis of BE (idiopathic, post-infective, COPD, asthma and non-common diseases [immunodeficiency or other rare conditions]). Multivariate models were used to identify predictors of each aetiological diagnosis. The suitability of performing a specific test for the diagnosis was also considered. Results We enrolled 354 patients with a new diagnosis of BE. Patients with different aetiological causes differed significantly with regard to age, sex, smoking habit, comorbidities, dyspnoea perception, airflow obstruction and severity scores. Various predictors were assessed, including sex, previous respiratory infections, diffuse localization of BE, risk scores, and laboratory variables (sodium and eosinophils). The levels of autoantibodies or immunoglobulins were reserved for the diagnosis of non-common disease. Conclusion Our research confirms that some predictors are specific for the aetiological diagnosis of BE. The possibility of integrating this information may represent a useful tool for the diagnosis. The execution of certain specific tests should be reserved for patients with a non-common disease.

Bronchiectasis is a chronic structural disease associated with exacerbations that provoke systemic inflammation. We aimed to evaluate the systemic acute proinflammatory cytokine and its biomarker profiles during and after exacerbations and its relationship with the severity of episode, microbiological findings, and the bronchiectasis severity index. This prospective observational study compared exacerbation and stable groups. Cytokine (interleukins (IL)-17a, IL-1&beta, IL-6, IL 8, tumor necrosis factor-alpha (&alpha, )) and high-sensitivity C-reactive protein (hsCRP) levels were determined by multiplex analysis on days 1, 5, 30, and 60 in the exacerbation group and on day 1 in the stable group. We recruited 165 patients with exacerbations, of which 93 were severe (hospitalized). Proinflammatory systemic IL-17a, IL-1&beta, IL-8, and tumor necrosis factor-&alpha, levels increased similarly on days 1 and 5 in severe and non-severe episodes, but on day 30, IL-17a, IL-8, and IL-6 levels were only increased for severe exacerbations. The highest IL-17a level occurred in patients with chronic plus the acute isolation of Pseudomonas aeruginosa. At 30 days, severe exacerbations were independently associated with higher levels of IL-17 (Odds ratio (OR) 4.58), IL-6 (OR 4.89), IL-8 (OR 3.08), and hsCRP (OR 6.7), adjusted for age, the bronchiectasis severity index, and treatment duration. Exacerbations in patients with chronic P. aeruginosa infection were associated with an increase in IL-17 and IL-6 at 30 days (ORs 7.47 and 3.44, respectively). Severe exacerbations elicit a higher systemic proinflammatory response that is sustained to day 30. Patients with chronic P. aeruginosa infection had impaired IL-17a reduction. IL-17a could be a useful target for measuring systemic inflammation.

BackgroundPatients with bronchiectasis have a less active lifestyle than healthy peers, but the association with hospital admission has not been explored. The aim of this study was to investigate the association between 1) any physical activity variable; and 2) sedentary time, with hospitalisation due to exacerbation in adults with bronchiectasis.MethodsIn this prospective observational study, baseline lung function, quality of life, exercise tolerance, severity of bronchiectasis and physical activity were recorded. Physical activity was objectively assessed over a week using a SenseWear armband and the results were expressed in steps·day–1 and sedentary time. Number of hospitalisations due to a bronchiectasis exacerbation and time to first event were recorded after 1-year follow-up.ResultsSixty-four patients with bronchiectasis were analysed, of whom 15 (23%) were hospitalised during the follow-up. Hospitalised patients showed poor baseline clinical and severity outcomes, fewer steps walked per day and more sedentary behaviour than the non-hospitalised group. Patients who walked ≤6290 steps·day–1 or spent ≥7.8 h·day–1 in sedentary behaviour had an increased risk of hospital admission due to bronchiectasis exacerbation at 1-year follow-up. Specifically, ≥7.8 h·day–1 of sedentary behaviour was associated with a 5.9-fold higher risk of hospital admission in the following year.ConclusionsLow levels of physical activity and high sedentary time at baseline were associated with a higher risk of hospitalisation due to bronchiectasis exacerbation. If these findings are validated in future studies, it might be appropriate to include physical activity and sedentary behaviour as an item in severity scores.

Introduction: Exacerbations of non-cystic fibrosis bronchiectasis (BE) are associated with increased systemic inflammation. Studies support an important role for neutrophils and cell-mediated immunity in the pathophysiology of BE, but the role of other inflammatory cells is less clear. Aims and Objectives: The aims of our study were: to describe changes in markers of inflammation during an exacerbation of BE and in a stable state; to investigate their relationship with clinical outcomes. Methods: A prospective bicentric observational study was performed in adult exacerbated BE patients*. Blood samples were taken for measurement of inflammatory markers at days 1 and 5 of the exacerbation and at day 30 after the exacerbation (stable state). Results: We measured the systemic levels of markers of 261 exacerbated BE patients (115 males, 72 [63; 78] years) (Table 1). Twenty-three (8.8%) patients died during the 1-year follow up and they showed significant different markers levels at days 5 and 30 (Table 2). Conclusions: CRP, WBC, neutrophils and NLR are measurable markers of inflammation that could be useful to predict the mortality in BE. *Hill AT et al. Eur. Respir. J (2017)

A delay in heart rate recovery (HRR) after an exercise test is a factor associated with morbidity and mortality in some cardiovascular and pulmonary diseases. However, HRR has not been evaluated yet in people with bronchiectasis Aim: To describe the HRR after the 6-min walk test (6MWT) and explore possible predictors of an abnormal HRR in people with bronchiectasis Methods: Stable adult patients with bronchiectasis were recruited in a two-centre study. Clinical data were collected and 6MWT was performed according to the international guidelines. HRR1 was defined as the change between the HR at the end of the 6MWT and 1 minute after the 6MWT and chronotropic response (CR) was calculated as the peak HR minus resting HR. Univariate and multivariate linear regression models were performed to analyse the possible relationship between HRR1 and clinical determinants. Results: 103 participants were evaluated (65±14 years; respectively 27%, 42% and 31% were classified as mild, moderate and severe using the Bronchiectasis Severity Index; distance walked during 6MWT was 508±96 metres). HRR1 showed weak-moderate correlations with the physical and emotional domain of quality of life, cough severity, 6MWT distance, and CR (Fig1). Multivariable linear regression analysis revealed that CR was the only independent factor of HRR1 (Fig1). Conclusion: CR was the only independent factor of HRR1 after 6MWT in people with bronchiectasis.

Background: Platelets have a recognized role in cardiovascular risk. In recent years, its involvement in the immunoinflammatory response has also been demonstrated. However, there is no data on its role in a chronic inflammatory disease such as non-cystic fibrosis bronchiectasis. Aims: We aimed to study a soluble marker of platelet activation and its relationship with severity in bronchiectasis. Methods: We conducted a prospective study in two tertiary care hospitals in Spain with BE patients in stable phase. Peripheral blood samples were obtained from patients and healthy controls. Platelet activation was evaluated through enzyme-linked immunosorbent assay measuring soluble P-selectin (sP-selectin), a recognized marker of platelet activation resulting from the scission of the platelet membrane receptor P-selectin (CD62 +). For severity assessment Bronchiectasis Severity Index (BSI) was measured. Results: We included 73 patients with stable bronchiectasis and 26 healthy controls. Increased levels of sP-selectin were found in bronchiectasis compared to healthy controls (p Conclusion: Patients with stable bronchiectasis present increased platelet activation compared to healthy controls. Platelet activation correlates with disease severity. The clinical consequences of these findings are to elucidate.

Objective To compare the efficacy of three slow expiratory airway clearance techniques (ACTs). Design Randomised crossover trial. Setting Tertiary hospital. Participants Thirty-one outpatients with bronchiectasis and chronic sputum expectoration. Interventions Autogenic drainage (AD), slow expiration with glottis opened in lateral posture (ELTGOL), and temporary positive expiratory pressure (TPEP). Main outcomes Sputum expectoration during each session (primary endpoint) and in the 24-hour period after each session. Leicester Cough Questionnaire (LCQ) score and spirometry results were recorded at the beginning and after each week of treatment. Data were summarised as median difference [95% confidence interval (CI)]. Results Median (interquartile range) daily expectoration at baseline was 21.1 (15.3 to 35.6)g. During physiotherapy sessions, AD and ELTGOL expectorated more sputum than TPEP [AD vs TPEP 3.1g (95% CI 1.5 to 4.8); ELTGOL vs TPEP 3.6g (95% CI 2.8 to 7.1)], while overall expectoration in the 24-hour period after each session was similar for all techniques ( P =0.8). Sputum clearance at 24hours post-intervention was lower than baseline assessment for all techniques [AD vs baseline −10.0g (95% CI −15.0 to −6.8); ELTGOL vs baseline −9.2g (95% CI −14.2 to −7.9); TPEP vs baseline −6.0g (95% CI −12.0 to −6.1)]. The LCQ score increased with all techniques (AD 0.5, 95% CI 0.1 to 0.5; ELTGOL 0.9, 95% CI 0.5 to 2.1; TPEP 0.4, 95% CI 0.1 to 1.2), being similar for all ACTs ( P =0.6). No changes in lung function were observed. Conclusions Slow expiratory ACTs enhance mucus clearance during treatment sessions, and reduce expectoration for the rest of the day in patients with bronchiectasis. Clinical Trial Registration Number NCT01854788.

Background: The role of hyaluronic acid plus hypertonic saline (HA+HS) as a mucoactive treatment in patients with bronchiectasis is still unknown. This study evaluated whether HA+HS solution enhances similar sputum quantity with better safety profile than HS alone in patients with bronchiectasis. Methods: In this double-blind randomized crossover trial, three solutions (7% HS; 0.1% HA +7%HS; and 0.9% isotonic saline, IS) were compared in outpatients with bronchiectasis and chronic sputum expectoration. Participants inhaled each solution across four consecutive sessions. All sessions, except on session 3, also included 30 minutes of airway clearance technique. A 7-day washout period was applied. Sputum weight was collected during the sessions (primary outcome) as well as during a 24-hour follow-up. The Leicester Cough Questionnaire (LCQ) and lung function were measured before/after each treatment arm. Safety was assessed by the monitoring of adverse events (AEs). Results: Twenty-eight patients with bronchiectasis (mean age of 64.0 (17.9) and FEV1% 60.9 (24.6) of predicted) were recruited. HS and HA+HS promoted similar expectoration during sessions, both being greater than IS [median difference HS vs. IS 3.7 g (95% CI 0.5-6.9); HA+HS vs. IS 3.2 g (95%CI 0.5-5.9)]. Sputum expectorated exclusively during the ACT period was similar across all treatment arms [HS vs. IS −0.3 g (95% CI −1.7 to 0.9); HA+HS vs. IS 0.0 g (95% CI −1.3 to 1.4); HS vs. HA+HS 0.0 g (95% CI −1.2 to 0.4)]. Sputum collected over the 24-hour follow-up tended to be lower for HS and HA+HS compared with IS [HS vs. IS −1.7 g (95% CI −4.2 to 0.0); HA+HS vs. IS −1.1 g (95%CI −3.6 to 0.7)]. No differences in LCQ or lung function were observed. Most severe AEs were reported using HS. Conclusion: HS and HA+HS were more effective on sputum expectoration than IS in patients with bronchiectasis, reporting HA+HS better safety profile than HS.

Objectives: Despite the clinical relevance of exacerbations in bronchiectasis (BE), little is known about the microbiology and outcomes of pneumonic (CAP) vs. non-pneumonic (NOCAP) exacerbations. Methods: This study compares clinical and microbiological characteristics of CAP vs. NOCAP in adults with BE. We performed a multicenter prospective observational study of consecutive cases of NOCAP and CAP from four Spanish hospitals (2011-2015). Results: We recruited 144 patients, 47 of them CAP (33%) cases. CAP patients were older, with a larger representation of males, more comorbidities, higher arterial hypertension and COPD but less chronic bronchial infection and previous history of exacerbations. Clinical presentation was similar, excepting creatinine, C-reactive protein (C-RP), glucose and leukocytes which were higher in CAP. C-RP of 8.38 mg/dL showed a significant predictive discrimination for CAP. Streptococcus pneumoniae and Pseudomonas aeruginosa were the first causes of CAP and NOCAP, respectively. The rate of microbiological concordance with previous chronic bronchial infection was variable. Main clinical outcomes (mortality, length of stay, etc.) were similar in the two groups. Chronic bronchial infection and history of frequent exacerbations (>= 2/year) were associated with a reduced risk of CAP. Conclusions: CAP and NOCAP in BE had similar clinical presentation with the exception of fever, leukocytosis, and C-RP. Microbiology also differed. A cut-off value of C-RP >= 8.83 mg/dL can predict CAP in bronchiectasis. (C) 2018 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

There is limited information on physical activity (PA) in adult patients with bronchiectasis. Aim: To determine PA levels in patients with bronchiectasis and to evaluate its association with clinical characteristics. Methods: An observational study was conducted in stable adult patients with bronchiectasis. PA was evaluated with an accelerometer (SenseWear armband) during one week and the International Physical Activity Questionnaire (IPAQ). Sociodemographic and clinical data, severity of bronchiectasis, exercise capacity, quality of life, lung function, were also assessed. Results: Table 1 shows the sociodemographic and clinical characteristics of 36 bronchiectasis patients. Mean (SD) time spent in moderate-to-vigorous PA intensity was 146 (108) and 258 (24) min with accelerometer and IPAQ respectively, (p Conclusions: IPAQ showed to be less reliable than accelerometry in assessing PA in bronchiectasis. Inactive bronchiectatic patients were characterized with more COPD and chronic infection by P. aeruginosa, higher dyspnea and lower exercise capacity and quality of life, in comparison with active group. The determinants and patterns of PA should be further investigated in bronchiectasis in order to optimize rehabilitation programs and behavioral interventions to increase PA.

Background: Bronchiectasis exacerbations are often treated with prolonged antibiotic use, even though there is limited evidence for this approach. We therefore aimed to investigate the baseline clinical and microbiological findings associated with long courses of antibiotic treatment in exacerbated bronchiectasis patients. Methods: This was a bi-centric prospective observational study of bronchiectasis exacerbated adults. We compared groups receiving short (&le, 14 days) and long (15&ndash, 21 days) courses of antibiotic treatment. Results: We enrolled 191 patients (mean age 72 (63, 79) years, 108 (56.5%) females), of whom 132 (69%) and 59 (31%) received short and long courses of antibiotics, respectively. Multivariable logistic regression of the baseline variables showed that long-term oxygen therapy (LTOT), moderate&ndash, severe exacerbations, and microbiological isolation of Pseudomonas aeruginosa were associated with long courses of antibiotic therapy. When we excluded patients with a diagnosis of community-acquired pneumonia (n = 49), in the model we found that an etiology of P. aeruginosa remained as factor associated with longer antibiotic treatment, with a moderate and a severe FACED score and the presence of arrhythmia as comorbidity at baseline. Conclusions: Decisions about the duration of antibiotic therapy should be guided by clinical and microbiological assessments of patients with infective exacerbations.

Bronchiectasis (BE) is a chronic and heterogeneous respiratory disease that requires a multidimensional scoring system to properly assess severity. The aim of this study was to compare the severity stratification by 2 validated scores (BSI and FACED) in a BE cohort and to determine their predictive capacity for exacerbations and hospitalizations. Moreover, we proposed a modified version of FACED which was created to better predict the risk of exacerbations in clinical practice. We performed a prospective cohort study including BE patients > 18 years old with a follow-up period of 1-year. One-hundred eighty-two patients (40% males; mean age 68) were studied. Patients were stratified according to the number of exacerbations during the follow-up, and according to BSI and FACED scores. BSI classified most of our patients as severe 99 (54.4%) or moderate 47 (25.8%), while FACED mainly classified as mild 108 (59.3%) or moderate 61 (33.5%). BSI and FACED showed an area under ROC curve (AUC) for exacerbations of 0.808 and 0.734; and for hospitalizations (due to BE exacerbations) of 0.893 and 0.809, respectively. Subsequently, we modified FACED by adding previous exacerbations (Exa-FACED) and this new score classified patients as mild 48.4%, moderate 34.6% and severe 17.0%, with an improved AUC for exacerbations (0.760) and hospitalizations (0.820). Despite previous validations of BSI and FACED, they classified our patients very differently. As expected, FACED showed poor prognostic capacity for exacerbations. We support the Exa-FACED score to predict the risk future exacerbations for been easy to use in clinical practice.