Prevention of exacerbations in patients with stable non-cystic fibrosis bronchiectasis: a systematic review and meta-analysis of pharmacological and non-pharmacological therapies

Abd Moain Abu Dabrh, Adam T. Hill, Claudia C. Dobler, Noor Asi, Wigdan H. Farah, Qusay Haydour, Zhen Wang, Khalid Benkhadra, Larry J. Prokop, Mohammad Hassan Murad

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Abstract

BACKGROUND: Several pharmacological and non-pharmacological therapies are used to treat stable bronchiectasis of non-cystic fibrosis (CF) aetiology. OBJECTIVE: We conducted a systematic review and meta-analysis to assess the evidence of the effectiveness of pharmacological and non-pharmacological treatment options in patients with stable non-CF bronchiectasis with a focus on reducing exacerbations. STUDY SELECTION: Multiple databases were searched through September 2017. Outcomes included the number of patients with exacerbation events, mean number of exacerbations, hospitalisations, mortality, quality of life measures, and safety and adverse effects. Meta-analysis was conducted using the random effects model. FINDINGS: 30 randomised controlled trials enrolled subjects with non-CF bronchiectasis using different interventions. Moderate-quality evidence supported the effect of long-term antibiotics (≥3 months) on lowering the number of patients experiencing exacerbation events (relative risk 0.77 (95% CI 0.68 to 0.89)), reducing number of exacerbations (incidence rate ratio 0.62 (95% CI 0.49 to 0.78)), improving forced expiratory volume (litre) in the first second (FEV1) (weighted mean difference (WMD); 0.02 (95% CI 0.00 to 0.04)), decreasing sputum purulence scores (numerical scale of 1-8) (WMD -0.90 (95% CI -1.58 to -0.22)) and improving quality of life scores assessed by the St George's Respiratory Questionnaire (WMD -6.07 (95% CI -10.7 to -1.43)). Bronchospasm increased with inhaled antibiotics while diarrhoea increased particularly with oral macrolide therapy. CONCLUSIONS: Moderate-quality evidence supports long-term antibiotic therapy for preventing exacerbations in stable non-CF bronchiectasis. However, data about the optimum agent, mode of therapy and length of treatment are limited. There is paucity of high-quality evidence to support the management of stable non-CF bronchiectasis including prevention of exacerbations.

Original languageEnglish
Pages (from-to)96-103
Number of pages8
JournalBMJ Evidence-Based Medicine
Volume23
Issue number3
DOIs
Publication statusPublished - 1 Jun 2018
Externally publishedYes

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Bronchiectasis
Meta-Analysis
Fibrosis
Pharmacology
Anti-Bacterial Agents
Therapeutics
Quality of Life
Bronchial Spasm
Macrolides
Forced Expiratory Volume
Sputum
Diarrhea
Hospitalization
Randomized Controlled Trials
Databases
Safety
Mortality
Incidence

Cite this

Abu Dabrh, Abd Moain ; Hill, Adam T. ; Dobler, Claudia C. ; Asi, Noor ; Farah, Wigdan H. ; Haydour, Qusay ; Wang, Zhen ; Benkhadra, Khalid ; Prokop, Larry J. ; Murad, Mohammad Hassan. / Prevention of exacerbations in patients with stable non-cystic fibrosis bronchiectasis : a systematic review and meta-analysis of pharmacological and non-pharmacological therapies. In: BMJ Evidence-Based Medicine. 2018 ; Vol. 23, No. 3. pp. 96-103.
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abstract = "BACKGROUND: Several pharmacological and non-pharmacological therapies are used to treat stable bronchiectasis of non-cystic fibrosis (CF) aetiology. OBJECTIVE: We conducted a systematic review and meta-analysis to assess the evidence of the effectiveness of pharmacological and non-pharmacological treatment options in patients with stable non-CF bronchiectasis with a focus on reducing exacerbations. STUDY SELECTION: Multiple databases were searched through September 2017. Outcomes included the number of patients with exacerbation events, mean number of exacerbations, hospitalisations, mortality, quality of life measures, and safety and adverse effects. Meta-analysis was conducted using the random effects model. FINDINGS: 30 randomised controlled trials enrolled subjects with non-CF bronchiectasis using different interventions. Moderate-quality evidence supported the effect of long-term antibiotics (≥3 months) on lowering the number of patients experiencing exacerbation events (relative risk 0.77 (95{\%} CI 0.68 to 0.89)), reducing number of exacerbations (incidence rate ratio 0.62 (95{\%} CI 0.49 to 0.78)), improving forced expiratory volume (litre) in the first second (FEV1) (weighted mean difference (WMD); 0.02 (95{\%} CI 0.00 to 0.04)), decreasing sputum purulence scores (numerical scale of 1-8) (WMD -0.90 (95{\%} CI -1.58 to -0.22)) and improving quality of life scores assessed by the St George's Respiratory Questionnaire (WMD -6.07 (95{\%} CI -10.7 to -1.43)). Bronchospasm increased with inhaled antibiotics while diarrhoea increased particularly with oral macrolide therapy. CONCLUSIONS: Moderate-quality evidence supports long-term antibiotic therapy for preventing exacerbations in stable non-CF bronchiectasis. However, data about the optimum agent, mode of therapy and length of treatment are limited. There is paucity of high-quality evidence to support the management of stable non-CF bronchiectasis including prevention of exacerbations.",
author = "{Abu Dabrh}, {Abd Moain} and Hill, {Adam T.} and Dobler, {Claudia C.} and Noor Asi and Farah, {Wigdan H.} and Qusay Haydour and Zhen Wang and Khalid Benkhadra and Prokop, {Larry J.} and Murad, {Mohammad Hassan}",
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Prevention of exacerbations in patients with stable non-cystic fibrosis bronchiectasis : a systematic review and meta-analysis of pharmacological and non-pharmacological therapies. / Abu Dabrh, Abd Moain; Hill, Adam T.; Dobler, Claudia C.; Asi, Noor; Farah, Wigdan H.; Haydour, Qusay; Wang, Zhen; Benkhadra, Khalid; Prokop, Larry J.; Murad, Mohammad Hassan.

In: BMJ Evidence-Based Medicine, Vol. 23, No. 3, 01.06.2018, p. 96-103.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Prevention of exacerbations in patients with stable non-cystic fibrosis bronchiectasis

T2 - a systematic review and meta-analysis of pharmacological and non-pharmacological therapies

AU - Abu Dabrh, Abd Moain

AU - Hill, Adam T.

AU - Dobler, Claudia C.

AU - Asi, Noor

AU - Farah, Wigdan H.

AU - Haydour, Qusay

AU - Wang, Zhen

AU - Benkhadra, Khalid

AU - Prokop, Larry J.

AU - Murad, Mohammad Hassan

PY - 2018/6/1

Y1 - 2018/6/1

N2 - BACKGROUND: Several pharmacological and non-pharmacological therapies are used to treat stable bronchiectasis of non-cystic fibrosis (CF) aetiology. OBJECTIVE: We conducted a systematic review and meta-analysis to assess the evidence of the effectiveness of pharmacological and non-pharmacological treatment options in patients with stable non-CF bronchiectasis with a focus on reducing exacerbations. STUDY SELECTION: Multiple databases were searched through September 2017. Outcomes included the number of patients with exacerbation events, mean number of exacerbations, hospitalisations, mortality, quality of life measures, and safety and adverse effects. Meta-analysis was conducted using the random effects model. FINDINGS: 30 randomised controlled trials enrolled subjects with non-CF bronchiectasis using different interventions. Moderate-quality evidence supported the effect of long-term antibiotics (≥3 months) on lowering the number of patients experiencing exacerbation events (relative risk 0.77 (95% CI 0.68 to 0.89)), reducing number of exacerbations (incidence rate ratio 0.62 (95% CI 0.49 to 0.78)), improving forced expiratory volume (litre) in the first second (FEV1) (weighted mean difference (WMD); 0.02 (95% CI 0.00 to 0.04)), decreasing sputum purulence scores (numerical scale of 1-8) (WMD -0.90 (95% CI -1.58 to -0.22)) and improving quality of life scores assessed by the St George's Respiratory Questionnaire (WMD -6.07 (95% CI -10.7 to -1.43)). Bronchospasm increased with inhaled antibiotics while diarrhoea increased particularly with oral macrolide therapy. CONCLUSIONS: Moderate-quality evidence supports long-term antibiotic therapy for preventing exacerbations in stable non-CF bronchiectasis. However, data about the optimum agent, mode of therapy and length of treatment are limited. There is paucity of high-quality evidence to support the management of stable non-CF bronchiectasis including prevention of exacerbations.

AB - BACKGROUND: Several pharmacological and non-pharmacological therapies are used to treat stable bronchiectasis of non-cystic fibrosis (CF) aetiology. OBJECTIVE: We conducted a systematic review and meta-analysis to assess the evidence of the effectiveness of pharmacological and non-pharmacological treatment options in patients with stable non-CF bronchiectasis with a focus on reducing exacerbations. STUDY SELECTION: Multiple databases were searched through September 2017. Outcomes included the number of patients with exacerbation events, mean number of exacerbations, hospitalisations, mortality, quality of life measures, and safety and adverse effects. Meta-analysis was conducted using the random effects model. FINDINGS: 30 randomised controlled trials enrolled subjects with non-CF bronchiectasis using different interventions. Moderate-quality evidence supported the effect of long-term antibiotics (≥3 months) on lowering the number of patients experiencing exacerbation events (relative risk 0.77 (95% CI 0.68 to 0.89)), reducing number of exacerbations (incidence rate ratio 0.62 (95% CI 0.49 to 0.78)), improving forced expiratory volume (litre) in the first second (FEV1) (weighted mean difference (WMD); 0.02 (95% CI 0.00 to 0.04)), decreasing sputum purulence scores (numerical scale of 1-8) (WMD -0.90 (95% CI -1.58 to -0.22)) and improving quality of life scores assessed by the St George's Respiratory Questionnaire (WMD -6.07 (95% CI -10.7 to -1.43)). Bronchospasm increased with inhaled antibiotics while diarrhoea increased particularly with oral macrolide therapy. CONCLUSIONS: Moderate-quality evidence supports long-term antibiotic therapy for preventing exacerbations in stable non-CF bronchiectasis. However, data about the optimum agent, mode of therapy and length of treatment are limited. There is paucity of high-quality evidence to support the management of stable non-CF bronchiectasis including prevention of exacerbations.

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U2 - 10.1136/bmjebm-2018-110893

DO - 10.1136/bmjebm-2018-110893

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SP - 96

EP - 103

JO - Evidence-Based Medicine

JF - Evidence-Based Medicine

SN - 1356-5524

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