RICERCA ITALIANA     

BRONCHIECTASIS IN COPD PATIENTS : PREVALENCE AND BACTERIAL COLONIZATION.

Università degli Studi di Milano

Abstract

Bronchiectasis is a chronic pulmonary disease characterized by an irreversible dilatation of the bronchi. The current view of the pathogenesis of bronchiectasis considers initial colonization of the lower respiratory tract by different microorganisms as the first step leading to an inflammatory response characterized by neutrophil migration within the airways and secondary secretion of a variety of tissue-damaging oxidants and enzymes such as neutrophil elastase and myeloperoxidase. Persistence of microorganisms in the airways because of impairment in mucus clearance may lead to a vicious circle of events characterized by chronic bacterial colonization, persistent inflammatory reaction, and progressive tissue damage.
The exact prevalence of bronchiectasis in COPD patients is not known. It would be important to assess the prevalence, the kind of bronchiectasis and the bacterial colonisation. These are all important features that can be related to the natural history of COPD and to the therapeutic management of patient with COPD and bronchiectasis. Recent data indicate that macrolide long-term treatment and inhaled steroids therapy are both associated with a reduced rate of exacerbation, bronchial colonization and inflammation
The present study will address, on a relatively large number of patients, the prevalence of bronchiectasis in COPD subjects using a multislice CT scan technique applied in all the units and centrally analysed by Unit 2 and 4. This analysis >>>

Principal Investigator

Francesco BLASI Università degli Studi di MILANO

Research Objectives

The research programm aims are the following:
-definition of bronchiectasis prevalence in patients affected by chronic obstructive pulmonary disease. Only few data on this issue are present in the literature .
-After bronchiectasis patients identification, we will evaluate the pathophysiologic implications, and microbiologic and inflammatory features of this subgroup in comparison to non-bronchiectasis patients.
-The interventional phase of the research will address the effects of long-term treatments with inhaled steroids and antibiotic on the natural history of the disease and their pathophysiologic implications.

Timescale

24 months

National and international background

Bronchiectasis is a chronic pulmonary disease characterized by an irreversible dilatation of the bronchi. The current view of the pathogenesis of bronchiectasis considers initial colonization of the lower respiratory tract by different microorganisms as the first step leading to an inflammatory response characterized by neutrophil migration within the airways and secondary secretion of a variety of tissue-damaging oxidants and enzymes such as neutrophil elastase and myeloperoxidase (1). Persistence of microorganisms in the airways because of impairment in mucus clearance may lead to a vicious circle of events characterized by chronic bacterial colonization, persistent inflammatory reaction, and progressive tissue damage.
Chronic obstructive pulmonary disease or COPD is characterised by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lung. The natural history of COPD is punctuated by acute exacerbations. COPD is a highly prevalent condition which generates a major consumption of resources. A large part of these resources goes to the treatment of exacerbations, which have also been shown to have a negative impact on the course of the disease and on mortality in these patients (2).
Although not all exacerbations are bacterial in origin, bacterial exacerbations are associated with the highest inflammatory response in the bronchi (3). Recurrent >>>