Year in review 2016: Respiratory infections, acute respiratory distress syndrome, pleural diseases, lung cancer and interventional pulmonology (original) (raw)

2017, Respirology (Carlton, Vic.)

Respirology has made important contributions related to respiratory infections over the past year. In this review, we focus on bronchiectasis, pneumonia, tuberculosis and non-tuberculous mycobacteria infections as the most relevant topics in the area of respiratory diseases. 1.1. Bronchiectasis Park et al. reported a study of 155 patients with bronchiectasis to identify the predictors of radiological progression of the disease. 1 Treatment in bronchiectasis aims to reduce inflammation and airway infection to prevent further lung damage. 2 Therefore identifying the drivers of poor outcome is important. In this analysis, older patients, those with lower body mass index (BMI) and patients infected with Pseudomonas aeruginosa or non-tuberculous mycobacteria (NTM) were more likely to show radiological progression, measured using the Bhalla score. 1 In multivariable analysis, only P. aeruginosa and BMI were statistically significant. The results are supported by existing literature. P. aeruginosa colonisation and BMI are both incorporated into the bronchiectasis severity index, a validated prediction tool, and P. aeruginosa in particular is strongly associated with other indicators of progression such as quality of life, forced expiratory volume in one second (FEV1), exacerbation frequency and mortality. 3,4 However, the most important step in the treatment of bronchiectasis is identifying the underlying cause, since many causes such as NTM infection, rheumatoid arthritis, primary ciliary dyskinesia, immunodeficiency or allergic bronchopulmonary aspergillosis require specific treatments. 5,6 Gao et al. 7 conducted a systematic review into the underlying causes of bronchiectasis identified in 56 studies (N=8608). 7 The study was limited by the high variability in testing across different studies, and the variable definitions used, but was able to suggest that 18.3% of bronchiectasis patients have an aetiology with a specific treatment. 7