Bronchoscopic Airway Clearance Therapy For Acute Exacerbations Of Bronchiectasis

Background: Persistent cough and large amounts of purulent sputum affects many bronchiectasis patients. No studies have evaluated the efficacy and safety of bronchoscopic airway clearance therapy and bronchoalveolar lavage (B-ACT) for non-cystic fibrosis bronchiectasis patients with acute exacerbation.Methods: A randomised controlled trial was conducted to explore the efficacy and safety of B-ACT among 189 bronchiectasis inpatients from February 1, 2018 to February 28, 2019. The primary outcome was the time to first acute exacerbation. Secondary outcomes included changes of health-related scores, length of hospital stay, hospitalization expenses and incidences of adverse events.Findings: B-ACT therapy significantly prolonged the median days to first acute exacerbation when compared with control group (198 vs 168 days, HR 0.555 (0.322-0.958), p=0.012; effect size(r)= 0.94). Further analysis showed that B-ACT therapy was more beneficial for these patients with severe disease and greater symptoms. COPD Assessment Test (CAT) scores improved significantly on the third day (5.45 vs 4.85, 0.60 (0.091.11), p=0.023), and Leicester Cough Questionnaire (LCQ) scores improved obviously on the third and seventh days (1.53 vs 1.23, 0.30 (0.05-0.55), p=0.044; 1.66 vs 1.32, 0.34 (0.08-0.60), p=0.022; respectively) after B-ACT therapy. Adverse events associated with B-ACT were mostly transient and mild. Differences of the lengths of hospital stay and hospitalization expenses in both group was not significant.Interpretation: B-ACT therapy significantly prolonged the time to first acute exacerbation after discharge, highlighting the importance of B-ACT therapy focused on symptom improvements in preventing exacerbation. (C) 2021 The Author(s). Published by Elsevier B.V.