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DOI: 10.1055/s-0033-1358087
Therapie von Bronchiektasen
Therapy of BronchiectasisPublication History
Publication Date:
27 February 2015 (online)
![](https://www.thieme-connect.de/media/zblchir/201501/lookinside/thumbnails/10.1055-s-0033-1358087-1.jpg)
Zusammenfassung
Die Prävalenz von Non-CF-Bronchiektasen (nicht mit zystischer Fibrose assoziierte Bronchiektasen) steigt mit zunehmendem Alter in der Bevölkerung an. Da die Ätiologie vielfältig ist, ist eine umfangreiche Diagnostik erforderlich. Diese umfasst eine gründliche Anamnese sowie die HRCT des Thorax. In der HRCT kann gleichzeitig Lokalisation und Ausmaß des Lungenbefalls bestimmt werden. Die therapeutischen Optionen orientieren sich an den zugrunde liegenden pathophysiologischen Mechanismen Infektion, Inflammation, Sekretretention und Destruktion und sollten abgestuft, aber konsequent zum Einsatz kommen. Bei häufigen Exazerbationen oder einer schweren Erkrankung sollte über den Einsatz von inhalativen Antibiotika und Makroliden nachgedacht werden. Die Operation von Bronchiektasen stellt inzwischen ein eher seltenes Ereignis dar und ist oftmals auf die Behandlung medikamentös nicht mehr zu beherrschender, lebensbedrohlicher Komplikationen der Bronchiektasenkrankheit wie Hämoptysen, Aspergillom, Lungenabszess und Pleuraempyem ausgerichtet. Die beiden Grundvoraussetzungen für eine erfolgreiche chirurgische Therapie mit gutem Langzeitergebnis stellen dar:
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Literatur
- 1 Agasthian T, Deschamps C, Trastek VF et al. Surgical management of bronchiectasis. Ann Thorac Surg 1996; 62: 976-978 discussion 979–980
- 2 Altenburg J, de Graaff CS, Stienstra Y et al. Effect of azithromycin maintenance treatment on infectious exacerbations among patients with non-cystic fibrosis bronchiectasis: the BAT randomized controlled trial. JAMA 2013; 309: 1251-1259
- 3 Balci AE, Balci TA, Ozyurtan MO. Current surgical therapy for bronchiectasis: surgical results and predictive factors in 86 patients. Ann Thorac Surg 2014; 97: 211-217
- 4 Barker AF, OʼDonnell AE Flume Pet al. Aztreonam for inhalation solution in patients with non-cystic fibrosis bronchiectasis (AIR-BX1 and AIR-BX2): two randomised double-blind, placebo-controlled phase 3 trials. Lancet Respir Med 2014; 2: 738-749
- 5 Beirne PA, Banner NR, Khaghani A et al. Lung transplantation for non-cystic fibrosis bronchiectasis: analysis of a 13-year experience. J Heart Lung Transplant 2005; 10: 1530-1535
- 6 Bilton D, Jones AL. Bronchiectasis: epidemiology and causes. Eur Respir Mon 2011; 52: 1-10
- 7 Bilton D, Tino G, Barker AF et al. for the B-305 Study Investigators. Inhaled mannitol for non-cystic fibrosis bronchiectasis: a randomised, controlled trial. Thorax 2014; 69: 1073-1079
- 8 Borrie J, Lichter I. Surgical treatment of bronchiectasis: ten-year survey. Br Med J 1965; 2 (5467) 908-912
- 9 Bradshaw HH, Putney FJ, Clerf LH. The fate of patients with untreated bronchiectasis. JAMA 1941; 116: 2561-2563
- 10 Brodt AM, Stovold E, Zhang L. Inhaled antibiotics for stable non-cystic fibrosis bronchiectasis: a systematic review. Eur Respir J 2014; 44: 382-393
- 11 Bryce AG. Surgical treatment of bronchiectasis. Br Med J 1935; 1 (3868) 350-372.2
- 12 Burness CB, Keating GM. Mannitol dry powder for inhalation: in patients with cystic fibrosis. Drugs 2012; 72: 1411-1421
- 13 Chalmers JD, Goeminne P, Aliberti S et al. The bronchiectasis severity index. An international derivation and validation study. Am J Respir Crit Care Med 2014; 189: 576-585
- 14 Churchill ED, Belsey R. Segmental pneumonectomy in bronchiectasis. Ann Surg 1939; 109: 481-499
- 15 Corris PA. Lung transplantation for cystic fibrosis and bronchiectasis. Semin Respir Crit Care Med 2013; 34: 297-304
- 16 Doğan R, Alp M, Kaya S et al. Surgical treatment of bronchiectasis: a collective review of 487 cases. Thorac Cardiovasc Surg 1989; 37: 183-186
- 17 Drobnic ME, Suñé P, Montoro JB et al. Inhaled tobramycin in non-cystic fibrosis patients with bronchiectasis and chronic bronchial infection with Pseudomonas aeruginosa. Ann Pharmacother 2005; 39: 39-44
- 18 Eren S, Esme H, Avci A. Risk factors affecting outcome and morbidity in the surgical management of bronchiectasis. J Thorac Cardiovasc Surg 2007; 134: 392-398
- 19 Farjah F, Symons RG, Krishnadasan B et al. Management of pleural space infections: a population-based analysis. J Thorac Cardiovasc Surg 2007; 133 (2) 346-351
- 20 Finley C, Clifton J, Fitzgerald JM et al. Empyema: an increasing concern in Canada. Can Respir J 2008; 15: 85-89
- 21 Fruchter O, Schneer S, Rusanov V et al. Bronchial artery embolization for massive hemoptysis: Long-term follow-up. Asian Cardiovasc Thorac Ann 2015; 23: 55-60
- 22 Fujimoto T, Hillejan L, Stamatis G. Current strategy for surgical management of bronchiectasis. Ann Thorac Surg 2001; 72: 1711-1715
- 23 Grijalva CG, Zhu Y, Nuorti JP et al. Emergence of parapneumonic empyema in the USA. Thorax 2011; 66: 663-668
- 24 Haworth CS, Bilton D, Elborn JS. Long-term macrolide maintenance therapy in non-CF bronchiectasis: Evidence and questions. Respir Med 2014; 108: 1397-1408
- 25 Haworth CS, Foweraker JE, Wilkinson P et al. Inhaled colistin in patients with bronchiectasis and chronic Pseudomonas aeruginosa infection. Am J Respir Crit Care Med 2014; 189: 975-982
- 26 Hayes jr. D, Meyer KC. Lung transplantation for advanced bronchiectasis. Semin Respir Crit Care Med 2010; 31: 123-138
- 27 Höffken G, Lorenz J, Kern W et al. Epidemiology, diagnosis, antimicrobial therapy and management of community-acquired pneumonia and lower respiratory tract infections in adults. Guidelines of the Paul-Ehrlich-Society for Chemotherapy, the German Respiratory Society, the German Society for Infectiology and the Competence Network CAPNETZ Germany. Pneumologie 2009; 63: e1-e68
- 28 Huang HC, Chen HC, Fang HY et al. Lung abscess predicts the surgical outcome in patients with pleural empyema. J Cardiothorac Surg 2010; 5: 88
- 29 Jin YX, Zhang Y Duan Let al. Surgical treatment of bronchiectasis: A retrospective observational study of 260 patients. Int J Surg 2014; 12: 1050-1054
- 30 Kellett F, Robert NM. Nebulised 7 % hypertonic saline improves lung function and quality of life in bronchiectasis. Respir Med 2011; 105: 1831-1835
- 31 Kellett F, Redfern J, Niven RM. Evaluation of nebulised hypertonic saline (7 %) as an adjunct to physiotherapy in patients with stable bronchiectasis. Resp Med 2005; 99: 27-31
- 32 Larici AR, Franchi P, Occhipinti M et al. Diagnosis and management of hemoptysis. Diagn Interv Radiol 2014; 20: 299-309
- 33 Li AM, Sonnappa S, Lex C et al. Non-CF bronchiectasis: does knowing the aetiology lead to changes in management?. Eur Respir J 2005; 26: 8-14
- 34 McDonnell MJ, Jary HR, Perry A et al. Non cystic fibrosis bronchiectasis: A longitudinal retrospective observational cohort study of Pseudomonas persistence and resistance. Respir Med 2014; DOI: 10.1016/j.rmed.2014.07.021.
- 35 Murray MP, Govan JR, Doherty CJ et al. A randomized controlled trial of nebulized gentamicin in non-cystic fibrosis bronchiectasis. Am J Respir Crit Care Med 2011; 183: 491-499
- 36 OʼDonnell AE, Barker AF, Ilowite JS et al. Treatment of idiopathic bronchiectasis with aerosolized recombinant human DNase. rhDNase Study Group. Chest 1998; 113: 1329-1334
- 37 Pasteur MC, Bilton D, Hill AT et al. British Thoracic Society Guideline for non-CF bronchiectasis. Thorax 2010; 65: i1-i58
- 38 Rademacher J, Ringshausen FC. Non-CF-Bronchiektasen mit Fokus auf die allergische bronchopulmonale Aspergillose. Pneumologie 2013; 67: 40-47 quiz 48–49
- 39 Rademacher J, Welte T. Bronchiektasen – Diagnostik und Therapie. bronchiectasis – diagnosis and treatment. Dtsch Ärztebl Int 2011; 108: 809-815
- 40 Rademacher J, Pletz MW, Welte T. Behandlung nicht mit zystischer Fibrose assoziierter Bronchiektasen (Non-CF-Bronchiektasen). Internist 2010; 51: 1510-1515
- 41 Ringshausen FC, de Roux A, Pletz MW et al. Bronchiectasis-associated hospitalizations in Germany, 2005–2011: a population-based study of disease burden and trends. PLoS One 2013; 8: e71109
- 42 Robert Koch-Institut – RKI. Stellungnahme der ständigen Impfkommission [STIKO] des Robert Koch-Instituts zur Impfung Erwachsener gegen Pneumokokken. Epid Bull 2012; 7: 55-56
- 43 Roles FC, Todd GS. Bronchiectasis: Diagnosis and prognosis in relation to treatment. Br Med J 1933; 2 (3796) 639-643
- 44 Schweigert M, Dubecz A, Beron M et al. Surgical therapy for necrotizing pneumonia and lung gangrene. Thorac Cardiovasc Surg 2013; 61: 636-641
- 45 Serisier DJ, Bilton D, De Soyza A et al. ORBIT-2 investigators. Inhaled, dual release liposomal ciprofloxacin in non-cystic fibrosis bronchiectasis (ORBIT-2): a randomised, double-blind, placebo-controlled trial. Thorax 2013; 68: 812-817
- 46 Serisier DJ, Martin ML, McGuckin MA et al. Effect of long-term, low-dose erythromycin on pulmonary exacerbations among patients with non-cystic fibrosis bronchiectasis: the BLESS randomized controlled trial. JAMA 2013; 309: 1260-1267
- 47 Shoemark A, Ozerovitch L, Wilson R. Aetiology in adult patients with bronchiectasis. Respir Med 2007; 101: 1163-1170
- 48 Wilson R, Welte T, Polverino E et al. Ciprofloxacin dry powder for inhalation in non-cystic fibrosis bronchiectasis: a phase II randomised study. Eur Respir J 2013; 41: 1107-1115
- 49 Wong C, Jayaram L, Karalus N et al. Azithromycin for prevention of exacerbations in non-cystic fibrosis bronchiectasis (EMBRACE): a randomised, double-blind, placebo-controlled trial. Lancet 2012; 380: 660-667
- 50 Yuncu G, Ceylan KC, Sevinc S et al. [Functional results of surgical treatment of bronchiectasis in a developing country]. Arch Bronconeumol 2006; 42: 183-188