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Clinical, imaging, functional and microbiological manifestations of bronchiectasis in adults


Author: Munteanu Oxana
Degree:doctor habilitat of medicine
Speciality: 14.00.05 - Internal Diseases (with specification: Pulmonology, Gastroenterology, Hepatology, Nephrology, Functional Diagnostics and Endoscopy)
Year:2023
Scientific consultant: Victor Botnaru
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 9 November, 2022
Approved by NCAA on the 24 February, 2023

Abstract

Adobe PDF document – 1.72 Mb / in romanian
Adobe PDF document – 1.68 Mb / in english

Thesis

CZU 616.233-007.64-07(043.2)

Adobe PDF document 11.36 Mb / in romanian
282 pages

Keywords

bronchiectasis, etiology, imaging, Pseudomonas, phenotype, aspergillosis.

Summary

Thesis structure: introduction, six chapters, conclusions, 401 bibliographic references, 86 figures, 92 tables. The results were published in 67 scientific papers.

Studied area: internal medicine, pulmonology

Aim of the study: To determine the etiological and phenotypical peculiarities, correlated with the clinical, imaging, functional and microbiological patterns in bronchiectasis for the proposal of the management strategy in adult patients.

Objectives of research: revealing of the etiological profile of bronchiectasis in adults; highlighting the microbiological spectrum in bronchiectasis in correlation with the functional and imaging patterns; assessment of the imaging diagnostic and prognostic significance of bronchiectasis; defining the role of the multidimensional approach in the management of patients with bronchiectasis, including severity (BSI, FACED, E-FACED) and comorbidity assessment tools (BACI, Charlson); estimation of the impact of pulmonary hypertension in patients with bronchiectasis; evaluation of some inflammatory markers in the evolution of bronchiectasis and their role in estimating the severity of exacerbations; revealing phenotypes in bronchiectasis and their potential role in the personalized treatment; highlighting the factors for an unfavorable evolution in different degrees of severity bronchiectasis.

Novelty and originality of the research: Based on the study, the etiological diversity of bronchiectasis in adults was demonstrated, including the rare etiological forms, with the presentation of imaging features and the needed paraclinical tests for their confirmation.

Sputum cultures monitoring revealed the prevalence and the types of pathogenic germs in the airways, as well as the spectrum of bacterial resistances. For the first time, the utility of the immunochromatographic rapid test was demonstrated for the identification of cases of aspergillosis among bronchiectasis patients. Several bronchiectasis phenotypes were revealed based on the analysis of clinical, radiological, microbiological and ventilatory patterns and their role in the personalized approach for patients with bronchiectasis in the Republic of Moldova was shown. The study demonstrated the prognostic value of imaging scores and multidimensional indices in assessing the severity of the disease and the impact on the quality of life of patients with bronchiectasis.

Fundamentally new scientific and practical results. Based on the study, the role of several inflammatory markers in the evaluation of the exacerbation severity, as well as the value of various clinical and paraclinical tools in the multidimensional assessment of bronchiectasis patients was demonstrated, highlighting the predictors. The spectrum of comorbidities and their prognostic role were assessed. The usefulness of imaging signs for the diagnosis of PH and of coronary lesions by using chest HRCT examination was demonstrated, underlying the role of modern diagnostic and treatment strategies in certain bronchiectasis patient sub-populations.

The theoretical significance consistsin the proposal of a new complex conceptual framework for scientific and practical evaluation of the bronchiectasis heterogeneity. The long-term monitoring of the bronchiectasis patients from a multidimensional perspective highlighted some correlations according to the etiological, imaging, ventilatory patterns and chronic airway infections in the bronchiectasis patients. The analysis of the determinants responsible for the disease severity and the identification of poor evolution predictors have led to the elaboration of a new diagnostic and treatment algorithm, contributed to improving the management of the disease and the quality of patients care.

The applicative value. The results of the study were applied for the development of diagnostic and treatment algorithms for bronchiectasis, included in national clinical protocols.

Implementation of scientific results. The results of the study are used in undergraduate and postgraduate education at the Division of Pneumology and Allergology, in the Phthisiopulmonology ward of the IFP "Chiril Draganiuc" and General Therapy and Allergology ward of the RCH "Timofei Moșneaga". There were registered 3 certificates of innovations and 3 acts of implementation of the results.