PT  - JOURNAL ARTICLE
AU  - Joana Tambascio
AU  - Hugo Celso Dutra De Souza
AU  - José Antonio Baddini Martinez
AU  - Juliana Lima Afonso
AU  - José Roberto Jardim
AU  - Ada Clarice Gastaldi
TI  - The Influence of Purulence on Ciliary and Cough Transport in Bronchiectasis
AID  - 10.4187/respcare.02152
DP  - 2013 May 14
TA  - Respiratory Care
PG  - respcare.02152
4099  - http://rc.rcjournal.com/content/early/2013/05/14/respcare.02152.short
4100  - http://rc.rcjournal.com/content/early/2013/05/14/respcare.02152.full
AB  - Background: Individuals with bronchiectasis exhibit colonization and infection of the respiratory system with a consequent alteration of the macroscopic appearance of secretions that may vary from mucoid to purulent. The presence of purulence is related to the structural conformation, rheological profile, and transport indexes of mucus. Objective: To analyze and compare the transport properties of respiratory secretions with a mucoid (M) or purulent (P) appearance in patients with bronchiectasis and in individuals without lung disease. Methods: A total of 32 M and 19 P samples from patients with bronchiectasis and 21 samples from individuals without lung disease were assessed for mucociliary transport, displacement in a simulated cough machine, and contact angle. ANOVA, followed by Tukey-Kramer whenever multiple comparisons were used at a 5% significance level. Results: The mucociliary transport was lower in the M samples (0.78±0.22) and in the P samples (0.73±0.22) compared to the samples from individuals without lung disease (1±0.19) (p<0.05). The P samples exhibited a lower displacement in the simulated cough machine compared to the M samples (P: 7.57±3 cm and M: 23±15 cm) and the samples from individuals without lung disease (34±8.4 cm) as did the M samples compared to the samples from individuals without lung disease (p<0.05). The P samples exhibited a higher contact angle compared to the M samples (P: 25±6.1° and M: 17±7.8°) and the samples from individuals without lung disease (10±2.5°) as did the M samples compared to the samples from individuals without lung disease (p<0.05). Conclusions: Respiratory secretions in individuals with bronchiectasis exhibit poor transport properties, which manifest as reduced MCT, reduced mucus transport by cough, and an increased CA. These features were more accentuated in the samples with a purulent appearance. This simple classification can be useful for therapists, to plan a treatment of patients, and for researchers, to provide more homogeneity between groups of patients.