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European Respiratory Review : An... Sep 2019Bronchiectasis is increasing in prevalence worldwide, yet current treatments available are limited to those alleviating symptoms and reducing exacerbations. The... (Review)
Review
Bronchiectasis is increasing in prevalence worldwide, yet current treatments available are limited to those alleviating symptoms and reducing exacerbations. The pathogenesis of the disease and the inflammatory, infective and molecular drivers of disease progression are not fully understood, making the development of novel treatments challenging. Understanding the role bacteria play in disease progression has been enhanced by the use of next-generation sequencing techniques such as 16S rRNA sequencing. The microbiome has not been extensively studied in bronchiectasis, but existing data show lung bacterial communities dominated by , and , while exhibiting intraindividual stability and large interindividual variability. and -dominated microbiomes have been shown to be linked to severe disease and frequent exacerbations. Studies completed to date are limited in size and do not fully represent all clinically observed disease subtypes. Further research is required to understand the microbiomes role in bronchiectasis disease progression. This review discusses recent developments and future perspectives on the lung microbiome in bronchiectasis.
Topics: Animals; Anti-Bacterial Agents; Bronchiectasis; Disease Progression; Haemophilus; Host-Pathogen Interactions; Humans; Lung; Microbiota; Pseudomonas; Risk Factors; Streptococcus
PubMed: 31484665
DOI: 10.1183/16000617.0048-2019 -
Annals of the American Thoracic Society Sep 2022
Topics: Bronchiectasis; Fibrosis; Humans; Lung Neoplasms; Smoking
PubMed: 36048124
DOI: 10.1513/AnnalsATS.202206-484ED -
BMC Pulmonary Medicine May 2018Bronchiectasis has an increasing profile within respiratory medicine. This chronic and irreversible airways disease is common but suffers from a lack of evidenced based...
Bronchiectasis has an increasing profile within respiratory medicine. This chronic and irreversible airways disease is common but suffers from a lack of evidenced based therapy for patients and, a lack of understanding of its inherent heterogeneity. Research focused on bronchiectasis must therefore be prioritized if we are to adequately address this evolving clinical problem. This special issue on bronchiectasis focuses on its clinical, microbiological and therapeutic aspects. By bringing together a unique collection of original research and review articles, we hope this issue will showcase international research efforts, encourage future research collaborations and stimulate debate. In doing so, we hope to bring greater attention to the urgent need for sustained investment into focused, dedicated and collaborative research platforms in bronchiectasis, an emerging "global epidemic".
Topics: Bronchiectasis; Epidemics; Global Health; Humans; Lung Transplantation
PubMed: 29788944
DOI: 10.1186/s12890-018-0629-1 -
Respiratory Research Dec 2017The role of neutrophil elastase (NE) is poorly understood in bronchiectasis because of the lack of preclinical data and so most of the assumptions made about NE... (Review)
Review
The role of neutrophil elastase (NE) is poorly understood in bronchiectasis because of the lack of preclinical data and so most of the assumptions made about NE inhibitor potential benefit is based on data from CF. In this context, NE seems to be a predictor of long-term clinical outcomes and a possible target of treatment. In order to better evaluate the role of NE in bronchiectasis, a systematic search of scientific evidence was performed.Two investigators independently performed the search on PubMed and included studies published up to May 15, 2017 according to predefined criteria. A final pool of 31 studies was included in the systematic review, with a total of 2679 patients. For each paper data of interest were extracted and reported in table.In this review sputum NE has proved useful as an inflammatory marker both in stable state bronchiectasis and during exacerbations and local or systemic antibiotic treatment. NE has also been associated with risk of exacerbation, time to next exacerbation and all-cause mortality. This study reviews also the role of NE as a specific target of treatment in bronchiectasis. Inhibition of NE is at a very early stage and future interventional studies should evaluate safety and efficacy for new molecules and formulations.
Topics: Biomarkers; Bronchiectasis; Cross-Sectional Studies; Humans; Leukocyte Elastase; Sputum
PubMed: 29258516
DOI: 10.1186/s12931-017-0691-x -
Respirology (Carlton, Vic.) Feb 2019Bronchiectasis has received increased attention recently, including an emphasis on preventing infective exacerbations that are associated with disease progression and... (Review)
Review
Bronchiectasis has received increased attention recently, including an emphasis on preventing infective exacerbations that are associated with disease progression and lung function decline. While there are several bacteria and viruses associated with bronchiectasis, licensed vaccines are only currently available for Streptococcus pneumoniae, Haemophilus influenzae (H. influenzae protein D as a conjugate in a pneumococcal vaccine), Mycobacterium tuberculosis, Bordetella pertussis and influenza virus. The evidence for the efficacy and effectiveness of these vaccines in both preventing and managing bronchiectasis in children and adults is limited with the focus of most research being on other chronic lung disorders, such as chronic obstructive pulmonary diseases, asthma and cystic fibrosis. We review the existing evidence for these vaccines in bronchiectasis and highlight the existing gaps in knowledge. High-quality experimental and non-experimental studies using current state-of-the-art microbiological methods and validated, standardised case definitions are needed across the depth and breadth of the vaccine development pathway.
Topics: Adult; Bronchiectasis; Child; Disease Progression; Humans; Needs Assessment; Respiratory Tract Infections; Vaccination; Vaccines
PubMed: 30477047
DOI: 10.1111/resp.13446 -
Clinical Medicine (London, England) May 2019Bronchiectasis is a chronic inflammatory condition with a diverse aetiology including recurrent infections, genetic abnormalities, immunodeficiency and autoimmune...
Bronchiectasis is a chronic inflammatory condition with a diverse aetiology including recurrent infections, genetic abnormalities, immunodeficiency and autoimmune disorders. The prevalence has increased over the past few years and this may be due to better imaging and diagnostic techniques. Management remains the emphasis for improving symptoms and reducing exacerbations. This article focuses on highlighting the latest data released since 2014 on new diagnostic techniques as well as potential future pharmacological and non-pharmacological treatment options for patients with bronchiectasis.
Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Bronchiectasis; Humans; Sputum
PubMed: 31092516
DOI: 10.7861/clinmedicine.19-3-230 -
BMC Pulmonary Medicine May 2018Bronchiectasis is a common feature of severe inherited and acquired pulmonary disease conditions. Among inherited diseases, cystic fibrosis (CF) is the major disorder... (Review)
Review
Bronchiectasis is a common feature of severe inherited and acquired pulmonary disease conditions. Among inherited diseases, cystic fibrosis (CF) is the major disorder associated with bronchiectasis, while acquired conditions frequently featuring bronchiectasis include post-infective bronchiectasis and chronic obstructive pulmonary disease (COPD). Mechanistically, bronchiectasis is driven by a complex interplay of inflammation and infection with neutrophilic inflammation playing a predominant role. The clinical characterization and management of bronchiectasis should involve a precise diagnostic workup, tailored therapeutic strategies and pulmonary imaging that has become an essential tool for the diagnosis and follow-up of bronchiectasis. Prospective future studies are required to optimize the diagnostic and therapeutic management of bronchiectasis, particularly in heterogeneous non-CF bronchiectasis populations.
Topics: Bronchiectasis; Cystic Fibrosis; Humans; Lung; Magnetic Resonance Imaging; Multidetector Computed Tomography; Phenotype
PubMed: 29788954
DOI: 10.1186/s12890-018-0630-8 -
International Journal of Chronic... 2017Computed tomography scan images have been used to identify different radiological COPD phenotypes based on the presence and severity of emphysema, bronchial wall... (Review)
Review
Computed tomography scan images have been used to identify different radiological COPD phenotypes based on the presence and severity of emphysema, bronchial wall thickening, and bronchiectasis. Bronchiectasis is defined as an abnormal dilation of the bronchi, usually as a result of chronic airway inflammation and/or infection. The prevalence of bronchiectasis in patients with COPD is high, especially in advanced stages. The identification of bronchiectasis in COPD has been defined as a different clinical COPD phenotype with greater symptomatic severity, more frequent chronic bronchial infection and exacerbations, and poor prognosis. A causal association has not yet been proven, but it is biologically plausible that COPD, and particularly the infective and exacerbator COPD phenotypes, could be the cause of bronchiectasis without any other known etiology, beyond any mere association or comorbidity. The study of the relationship between COPD and bronchiectasis could have important clinical implications, since both diseases have different and complementary therapeutic approaches. Longitudinal studies are needed to investigate the development of bronchiectasis in COPD, and clinical trials with treatments aimed at reducing bacterial loads should be conducted to investigate their impact on the reduction of exacerbations and improvements in the long-term evolution of the disease.
Topics: Adult; Aged; Aged, 80 and over; Bronchiectasis; Comorbidity; Female; Humans; Lung; Male; Middle Aged; Phenotype; Prevalence; Prognosis; Pulmonary Disease, Chronic Obstructive; Risk Factors; Tomography, X-Ray Computed
PubMed: 28546748
DOI: 10.2147/COPD.S132961 -
CMAJ : Canadian Medical Association... Jun 2017KEY POINTS Following a diagnosis of bronchiectasis, it is important to investigate for an underlying cause. Goals of management are to suppress airway infection and... (Review)
Review
KEY POINTS Following a diagnosis of bronchiectasis, it is important to investigate for an underlying cause. Goals of management are to suppress airway infection and inflammation, to improve symptoms and health-related quality of life. There are now validated scoring tools to help assess disease severity, which can help to stratify management. Good evidence supports the use of both exercise training and long-term macrolide therapy in long-term disease management.
Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Bronchiectasis; Bronchodilator Agents; Canada; Evidence-Based Medicine; Humans; Prognosis; Pulmonary Medicine; Severity of Illness Index
PubMed: 28630359
DOI: 10.1503/cmaj.160830 -
The European Respiratory Journal Jun 2022
Topics: Bronchiectasis; Humans
PubMed: 35772798
DOI: 10.1183/13993003.01249-2022