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European Respiratory Review : An... Jun 2023Bronchiectasis is a common progressive respiratory disease with recognisable radiological abnormalities and a clinical syndrome of cough, sputum production and recurrent...
Bronchiectasis is a common progressive respiratory disease with recognisable radiological abnormalities and a clinical syndrome of cough, sputum production and recurrent respiratory infections. Inflammatory cell infiltration into the lung, in particular neutrophils, is central to the pathophysiology of bronchiectasis. Herein we explore the roles and relationships between infection, inflammation and mucociliary clearance dysfunction in the establishment and progression of bronchiectasis. Microbial and host-mediated damage are important processes underpinning bronchiectasis and the relative contribution of proteases, cytokines and inflammatory mediators to the propagation of inflammation is presented. We also discuss the emerging concept of inflammatory endotypes, defined by the presence of neutrophilic and eosinophilic inflammation, and explore the role of inflammation as a treatable trait. Current treatment for bronchiectasis focuses on treatment of underlying causes, enhancing mucociliary clearance, controlling infection and preventing and treating complications. Data on airway clearance approaches exercise and mucoactive drugs, pharmacotherapy with macrolides to decrease exacerbations and the usefulness of inhaled antibiotics and bronchodilators are discussed, finishing with a look to the future where new therapies targeting host-mediated immune dysfunction hold promise.
Topics: Humans; Adult; Bronchiectasis; Inflammation; Cough; Anti-Bacterial Agents; Macrolides
PubMed: 37286220
DOI: 10.1183/16000617.0015-2023 -
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 -
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 -
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 -
Respirology (Carlton, Vic.) Nov 2019Bronchiectasis has historically been considered to be irreversible dilatation of the airways, but with modern imaging techniques it has been proposed that 'irreversible'... (Review)
Review
Bronchiectasis has historically been considered to be irreversible dilatation of the airways, but with modern imaging techniques it has been proposed that 'irreversible' be dropped from the definition. The upper limit of normal for the ratio of airway to arterial development increases with age, and a developmental perspective is essential. Bronchiectasis (and persistent bacterial bronchitis, PBB) is a descriptive term and not a diagnosis, and should be the start not the end of the patient's diagnostic journey. PBB, characterized by airway infection and neutrophilic inflammation but without significant airway dilatation may be a precursor of bronchiectasis, and there are many commonalities in the microbiology and the pathology, which are reviewed in this article. A high index of suspicion is essential, and a history of chronic wet or productive cough for more than 4-8 weeks should prompt investigation. There are numerous underlying causes of bronchiectasis, although in many cases no cause is found. Causes include post-infectious, especially after tuberculosis, adenoviral or pertussis infection; aspiration syndromes; defects in host defence, which may solely affect the airways (cystic fibrosis, not considered in this review, and primary ciliary dyskinesia); and primary ciliary dyskinesia or be systemic, such as common variable immunodeficiency; genetic syndromes; and anatomical defects such as intraluminal airway obstruction (e.g. foreign body), intramural obstruction (e.g. complete cartilage rings) and external airway compression (e.g. by tuberculous lymph nodes). Identification of the underlying cause is important, because some of these conditions have specific treatments and others genetic implications for the family.
Topics: Adult; Bronchiectasis; Child; Diagnosis, Differential; Humans; Respiratory System
PubMed: 30801930
DOI: 10.1111/resp.13509 -
Experimental Biology and Medicine... Feb 2021Bronchiectasis is a chronic airway disease with abnormal and persistent bronchial dilatation caused by a variety of reasons. In recent years, numerous reports have shown... (Review)
Review
Bronchiectasis is a chronic airway disease with abnormal and persistent bronchial dilatation caused by a variety of reasons. In recent years, numerous reports have shown that bronchiectasis is heterogeneous, the clinical characteristics of patients with different phenotypes are different, and the efficacy of a treatment regimen may vary greatly in patients with different bronchiectasis phenotypes. This paper summarizes the current clinical phenotypic classification of bronchiectasis from the perspective of etiology, microbiology, and the frequency of acute exacerbation, and cluster analysis was used to determine new clinical phenotypes and their statistical and clinical significance. Different tools for assessing disease severity yield different outcomes. This article summarizes the research progress in the above areas, hoping to provide a more comprehensive understanding of the disease.
Topics: Bronchi; Bronchiectasis; China; Humans; Lung Diseases; Lung Injury; Phenotype; Pulmonary Disease, Chronic Obstructive; Severity of Illness Index
PubMed: 33241711
DOI: 10.1177/1535370220972324 -
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 -
Respirology (Carlton, Vic.) May 2019Bronchiectasis is a chronic, debilitating disease with increasing worldwide prevalence and burden. Accurate and early diagnosis is essential for both its management and... (Review)
Review
Bronchiectasis is a chronic, debilitating disease with increasing worldwide prevalence and burden. Accurate and early diagnosis is essential for both its management and prognosis. This review will discuss the diagnosis of bronchiectasis, the international burden of the disease and its current prognosis.
Topics: Adult; Bronchiectasis; Child; Humans; Prevalence; Prognosis
PubMed: 30779274
DOI: 10.1111/resp.13495 -
American Journal of Respiratory and... Apr 2023
Topics: Humans; Lung; Bronchiectasis; Thorax
PubMed: 36473273
DOI: 10.1164/rccm.202211-2179ED -
The European Respiratory Journal Jun 2022
Topics: Bronchiectasis; Humans
PubMed: 35772798
DOI: 10.1183/13993003.01249-2022