There is renewed interest in non-cystic fibrosis bronchiectasis, which is a cause of significant morbidity in adults and can be diagnosed by high-resolution chest computed tomography scan. No longer mainly a complication after pulmonary infection with Mycobacterium tuberculosis, diverse disease processes and mechanisms have been demonstrated to result in the chronic cough, purulent sputum production, and airway dilation that characterize this disease. Improved understanding of the role of mucus stasis in causing bacterial colonization has led to increased emphasis on the use of therapies that enhance airway clearance. Inhalational antibiotics reduce the bacterial burden associated with a worse outcome. Low-dose, chronic macrolide therapy has been shown to decrease exacerbation frequency and airway inflammation. For the first time, a number of therapies for non-cystic fibrosis bronchiectasis are undergoing testing in clinical research trials designed specifically for this population. This concise clinical review focuses on the major etiologies, diagnostic testing, microbiology, and management of patients with adult non-cystic fibrosis bronchiectasis. Systematic evaluation identifies a specific cause in the majority of patients and may affect subsequent treatment. We outline current therapies and review the data that support their use.
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Abstract-Alveolar epithelial -adrenergic receptor (AR) activation accelerates active Na ϩ transport in lung epithelial cells in vitro and speeds alveolar edema resolution in human lung tissue and normal and injured animal lungs. Whether these receptors are essential for alveolar fluid clearance (AFC) or if other mechanisms are sufficient to regulate active transport is unknown. In this study, we report that mice with no  1 -or  2 -adrenergic receptors ( 1 AR Ϫ/Ϫ / 2 AR Ϫ/Ϫ ) have reduced distal lung Na,K-ATPase function and diminished basal and amiloride-sensitive AFC. Total lung water content in these animals was not different from wild-type controls, suggesting that AR signaling may not be required for alveolar fluid homeostasis in uninjured lungs. Comparison of isoproterenol-sensitive AFC in mice with  1 -but not  2 -adrenergic receptors to  1 AR Ϫ/Ϫ / 2 AR Ϫ/Ϫ mice indicates that the  2 AR mediates the bulk of -adrenergic-sensitive alveolar active Na ϩ transport. To test the necessity of AR signaling in acute lung injury, Key Words: alveolar fluid clearance Ⅲ pulmonary edema Ⅲ  2 -adrenergic receptor Ⅲ adenovirus Ⅲ Na ϩ channel T he combined action of alveolar epithelial Na ϩ channels (ENaCs), the cystic fibrosis transmembrane conductance regulator (CFTR), Na,K-ATPases, and K ϩ channels creates the transepithelial Na ϩ gradient needed for the transit of excess fluid from the alveolar airspace. 1,2 The importance of these proteins to this energy-dependent (ie, active) process is evidenced by data showing that their inhibition reduces the lung's ability to clear excess alveolar fluid [3][4][5][6][7] and that their upregulation confers protection from acute injury. 4,8,9 Despite these extensive investigations, the mechanisms by which these proteins are upregulated in response to excess alveolar fluid (pulmonary edema) are not well resolved.One possible pathway for upregulation of alveolar-active Na ϩ transport is -adrenergic receptor activation. Stimulation of alveolar epithelial ARs by endogenous or exogenous catecholamines accelerates active Na ϩ transport in lung epithelial cells in vitro and in experimental in vivo systems by increasing the expression and/or function of epithelial transport proteins. 10 -12 Thus, this G protein-dependent pathway represents a mechanism by which the lung can alter its physiology to adapt to and protect itself from excess alveolar fluid. What is not known is if AR signaling is essential for the regulation of alveolar active Na ϩ transport or whether other mechanisms (eg, intracellular osmo-, redox-, or chemosensitive regulators) can enhance alveolar active transport to clear pulmonary edema.The present study was structured to define what contribution alveolar epithelial ARs make to active Na ϩ transport in the alveolar epithelium of normal mice and mice with acute lung injury caused by exposure to hyperoxia. Herein, we show that distal lung transport protein function and the lung's ability to clear excess alveolar fluid is highly dependent on Materials an...
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