Investigation of bronchiectasis in severe uncontrolled asthma

Dimakou, Katerina; Gousiou, Anna; Toumbis, Michael; Kaponi, Maria; Chrysikos, Serafeim; Thanos, Loukas; Triantafillidou, Christina

doi:10.1111/crj.12653

Cited by 47 publications

(44 citation statements)

References 35 publications

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“…The cases were selected after a complete aetiological investigation and aetiologies of bronchiectasis other than asthma were excluded. These patients with severe asthma showed pathogens in sputum (mainly P. aeruginosa) in 22.5% of cases, all concomitant with bronchiectasis [18].…”

Section: Bronchiectasis In Asthmamentioning

confidence: 95%

“…Hypogammaglobulinaemia was described in a group of asthma patients in association with an increased risk of bronchiectasis compared to normoglobulinaemia [115]. However, DIMAKOU et al [16] recently described bronchiectasis in 67.5% of patients with severe uncontrolled asthma. The cases were selected after a complete aetiological investigation and aetiologies of bronchiectasis other than asthma were excluded.…”

Section: Bronchiectasis In Asthmamentioning

confidence: 99%

“…In recent years, the association between asthma and bronchiectasis has shown potentially specific features in terms of age, clinical presentation, risk of exacerbations and diagnostic and therapeutic options [4,7,15]. Unfortunately, there is still limited information on the prognosis of asthma-bronchiectasis overlap, although it has been suggested that patients with severe asthma with bronchiectasis may have a worse prognosis (more symptoms and exacerbations) than asthma patients without bronchiectasis [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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The overlap between bronchiectasis and chronic airway diseases: state of the art and future directions

et al. 2018

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Bronchiectasis is a clinical and radiological diagnosis associated with cough, sputum production and recurrent respiratory infections. The clinical presentation inevitably overlaps with other respiratory disorders such as asthma and chronic obstructive pulmonary disease (COPD). In addition, 4-72% of patients with severe COPD are found to have radiological bronchiectasis on computed tomography, with similar frequencies (20-30%) now being reported in cohorts with severe or uncontrolled asthma. Co-diagnosis of bronchiectasis with another airway disease is associated with increased lung inflammation, frequent exacerbations, worse lung function and higher mortality. In addition, many patients with all three disorders have chronic rhinosinusitis and upper airway disease, resulting in a complex "mixed airway" phenotype.The management of asthma, bronchiectasis, COPD and upper airway diseases has traditionally been outlined in separate guidelines for each individual disorder. Recognition that the majority of patients have one or more overlapping pathologies requires that we re-evaluate how we treat airway disease. The concept of treatable traits promotes a holistic, pathophysiology-based approach to treatment rather than a syndromic approach and may be more appropriate for patients with overlapping features.Here, we review the current clinical definition, diagnosis, management and future directions for the overlap between bronchiectasis and other airway diseases.

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Section: Bronchiectasis In Asthmamentioning

confidence: 95%

Section: Bronchiectasis In Asthmamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The overlap between bronchiectasis and chronic airway diseases: state of the art and future directions

et al. 2018

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“…Nevertheless, no single therapeutic approach for all patients is ever likely to succeed as an approach for bronchiectasis. In fact, with the emergence of overlap syndromes, a broader, more comprehensive and complementary approach to treatment will more likely be required [15][16][17][18].…”

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confidence: 99%

RESPIRE: breathing new life into bronchiectasis

Chotirmall

Chalmers

2018

Eur Respir J

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“…Bronchiectasis can be identified before the definitive diagnosis of asthma [73] or during the disease course, with a wide frequency ranging from 0.8 to 77% [7][8][9][10][11][12][13][14][15][16][17][18][19][20] (17.5-40% [10,15,74] in mild forms and 67.5-77% [7,18] in severe forms [ Table 2]). This wide variability is caused by the different analytical methods used in each study: type of enrolled patient populations, sample size, diagnostic criteria for the detection of bronchiectasis (e.g., the CT scan is often operator dependent), and not known causes of diagnosed bronchiectasis.…”

Section: Prevalence Of Bronchiectasis In Asthmamentioning

confidence: 99%

The Link between Asthma and Bronchiectasis: State of the Art

et al. 2020

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The nonrecognition of asthma-associated comorbidities is often responsible for the therapeutic failure and the worsening of symptoms, and it is associated with frequent exacerbations, higher disease severity, and increased health costs. Bronchiectasis, one of the most frequent asthma-associated comorbidities, can increase airways inflammation and exacerbation rates and cause respiratory functional impairment. The aim of this article is to review the interactions between bronchiectasis and asthma, in order to better identify patients in the overlap between the 2 diseases and to select an "ad hoc" therapy. A literature search on PubMed/MEDLINE was performed using the following search terms: bronchiectasis in asthma, the association between asthma and bronchiectasis, comorbidities in asthma, and severe asthma. This review analyzed the following items: incorrect or underestimated diagnosis of asthma and bronchiectasis, prevalence of bronchiectasis in asthma, the impact of bronchiectasis in asthma, radiological imaging features of the 2 diseases, etiopathogenesis, and common causes (such as gastroesopha-geal reflux disease, immune deficits, chronic rhinosinusitis and allergic bronchopulmonary aspergillosis, and treatment of asthma and bronchiectasis). The concomitant presence of bronchiectasis and asthma should be suspected and investigated in patients with severe asthma, frequent exacerbations, and not responding to standard therapy. This clinical phenotype, characterized by a more severe disease, worse outcomes, and functional decline, must be readily recognized in order to choose the most appropriate therapeutic approach, able to potentially improve the management of bronchial asthma, to prevent the onset of exacerbations as well the functional decline, and to reduce health costs.

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Investigation of bronchiectasis in severe uncontrolled asthma

Abstract: Bronchiectasis is common in patients with severe asthma. Sputum production and pathogen isolation in sputum may indicate the presence of bronchiectasis which seems to contribute to the severity of asthma.

Cited by 47 publications

References 35 publications

The overlap between bronchiectasis and chronic airway diseases: state of the art and future directions

The overlap between bronchiectasis and chronic airway diseases: state of the art and future directions

RESPIRE: breathing new life into bronchiectasis

The Link between Asthma and Bronchiectasis: State of the Art

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