Bronchiectasis and cough: An old relationship in need of renewed attention

Abstract

A B S T R A C TBronchiectasis is an increasingly recognised respiratory condition with limited therapeutic options and a complex spectrum of clinical manifestations that invariably includes chronic cough. As the primary presentation of bronchiectasis in most cases, chronic cough and its mechanistic underpinnings are of central importance but remain poorly understood in this setting. Bronchiectasis is also increasingly identified as an underlying cause of chronic cough highlighting the interrelationship between the two conditions that share overlapping clinical features. Several therapeutic approaches have illustrated positive effects on bronchiectasis-associated cough, however, more focused treatment of heterogeneous cough subtypes may yield better outcomes for patients. A current challenge is the identification of bronchiectasis and cough endophenotypes that may allow improved patient stratification and more targeted therapeutic matching of the right treatment to the right patient. Here we discuss the complex disease phenotypes of bronchiectasis and their interrelationship with cough while considering current and emerging treatment options. We discuss some key cough promoters in bronchiectasis including infection, allergy and immune dysfunction.

Lung microbiome: new insights into bronchiectasis’ outcome

“…Increased inflammation brought on by these infections is linked to lung function reduction, dyspnea, and damage to the airways ( Chalmers et al., 2018 ). Clinically, malaise, pain in the chest, hemoptysis, and weight loss are possible additional symptoms ( Mac Aogáin and Chotirmall, 2019 ). High-resolution computed tomography (HRCT) is the gold standard for diagnosing it; note the morphological subtypes as well ( Mac Aogáin and Chotirmall, 2019 ): cylindrical, common and characterized by smooth tubular bronchi and mild disease; varicose, non-uniform dilation; cystic, associated with more severe disease and complete loss of bronchial morphology.…”

“…The microbial colonization of the lung is ensured by impaired mucociliary clearance and mucus inspissation, in addition to other detrimental effects ( Flume et al., 2018 ). The principal etiology is indicated by: post-infectious bronchiectasis, immunodeficiency diseases, obstructive lung disease, ciliary disorders, genetic disorders, skeletal diseases, obliterans bronchiolitis, idiopathic ( Chalmers et al., 2018 ; Chandrasekaran et al., 2018 ; Flume et al., 2018 ; Mac Aogáin and Chotirmall, 2019 ; Lupu et al., 2023 ).…”

Bronchiectasis and Other Chronic Airway Diseases: A Clinical-based Approach

“…Cough, for example, represents a hallmark of BE syndrome, being reported by > 90% of patients 39 , mostly together with sputum production 40 . However, in patients with history of exposure to noxious particles or gases, such as cigarette smoke, toxic fumes, biomasses, etc, the presence of productive cough should always lead to ruling out co-existing COPD 39,41 .…”

Hot topics and current controversies in non-cystic fibrosis bronchiectasis

“…As in many areas of medicine, precision medicine has emerged as a promising strategy to improve clinical outcomes in patients with NCFB; thus, endophenotypes are being evaluated to identify common characteristics that may be tailored for specific treatments and interventions in individual patients [14, 17, 18]. Therefore, it is now accepted that a single treatment approach is not appropriate for all NCFB patients.…”