Bronchiectasis

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

“…Bronchiectasis is an increasingly recognised respiratory syndrome defined by permanent and irreversible dilatation of the bronchi [1]. Cole's vicious cycle remains the central model of disease pathogenesis whereby a self-perpetuating cycle of infection and inflammation precipitates damage to the bronchial wall leading to impaired mucociliary clearance and predisposition to recurrent infection.…”

“…Cole's vicious cycle remains the central model of disease pathogenesis whereby a self-perpetuating cycle of infection and inflammation precipitates damage to the bronchial wall leading to impaired mucociliary clearance and predisposition to recurrent infection. The primary clinical presentation of bronchiectasis includes chronic cough and recurrent respiratory infections responsible for the increased inflammation, airway damage and shortness of breath with eventual lung function decline, respiratory failure and death [1]. An increased awareness of disease heterogeneity, including its presence in overlap syndromes has brought renewed focus upon potential underlying molecular endophenotypes that may better define specific disease traits and subtypes amenable to treatment [2][3][4][5].…”

Twenty‐five years of Respirology: Advances in bronchiectasis

“…Bronchiectasis, a silent emerging global epidemic, has experienced a clinical and research renaissance over the last decade . Increased access to radiology, physician awareness and its overlap with other chronic respiratory disease states has brought renewed attention to this neglected disease .…”

“…Other advances on the clinical front include an increasing appreciation of the burden bronchiectasis has on health systems and particularly importantly to adults, children and their parents. There are now data on quality of life, hospitalizations, economic costs and patients' needs . In adults with bronchiectasis, we now also have better data on airway clearance and pulmonary rehabilitation, availability of various validated bronchiectasis‐specific clinical scores (e.g.…”

“…Cole's ‘vicious cycle hypothesis’ proposed a sequential chain of events incited by an airway insult on a background of host susceptibility and/or immune defect. A destructive and perpetual ‘cycle’ impairing mucociliary clearance, promoting mucus retention, establishing chronic infection and provoking inflammation ensues with resultant bronchial wall destruction, dilatation and airway remodelling . While this model illustrates how bronchiectasis develops in patients with mucociliary abnormalities, post‐infection or in immune‐deficient states, it fails to adequately explain why treatments ‘targeted’ to one aspect of the cycle (e.g.…”