Bronchodilators in bronchiectasis: there is light but it is still too dim

Cazzola, Mario; Martínez‐García, Miguel Ángel; Matera, Maria Gabriella

doi:10.1183/13993003.03127-2021

Cited by 3 publications

(2 citation statements)

References 29 publications

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“…Some studies have suggested that bronchodilators can be effective in improving lung function in bronchiectasis [ 27 - 29 ]. Although a randomized controlled trial for dual bronchodilators in bronchiectasis is ongoing [ 30 ], the effect of bronchodilators on the treatment outcomes of bronchiectasis has not been established other than lung function (e.g., quality of life and acute exacerbations) ( Table 3 ) [ 31 , 32 ]. For example, although inhaled tiotropium increased lung function in individuals with bronchiectasis and airflow obstruction, it did not show reduced exacerbation or improved quality of life [ 27 ], which are all observed in classical COPD [ 33 ].…”

Section: Controversial Issues 1: Bronchiectasis With Airflow Limitationmentioning

confidence: 99%

Proposed Etiotypes for Chronic Obstructive Pulmonary Disease: Controversial Issues

Kim,

Moon,

Min

et al. 2024

Tuberc Respir Dis

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The 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) revised the definition of chronic obstructive pulmonary disease (COPD) to broadly include a variety of etiologies. A new taxonomy, composed of etiotypes, aims to highlight the heterogeneity in causes and pathogenesis of COPD, allowing more personalized management strategies and emphasizing the need for targeted research to understand and manage COPD better. However, controversy arises with including some diseases under the umbrella term of COPD, as their clinical presentations and treatments differ from classical COPD, which is smoking-related. COPD due to infection (COPD-I) and COPD due to environmental exposure (COPD-P) are classifications within the new taxonomy. Some disease entities in these categories show distinct clinical features and may not benefit from conventional COPD treatments, raising questions about their classification as COPD subtypes. There is also controversy regarding whether bronchiectasis with airflow limitations should be classified as an etiotype of COPD. This article discusses controversial issues associated with the proposed etiotypes for COPD in terms of COPD-I, Controversial Issues 1: Bronchiectasis with Airflow LimitationBronchiectasis is a disease entity of clinical and radio-COPD-P, and bronchiectasis. While the updated COPD definition by GOLD 2023 is a major step towards recognizing the disease's complexity, it also raises questions about the classification of related respiratory conditions. This highlights the need for further research to improve our understanding and approach to COPD management.

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Section: Controversial Issues 1: Bronchiectasis With Airflow Limitationmentioning

confidence: 99%

Proposed Etiotypes for Chronic Obstructive Pulmonary Disease: Controversial Issues

Kim,

Moon,

Min

et al. 2024

Tuberc Respir Dis

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“…Bronchodilators should theoretically improve breathlessness and, in vitro , long-acting muscarinic antagonists reduce mucus production [ 75 ]. In the largest study of bronchodilators to date, tiotropium improved lung function but did not reduce exacerbations or improve symptoms in 90 patients with bronchiectasis [ 75 , 76 ]. The approach to the investigation and management of bronchiectasis is summarised in figure 2 .…”

Section: Current Therapiesmentioning

confidence: 99%

Basic, translational and clinical aspects of bronchiectasis in adults

Chalmers¹,

Elborn²,

Greene³

2023

Eur Respir Rev

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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 approachesviaexercise 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.

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Dual Broncodilator and Triple Therapy in Bronchiectasis. Clinical Trials are Urgently Needed

Cazzola

Matera

Martínez‐García

2023

Archivos de Bronconeumología

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Bronchodilators in bronchiectasis: there is light but it is still too dim

Abstract: Despite the fact that the first large randomised controlled trial on the effect of bronchodilators in bronchiectasis has now been published, more information in this field is urgently needed https://bit.ly/3Fhy6Hf

Cited by 3 publications

References 29 publications

Proposed Etiotypes for Chronic Obstructive Pulmonary Disease: Controversial Issues

Proposed Etiotypes for Chronic Obstructive Pulmonary Disease: Controversial Issues

Basic, translational and clinical aspects of bronchiectasis in adults

Dual Broncodilator and Triple Therapy in Bronchiectasis. Clinical Trials are Urgently Needed

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