Hot topics and current controversies in non-cystic fibrosis bronchiectasis

Abstract

Non-cystic fibrosis bronchiectasis (NCFB) is a neglected and orphan disease with poor advances through the 20th century. However, its prevalence is rising and with this come new challenges for physicians. Few guidelines are available to guide clinicians on how to diagnose and manage patients with NCFB. Many areas of debate persist, and there is lack of consensus about research priorities most needed to advance patient care and improve clinical outcomes. In this review, we highlight the current hot topics in NCFB and present updated evidence to inform the critical areas of controversy.Key pointsPostural drainage, active cycle of breathing techniques and pulmonary rehabilitation are non-pharmacological treatment options that should be offered to all patients with non-cystic fibrosis bronchiectasis (NCFB).Eradication of Pseudomonas aeruginosa (PA) colonisation in patients without an acute exacerbation remains debatable.Sputum cultures are the leading and most readily available tool to detect patients with chronic colonisation by PA and should be performed in all patients with NCFB.Antibacterial monoclonal antibodies and vaccine studies have shown promising results in the prevention of chronic colonisation with PA and should stimulate new studies in NCFB.NCFB patients colonised with PA are at more risk of a rapid decline in lung function, worsening quality of life and more hospital admissions.Dual therapy is a promising option for the management of patients with PA-related exacerbations.Patients with PA-related exacerbations benefit from prolonged courses of antibiotics (i.e. 14 days) but emerging and future studies, including dual therapy, may show promising results with shorter courses.Endophenotyping bronchiectasis to address its inherent heterogeneity is a promising avenue for future investment and research.

The airway microbiome in COPD, bronchiectasis and bronchiectasis‐COPD overlap

“…Additionally, patients may be classified into distinct endophenotypes offering a potential for precision-based therapeutic approaches where disease is heterogeneous. [66][67][68][69][70] Attempts to stratify bronchiectasis based on symptoms, inflammation and the airway microbiome have been undertaken. A significant correlation between cough and bacterial communities are reported in the BLESS cohort indicative that cough symptoms may be predictive of disease progression associated with the presence of specific microbial taxa.…”

Nontuberculous mycobacterial pulmonary disease: an integrated approach beyond antibiotics

“…Adherence is needed to ensure successful implementation in clinical practice. Therefore, according to current evidence, ACTs and PR should be offered to all patients with bronchiectasis, including those with NTM-PD and a bronchiectasis/bronchiolitic pattern [ 56 , 63 ].…”

Antimicrobial Resistance in Common Respiratory Pathogens of Chronic Bronchiectasis Patients: A Literature Review

“…Eradication treatment aims at achieving complete pathogen elimination from the lungs of patients using antibiotics [ 69 ]. Bronchiectasis is mainly caused by chronic P. aeruginosa infection; therefore, it is recommended to promptly eradicate these bacteria [ 69 , 92 , 93 ]. Unfortunately, until today, different eradication protocol exist and consensus is lacking on the best eradication treatment for bronchiectasis patients ( Figure 1 ) [ 69 ].…”