Management of bronchiectasis in adults

Abstract

Formerly regarded as a rare disease, bronchiectasis is now increasingly recognised and a renewed interest in the condition is stimulating drug development and clinical research. Bronchiectasis represents the final common pathway of a number of infectious, genetic, autoimmune, developmental and allergic disorders and is highly heterogeneous in its aetiology, impact and prognosis.The goals of therapy should be: to improve airway mucus clearance through physiotherapy with or without adjunctive therapies; to suppress, eradicate and prevent airway bacterial colonisation; to reduce airway inflammation; and to improve physical functioning and quality of life.Fortunately, an increasing body of evidence supports interventions in bronchiectasis. The field has benefited greatly from the introduction of evidence-based guidelines in some European countries and randomised controlled trials have now demonstrated the benefit of long-term macrolide therapy, with accumulating evidence for inhaled therapies, physiotherapy and pulmonary rehabilitation.This review provides a critical update on the management of bronchiectasis focussing on emerging evidence and recent randomised controlled trials. @ERSpublications Bronchiectasis is a rapidly developing field: review of recent RCTs and progress towards developing new therapies

Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults

“…This can be achieved by reducing airways inflammation, inhalation of hyperosmolar agents and by pulmonary physiotherapy and exercise [151]. …”

“…Low-dose macrolide treatment may reduce exacerbations in patients with bronchiectasis [151,152]. However, the effect of treating bronchiectasis in severe asthma has not been investigated, and there is a need for further studies.…”

Quality standards for the management of bronchiectasis in Italy: a national audit

“…Although historically considered a neglected disease, bronchiectasis has become a disease of renewed interest over recent decades in light of an increase in prevalence and a substantial burden on healthcare systems [1][2][3]. In 2010, the British Thoracic Society (BTS) published guidelines on the management of bronchiectasis in adults, along with specific quality standards [4,5].…”

“…49% had been hospitalised at least once in the previous year for lower respiratory tract infections (LRTI). The median (IQR) number of antibiotic courses for LRTI in the previous year was 2 (2)(3), with 40% of the study population receiving three or more antibiotic courses in the previous year. Specifically, 36% of them received at least one course of intravenous antibiotics because of an exacerbation during the previous year.…”

The double-edged sword of neutrophilic inflammation in bronchiectasis

“…(fewer intakes per day), the administration route (inhaled and nebulised antibiotics), increased potency along with reduced side-effects (broncodilators, inhaled steroids and hypertonic saline) and molecules with a proven degree of anti-inflammatory action (macrolides) [7]. However, barely any studies, so far, have seriously investigated any new products with new action mechanisms ( particularly in the case of anti-inflammatory drugs) or new pathophysiological routes or pathways.…”