Paediatric and adult bronchiectasis: Specific management with coexisting asthma, COPD, rheumatological disease and inflammatory bowel disease

Abstract

Bronchiectasis, conventionally defined as irreversible dilatation of the bronchial tree, is generally suspected on a clinical basis and confirmed by means of chest high-resolution computed tomography. Clinical manifestations, including chronic productive cough and endobronchial suppuration with persistent chest infection and inflammation, may deeply affect quality of life, both in children/adolescents and adults. Despite many cases being idiopathic or post-infectious, a number of specific aetiologies have been traditionally associated with bronchiectasis, such as cystic fibrosis (CF), primary ciliary dyskinesia or immunodeficiencies. Nevertheless, bronchiectasis may also develop in patients with bronchial asthma; chronic obstructive pulmonary disease; and, less commonly, rheumatological disorders and inflammatory bowel diseases. Available literature on the development of bronchiectasis in these conditions and on its management is limited, particularly in children. However, bronchiectasis may complicate the clinical course of the underlying condition at any age, and appropriate management requires an integration of multiple skills in a team of complementary experts to provide the most appropriate care to affected children and adolescents. The present review aims at summarizing the current knowledge and available evidence on the management of bronchiectasis in the other conditions mentioned and focuses on the new therapeutic strategies that are emerging as promising tools for improving patients' quality of life.

Predictors of mortality in inflammatory bowel disease patients treated for pneumonia

“…Bronchiectasis is one of the most common respiratory disorders in IBD patients; its frequency ranges from 18% to 26% and it may precede or follow disease diagnosis. 15 , 16 In our cohort three IBD patients had bronchiectasis (3%), and there were two CD patients and one UC patient. Exacerbations are usually caused by acute bacterial infections, 17 , 18 thus, the importance of vaccinations regimen adherence cannot be overemphasized.…”

Impact of Radiographic Bronchiectasis in COPD

“…At the clinical level, our findings highlight the importance of sputum surveillance for all patients with COPD with bronchiectasis; at the research level, we advocate for better evidence on the effectiveness of eradication or long-term suppressive therapy for potentially pathogenic microorganism or non-tuberculosis mycobacteria infection. 57 Our meta-analysis showed that subjects with COPD and with bronchiectasis had different demographic characteristics, clinical manifestations, and also laboratory parameters, and that these factors were individually associated with prognosis. Therefore, early diagnosis and management of bronchiectasis is of major importance for the prognosis of patients with COPD.…”

Inflammatory bowel disease and the lung in paediatric patients

“…The pathogenesis of pulmonary involvement in IBD is not well understood. Molecular mimicry or aberrant cell homing from the shared embryological origin of the pulmonary and intestinal system from the primitive foregut may play a role in the disease process [ 30 ]. Colonic and respiratory epithelia express submucosal lymphoid tissue and are important for host mucosal defence mechanisms.…”