The Link between Asthma and Bronchiectasis: State of the Art

Abstract

The nonrecognition of asthma-associated comorbidities is often responsible for the therapeutic failure and the worsening of symptoms, and it is associated with frequent exacerbations, higher disease severity, and increased health costs. Bronchiectasis, one of the most frequent asthma-associated comorbidities, can increase airways inflammation and exacerbation rates and cause respiratory functional impairment. The aim of this article is to review the interactions between bronchiectasis and asthma, in order to better identify patients in the overlap between the 2 diseases and to select an "ad hoc" therapy. A literature search on PubMed/MEDLINE was performed using the following search terms: bronchiectasis in asthma, the association between asthma and bronchiectasis, comorbidities in asthma, and severe asthma. This review analyzed the following items: incorrect or underestimated diagnosis of asthma and bronchiectasis, prevalence of bronchiectasis in asthma, the impact of bronchiectasis in asthma, radiological imaging features of the 2 diseases, etiopathogenesis, and common causes (such as gastroesopha-geal reflux disease, immune deficits, chronic rhinosinusitis and allergic bronchopulmonary aspergillosis, and treatment of asthma and bronchiectasis). The concomitant presence of bronchiectasis and asthma should be suspected and investigated in patients with severe asthma, frequent exacerbations, and not responding to standard therapy. This clinical phenotype, characterized by a more severe disease, worse outcomes, and functional decline, must be readily recognized in order to choose the most appropriate therapeutic approach, able to potentially improve the management of bronchial asthma, to prevent the onset of exacerbations as well the functional decline, and to reduce health costs.

Impact of Pseudomonas aeruginosa Infection on Patients with Chronic Inflammatory Airway Diseases

“…Many studies have been published on CBI by P. aeruginosa in bronchiectasis and people with COPD but only a few have evaluated the isolation of bacterial pathogens in the respiratory secretions of people with asthma. People with severe asthma can present both bronchiectasis and CBI by various pathogens, but they are often not subjected to a microbiological study, thereby complicating the management of their disease and hindering a successful therapy [210,211]. In such people, the presence of uncontrolled bronchial inflammation can lead to increased production of respiratory secretions, with a consequent formation of mucous blockages, leading to local damage to the bronchial mucus and P. aeruginosa the development of bronchiectasis.…”

“…In such people, the presence of uncontrolled bronchial inflammation can lead to increased production of respiratory secretions, with a consequent formation of mucous blockages, leading to local damage to the bronchial mucus and P. aeruginosa the development of bronchiectasis. People with coexisting bronchiectasis and asthma tend to be older, with a longer duration of asthma, greater airway inflammation and functional decline, more frequent exacerbations and, therefore, greater disease severity [211][212][213][214][215][216][217][218][219]. Studies that have analyzed the cultures of respiratory secretions of people with asthma have found that the presence of bacteria in the sputum is associated with a longer duration of the disease, poorer lung function (FEV1), and more neutrophils and a higher concentration of Il-8 in the sputum [219,220].…”

Surgical management of pulmonary aspergilloma—12 years’ experience from a tertiary care centre in India

“…In patients who never had TB, it was observed that they had chronic lung diseases like bronchial asthma and chronic obstructive pulmonary disease (COPD) which predisposed them to develop bronchiectasis [12]. There was one patient with congenital intra-lobar sequestration, colonised by the fungus (Fig.…”

Clinical and Inflammatory Features of Exacerbation-Prone Asthma: A Cross-Sectional Study Using Multidimensional Assessment

“…Instead, our data revealed that COPD, bronchiectasis, and anxiety were associated with EPA. It emphasized the necessity to raise awareness and make correct diagnosis of these comorbidities among clinicians to guide an appropriate treatment strategy in these patients with EPA [57, 58]. This suggests that comorbidity varies among races.…”