The overlap between bronchiectasis and chronic airway diseases: state of the art and future directions

Abstract

Bronchiectasis is a clinical and radiological diagnosis associated with cough, sputum production and recurrent respiratory infections. The clinical presentation inevitably overlaps with other respiratory disorders such as asthma and chronic obstructive pulmonary disease (COPD). In addition, 4-72% of patients with severe COPD are found to have radiological bronchiectasis on computed tomography, with similar frequencies (20-30%) now being reported in cohorts with severe or uncontrolled asthma. Co-diagnosis of bronchiectasis with another airway disease is associated with increased lung inflammation, frequent exacerbations, worse lung function and higher mortality. In addition, many patients with all three disorders have chronic rhinosinusitis and upper airway disease, resulting in a complex "mixed airway" phenotype.The management of asthma, bronchiectasis, COPD and upper airway diseases has traditionally been outlined in separate guidelines for each individual disorder. Recognition that the majority of patients have one or more overlapping pathologies requires that we re-evaluate how we treat airway disease. The concept of treatable traits promotes a holistic, pathophysiology-based approach to treatment rather than a syndromic approach and may be more appropriate for patients with overlapping features.Here, we review the current clinical definition, diagnosis, management and future directions for the overlap between bronchiectasis and other airway diseases.

Prevalence and characterization of chronic rhinosinusitis in patients with non‒cystic fibrosis bronchiectasis at a tertiary care center in the United States

“…However, we found significantly higher peripheral eosinophil counts in patients with bronchiectasis and CRS than in patients with bronchiectasis alone. It remains unclear whether the elevated peripheral eosinophil counts are simply a manifestation of CRS, a traditionally eosinophilic disorder, or if bronchiectasis patients with CRS have a different pathogenic mechanism that leads to a distinct eosinophil‐driven endotype . If this endotype is confirmed, the use of biologic agents targeting type II inflammation in patients with bronchiectasis and CRS should be studied …”

The microbiome in bronchiectasis

“…The cause of disease progression is hypothesised to be the result of a complex interaction between chronic infection, inflammation and impaired mucociliary clearance, which leads to structural changes in the lungs, allowing further infections to develop [6][7][8][9]. Each of these individual components interacts with the others, allowing the disease to progress.…”

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

“…Perhaps the murkiest assignment of association of adult bronchiectasis with coexisting diseases is the connection with other airways diseases, including asthma and COPD . In particular, 4–72% of patients with severe COPD have been recently reported to have bronchiectasis on CT, with similar frequencies (20–30%) reported in cohorts with severe or uncontrolled asthma . For the purposes of this review, ABPA will be considered a distinct and separate entity aside from asthma and will not be further discussed.…”