Chest. 2018 Nov 04;:
Authors: McShane PJ, Tino G
Bronchiectasis is an important clinical syndrome due to its increasing prevalence, significant economic burden on healthcare, and associated morbidity. Until recently, the disease was considered an "orphan" and essentially neglected from a therapeutic standpoint. Fortunately, many recent advances have been made in the field. Several national registries have formed to provide databases from which to study bronchiectasis patients. Experts published a consensus definition of a bronchiectasis-specific exacerbation which will serve as a unified definition for future clinical trials. Several inhaled antibiotic trials aimed to reduce exacerbation frequency have been completed. Researchers have investigated non-culture techniques, such as 16S rRNA and whole genome sequencing to characterize the microbiology. Studies of anti-Pseudomonas antibodies are providing interesting insight into varying host response to chronic Pseudomonas infection. After three successful trials demonstrating that macrolides reduce exacerbations in bronchiectasis, other anti-inflammatory agents have been investigated, and trial of a novel anti-inflammatory drug is on-going. A relatively robust study has been published in airway clearance, a therapy that is universally accepted as beneficial but has never been accompanied by strong evidence. To build on the successes bronchiectasis thus far, better phenotyping of bronchiectasis patients must occur. In this regard, clinical tools have been developed to quantify disease severity and predict prognosis. Studies of different clinical phenotypes of bronchiectasis patients have been published. With continued advances in the field of bronchiectasis, there is hope that evidenced-based therapies will become available.
PMID: 30403962 [PubMed - as supplied by publisher]