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. 2023 Jun 7;32(168):230015.
doi: 10.1183/16000617.0015-2023. Print 2023 Jun 30.

Basic, translational and clinical aspects of bronchiectasis in adults

James D Chalmers  1 , Stuart Elborn  2 , Catherine M Greene  3
Affiliations

Basic, translational and clinical aspects of bronchiectasis in adults

James D Chalmers et al. Eur Respir Rev. .

Abstract

Bronchiectasis is a common progressive respiratory disease with recognisable radiological abnormalities and a clinical syndrome of cough, sputum production and recurrent respiratory infections. Inflammatory cell infiltration into the lung, in particular neutrophils, is central to the pathophysiology of bronchiectasis. Herein we explore the roles and relationships between infection, inflammation and mucociliary clearance dysfunction in the establishment and progression of bronchiectasis. Microbial and host-mediated damage are important processes underpinning bronchiectasis and the relative contribution of proteases, cytokines and inflammatory mediators to the propagation of inflammation is presented. We also discuss the emerging concept of inflammatory endotypes, defined by the presence of neutrophilic and eosinophilic inflammation, and explore the role of inflammation as a treatable trait. Current treatment for bronchiectasis focuses on treatment of underlying causes, enhancing mucociliary clearance, controlling infection and preventing and treating complications. Data on airway clearance approaches via exercise and mucoactive drugs, pharmacotherapy with macrolides to decrease exacerbations and the usefulness of inhaled antibiotics and bronchodilators are discussed, finishing with a look to the future where new therapies targeting host-mediated immune dysfunction hold promise.

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Conflict of interest statement

Conflict of interest: J.D. Chalmers reports grants or contracts from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Gilead Sciences, Grifols, Novartis and Insmed, outside the submitted work; consulting fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Insmed, Janssen, Novartis, Pfizer and Zambon, outside the submitted work. Conflict of interest: S. Elborn holds a joint public–private grant from the European commission in the innovative medicines initiative with Novartis AG and Spexsis; he worked as a paid consultant for Vertex Pharmaceuticals and Viatris Inc.; and has been a paid speaker for many pharmaceutical companies over 30 years in respiratory medicine. Conflict of interest: C.M. Greene reports grants or contracts from NIH and Vertex, outside the submitted work; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Vertex, outside the submitted work; support for attending meetings and/or travel from European Respiratory Society, outside the submitted work; and was Head of ERS Assembly 3 2019–2022, outside the submitted work.

Figures

FIGURE 1
FIGURE 1
The four key aspects underpinning the vicious vortex of bronchiectasis. Pulmonary infection and inflammation, mucociliary clearance (MCC) dysfunction, and structural lung damage are common features of the pathophysiology of bronchiectasis regardless of cause. The interactions between these four aspects are not best represented as a cycle; this is due to the fact that each of the individual components can independently affect all of the other aspects and therefore it is better described as a “vicious vortex”. ASL: airway surface liquid; NET: neutrophil extracellular trap; NTM: nontuberculous mycobacteria.
FIGURE 2
FIGURE 2
Diagnosis and management of bronchiectasis. Schematic summarising the key aspects in the assessment and treatment of bronchiectasis. HRCT: high-resolution computed tomography; PsA: Pseudomonas aeruginosa.
See this image and copyright information in PMC

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