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 COPD. In addition, 4% to 72% of patients with severe COPD are found to have radiological bronchiectasis on CT scanning, with similar frequencies (20–30%) now being reported in cohorts with severe or uncontrolled asthma. Co-diagnosis of bronchiectasis with another airways disease has been reported to be associated with increased lung inflammation, frequent exacerbations, worse lung function and higher mortality. In addition, many patients with all three disorders suffer from chronic rhinosinusitis and upper airway disease resulting in a complex “mixed airway” phenotype.
The management of asthma, bronchiectasis, COPD and upper airway diseases has been traditionally outlined in separate guidelines for each individual disorder. Recognition that the majority of patients have one or more overlapping pathologies requires a re-evaluation of 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.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. POLVERINO reports personal fees from BAYER, GRIFOLS, INSMED, ZAMBON, outside the submitted work.
Conflict of interest: Dr. Dimakou has nothing to disclose.
Conflict of interest: Dr. Hurst has nothing to disclose.
Conflict of interest: Dr. Miravitlles has nothing to disclose.
Conflict of interest: Dr. Paggiaro reports grants and personal fees from AstraZeneca, grants and personal fees from Chiesi, personal fees and non-financial support from GSK, personal fees from Guidotti, personal fees and non-financial support from Menarini, personal fees from Mundipharma, personal fees and non-financial support from Novartis, grants and personal fees from Sanofi, outside the submitted work.
Conflict of interest: Dr. Shteinberg reports having received research grants from Novartis, Trudell pharma; travel grants- actelion, BI, GSK, Rafa. Speaker's fees- BI, GSK, Astra Zeneca, Teva, Novartis. A member- EMBARC collaboration.
Conflict of interest: Prof. Aliberti reports grants and personal fees from Bayer Healthcare, grants and personal fees from Aradigm Corporation, grants and personal fees from Grifols, personal fees from Astra Zeneca, personal fees from Basilea, personal fees from Zambon, personal fees from Novartis, personal fees from Raptor, grants and personal fees from Chiesi, personal fees from Actavis UK Ltd, personal fees from Horizon, grants and personal fees from INSMED, outside the submitted work; .Dr. Aliberti reports grants and personal fees from Bayer Healthcare, grants and personal fees from Aradigm Corporation, grants and personal fees from Grifols, personal fees from Astra Zeneca, personal fees from Basilea, personal fees from Zambon, personal fees from Novartis, personal fees from Raptor, grants and personal fees from Chiesi, personal fees from Actavis UK Ltd, personal fees from Horizon, grants and personal fees from INSMED, outside the submitted work.
Conflict of interest: Dr. Chalmers reports grants and personal fees from BAYER, grants and personal fees from GRIFOLS, grants and personal fees from INSMED, personal fees from ZAMBON, grants and personal fees from Boehringer Ingelheim, grants and personal fees from GSK, grants from Astrazeneca, grants and personal fees from Pfizer, outside the submitted work.
Conflict of interest: Dr. MARTINEZ-GARCIA reports personal fees from BAYER, GRIFOLS, ZAMBON, TEVA, ASTRA, GSK, NOVARTIS outside the submitted work.
This is a PDF-only article. Please click on the PDF link above to read it.
- Copyright ©ERS 2018