Advances in bronchiectasis: endotyping, genetics, microbiome, and disease heterogeneity

Patrick A. Flume (Lead / Corresponding author), James D. Chalmers, Kenneth N. Olivier

Research output: Contribution to journalReview articlepeer-review

231 Citations (Scopus)
741 Downloads (Pure)


Bronchiectasis is characterised by pathological dilation of the airways. More specifically, the radiographic demonstration of airway enlargement is the common feature of a heterogeneous set of conditions and clinical presentations. No approved therapies exist for the condition other than for bronchiectasis caused by cystic fibrosis. The heterogeneity of bronchiectasis is a major challenge in clinical practice and the main reason for difficulty in achieving endpoints in clinical trials. Recent observations of the past 2 years have improved the understanding of physicians regarding bronchiectasis, and have indicated that it might be more effective to classify patients in a different way. Patients could be categorised according to a heterogeneous group of endotypes (defined by a distinct functional or pathobiological mechanism) or by clinical phenotypes (defined by relevant and common features of the disease). In doing so, more specific therapies needed to effectively treat patients might finally be developed. Here, we describe some of the recent advances in endotyping, genetics, and disease heterogeneity of bronchiectasis including observations related to the microbiome.

Original languageEnglish
Pages (from-to)880-890
Number of pages11
JournalThe Lancet
Issue number10150
Early online date6 Sept 2018
Publication statusPublished - 8 Sept 2018


  • Autoimmune Diseases/complications
  • Bronchiectasis/etiology
  • Cystic Fibrosis/complications
  • Disease Progression
  • Genetic Predisposition to Disease
  • Humans
  • Immunocompetence
  • Microbiota
  • Mutation


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