Bronchiectasis: new therapies and new perspectives

James D. Chalmers (Lead / Corresponding author), Sanjay H. Chotirmall

Research output: Contribution to journalReview article

51 Citations (Scopus)
350 Downloads (Pure)

Abstract

European Respiratory Society guidelines for the management of adult bronchiectasis highlight the paucity of treatment options available for patients with this disorder. No treatments have been licensed by regulatory agencies worldwide, and most therapies used in clinical practice are based on very little evidence. Development of new treatments is needed urgently. We did a systematic review of scientific literature and clinical trial registries to identify agents in early-to-late clinical development for bronchiectasis in adults. In this Review, we discuss the mechanisms and potential roles of emerging therapies, including drugs that target airway and systemic inflammation, mucociliary clearance, and epithelial dysfunction. To ensure these treatments achieve success in randomised clinical trials-and therefore reach patients-we propose a reassessment of the current approach to bronchiectasis. Although understanding of the pathophysiology of bronchiectasis is at an early stage, we argue that bronchiectasis is a heterogeneous disease with many different biological mechanisms that drive disease progression (endotypes), and therefore the so-called treatable traits approach used in asthma and chronic obstructive pulmonary disease could be applied to bronchiectasis, with future trials targeted at the specific disease subgroups most likely to benefit.

Original languageEnglish
Pages (from-to)715-726
Number of pages12
JournalThe Lancet Respiratory Medicine
Volume6
Issue number9
Early online date23 Feb 2018
DOIs
Publication statusPublished - Sep 2018

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