Bronchiectasis: new therapies and new perspectives

TY - JOUR

T1 - Bronchiectasis

T2 - new therapies and new perspectives

AU - Chalmers, James D.

AU - Chotirmall, Sanjay H.

N1 - JDC is funded by the GlaxoSmithKline/British Lung Foundation Chair of Respiratory Research. SHC is supported by the Singapore Ministry of Health's National Medical Research Council under its Transition Award (NMRC/TA/0048/2016) and the Lee Kong Chian School of Medicine, Nanyang Technological University Start-Up Grant. The funding sources had no role in the writing of this Review or in the decision to submit the review for publication.

PY - 2018/9

Y1 - 2018/9

N2 - 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.

AB - 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.

U2 - 10.1016/S2213-2600(18)30053-5

DO - 10.1016/S2213-2600(18)30053-5

M3 - Review article

C2 - 29478908

SN - 2213-2600

VL - 6

SP - 715

EP - 726

JO - The Lancet Respiratory Medicine

JF - The Lancet Respiratory Medicine

IS - 9

ER -