TY - JOUR
T1 - The overlap between bronchiectasis and chronic airway diseases
T2 - state of the art and future directions
AU - Polverino, Eva
AU - Dimakou, Katerina
AU - Hurst, John
AU - Martinez-Garcia, Miguel-Angel
AU - Miravitlles, Marc
AU - Paggiaro, Pierluigi
AU - Shteinberg, Michal
AU - Aliberti, Stefano
AU - Chalmers, James D
N1 - Copyright ©ERS 2018.
PY - 2018/9/15
Y1 - 2018/9/15
N2 - 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 chronic obstructive pulmonary disease (COPD). In addition, 4-72% of patients with severe COPD are found to have radiological bronchiectasis on computed tomography, with similar frequencies (20-30%) now being reported in cohorts with severe or uncontrolled asthma. Co-diagnosis of bronchiectasis with another airway disease is associated with increased lung inflammation, frequent exacerbations, worse lung function and higher mortality. In addition, many patients with all three disorders have chronic rhinosinusitis and upper airway disease, resulting in a complex "mixed airway" phenotype.The management of asthma, bronchiectasis, COPD and upper airway diseases has traditionally been outlined in separate guidelines for each individual disorder. Recognition that the majority of patients have one or more overlapping pathologies requires that we re-evaluate 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.
AB - 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 chronic obstructive pulmonary disease (COPD). In addition, 4-72% of patients with severe COPD are found to have radiological bronchiectasis on computed tomography, with similar frequencies (20-30%) now being reported in cohorts with severe or uncontrolled asthma. Co-diagnosis of bronchiectasis with another airway disease is associated with increased lung inflammation, frequent exacerbations, worse lung function and higher mortality. In addition, many patients with all three disorders have chronic rhinosinusitis and upper airway disease, resulting in a complex "mixed airway" phenotype.The management of asthma, bronchiectasis, COPD and upper airway diseases has traditionally been outlined in separate guidelines for each individual disorder. Recognition that the majority of patients have one or more overlapping pathologies requires that we re-evaluate 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.
KW - Asthma/diagnosis
KW - Bronchiectasis/diagnosis
KW - Comorbidity
KW - Humans
KW - Phenotype
KW - Precision Medicine
KW - Pulmonary Disease, Chronic Obstructive/diagnosis
U2 - 10.1183/13993003.00328-2018
DO - 10.1183/13993003.00328-2018
M3 - Review article
C2 - 30049739
SN - 0903-1936
VL - 52
JO - The European respiratory journal
JF - The European respiratory journal
IS - 3
ER -