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 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.
Abstract
Bronchiectasis is a heterogeneous disease and frequently overlaps with other chronic airway diseases. Management of these overlap conditions is particularly challenging in terms of diagnosis and therapy, and requires future research. http://ow.ly/snLK30lsrkr
Footnotes
Conflict of interest: E. Polverino reports personal fees from Bayer, Grifols, Insmed and Zambon, outside the submitted work.
Conflict of interest: K. Dimakou has nothing to disclose.
Conflict of interest: J. Hurst has nothing to disclose.
Conflict of interest: M.A. Martinez-Garcia reports personal fees from Bayer, Grifols, Zambon, Teva, AstraZeneca, GSK and Novartis, outside the submitted work.
Conflict of interest: M. Miravitlles has nothing to disclose.
Conflict of interest: P. 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, and grants and personal fees from Sanofi, outside the submitted work.
Conflict of interest: M. Shteinberg reports having received research grants from Novartis and Trudell pharma; travel grants from Actelion, Boehringer Ingelheim, GSK and Rafa; speaker's fees from Boehringer Ingelheim, GSK, AstraZeneca, Teva and Novartis; and is a member of the EMBARC collaboration.
Conflict of interest: S. 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 AstraZeneca, 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, and grants and personal fees from INSMED, outside the submitted work.
Conflict of interest: J.D. 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, and grants and personal fees from Pfizer, outside the submitted work.
- Received February 14, 2018.
- Accepted July 10, 2018.
- Copyright ©ERS 2018