TABLE 3

Suggested future research priorities in bronchiectasis (adapted from Aliberti et al. [122])

Evidence for current treatments
1) An RCT of Pseudomonas eradication therapy compared with symptomatic treatment
2) An RCT to determine the optimal duration of antibiotic treatment for bronchiectasis exacerbations
3) Biomarkers are needed to identify which patients respond optimally to inhaled antibiotics
4) An RCT of inhaled corticosteroids in bronchiectasis, including determining whether biomarkers such as blood eosinophil counts can guide treatment
5) Large-scale pragmatic trials of airway clearance techniques and pulmonary rehabilitation are required to establish a robust evidence base and the optimal mode of delivery for this intervention
Novel treatments and disease understanding
6) Development of novel strategies to modify the microbiome as alternatives to broad-spectrum antibiotics (including antibodies/vaccines, phage therapy and probiotics)
7) Development of novel therapeutics targeting neutrophilic inflammation/neutrophil extracellular traps to prevent exacerbations and improve symptoms
8) A large-scale genetic study of unselected patients with bronchiectasis is needed to identify underlying causes, find new causes of “idiopathic bronchiectasis” and to identify new therapeutic targets
9) Deep molecular endotyping of bronchiectasis incorporating proteomics, transcriptomics, microbiomics and other profiling is needed to understand the biological mechanisms underlying bronchiectasis and identify new biomarkers and targets
10) Studies of early bronchiectasis, including syndromes such as persistent bacterial bronchitis and the early stages of diseases such as primary ciliary dyskinesia, are needed to understand the initial molecular mechanisms leading to the development and progression of bronchiectasis

RCT: randomised controlled trial.