The overlap between bronchiectasis and chronic airway diseases: state of the art and future directions

Eva Polverino, Katerina Dimakou, John Hurst, Miguel-Angel Martinez-Garcia, Marc Miravitlles, Pierluigi Paggiaro, Michal Shteinberg, Stefano Aliberti, James D Chalmers

Research output: Contribution to journalReview article

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.

Original languageEnglish
Article number1800328
JournalEuropean Respiratory Journal
Volume52
Issue number3
DOIs
Publication statusPublished - Sep 2018

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    Polverino, E., Dimakou, K., Hurst, J., Martinez-Garcia, M-A., Miravitlles, M., Paggiaro, P., Shteinberg, M., Aliberti, S., & Chalmers, J. D. (2018). The overlap between bronchiectasis and chronic airway diseases: state of the art and future directions. European Respiratory Journal, 52(3), [1800328]. https://doi.org/10.1183/13993003.00328-2018