Advances in bronchiectasis: endotyping, genetics, microbiome, and disease heterogeneity

Bronchiectasis is characterised by pathological dilation of the airways. More specifically, the radiographic demonstration of airway enlargement is the common feature of a heterogeneous set of conditions and clinical presentations. No approved therapies exist for the condition other than for bronchi...

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Bibliographic Details
Published in:The Lancet (British edition) Vol. 392; no. 10150; pp. 880 - 890
Main Authors: Flume, Patrick A, Chalmers, James D, Olivier, Kenneth N
Format: Journal Article
Language:English
Published: England Elsevier Ltd 08.09.2018
Elsevier Limited
Subjects:
Age
Antibiotics
Asthma
Autoimmune Diseases - complications
Bacterial infections
Biomarkers
Bronchiectasis
Bronchiectasis - etiology
Bronchiectasis - genetics
Bronchiectasis - microbiology
Bronchiectasis - physiopathology
Chronic obstructive pulmonary disease
Clinical trials
Cystic fibrosis
Cystic Fibrosis - complications
Disease Progression
Enlargement
Genetic Predisposition to Disease
Genetics
Heterogeneity
Humans
Immunocompetence
Infections
Inflammatory bowel disease
Kidney diseases
Medical research
Microbiomes
Microbiota
Mutation
Pathogens
Patients
Phenotypes
Physicians
R&D
Research & development
Respiratory tract
United States > US
ISSN:0140-6736, 1474-547X, 1474-547X
Online Access:Get full text
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Summary:Bronchiectasis is characterised by pathological dilation of the airways. More specifically, the radiographic demonstration of airway enlargement is the common feature of a heterogeneous set of conditions and clinical presentations. No approved therapies exist for the condition other than for bronchiectasis caused by cystic fibrosis. The heterogeneity of bronchiectasis is a major challenge in clinical practice and the main reason for difficulty in achieving endpoints in clinical trials. Recent observations of the past 2 years have improved the understanding of physicians regarding bronchiectasis, and have indicated that it might be more effective to classify patients in a different way. Patients could be categorised according to a heterogeneous group of endotypes (defined by a distinct functional or pathobiological mechanism) or by clinical phenotypes (defined by relevant and common features of the disease). In doing so, more specific therapies needed to effectively treat patients might finally be developed. Here, we describe some of the recent advances in endotyping, genetics, and disease heterogeneity of bronchiectasis including observations related to the microbiome.
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ISSN:0140-6736
1474-547X
1474-547X
DOI:10.1016/S0140-6736(18)31767-7