Diagnosis and Initial Investigation of Bronchiectasis

Amati, Francesco; Simonetta, Edoardo; Pilocane, Tommaso; Gramegna, Andrea; Goeminne, Pieter; Oriano, Martina; Pascual-Guardia, Sergi; Mantero, Marco; Voza, Antonio; Santambrogio, Martina; Blasi, Francesco; Aliberti, Stefano

doi:10.1055/s-0041-1730892

Cited by 9 publications

(5 citation statements)

References 127 publications

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“…The first step in bronchiectasis management is to identify an aetiology that may be treatable or influence management. Non-tuberculous mycobacterial (NTM) pulmonary disease, allergic bronchopulmonary aspergillosis (ABPA) and primary and secondary immunodeficiency are examples of underlying causes with specific treatments [ 17 , 18 , 31 ], while rheumatoid arthritis and primary ciliary dyskinesia (PCD) are examples of conditions that are associated with worse outcomes and differences in clinical phenotype which require a change in management [ 32 , 33 ]. Table 1 shows details on the diagnosis and treatment of NTM pulmonary disease, ABPA, immunodeficiency and α 1 -antitrypsin deficiency in bronchiectasis patients.…”

Section: Identifying and Treating The Underlying Causementioning

confidence: 99%

Bronchiectasis management in adults: state of the art and future directions

Choi,

McShane,

Aliberti

et al. 2024

Eur Respir J

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Formerly regarded as a rare disease, bronchiectasis is increasingly recognised. A renewed interest in this disease has led to significant progress in bronchiectasis research. Randomised clinical trials have demonstrated the benefits of airway clearance techniques, inhaled antibiotics and long-term macrolide therapy in bronchiectasis patients. However, the heterogeneity of bronchiectasis remains one of the most challenging aspects of management. Phenotypes and endotypes of bronchiectasis have been identified to help find “treatable traits” and partially overcome disease complexity. The goals of therapy for bronchiectasis are to reduce the symptom burden, improve quality of life, reduce exacerbations and prevent disease progression. We review the pharmacological and non-pharmacological treatments that can improve mucociliary clearance, reduce airway inflammation and tackle airway infection, the key pathophysiological features of bronchiectasis. There are also promising treatments in development for the management of bronchiectasis, including novel anti-inflammatory therapies. This review provides a critical update on the management of bronchiectasis focusing on treatable traits and recent randomised clinical trials.

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Section: Identifying and Treating The Underlying Causementioning

confidence: 99%

Bronchiectasis management in adults: state of the art and future directions

Choi,

McShane,

Aliberti

et al. 2024

Eur Respir J

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“…A broad spectrum of diagnostic tests is necessary to investigate the etiology of bronchiectasis focusing both on pulmonary and extrapulmonary features. The diagnostic flowchart should be tailored to each patient depending on their clinical manifestations and the site of care (e.g., primary, secondary, and tertiary care) to optimize patient management 13 .…”

Section: The Relevance Of the Etiological Investigationmentioning

confidence: 99%

“…The diagnostic approach to bronchiectasis is, therefore, challenging, especially considering that bronchiectasis-related signs and symptoms may overlap with other chronic respiratory diseases 13 .…”

Section: Limitations In Understanding the Etiologies Of Bronchiectasismentioning

confidence: 99%

The Etiological Screening of Bronchiectasis

Leonardi¹,

Amati²,

Aliberti³

et al. 2022

BRN

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Bronchiectasis was once considered to be the manifestation of other diseases, but this topic is gaining growing interest due to its increase in incidence and prevalence. Bronchiectasis is characterized by a combination of clinical and radiological features, but we still lack a full understanding of their pathophysiological mechanisms. They are often present in patients affected by cystic fibrosis and therefore the exclusion of this disease is of paramount importance in patients affected by bronchiectasis.The most recent guidelines, mostly based on expert opinions, state that all individuals with bronchiectasis should undergo a minimum bundle of tests which should be tailored to each patient. The determination of the etiology of bronchiectasis can guide treatment and influence prognosis.The next step in this field of research is the standardization of etiological screening of bronchiectasis that would allow optimal patient management and the optimization of the available resources.

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“…Bronchiectasis is a chronic progressive respiratory disease characterized by permanent damage and dilatation of the bronchi [1]. Bronchiectasis can be considered a syndrome and a common endpoint of various diseases, but it can also occur as a single radiological appearance that may or may not be associated with various diseases [2]. It is a complex condition with numerous different etiologies (infective, deficiency of alpha 1 antitrypsin, immunodeficiency, cystic fibrosis, and tuberculosis), co-morbidities (asthma and chronic obstructive pulmonary disease), and a heterogeneous presentation associated with respiratory symptoms and recurrent respiratory infections because of reduced mucus clearance, which favors mucus impaction [3].…”

Section: Introductionmentioning

confidence: 99%

Phenotype and Clinicoradiological Differences in Multifocal and Focal Bronchiectasis

Jankovic,

Jandric,

Djurdjevic

et al. 2024

Medicina

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Introduction: Bronchiectasis is a chronic progressive respiratory disease characterized by permanent dilatation of the bronchi. It is a complex condition with numerous different etiologies, co-morbidities, and a heterogeneous presentation. As we know, there is a lack of studies that describe the differences and compare the characteristics between focal and multifocal bronchiectasis. The aim of this study is to identify differences in clinical characteristics presentation, severity or distribution in focal and multifocal bronchiectasis, and prognostic implications. Methods: 126 patients with computed tomography (CT)-verified bronchiectasis were enrolled. Baseline characteristics that included age, sex, smoking history, and respiratory symptoms were recorded, with special attention paid to hemoptysis appearance, body mass index, and comorbidities. The type of bronchiectasis determined by CT scan and the modified Reiff scores indicating radiological severity were recorded. Patients were divided in two groups (I is focal and II is multifocal). Results: There were no statistically significant differences in age, smoking status, comorbidity, and BMI between the two groups. Multifocality was associated with a significantly higher proportion of females (p = 0.014), the rate of hemoptysis (p = 0.023), and the number of hospitalizations, but not of exacerbations and prevalence of immunodeficiency (p = 0.049). Significantly, a high number of subjects with multifocality had bronchiectasis of moderate severity, and post-infective and asthma-associated phenotypes were the dominant in this group. Unexpectedly, the cystic and varicose radiological phenotype (which need more time to develop) were more dominant in the focal group. The cylindrical phenotype was equally observed in the multifocal and focal groups. Conclusions: Our study suggests that multifocality is not related to age, number of exacerbations, or radiological phenotype, but it seems to be associated with the clinical post-infective phenotype, immunodeficiency, frequent hospitalizations, and severity. Thus, the presence of multifocal bronchiectasis may act as a biomarker of severity and poor outcomes in these patients.

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Diagnosis and Initial Investigation of Bronchiectasis

Cited by 9 publications

References 127 publications

Bronchiectasis management in adults: state of the art and future directions

Bronchiectasis management in adults: state of the art and future directions

The Etiological Screening of Bronchiectasis

Phenotype and Clinicoradiological Differences in Multifocal and Focal Bronchiectasis

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