Precision medicine in bronchiectasis

Abstract

Bronchiectasis, due to its highly heterogenous nature, requires an individualised approach to therapy. Patients experience symptoms and exacerbations driven by a combination of impaired mucociliary clearance, airway inflammation and airway infection. Treatment of bronchiectasis aims to enhance airway clearance and to address the underlying causes of inflammation and infection susceptibility. Bronchiectasis has multiple causes and so the pathophysiology leading to individual symptoms and exacerbations are different between individuals. Standardised investigations are recommended by international guidelines to identify the underlying causes of bronchiectasis. The process of identifying the underlying biology within an individual is called “endotyping” and is an emerging concept across chronic diseases. Endotypes that have a specific treatment are referred to as “treatable traits” and a treatable traits approach to managing patients with bronchiectasis in a holistic and evidence-based manner is the key to improved outcomes. Bronchiectasis is an area of intense research. Endotyping allows identification of subsets of patients to allow medicines to be tested differently in the future where trials, rather than trying to achieve a “one size fits all” solution, can test efficacy in subsets of patients where the treatment is most likely to be efficacious.

Factors influencing poor response to type 2 targeted therapies in severe asthma: a retrospective cohort study

“…High-resolution CT scans are a reliable method to confirm bronchiectasis while using the NOPES score (FeNO, Pneumonia, Exacerbations, and Severity) helps assess risk [33][34][35][36]. It is important to personalize treatment strategies for each disease and use precise therapy for asthma (37)(38). ICS may be suitable for asthma and COPD, but they are controversial for bronchiectasis [39].…”

Emerging Role of Precision Medicine in Diagnosis and Treatment of Chronic Respiratory Disease

“…Precision medicine targets the specific molecular mechanisms of each patient to find the most effective treatment, which aims to avoid ineffective therapy. 9 Phenotype is a characteristic of an organism that can be observed and modified for a clinical framework. Clinical phenotypes are disease attributes, either singly or in combination, that explain differences between individuals.…”

ERS International Congress 2022: highlights from the Airway Diseases Assembly

“…Therefore, recent research in bronchiectasis has focused on developing strategies to identify underlying aetiologies of the disease, the impact of overlap syndromes, diversity of the airway microbiome and its interactions, the local and systemic inflammatory responses and assessing the impact of these key aspects on clinical outcomes and prognosis. At the ERS Congress 2022, we had the opportunity to broaden our knowledge on these topics that will help us to stratify patients based on their endotype and clinical phenotype to support the use of personalised medicine [ 85 ].…”