Successful treatment of ulcerative bronchiolitis in a woman with refractory<i>Mycobacterium intracellulare</i>infection

Εgan, John; Seides, Benjamin; Olivier, Kenneth N.; Addrizzo-Harris, Doreen

doi:10.1136/bcr-2015-209604

Cited by 4 publications

(1 citation statement)

References 22 publications

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“…These pulmonary manifestations may respond to anti-inflammatory agents such as inhaled or systemic steroids; however, some cases may require tumor necrosis factor alpha blockade (once infection is identified and controlled with antibiotics) or other immunodulatory drugs commonly used to treat bowel inflammation to control the progression of bronchiectasis. 32 Causative genes have not been identified for these disorders. For inflammatory bowel disease, associated genetic risk loci have been reported including CARD15/NOD2, ATG16L1, IRGM, IL23R, TNFSF15 , and HLAD-QA1 .…”

Section: Endotypes and Genotypesmentioning

confidence: 99%

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

2018

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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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Section: Endotypes and Genotypesmentioning

confidence: 99%

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

2018

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Bronchiectasis in rheumatoid arthritis. A clinical appraisial

2020

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Bronchiectasis is defined as irreversibly damaged and dilated bronchi and is one of the most common pulmonary manifestations in patients with rheumatoid arthritis (RA). The model of RA-associated autoimmunity induced by chronic bacterial infection in bronchiectasis is becoming increasingly acceptable, although a genetic predisposition to RA-associated bronchiectasis has also been demonstrated. Bronchiectasis should be suspected in RA patients with chronic cough and sputum production or frequent respiratory infections and the diagnosis must be confirmed by thoracic high-resolution computed tomography. Management of patients with RA-associated bronchiectasis includes a multimodal treatment approach. Similar to all patients with non-cystic fibrosis bronchiectasis, patients with RA-associated bronchiectasis benefit from a pulmonary rehabilitation program, including an exercise/muscle strengthening program and an education program with a specific session on airway clearance techniques. Prophylactic antibiotics are recommended for patients with frequent (3 or more infective exacerbations per year) or severe infections requiring hospitalization/intravenous antibiotics and inhaled corticosteroids and long-acting β2-agonists should be used in patients with non-cystic fibrosis bronchiectasis and associated airway hyperresponsiveness. In patients with RA-associated bronchiectasis the use of immunomodulatory drugs has to be carefully considered, as they are essential to control disease activity and pulmonary manifestations, despite being associated with an increased infectious risk. Pneumococcal and influenza vaccines are advised to all patients with RA-associated bronchiectasis in order to reduce the risk of infection. Patients with RA-associated bronchiectasis have a poorer prognosis when compared to those with RA or bronchiectasis alone and require regular follow-up, under the joint care of a rheumatologist and a pulmonologist.

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