Javier Perez-Miranda1,2, Letizia Traversi3, Eva Polverino1,2,4. 1. Cystic Fibrosis and primary immunodeficiencies Unit, Institut de Recerca Vall d'Hebron (VHIR). 2. Pneumology Department, Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain. 3. Department of Medicine and Surgery, Respiratory Diseases, Università dell'Insubria, Varese-Como, Italy. 4. CIBER Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
Abstract
PURPOSE OF REVIEW: The presence of bronchiectasis has been described in about 30% of severe asthma patients. The coexistence of these two respiratory conditions poses new challenges from both clinical and research perspectives. We will review the available literature on this topic to discuss the existance of a specific clinical phenotype of asthma. RECENT FINDINGS: Despite the paucity of literature, the presence of bronchiectasis with severe asthma is associated with older age, chronic bronchial expectoration, rhinosinusitis, more frequent and severe exacerbations, neutrophilic airway inflammation and poor response to usual treatment. Conversely, asthma features are also described in bronchiectasis patients even in the absence of an appropriate diagnosis of asthma. In both cases, there is some evidence supporting the use of bronchodilators, macrolides and respiratory physiotherapy, while the use of inhaled corticosteroids and antibiotics is controversial. SUMMARY: Based on available evidence on the association between (severe) asthma and bronchiectasis, its pathophysiology, certain clinical aspects and prognosis are largely unclear. Although specific management appears to be required in most cases, in our opinion there is still insufficient evidence to consider it a distinct phenotype of severe asthma. Hopefully, future research will shed more light on this topic and define the best therapeutic approach.
PURPOSE OF REVIEW: The presence of bronchiectasis has been described in about 30% of severe asthmapatients. The coexistence of these two respiratory conditions poses new challenges from both clinical and research perspectives. We will review the available literature on this topic to discuss the existance of a specific clinical phenotype of asthma. RECENT FINDINGS: Despite the paucity of literature, the presence of bronchiectasis with severe asthma is associated with older age, chronic bronchial expectoration, rhinosinusitis, more frequent and severe exacerbations, neutrophilic airway inflammation and poor response to usual treatment. Conversely, asthma features are also described in bronchiectasispatients even in the absence of an appropriate diagnosis of asthma. In both cases, there is some evidence supporting the use of bronchodilators, macrolides and respiratory physiotherapy, while the use of inhaled corticosteroids and antibiotics is controversial. SUMMARY: Based on available evidence on the association between (severe) asthma and bronchiectasis, its pathophysiology, certain clinical aspects and prognosis are largely unclear. Although specific management appears to be required in most cases, in our opinion there is still insufficient evidence to consider it a distinct phenotype of severe asthma. Hopefully, future research will shed more light on this topic and define the best therapeutic approach.
Authors: Shaan N Somani; Jason H Kwah; Chen Yeh; David B Conley; Leslie C Grammer; Robert C Kern; Michelle Prickett; Robert P Schleimer; Stephanie S Smith; Whitney W Stevens; Bruce K Tan; Kevin C Welch; Anju T Peters Journal: Int Forum Allergy Rhinol Date: 2019-10-07 Impact factor: 3.858