Is prevention and remission of bronchiectasis possible?

Bronchiectasis had a declining incidence over the last century but in the recent 2 decades has had a global resurgence of bronchiectasis in children and adults as there is increasing appreciation of its morbidity with increased availability of CT scans.^1-3 However, despite its increasing prevalence³ and its substantial impact on morbidity¹ and mortality,⁴ bronchiectasis remains relatively under-researched. 

 

A paradigm for bronchiectasis development and its progression is internationally accepted.^1,2 This paradigm is framed around the notion that primary prevention of bronchiectasis is possible and the knowledge that early detection of causal conditions (eg. hypogammaglobulinemia) substantially reduces the risk of the future development of bronchiectasis through early initiation of treatment and optimal care. In children, mild (ie. when detected early) bronchiectasis is potentially reversible.^1,2,5 Many factors influence progression of the illness, most of which modifiable and represent potential intervention points. These factors (secondary prevention) include better clinical management and guideline implementation. There are also primary prevention factors eg, reducing the lower respiratory infections.

 

Prompt and accurate detection of bronchiectasis is pivotal when starting treatment to reverse early disease. Diagnosis requires clinical suspicion and objective tests and thus appropriate case ascertainment is important. Objective diagnosis of bronchiectasis is based upon radiological finding of an increased broncho-arterial ratio (BAR) on chest CT scans using the paeditric-derived ratio of 0.8 instead of the adult ratio of >1.0.^1,2,6 

 

Effective clinical management should include a multi-disciplinary team. There is increasing evidence that intensive treatment of children who either have bronchiectasis, or who are at risk of developing severe bronchiectasis, prevents severe disease and future poor lung function in adulthood. New approaches to managing people with other chronic airway diseases, include the concept of phenotypes and ‘treatable traits’,2 While they be may be useful, clinical validation and more knowledge is needed to understand how these concepts would improve short-term clinical outcomes and long-term prognosis in children with bronchiectasis. 

 

This talk will focus on possible prevention factors and outline data on the remission of bronchiectasis in children. 

 

References

1 Chalmers JD, Chang AB, Chotirmall SH, Dhar R, McShane PJ. Bronchiectasis. Nature Rev Dis Primers 2018; 4: 45.

2 Chang AB, Bush A, Grimwood K. Bronchiectasis in children: Diagnosis and Treatment. Lancet 2018; 392: 866-79.

3 Flume PA, Chalmers JD, Olivier KN. Advances in bronchiectasis: endotyping, genetics, microbiome, and disease heterogeneity. Lancet 2018; 392: 880-90.

4 McCallum GB, Chang AB. 'Good enough' is 'not enough' when managing Indigenous adults with bronchiectasis in Australia and New Zealand. Respirology 2018; 23: 725-26.

5 Mills DR, Masters IB, Yerkovich ST, et al. Radiographic Outcomes in Paediatric Bronchiectasis and Factors Associated with Reversibility. Am J Respir Crit Care Med 2024.

6 Chang AB, Fortescue R, Grimwood K, et al. Task Force report: European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis. Eur Respir J 2021; 58: 2002990.