Rethinking bronchiectasis as an inflammatory disease.

IF 38.7 1区 医学 Q1 CRITICAL CARE MEDICINE
Lancet Respiratory Medicine Pub Date : 2024-11-01 Epub Date: 2024-07-03 DOI:10.1016/S2213-2600(24)00176-0
Merete B Long, Sanjay H Chotirmall, Michal Shteinberg, James D Chalmers
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引用次数: 0

Abstract

Bronchiectasis is understood to be the result of a complex interaction between infection, impaired mucociliary clearance, inflammation, and lung damage. Current therapeutic approaches to bronchiectasis are heavily focused on management of infection along with enhancing mucus clearance. Long-term antibiotics have had limited success in clinical trials, suggesting a need to re-evaluate the concept of bronchiectasis as an infective disorder. We invoke the example of asthma, for which treatment paradigms shifted away from targeting smooth muscle constriction, towards permanently suppressing airway inflammation, reducing risk and ultimately inducing remission with precision anti-inflammatory treatments. In this Review, we argue that bronchiectasis is primarily a chronic inflammatory disease, requiring early identification of at-risk individuals, and we introduce a novel concept of disease activity with important implications for clinical practice and future research. A new generation of novel anti-inflammatory treatments are under development and repurposing of anti-inflammatory agents from other diseases could revolutionise patient care.

重新思考支气管扩张症这种炎症性疾病。
据了解,支气管扩张症是感染、粘液清除障碍、炎症和肺损伤之间复杂相互作用的结果。目前治疗支气管扩张症的方法主要集中在控制感染和提高粘液清除率上。长期使用抗生素在临床试验中收效甚微,这表明有必要重新评估支气管扩张症作为一种感染性疾病的概念。我们以哮喘为例,哮喘的治疗模式已从以平滑肌收缩为目标转向永久性抑制气道炎症、降低风险并最终通过精确抗炎治疗诱导缓解。在这篇综述中,我们认为支气管扩张症主要是一种慢性炎症性疾病,需要早期识别高危人群,我们还提出了疾病活动性的新概念,这对临床实践和未来研究具有重要意义。新一代新型抗炎治疗方法正在研发中,将其他疾病的抗炎药物重新用于临床可能会彻底改变对患者的治疗。
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来源期刊
Lancet Respiratory Medicine
Lancet Respiratory Medicine RESPIRATORY SYSTEM-RESPIRATORY SYSTEM
CiteScore
87.10
自引率
0.70%
发文量
572
期刊介绍: The Lancet Respiratory Medicine is a renowned journal specializing in respiratory medicine and critical care. Our publication features original research that aims to advocate for change or shed light on clinical practices in the field. Additionally, we provide informative reviews on various topics related to respiratory medicine and critical care, ensuring a comprehensive coverage of the subject. The journal covers a wide range of topics including but not limited to asthma, acute respiratory distress syndrome (ARDS), chronic obstructive pulmonary disease (COPD), tobacco control, intensive care medicine, lung cancer, cystic fibrosis, pneumonia, sarcoidosis, sepsis, mesothelioma, sleep medicine, thoracic and reconstructive surgery, tuberculosis, palliative medicine, influenza, pulmonary hypertension, pulmonary vascular disease, and respiratory infections. By encompassing such a broad spectrum of subjects, we strive to address the diverse needs and interests of our readership.
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