Management of bronchiectasis exacerbation

14 Oct 2022 15:30 16:00
Vikas Goyal Speaker

Bronchiectasis is a chronic respiratory disease characterised by chronic or recurrent wet/productive cough combined with airway infection, neutrophilic inflammation and abnormal bronchial dilatation on a chest computed tomography scan. The European Respiratory Society (ERS) considers bronchiectasis as one of the most neglected pulmonary disorders in paediatric and adult medicine. Exacerbations are common in children and adolescents with bronchiectasis. Exacerbations are clinically important as they are associated with psychological stress, impaired quality of life, lung function decline, and are among the top clinical and research priorities expressed by parents/patients/clinicians in paediatrics and adult European and USA bronchiectasis groups. The recent ERS clinical practice guideline for managing children/adolescents with bronchiectasis recommendations include early and appropriate management using a multidisciplinary approach, including that for exacerbations. Currently, all bronchiectasis guidelines recommend at least 14-days of antibiotics for respiratory exacerbations and airway clearnace for children. Recent publications have provided robust paediatric data for use of antibiotics for acute exacerbations, long term macrolides and hypertonic saline for children with bronchiectasis but gaps in knowledge remain. For example, we need novel data that can identify those who will most benefit from antibiotics and those in whom such treatment may be unnecessary. Studies are currently underway to examine the role of novel agents to decrease airway neutrophilic inflammation and role of vaccines. The next few years is likely to see significant advances in our understanding of endotypes and phenotypes in paediatric bronchiectasis. This will allow for a precision medicine approach where treatable traits are addressed.