Bronchiectasis: An Emerging Global Epidemic

Sanjay H. Chotirmall; James D. Chalmers

Disclosures

BMC Pulm Med. 2018;18(76) 

In This Article

Editorial

Bronchiectasis is experiencing a clinical and research renaissance. This emerging epidemic of chronic and progressive immune-infective-inflammatory airway destruction results in a vicious cycle of repeated exacerbations and irreversible damage that now clearly necessitates greater global focus and investment. The recent publication of the first international guidelines for its management is welcome, particularly as its prevalence and recognition continues to rise.[1–3] Over the forthcoming years, international health systems are likely to face great challenges in managing this group of patients and their associated costs. Therefore, it appears logical that more research, increased therapeutic trials and improved specialist services should be prioritised. Importantly, the clear need for greater bronchiectasis-focused research is further evidenced by the fact that no single licensed therapy can yet be recommended for patients. This is despite the large numbers of trialled agents necessitating re-consideration of our approach, research strategy, clinical focus and understanding of the disease's inherent heterogeneity.[4] Significant knowledge gaps persist in key areas of disease including aetiology, pathogenesis and microbial infection. The rising profile of bronchiectasis is welcome. If we are to effect the true impact of this, we must continue to develop and curate large datasets across international populations to inform our clinical practice and importantly our research.[5–7]

As academic respiratory research enters unchartered territory; one plagued by the challenge of overlap syndromes, the application of new "omics" technologies, improved tools to understand disease endo-phenotypes and a complex arena of bioinformatics, the relevance of these developing areas to bronchiectasis focused research must be considered.[3,8–10] The quality and quantity of research in the field should increase in parallel to ensure a secure future for our patients and the care they receive. Airway infection remains a major challenge in bronchiectasis and emerging culture-independent sequencing technologies provide further insight into its complexity.[5–7] A deeper understanding of the functional implications of airway microbes in a lung affected by bronchiectasis is necessary and this goes beyond bacteria to include non-tuberculous mycobacterial species, viruses and even fungi.[11–14]

To add to the growing focus and interest in bronchiectasis, we dedicate this special issue to further promote its resurgence. This issue includes six original and three commissioned review articles organized into three thematic areas of importance: (1) clinical disease (2) airway infection and (3) lung transplantation.

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