Bronchiectasis: new findings in the pathogenesis and treatment of this disease.
OBJECTIVE
Bronchiectasis is an under-appreciated cause of chronic lung disease in the USA. We highlight developments in diagnosis and treatment of this debilitating disease.


RESULTS
A possible link between gastroesophageal reflux and development of nontuberculous mycobacterial lung disease was highlighted. Reflux is more common in patients with nontuberculous mycobacterial lung disease, and among those with established bronchiectasis more extensive disease was observed in those patients who also had reflux. Long-term mortality in bronchiectasis was significantly associated with age, lower body mass index, dyspnea, lack of vaccination, hypoxemia, hypercapnia, and other functional parameters. In a large, randomized clinical trial, addition of inhaled tobramycin to ciprofloxacin for acute exacerbations of Pseudomonas infection produced microbiologic improvement correlating with clinical outcomes but not overall improvement. A review noted that five macrolide trials reported reduced sputum volume, improved lung function, and better symptom control. Finally, articles suggested benefit from inhaled hyperosmolar agents (e.g. hypertonic saline and inhaled mannitol).


CONCLUSIONS
The possible link between gastroesophageal reflux and nontuberculous mycobacterial lung disease, and the microbiology and resistance patterns of bacteria observed in these patients were clarified. A large study of inhaled tobramycin for exacerbations was inconclusive, but macrolide therapy and hyperosmolar agents hold promise.
Ilowite
Jonathan
J
Winthrop University Hospital, State University Hospital of New York at Stony Brook, Stony Brook, NY, USA. jilowite@winthrop.org
Spiegler
Peter
P
Chawla
Shalinee
S
D000890:Anti-Infective Agents / Q000008:administration & dosage; D001987:Bronchiectasis / Q000209:etiology / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D005764:Gastroesophageal Reflux / Q000150:complications; D006090:Gram-Negative Bacteria; D006094:Gram-Positive Bacteria; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012138:Respiratory Therapy / Q000379:methods; D012307:Risk Factors; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage
D000890:Anti-Infective Agents; D012462:Saline Solution, Hypertonic