Advances in pharmacotherapy for bronchiectasis in adults

Expert Opin Pharmacother. 2023 Jun;24(9):1075-1089. doi: 10.1080/14656566.2023.2210763. Epub 2023 May 9.

Abstract

Introduction: Bronchiectasis has become a growing concern of chronic airway disease because of the enormous socioeconomic burden. Four cardinal interdependent components - impaired airway defense, recurrent airway infections, inflammatory response, and airway damage, in conjunction with the underlying etiology, have collectively played a role in modulating the vicious vortex of the pathogenesis and progression of bronchiectasis. Current pharmacotherapy aims to target at these aspects to break the vicious vortex.

Areas covered: The authors retrieve and review, in MEDLINE, Web of Science and ClinicalTrials.gov registry, the studies about pharmacotherapy for bronchiectasis from these aspects: antibiotics, mucoactive medications, bronchodilators, anti-inflammatory drug, and etiological treatment.

Expert opinion: Future drug development and clinical trials of bronchiectasis need to pay more attention to the different phenotypes or endotypes of bronchiectasis. There is a need for the development of novel inhaled antibiotics that could reduce bacterial loads, improve quality-of-life, and decrease exacerbation risks. More efforts are needed to explore the next-generation neutrophil-targeted therapeutic drugs that are expected to ameliorate respiratory symptom burden, reduce exacerbation risks, and hinder airway destruction in bronchiectasis.

Keywords: Bronchiectasis; exacerbation; inhaled antibiotics; neutrophil inflammation; pharmacotherapy.

Publication types

  • Review

MeSH terms

  • Administration, Inhalation
  • Anti-Bacterial Agents* / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use
  • Bronchiectasis* / drug therapy
  • Bronchiectasis* / microbiology
  • Humans

Substances

  • Anti-Bacterial Agents
  • Anti-Inflammatory Agents