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Asthma and Bronchiectasis PreFinal
Asthma and Bronchiectasis PreFinal
Key Points
• Asthma and bronchiectasis share common symptoms,
several comorbidities and pathogenesis.
• This overlap results in a more severe disease with
frequent exacerbations.
• HRCT chest should be considered in patients with severe
asthma to rule out the co-presence of bronchiectasis.
• Tailored treatment of both diseases is crucial for
symptoms control and halt disease progression and
structural lung injury.
Asthma and Bronchiectasis;
a New Kid on The Block
• B:A Ratio
• Cough • Bronchiola <2cm
Clinical Symptoms Radiological • Mucous plugging
• Sputum
and Signs Alteration • Lack of bronchial
• Recurrent Infections
tapering in the
peripheral areas
• B:A Ratio
• Cough
Clinical Symptoms Radiological • Bronchiola <2cm
• Sputum
and Signs Alteration • Mucous plugging
• Recurrent Infections
• Lack of tapering
Bronchiectasis
A Pool of Different Conditions
• Bronchiectasis: irreversible dilatation of the bronchial tree, is
caused by recurrent inflammation or infection of the airway
Asthma Bronchiectasis
Neutrophil
TGF-b Eastase
MM Airway Matrix
Metalloproteinase
IL-13 Damage
IL-8
Asthma and Bronchiectasis
Airway Inflammation
Asthma Bronchiectasis
Simplified
Excess of Dysfunctional
Microbiota
pathogenic Microbiota
Bronchiectasis in Asthma Patients
Bronchiectasis in Asthma Patients
How can you suspect?
Bronchiectasis in Asthma Patients
How can you suspect?
Fe NOPES
AUC-ROC 75% Pneumonia
Expectoration
Severity
Specificity 95% asthma
• NOPES score was developed on the basis of these variables: FeNO (cut
off point:20.5 ppb), Pneumonia, Expectoration and asthma Severity.
Bronchiectasis in Asthma Patients
How can you suspect?
Fe NOPES
AUC-ROC 75% Pneumonia
Lower FeNO Expectoration
(<20.5 ppb) Severity
Specificity 95% asthma
Chronic Expectoration
Bronchiectasis Prevalence
Bronchiectasis in Asthma Patients:
Associated Factors
Bronchiectasis Prevalence
Could it be simply a
matter of time ?
Asthma and Bronchiectasis:
What is The Problem (Challenges in Diagnosis)
• Overlap of symptoms
Clinical without functional criteria
• Hyperreactivity in Bx even in
Functional absence of asthma features
Bronchodilators
• Established treatment • Recommended in presence of
breathlessness
• Recommended when asthma or COPD is
associated
• Pre-medication for physiotherapy or
inhaled treatment
• No contraindications • Risk of hemoptysis ??
Inhaled Corticosteroids
• First line treatment in asthma
Macrolides
• Improved QoL • Improved QoL
• Reduced symptoms and exacerbation • Reduced symptoms and exacerbation
rate rate
• Macrolide resistant NTM strains • Macrolide resistant NTM strains
• Cardiovascular and auditive side effects • Cardiovascular and auditive side effects
Inhaled Antibiotics
• No indication • Reduced exacerbation rate
• Potential bronchospasm • No contra-indication
Physiotherapy
• Improve muco-ciliary function • Improve muco-ciliary function
• Reduced infection
• No contraindication • No contraindication
Bronchiectasis in Asthma
Take Home Message
1. CATCH IT
Chronic
Severe Asthma
Expectoration
Bronchial
Obstruction
BD
ICS
Bronchiectasis in Asthma
Take Home Message
3. TREAT IT
Bronchial Chronic
Obstruction Inflammation
BD Macrolides
Immuno-modulatory
role directed at
neutrophilic
inflammation
(no specific trial in
ICS asthma)
Bronchiectasis in Asthma
Take Home Message
3. TREAT IT
BD Macrolides
Immuno-modulatory
role directed at
Physiotherapy
neutrophilic With maneuvers
inflammation adapted to
(no specific trial in obstructive pattern
ICS asthma)
Bronchiectasis in Asthma
Unresolved Issue
Prognosis
No longitudinal or comparative study
Biomarkers
Which and how?
Inhaled Antibiotics
No studies in asthmatic patients, risk of bronchospasm
Respiratory Physiotherapy
No consensus on best technique
Thank You