The Authors: Professor Kenneth W. Tsang is a consultant physician in respiratory medicine in private practice and honorary consultant to the Faculty of Medicine of the University of Hong Kong. His clinical and research interest focus on respiratory infection, particularly basic and clinical aspects of bronchiectasis. Dr Diana Bilton is a consultant physician at the Royal Brompton National Heart and Lung Institutes in London. She has major research interest in respiratory infection and a very busy clinical practice.
Clinical challenges in managing bronchiectasis
Article first published online: 16 JUL 2009
© 2009 The Authors. Journal compilation © 2009 Asian Pacific Society of Respirology
Volume 14, Issue 5, pages 637–650, July 2009
How to Cite
TSANG, K. W. and BILTON, D. (2009), Clinical challenges in managing bronchiectasis. Respirology, 14: 637–650. doi: 10.1111/j.1440-1843.2009.01569.x
SERIES EDITORS: GRANT WATERER AND KENNETH TSANG
- Issue published online: 16 JUL 2009
- Article first published online: 16 JUL 2009
- Received 29 April 2009; accepted 7 May 2009.
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Bronchiectasis is a common disease in the Asia–Pacific and affected patients suffer from chronic sputum production and recurrent exacerbations. Bronchiectasis is largely idiopathic although there is diverse aetiology. The pathogenesis of bronchiectasis comprises infective, inflammatory and emzymetic elements. These interact to perpetuate continued airway damage in bronchiectasis leading to progressive airway and lung damages. Treatment of bronchiectasis is unsatisfactory and there are only very few trials. Existing data suggest some efficacy of inhaled corticosteroid therapy, which has been shown recently to clinical and anti-inflammatory properties in bronchiectasis. Immunomodulating agent such as low-dose macrolides have also been shown to have some efficacy although more data are needed to advocate their long-term usage. Antibiotic therapy is complex in bronchiectasis and includes short-term empirical treatment for acute exacerbation, and consideration of long-term maintenance of oral, nebulized and i.v. therapy. This long-neglected illness should receive more research attention in order that we can have better understanding of its aetiology, pathogenesis and treatment.