Personalized approaches to bronchiectasis

ABSTRACT

Introduction: Interest in bronchiectasis is increasing due to its rising prevalence, associated with aging populations and the extended use of high-resolution chest tomography (HRCT), and the resulting high morbidity, mortality, and demand for resources.

Areas covered: This article provides an extensive review of bronchiectasis as a complex and heterogeneous disease, as well as examining the difficulty of establishing useful clinical phenotypes. In keeping with the aims of ‘precision medicine’, we address the disease of bronchiectasis from three specific perspectives: severity, activity, and impact. We used PubMed to search the literature for articles including the following keywords: personalized medicine, bronchiectasis, biomarkers, phenotypes, precision medicine, treatable traits. We reviewed the most relevant articles published over the last 5 years.

Expert opinion: This article reflects on the usefulness of these three dimensions in ‘control panels’ and clinical fingerprinting, as well as approaches to personalized medicine and the treatable features of bronchiectasis non-cystic fibrosis.

KEYWORDS:

• Bronchiectasis
• non-cystic fibrosis
• personalized medicine
• phenotypes
• cluster
• fingerprint
• treatable features
• dimensions
• severity
• activity
• impact

Article highlights

• Bronchiectasis is heterogeneous in its presentation and complex in its nature. This has led to the analysis of different clinical phenotypes with similar clinical, prognostic or responses to treatment

• Both the heterogeneity and complexity of bronchiectasis mean that one single variable is not capable of capturing the disease’s overall impact on a patient, which is why some authors have proposed useful tools to help us predict its prognosis (FACE, E -FACED, and BSI). However, new concepts have been described to better understand all the dimensions that affect bronchiectasis and take a personalized medicine approach: the clinical footprint and the treatable features.

• The fingerprint refers to a personalized scheme of the disease’s effect on three key dimensions that provide independent information: severity, biological activity and the impact on the patient

• Treatable features refer to all those aspects that must be treated, over and above the pulmonary implications of bronchiectasis, achieve optimal patient control; these include extra-pulmonary factors, lifestyle, etiology, and comorbidities.

• Development of ‘omica’ (genomics, proteomics, metabolomics, and microbiome) and big data analysis will, in the future, help personalized medicine in bronchiectasis

Reviewer disclosures

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancy fees, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.