The role of precision medicine in bronchiectasis: emerging data and clinical implications

ABSTRACT

Introduction

Bronchiectasis is a very heterogeneous disease. This heterogeneity has several consequences: severity cannot be measured by a single variable, so multidimensional scores have been developed to capture it more broadly. Some groups of patients with similar clinical characteristics or prognoses (clinical phenotypes), and even similar inflammatory profiles (endotypes), have been identified, and these have been shown to require a more specific treatment.

Areas covered

We comment on this ‘stratified’ model of medicine as an intermediate step toward the application of the usual concepts on which precision medicine is based (such as cellular, molecular or genetic biomarkers, treatable traits and individual clinical fingerprinting), whereby each subject presents certain specific characteristics and receives individualized treatment.

Expert opinion

True precision or personalized medicine is based on concepts that have not yet been fully achieved in bronchiectasis, although some authors are already beginning to adapt them to this disease in terms of pulmonary and extrapulmonary etiologies, clinical fingerprinting (specific to each individual), cellular biomarkers such as neutrophils and eosinophils (in peripheral blood) and molecular biomarkers such as neutrophil elastase. In therapeutic terms, the future is promising, and some molecules with significant antibiotic and anti-inflammatory properties are being developed.

KEYWORDS:

• Bronchiectasis
• phenotype
• endotype
• neutrophil
• eosinophil
• personalized medicine
• traitable trait
• precision medicine

Article highlights

• Bronchiectasis is a very heterogeneous and complex disease in both its clinical presentation and its prognosis.

• It is not possible to capture the severity of bronchiectasis through a single variable, and so multidimensional scores have been developed.

• From a pathophysiological point of view, patients can be divided into different groups, depending on the predominant inflammatory profile (endotypes).

• From a clinical point of view, there are at least four well studied phenotypes: chronic bronchial infection by Pseudomonas aeruginosa, overlap with COPD, overlap with asthma and the frequent exacerbator.

• Some progress toward a more personalized medicine has been made in bronchiectasis: cellular, molecular and genetic biomarkers, treatable traits and clinical fingerprinting.

• New treatments are being developed, especially new antibiotics and anti-inflammatory drugs intended for more precise targets.

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, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they consult for Boehringer Ingelheim. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.