Pharmacotherapeutic strategies for treating bronchiectasis in pediatric patients

ABSTRACT

Introduction: The social and medical costs of bronchiectasis in children are becoming considerable due to its increasing prevalence. Early identification and intensive treatment of bronchiectasis are needed to decrease the morbidity and mortality associated with bronchiectasis in children.

Area covered: This review presents the current pharmacotherapeutic strategies for treating bronchiectasis in children with a focus on non-cystic fibrosis bronchiectasis.

Expert opinion: Evidence for the effectiveness of diverse treatment strategies in bronchiectasis is lacking, particularly in children, although the disease burden is substantial for bronchiectasis. Most treatment strategies for non-cystic fibrosis bronchiectasis in children have been extrapolated from those in adults with bronchiectasis or children with cystic fibrosis. Antibiotics combined with an active airway clearance therapy via the inhalation of mucoactive agents can stabilize bronchiectasis. The timely and intensive administration of antibiotics during acute exacerbation of bronchiectasis is essential to prevent its progression in children. To suppress the bacterial loads in the airway, systemic or inhaled antibiotics can be administered intermittently or continuously. However, studies on these protocols, including the appropriate duration and effective dosages are lacking. Long-term administration of azithromycin for 12–24 months may reduce the exacerbation frequency with the increased carriage rate of azithromycin-resistant bacteria.

KEYWORDS:

• Antibiotics
• bronchiectasis
• children
• mucolytics
• pharmacotherapy
• treatment

Article highlights

• High-quality evidence for the effective treatment of bronchiectasis in children are lacking; treatment strategies for non-cystic fibrosis bronchiectasis in children were extrapolated from those used for children with cystic fibrosis or adults with non-cystic fibrosis bronchiectasis

• Phenotypic classification of bronchiectasis, considering the underlying airway inflammatory responsiveness, severity, and frequency of acute exacerbation could play a role in the identification of personalized treatment.

• Airway clearance therapy with exercise can be helpful in improving exercise tolerance and health-related quality of life. Administration of long-term macrolides can be effective in the control of airway inflammation in children with stable bronchiectasis.

• Systemic antibiotics treatment should be actively administered to control airway infection during acute exacerbation of bronchiectasis. Inhaled antibiotics can be prescribed to suppress airway colonization with lack of strong evidence in children with bronchiectasis.

• Inhalation of hypertonic saline can be helpful in enhancing mucociliary clearance or reducing cough in children, whereas evidence for effectiveness of inhalation of other mucoactive agents in children with bronchiectasis is lacking.

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Declaration of interest

The authors have no other 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 apart from those disclosed.

Reviewer Disclosures

One referee is a member of an Expert Advisory Group for GlaxoSmithKline. They have also received funding from GlaxoSmithKline for an investigator-initiated study. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This study was funded by the Korea Ministry of Environment (MOE) via ‘the Environmental Health Action Program (2016001360006)’ and by the Bio & Medical Technology Development Program of the National Research Foundation (NRF) funded by the Korean government (MSIT) (2017M3A9F3043834).