Grimwood Keith, Bell Scott C, Chang Anne B
Griffith Health Institute, Griffith University, Gold Coast, QLD 4222, Australia.
Expert Rev Anti Infect Ther. 2014 Oct;12(10):1277-96. doi: 10.1586/14787210.2014.952282. Epub 2014 Aug 26.
Bronchiectasis unrelated to cystic fibrosis is characterized by chronic wet or productive cough, recurrent exacerbations and irreversible bronchial dilatation. After antibiotics and vaccines became available and living standards in affluent countries improved, its resulting reduced prevalence meant bronchiectasis was considered an 'orphan disease'. This perception has changed recently with increasing use of CT scans to diagnose bronchiectasis, including in those with severe chronic obstructive pulmonary disease or 'difficult to control' asthma, and adds to its already known importance in non-affluent countries and disadvantaged Indigenous communities. Following years of neglect, there is renewed interest in identifying the pathogenetic mechanisms of bronchiectasis, including the role of infection, and conducting clinical trials. This is providing much needed evidence to guide antimicrobial therapy, which has relied previously upon extrapolating treatments used in cystic fibrosis and chronic obstructive pulmonary disease. While many knowledge gaps and management challenges remain, the future is improving for patients with bronchiectasis.
与囊性纤维化无关的支气管扩张症的特征是慢性湿性咳嗽或咳痰、反复加重以及不可逆的支气管扩张。在抗生素和疫苗问世以及富裕国家生活水平提高之后，其患病率降低，这意味着支气管扩张症被视为一种“罕见病”。随着CT扫描越来越多地用于诊断支气管扩张症，包括在患有严重慢性阻塞性肺疾病或“难以控制”哮喘的患者中，这种观念最近发生了变化，这也凸显了支气管扩张症在非富裕国家和处境不利的原住民社区中已为人所知的重要性。在多年的忽视之后，人们重新对确定支气管扩张症的发病机制（包括感染的作用）以及开展临床试验产生了兴趣。这为指导抗菌治疗提供了急需的证据，此前抗菌治疗一直依赖于类推用于囊性纤维化和慢性阻塞性肺疾病的治疗方法。虽然仍然存在许多知识空白和管理挑战，但支气管扩张症患者的未来正在改善。
