a Fisiopatologia e Riabilitazione Respiratoria, Dipartimento Vasi, Cuore e Torace, Policlinico Le Scotte , Azienda Ospedaliera Universitaria Senese , Siena , Italy.
b Clinica delle Malattie dell'Apparato Respiratorio, Dipartimento di Medicine Specialistica, Policlinico Le Scotte , Azienda Ospedaliera Universitaria Senese , Siena , Italy.
Expert Rev Clin Pharmacol. 2018 Mar;11(3):245-258. doi: 10.1080/17512433.2018.1421064. Epub 2018 Jan 10.
Until recently considered as a minor health problem, the role of bronchiectasis is now increasingly recognized. New specific drugs are being approved for treatment of bronchiectasis. Possibly they will offer better perspectives to bronchiectatic subjects with evolving course. Areas covered: We provide an overview of aetiopathogenesis, clinics and non-pharmacological management, extending the topic of pharmacological treatment. Present therapies were extrapolated from other chronic lung diseases, but newer promising specific drugs are being awaited. Therapy aims at improving mobilisation of bronchial secretions and, if any, reversing airflow obstruction. Antibiotics are indicated to treat exacerbations, eradicate or reduce sputum bacterial load. Expert commentary: Over the last years evidence is mounted that bronchiectatic subjects with accelerated course of disease should be referred to secondary and tertiary centres. This requires increased awareness on the role and the frequency of bronchiectasis in primary care. Long-term continuous or cyclical use of antibiotics is recommended to stabilize or improve the course of evolving disease. Macrolides are a currently preferred option. Inhaled antibiotics are gaining importance and are the object of ongoing research interest. Practical challenges of inhaled antibiotic treatment remain the need of defining the best therapeutic regimen and optimizing true adherence.
直到最近，支气管扩张症还被认为是一个次要的健康问题，但现在它的作用正越来越受到重视。新的特定药物正被批准用于治疗支气管扩张症。这些药物可能会为病情不断发展的支气管扩张症患者提供更好的前景。
我们概述了支气管扩张症的发病机制、临床特征和非药物治疗，并扩展了药物治疗的主题。目前的治疗方法是从其他慢性肺部疾病中推断出来的，但新的有前途的特定药物仍在等待中。治疗的目的是改善支气管分泌物的排出，并在有气流阻塞时逆转气流阻塞。抗生素用于治疗恶化，消除或减少痰中的细菌负荷。
近年来，越来越多的证据表明，病情加速发展的支气管扩张症患者应转诊至二级和三级中心。这就需要提高对初级保健中支气管扩张症的作用和频率的认识。建议长期持续或周期性使用抗生素来稳定或改善病情不断发展的患者的病程。大环内酯类药物是目前的首选药物。吸入性抗生素的作用越来越重要，也是目前研究的热点。吸入性抗生素治疗的实际挑战仍然是需要确定最佳治疗方案并优化真正的依从性。
