Cystic Fibrosis and primary immunodeficiencies Unit, Institut de Recerca Vall d'Hebron (VHIR).
Pneumology Department, Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain.
Curr Opin Pulm Med. 2019 Jan;25(1):71-78. doi: 10.1097/MCP.0000000000000542.
The presence of bronchiectasis has been described in about 30% of severe asthma patients. The coexistence of these two respiratory conditions poses new challenges from both clinical and research perspectives. We will review the available literature on this topic to discuss the existance of a specific clinical phenotype of asthma.
Despite the paucity of literature, the presence of bronchiectasis with severe asthma is associated with older age, chronic bronchial expectoration, rhinosinusitis, more frequent and severe exacerbations, neutrophilic airway inflammation and poor response to usual treatment. Conversely, asthma features are also described in bronchiectasis patients even in the absence of an appropriate diagnosis of asthma. In both cases, there is some evidence supporting the use of bronchodilators, macrolides and respiratory physiotherapy, while the use of inhaled corticosteroids and antibiotics is controversial.
Based on available evidence on the association between (severe) asthma and bronchiectasis, its pathophysiology, certain clinical aspects and prognosis are largely unclear. Although specific management appears to be required in most cases, in our opinion there is still insufficient evidence to consider it a distinct phenotype of severe asthma. Hopefully, future research will shed more light on this topic and define the best therapeutic approach.
约 30%的重症哮喘患者存在支气管扩张症。这两种呼吸系统疾病并存，无论从临床角度还是研究角度都带来了新的挑战。我们将回顾这一主题的现有文献，讨论哮喘是否存在特定的临床表型。
尽管文献有限，但重症哮喘伴支气管扩张症与年龄较大、慢性支气管咳痰、鼻旁窦炎、更频繁和更严重的恶化、中性粒细胞气道炎症以及对常规治疗反应不佳有关。相反，即使没有适当的哮喘诊断，支气管扩张症患者也有哮喘特征。在这两种情况下，都有一些证据支持使用支气管扩张剂、大环内酯类药物和呼吸物理疗法，而吸入皮质类固醇和抗生素的使用则存在争议。
基于（重症）哮喘和支气管扩张症之间关联的现有证据，其病理生理学、某些临床方面和预后在很大程度上尚不清楚。尽管大多数情况下似乎需要特定的治疗，但我们认为，目前仍缺乏足够的证据将其视为重症哮喘的一种独特表型。希望未来的研究能进一步阐明这一问题，并确定最佳的治疗方法。
