School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
King's Centre for Lung Health, King's College London, London, UK.
Eur Respir Rev. 2024 Oct 30;33(174). doi: 10.1183/16000617.0087-2024. Print 2024 Oct.
Bronchiectasis is a chronic lung condition which is characterised by recurrent chest infections, chronic sputum production and cough, and limited exercise tolerance. While bronchiectasis may be caused by various aetiologies, these features are shared by most patients with bronchiectasis regardless of the cause. This review consolidates the existing evidence on patient-managed interventions for adults with bronchiectasis, while also outlining areas for future research. Airway clearance techniques and hyperosmolar agents are key components of the bronchiectasis management and consistently recommended for clinical implementation. Questions around their prescription, such as optimal sequence of delivery, are still to be answered. Pulmonary rehabilitation and exercise are also recommended for patients with bronchiectasis. Relatively strong evidence underpins this recommendation during a clinically stable stage of the disease, although the role of pulmonary rehabilitation following an exacerbation is still unclear. Additionally, self-management programmes feature prominently in bronchiectasis treatment, yet the lack of consensus regarding their definition and outcomes presents hurdles to establishing a cohesive evidence base. Moreover, cough, a cardinal symptom of bronchiectasis, warrants closer examination. Although managing cough in bronchiectasis may initially appear risky, further research is necessary to ascertain whether strategies employed in other respiratory conditions can be safely and effectively adapted to bronchiectasis, particularly through identifying patient responder populations and criteria where cough may not enhance airway clearance efficacy and its control is needed. Overall, there is a growing recognition of the importance of patient-managed interventions in the bronchiectasis management. Efforts to improve research methodologies and increase research funding are needed to further advance our understanding of these interventions, and their role in optimising patient care and outcomes.
支气管扩张症是一种慢性肺部疾病，其特征是反复发生的胸部感染、慢性咳痰和咳嗽，以及运动耐量受限。虽然支气管扩张症可能由多种病因引起，但大多数支气管扩张症患者无论病因如何，都具有这些特征。本综述总结了现有关于支气管扩张症成人患者管理干预的证据，同时也概述了未来研究的领域。气道清除技术和高渗剂是支气管扩张症管理的关键组成部分，一致推荐用于临床实施。关于其处方的问题，如最佳给药顺序，仍有待回答。肺康复和运动也被推荐用于支气管扩张症患者。在疾病的临床稳定阶段，有相对较强的证据支持这一建议，尽管在加重后肺康复的作用仍不清楚。此外，自我管理计划在支气管扩张症治疗中占有重要地位，但由于缺乏对其定义和结果的共识，建立一个连贯的证据基础仍然存在障碍。此外，咳嗽作为支气管扩张症的一个主要症状，值得进一步研究。虽然管理支气管扩张症的咳嗽最初可能看起来有风险，但需要进一步研究以确定其他呼吸系统疾病中使用的策略是否可以安全有效地应用于支气管扩张症，特别是通过确定患者的应答人群和标准，在这些标准下，咳嗽可能不会增强气道清除效果，需要对其进行控制。总的来说，人们越来越认识到患者管理干预在支气管扩张症管理中的重要性。需要努力改进研究方法和增加研究资金，以进一步深入了解这些干预措施及其在优化患者护理和结局方面的作用。
