Severe Asthma and Bronchiectasis Interactions

Severe asthma and bronchiectasis frequently co-exist, forming a complex clinical syndrome marked by overlapping airway pathology, chronic inflammation and recurrent infective events. Severe asthma is defined by poor control despite high-dose corticosteroids and leads to irreversible airway remodelling, mucus plugging and variable airflow obstruction. Bronchiectasis is characterised by permanent dilation of bronchi, impaired mucociliary clearance and persistent bacterial colonisation. When these conditions coincide, patients often present with more frequent exacerbations, heightened symptom burden and accelerated lung function decline. Shared immunopathological processes include eosinophilic and neutrophilic infiltration, airway epithelial damage and dysregulated mucus production, fostering a cycle of inflammation and infection. High-resolution computed tomography (HRCT) is indispensable for establishing bronchiectatic changes in patients with severe asthma phenotypes, revealing bronchial wall thickening and tubular or cystic dilatations. Identifying bronchiectasis in asthmatic individuals has important therapeutic implications, guiding the addition of targeted antimicrobials, airway clearance techniques and adjustments of biologic therapy. A precision-medicine approach, integrating inflammatory biomarkers and imaging findings, is pivotal to optimising management, reducing exacerbation rates and improving quality of life.

Research from Nature Portfolio

Recent work has elucidated risk factors that predispose patients with moderate-to-severe asthma to develop bronchiectasis. A multi-centre cohort study assessed over two hundred asthmatic individuals, employing quantitative scoring systems to gauge bronchiectatic severity alongside clinical variables. Older age, higher asthma grade and frequent exacerbations emerged as independent predictors of bronchiectasis onset. The study also highlighted that late-onset asthma and exacerbation frequency independently correlated with bronchiectasis in the severe subgroup. These findings underscore the importance of vigilant screening in older patients or those with refractory symptoms and frequent asthma attacks, advocating for early HRCT assessment to detect subclinical bronchial dilation and prompt tailored interventions.

Severe Asthma and Bronchiectasis Interactions publication trend

The graph below shows the total number of articles in severe asthma and bronchiectasis interactions across all publications each year (not limited to Nature Index journals).

Technical terms

High-resolution computed tomography (HRCT): A radiological technique providing detailed images of airway and parenchymal structures, essential for diagnosing bronchiectasis.

Exacerbation: An acute or subacute worsening of respiratory symptoms requiring additional treatment.

Eosinophilia: Elevated eosinophil count in blood or sputum indicative of type 2 airway inflammation.

Biologic therapy: Targeted monoclonal antibodies directed against specific inflammatory mediators such as interleukin-5.

Forced expiratory volume in one second (FEV1): The volume of air expelled in the first second of a forced expiration, used to assess airway obstruction.

References

1. Risk factors for the development of bronchiectasis in patients with asthma. Scientific Reports (2021).
2. Benralizumab Effectiveness in Severe Eosinophilic Asthma with Co-Presence of Bronchiectasis: A Real-World Multicentre Observational Study. Journal of Clinical Medicine (2023).
3. Bronchiectasis in severe asthma is associated with eosinophilic airway inflammation and activation. Journal of Allergy and Clinical Immunology Global (2022).