Bronchiectasis: 370 experts share views during third European Bronchiectasis Workshop held in Humanitas University

One in 600 people in Italy – mainly women over 60 – suffer from bronchiectasis, a chronic respiratory disease for which no approved drug therapy is yet available.

Coughing, daily expectoration and frequent respiratory infections such as bronchitis and pneumonia are the most frequent symptoms. It is characterised by an abnormal and irreversible dilatation of certain portions of the bronchial tree that reduces the so called mucociliary clearance, the natural self-cleansing mechanism that protects the body from infections. Bronchiectasis can be congenital or acquired, i.e. the result of a disease such as poorly treated pneumonia.

Diagnosis and treatment

Since the symptoms are non-specific and the diagnosis difficult, reaching a diagnostic profile can take a long time, between 3 and 5 years. The gold standard for diagnosis is a high-resolution CT scan of the chest. The main treatment is respiratory physiotherapy which removes mucus that tends to stagnate in the dilated bronchi. In addition, antibiotics, immunomodulating therapies in the most severe patients and bronchodilator drugs in the case of respiratory deficiency may be used, as well as treatments for the two main complications of the disease: flare-ups and the presence of blood in the sputum.

European Bronchiectasis Workshop

Over 370 European specialists gathered at the Simulation Lab of Humanitas University on 23-24 February for the third European Bronchiectasis Workshop. The event was attended by pulmonologists, physiotherapists, nurses, paediatricians, general practitioners, radiologists, immunologists, infectivologists and clinical microbiologists involved in the treatment of bronchiectasis.

“To date, there are no approved and specific pharmacological therapies to cure patients with bronchiectasis, and the tratment mainly involves daily respiratory physiotherapy and the cautious use of antibiotics. The latest evidence, however,’ explains Stefano Aliberti, professor at Humanitas University and head of Pneumology at the IRCCS Istituto Clinico Humanitas, as well as coordinator of the workshop, ‘suggests that we are dealing with a disease sustained by an important inflammatory component of the bronchi. Until a few years ago, it was generally believed that therapies should only aim at infection control; now, however, new horizons are opening up for bronchiectasis patients: some of the drugs currently being studied are in fact modulators of the immune system, which reduce inflammation in the bronchi.

The workshop was introduced by a lectio magistralis held by Alberto Mantovani, Scientific Director of Humanitas and Professor Emeritus of Humanitas University, on the role of immunity and inflammation as a meta-narrative of Medicine.

The specialists were therefore able to compare and test themselves with exercises simulating the treatment of patients with bronchiectasis.

Long diagnosis timelines and inconsistent and incomplete epidemiological data

According to the European scientific community, bronchiectasis and its co-morbidities are still often misdiagnosed and inappropriately treated.  Moreover, epidemiological data are still incomplete and vary from country to country. Concrete help in this direction comes from EMBARC, the European Bronchiectasis Registry: it promotes clinical research on this disease by sharing protocols, research areas and expertise.

‘In this rapidly changing landscape,’ Prof. Aliberti concludes, ‘it is crucial to bring experts together to constantly improve knowledge and treatment of this disease. In addition, we need to focus on new studies to help the small but active community of specialists studying bronchiectasis. It is also necessary to expand clinical and research networking, which, in recent years, has improved the knowledge and treatment of the disease: our primary goal always remains the well-being and quality of life of patients’.