A collaboration involving physicians and patients has identified 22 research priorities for bronchiectasis research.
According to the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) current knowledge was limited by the fact that treatment was mainly extrapolated from cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD), or based on expert opinions.
“High-quality evidence is still missing…large gaps in our knowledge could be identified on several aspects of this disease and this emphasises the need for additional clinical and translational research, as well as collaborative working” they wrote in a consensus statement.
The collaboration involved several European experts from five European Countries. The research priorities were determined using a delphi process and were analysed together with a survey of patients and their carers.
Summary of recommendations
1) DNA biobanks linked to well-phenotyped patient cohorts should be established to enable underlying genetic susceptibility to bronchiectasis to be established.
2) Observational research in large patient cohorts is needed to establish the natural history of bronchiectasis due to different aetiologies.
3) A comprehensive study enrolling patients when stable and during exacerbation should be conducted, evaluating the impact of bacteria, viruses, fungi and noninfectious stimuli to identify the cause(s) of bronchiectasis exacerbations.
4) Studies are required to optimise compliance, and access to chest physiotherapy and pulmonary rehabilitation in bronchiectasis.
5) A deeper understanding of the inflammatory pathways in bronchiectasis is needed to develop new therapies. We recommend using emerging techniques and technologies (particularly proteomics, metabolomics and genomics) in large, well-characterised cohorts to identify new treatment targets and deeper patient phenotyping.
6) An implementation study should be performed to investigate whether the use of bronchiectasis severity scores could improve patient care.
7) A randomised controlled trial of Pseudomonas aeruginosa eradication therapy, compared to no eradication treatment, should be performed.
8) A randomised controlled trial comparing at least 14 days of antibiotic treatment for exacerbations with shorter-course treatments is required.
9) We suggest studies of the microbiome (incorporating bacteria and potentially fungi) in bronchiectasis linked to detailed clinical phenotyping data.
10) A longitudinal study of the bacteriology of bronchiectasis incorporating data on antibiotic resistance is needed.
11) Longitudinal studies should be conducted in patients receiving oral and inhaled antibiotics to monitor for the emergence of antibiotic resistance.
12) Studies should ideally evaluate whether cyclical or continuous administration of long-term antibiotics is superior both in terms of clinical efficacy and the emergence of resistance.
13) Further studies are required to define the optimal patient population to benefit from long-term macrolide therapy.
14) More “real world” data on the long-term safety and resistance impact of macrolide treatment are required.
15) Inhaled antibiotics such as colistin, gentamicin and tobramycin should be subject to definitive phase III trials to demonstrate a reduction in exacerbations and improvements in quality of life.
16) Mechanistic studies investigating the genetic, microbiological, inflammatory and clinical susceptibility factors for P. aeruginosa colonisation should be conducted.
17) Long-term cohort studies are needed to identify which patients acquire P. aeruginosa colonisation and to identify its independent effects on outcome.
18) Comparative studies are needed to determine the optimal choice between oral and inhaled antibiotic treatment in patients with and without P. aeruginosa colonisation.
19) Randomised controlled trials should address whether alternative long-term oral antibiotics (other than macrolides) are effective at reducing exacerbations.
20) Studies should be conducted to determine the effectiveness of patient self-management in bronchiectasis and adherence to treatment.
21) Further research with patients as partners could explore the specific information needs of bronchiectasis patients, effective health care professionals and patient communication strategies, and develop improved patient-reported outcomes.
22) A multidisciplinary education programme is needed for bronchiectasis to increase awareness among non-specialists in secondary care and among primary care.