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.