Inhaled Corticosteroids in Adults with Non-cystic Fibrosis Bronchiectasis: From Bench to Bedside. A Narrative Review.
Miguel Angel Martinez-GarciaFernando Santamaría-MartosAlberto García-OrtegaMaria Gabriella MateraRogliani PaolaMario CazzolaPublished in: Drugs (2022)
Due to their potent anti-inflammatory capacity (particularly in predominantly eosinophilic inflammation) and immunosuppressive properties, inhaled corticosteroids (ICSs) are widely used in asthmatic patients and also in individuals with chronic obstructive pulmonary disease (COPD) who suffer multiple exacerbations or have peripheral eosinophilia. However, there is little evidence for their use in non-cystic fibrosis bronchiectasis (hereafter, bronchiectasis). According to data extracted from large databases of bronchiectasis in adults, ICSs are used in more than 50% of patients without any scientific evidence to justify their efficacy and contrary to the recommendations of international guidelines on bronchiectasis that generally advise against their use. Indeed, bronchiectasis is a disease with predominantly neutrophilic inflammation and a high likelihood of chronic bacterial bronchial infection. Furthermore, it is known that due to their immunosuppressive properties, ICSs can induce an increase in bacterial infections. This manuscript aims to review the basic properties of ICSs, how they impact bronchiectasis in adults, the current position of international guidelines on this treatment, and the current indications and future challenges related to ICS use in bronchiectasis.
Keyphrases
- cystic fibrosis
- lung function
- pseudomonas aeruginosa
- chronic obstructive pulmonary disease
- end stage renal disease
- ejection fraction
- newly diagnosed
- chronic kidney disease
- anti inflammatory
- clinical practice
- patient reported outcomes
- machine learning
- deep learning
- current status
- combination therapy
- african american