Bronchiectasis-Could Immunonutrition Have a Role to Play in Future Management?

Emma J Derbyshire,Philip C Calder

doi:10.3389/fnut.2021.652410

Abstract

Bronchiectasis is a chronic condition in which areas of the bronchial tubes become permanently widened predisposing the lungs to infection. Bronchiectasis is an age-associated disease with the highest prevalence in people older than 75 years. While the prevalence of bronchiectasis is higher in males, disease is more severe in females who have a poorer prognosis. The overall prevalence of the disease is thought to be rising. Its aetiology is multi-faceted, but a compromised immune system is now thought to play a central role in the pathology of this disease. Research has begun to study the role of malnutrition and certain nutrients—vitamin D and zinc—along with the role of the lung microbiome in relation to the management of bronchiectasis. Given this, the present mini review sets out to provide an overview of the state-of-the-art within the field, identify research gaps and pave the way for future developments and research investment within this field.

Highlights

For a long time, bronchiectasis has been regarded as an “orphan disease,” a disease so rare that it was not considered commercially viable to develop drugs to treat it [1]
The British Lung Foundation’s “Respiratory Health of the Nation” project estimated that ∼212,000 people in the United Kingdom (UK) are living with bronchiectasis – levels higher than previously thought, with the severity of the condition more prevalent in females, in those aged over 70 years and in the least deprived sectors of the population, which is in contrast to other respiratory disorders [6]
While a spectrum of causative factors underpin bronchiectasis, the majority of these compromise immune function and the ability to fight infection [12]. Both the adaptive and innate immune responses are activated in bronchiectasis [12], with neutrophils having a central role in bronchiectasis pathology

Summary

INTRODUCTION

Bronchiectasis has been regarded as an “orphan disease,” a disease so rare that it was not considered commercially viable to develop drugs to treat it [1]. Amongst the array of causative factors behind bronchiectasis, the majority of these compromise the immune response in some form resulting in an impaired ability to fight infection [12]. While a spectrum of causative factors underpin bronchiectasis, the majority of these compromise immune function and the ability to fight infection [12] Both the adaptive and innate immune responses are activated in bronchiectasis [12], with neutrophils having a central role in bronchiectasis pathology. These includes malnutrition, pro-inflammatory diets, suboptimal hydration status and vitamin D and zinc shortfalls. Malnutrition (lack of adequate nutrition) can cause diverse alterations in the innate and adaptive immune responses These include the involution of the thymus, reducing T cell numbers and responses and exacerbating the susceptibility to infections. EFSA advise water intakes of 2 litres/day for females and 2.5 litres/day for males from food and beverage sources

Findings

DISCUSSION

CONCLUDING REMARKS