Abstract
Bronchiectasis is a complex chronic respiratory condition traditionally characterized by chronic infection, airway inflammation, and progressive decline in lung function. Early diagnosis and intensive treatment protocols can stabilize or even improve the clinical prognosis of children with bronchiectasis. However, understanding the host immunologic mechanisms that contribute to recurrent infection and prolonged inflammation has been identified as an important area of research that would contribute substantially to effective prevention strategies for children at risk of bronchiectasis. This review will focus on the current understanding of the role of the host immune response and important pathogens in the pathogenesis of bronchiectasis (not associated with cystic fibrosis) in children.
Highlights
Bronchiectasis is a complex chronic respiratory condition traditionally characterized by recurrent infection, airway inflammation, and progressive decline in lung function
Rarely reported in association with bronchiectasis, our studies have identified a high prevalence of airway eosinophilia in Australian Indigenous children with bronchiectasis, which correlates with circulating eosinophils [13, 16]
In a cross-sectional study of 104 Australian Indigenous children with bronchiectasis, 19 and 33% of non-typeable Haemophilus influenzae (NTHi) isolates from the NP and bronchoalveolar lavage (BAL), respectively, were β-lactamase positive and 6% and 13%, respectively, were azithromycin resistant (MIC >4 mg/L); all other isolates tested had intermediate azithromycin resistance [89]
Summary
Bronchiectasis is a complex chronic respiratory condition traditionally characterized by recurrent infection, airway inflammation, and progressive decline in lung function. On a global scale, lower respiratory infection in the absence of known underlying conditions accounts for the greatest number of bronchiectasis cases [1]. This review will begin by exploring the role of the child’s immune response in establishing an environment conducive to the recurrent infection and chronic inflammation characteristic of bronchiectasis. This will be followed by a discussion of the important pathogens associated with bronchiectasis in children and the obstacles in treating and preventing these infections. The review will conclude with “the road forward” areas of research identified by the authors as important for the advancement of understanding and addressing the pathogenesis of bronchiectasis in children
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