Clinical Fingerprinting: A Way to Address the Complexity and Heterogeneity of Bronchiectasis in Practice.

Abstract

The term bronchiectasis describes a complex and heterogeneous clinical syndrome which can be characterized by chronic respiratory symptoms and permanent dilation of the airways due to multiple causes. Understanding what "complex" and "heterogeneous" precisely means in the context of bronchiectasis disease is challenging. Complexity means that bronchiectasis has several components with "nonlinear dynamic interactions", whereas Heterogeneity indicates that not all the potential components that define bronchiectasis are present in all patients (or in any given patient) during various time points in the clinical course of the disease. The current multidimensional scoring systems developed in bronchiectasis are useful to assess the clinical severity and prognosis of the disease, but they do not include other important dimensions such us the biological activity or the impact of bronchiectasis upon the patient. With this Pulmonary Perspective, we develop and propose the use of two tools: the "control panel" (which include three dimensions: severity, activity and impact of bronchiectasis), and the "clinical fingerprint" as a way to graphically depict a snapshot of the three modules of the control panel for a given patient at a given time point. These tools may help to address the complexity and heterogeneity of bronchiectasis in clinical practice and improve the patient care by moving the field towards a "precision medicine" approach, defined as "treatments targeted to the needs of individual patients on the basis of genetic, biomarker, phenotypic, or psychosocial characteristics that distinguish a given patient from other patients with similar clinical presentations".