Basic, translational and clinical aspects of bronchiectasis in adults.

Bronchiectasis is a common progressive respiratory disease with recognisable radiological abnormalities and a clinical syndrome of cough, sputum production and recurrent respiratory infections. Inflammatory cell infiltration into the lung, in particular neutrophils, is central to the pathophysiology of bronchiectasis. Herein we explore the roles and relationships between infection, inflammation and mucociliary clearance dysfunction in the establishment and progression of bronchiectasis. Microbial and host-mediated damage are important processes underpinning bronchiectasis and the relative contribution of proteases, cytokines and inflammatory mediators to the propagation of inflammation is presented. We also discuss the emerging concept of inflammatory endotypes, defined by the presence of neutrophilic and eosinophilic inflammation, and explore the role of inflammation as a treatable trait. Current treatment for bronchiectasis focuses on treatment of underlying causes, enhancing mucociliary clearance, controlling infection and preventing and treating complications. Data on airway clearance approaches

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Conflict of interest: J.D. Chalmers reports grants or contracts from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Gilead Sciences, Grifols, Novartis and Insmed, outside the submitted work; consulting fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Insmed, Janssen, Novartis, Pfizer and Zambon, outside the submitted work. Conflict of interest: S. Elborn holds a joint public–private grant from the European commission in the innovative medicines initiative with Novartis AG and Spexsis; he worked as a paid consultant for Vertex Pharmaceuticals and Viatris Inc.; and has been a paid speaker for many pharmaceutical companies over 30 years in respiratory medicine. Conflict of interest: C.M. Greene reports grants or contracts from NIH and Vertex, outside the submitted work; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Vertex, outside the submitted work; support for attending meetings and/or travel from European Respiratory Society, outside the submitted work; and was Head of ERS Assembly 3 2019–2022, outside the submitted work.