Complexity and Heterogeneity in Bronchiectasis: Towards a Personalized Medicine

Abstract

Bronchiectasis is a complex and heterogeneous disease, defining complexity as to the non-linear relationship between the different characteristics that make up the disease, and heterogeneous in the sense that not all these variables appear in the same patient. As a consequence of the complexity and heterogeneity of bronchiectasis, different clinical phenotypes can be established (mainly chronic bronchial infection by Pseudomonas aeruginosa, the exacerbator patient, and the overlap with chronic obstructive pulmonary disease [COPD]), as well as endotypes (basically neutrophilic and eosinophilic). Beyond phenotypes and endotypes, some authors have recently developed some tools to capture the multidimensional nature of bronchiectasis such as the control panel and clinical fingerprint. These tools are based on the concepts of severity, activity and impact of the disease. Finally, the concept of treatable trait, initially described in COPD patients and defined as those characteristics of bronchiectasis that are treatable (or potentially treatable) is discussed.

Keywords

• Chronic obstructive pulmonary disease. Endotypes. Exacerbation. Precision medicine. Phenotypes. Treatable trait.