Tuberc Respir Dis.
2025 Jan;88(1):109-119. 10.4046/trd.2024.0120.
Disease Severity and Activity in Bronchiectasis: A Paradigm Shift in Bronchiectasis Management
- Affiliations
-
- 1Division of Pulmonology and Allergy, Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
- 2Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
- 3Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
- KMID: 2562633
- DOI: http://doi.org/10.4046/trd.2024.0120
Abstract
- Bronchiectasis has an increasing prevalence and substantial clinical and economic burden. Therefore, physicians should identify patients with bronchiectasis at high risk of disease progression to ensure optimal management in advance. The heterogeneity of bronchiectasis means it is unlikely that any single parameter could identify highrisk patients; therefore, disease severity is usually assessed using validated composite tools, such as the Bronchiectasis Severity Index, FACED, and Bronchiectasis Aetiology Comorbidity Index, to predict long-term outcomes in bronchiectasis. Disease severity, however, implies an advanced process with lung destruction. Earlier intervention may prevent disease progression and improve outcomes. To identify patients at risk, rather than patients with established advanced disease, we need to shift our focus from disease severity to disease activity. Disease activity denotes the activation level of underlying pathophysiological processes and can be measured using clinical presentations and biomarkers. This review discusses a paradigm shift in bronchiectasis management, focusing on disease activity rather than severity, to prevent disease progression.
