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Editorial
. 2024 Jul 1;210(1):24-34.
doi: 10.1164/rccm.202403-0473PP.

The Precision Medicine Era of Bronchiectasis

Sanjay H Chotirmall  1   2 , James D Chalmers  3
Affiliations
Editorial

The Precision Medicine Era of Bronchiectasis

Sanjay H Chotirmall et al. Am J Respir Crit Care Med. .
No abstract available

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Figures

Figure 1.
Figure 1.
(A) Timeline summary of the key milestones in bronchiectasis, including patient registries and clinical trials. (B) Drug development pipeline (not comprehensive) in bronchiectasis categorized by the different aspects of the “vicious vortex” model of pathogenesis. A1AT = alpha-1 antitrypsin; CatC = cathepsin C; CFTR = cystic fibrosis transmembrane conductance regulator; DNAI1 = dynein axonemal intermediate chain 1; DPP-1 = dipeptidyl peptidase-1; EMBARC = European Multicentre Bronchiectasis Audit and Research Collaboration; ENaC = epithelial sodium channel; MRC = Medical Research Council; NE = neutrophil elastase; PCD = primary ciliary dyskinesia.
Figure 2.
Figure 2.
A proposed model to apply precision medicine to bronchiectasis care and research: consider each individual patient a Rubik’s cube, which varies in size and shape, requiring individualized algorithms to “solve.” Each patient (or cube) has varying disease domains that allow the assessment of bronchiectasis at the individual level. Disease traits must be identified, using a precision medicine approach, each of which offers disease targets that may be addressed by specific therapeutic intervention. Reassessment is necessary at specified intervals, as the precision medicine approach is not a static but rather a dynamic process requiring consistent reevaluation. ABPA = allergic bronchopulmonary aspergillosis; BACI = bronchiectasis etiology and comorbidity index; BMI = body mass index; BSI = bronchiectasis severity index; CatC = cathepsin C; CF = cystic fibrosis; CFTR = cystic fibrosis transmembrane conductance regulator; CVS = cardiovascular; DPP-1 = dipeptidyl peptidase-1; E-FACED = severity score including exacerbations, FEV1, age, chronic colonization by Pseudomonas aeruginosa, radiological extension (number of pulmonary lobes affected), and dyspnea; FACED = severity score including FEV1, age, chronic colonization by Pseudomonas aeruginosa, radiological extension (number of pulmonary lobes affected), and dyspnea; GERD = gastroesophageal reflux disease; GM-CSF = granulocyte–macrophage colony-stimulating factor; HTS = hypertonic saline; IBD = inflammatory bowel disease; ICS = inhaled corticosteroids; IV = intravenous; MAC = Mycobacterium avium complex; NAC = N-acetylcysteine; NE = neutrophil elastase; NET = neutrophil extracellular trap; NTM = nontuberculous mycobacteria; PCD = primary ciliary dyskinesia; QOL = quality of life; S/C = subcutaneous.
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