Clinical challenges in managing bronchiectasis.

Bronchiectasis is a common disease in the Asia-Pacific and affected patients suffer from chronic sputum production and recurrent exacerbations. Bronchiectasis is largely idiopathic although there is diverse aetiology. The pathogenesis of bronchiectasis comprises infective, inflammatory and emzymetic elements. These interact to perpetuate continued airway damage in bronchiectasis leading to progressive airway and lung damages. Treatment of bronchiectasis is unsatisfactory and there are only very few trials. Existing data suggest some efficacy of inhaled corticosteroid therapy, which has been shown recently to clinical and anti-inflammatory properties in bronchiectasis. Immunomodulating agent such as low-dose macrolides have also been shown to have some efficacy although more data are needed to advocate their long-term usage. Antibiotic therapy is complex in bronchiectasis and includes short-term empirical treatment for acute exacerbation, and consideration of long-term maintenance of oral, nebulized and i.v. therapy. This long-neglected illness should receive more research attention in order that we can have better understanding of its aetiology, pathogenesis and treatment.